Disability Insurance companies have multiple approaches to denying valid claims for long-term disability benefits. Once your claim has been denied, you must have an experienced attorney to prepare an administrative appeal in order to maximize your chances of winning in court. You want to make it as difficult as possible for the company to deny your claim for reasons including: failing to provide recent medical reports; lacking evidence demonstrating that you are totally disabled; failing to provide data to support your claim that you cannot do even sedentary work; lacking documentation to support your claims of severe pain which you say is so debilitating that you cannot work at all.
Please be aware that you were denied benefits under terms of a policy, which is a contract. This is a legal document with language that has real meaning. If you do not understand exactly what the language means, from a legal point of view, then you have very little chance to succeed in a battle against insurance companies with a battery of experienced attorneys who are basically looking for ways to deny your valid claim for benefits.
Claim Denied: Now You Must Appeal
When you submit your appeal, it is mandatory that you have the proper documentation and that your documentation has language that clearly supports your claim. For example, if you have severe and unrelenting back pain, which radiates down your legs, you no doubt are unable to do any type of work. But if you do not clearly state your complaints to all of the physicians you see, and some of those doctors write notes that make it appear that you are not in pain, the insurance companies will seize on those notes to maintain that your documentation does not support your claim. For example, if you have back pain, as described above, but when you go to see your eye doctor for an examination and you do not mention this to him, he may write something like, “Patient is in his usual state of good health and is here for a routine eye exam”. The insurance company will pounce on notes such as this and take the position that your claim of back pain is a lie.
Many people do not want to admit that they are disabled. Accordingly, they play down their disability when seeing a doctor. Please do not do this! If you are in excruciating pain, tell the doctor exactly that — in no uncertain terms. And do so consistently, every time you go to the doctor. If you fail to honestly tell each doctor about the extent of your difficulties, the company will use that failure against you. An example is if your doctor writes down, “Full range of motion both legs with 5 out of 5 strength and no loss of sensation.” your company will point to that language to claim that whatever problem you might have had, you have completely recovered and therefore your claim is denied. So, when you go to your doctor please make absolutely certain that you clearly articulate your physical situation to the doctor so that he accurately writes notes that reflect your true condition on each and every visit.
There are many more aspects to this disability insurance area of law, so please read our other articles that will give you additional information to help you. Remember, you will do best with the assistance of an experienced attorney who can prepare an administrative appeal that will give you the best opportunity to succeed.
Call today for a free consultation with J. Brooke Hern, Esq., chair of the firm’s long term disability insurance benefits practice. For more information on why you need an attorney to appeal, please read the following article: http://disabilityinsattorney.com/article/why-you-need-a-lawyer-to-appeal/