It’s a mistake to write your own appeal letter requesting that the insurance company reconsider it’s decision to deny your claim or terminate your benefits. You need to hire a lawyer immediately to work with your doctors, write your appeal, and battle with the insurance company to win the benefits you deserve.
From the day you file a claim for long term disability benefits, the insurance company compiles a claim file that includes your medical records (at least some of them), notes of conversations you’ve had with your claims representative, expert reports paid for by the insurance company, and other documents completed by you and your doctors. The claim file need not be complete in order for the insurance company to deny your claim. The burden is on you to make sure that your claim file has all of the documents and information proving that you are entitled to benefits.
Moreover, the insurance company can rely on unrefuted, inaccurate information, to deny your claim for long term disability benefits. The law does not impose any obligation for the insurance company to make sure the claim is accurate and complete. That obligation rests solely with you.
Don’t Write Your Appeal Letter without an Attorney
It’s never too early in the claims process to hire an experienced attorney. But it’s very important to you hire a lawyer immediately after your claim for benefits is denied. At that point, you will have 180 days to file an appeal. Don’t be fooled by the letter you receive from the insurance company saying that you can “request a review” of their decision and include additional information that might be helpful to your claim. This “review” is not an informal process. Rather, it’s a formal administrative appeal required by federal law. That federal law is stacked against you. In fact, rather than establishing a government board to consider your formal administrative appeal, federal law places the appeal right back into the hands of the insurance company to decide whether or not they correctly denied your claim for long term disability benefits.
Once you file your formal administrative appeal with the insurance company, the administrative record is locked. This means that, absent very rare circumstances, no other information can be added to prove your case in court. The administrative record will serve as the sole evidentiary basis for a judge to decide whether or not the insurance company should have paid your benefits.
You Need a Lawyer to Appeal to the Insurance Company
That’s why it is important for you to hire a lawyer immediately after you are denied benefits, so that your appeal letter is successful. At Walker & Hern, we have the experience it takes to file a comprehensive, complete, and thorough appeal that will give you the best chance of getting the benefits you deserve. We will carefully review your claim file, identify problems, work with your doctors to make sure the medical records are complete and accurate, and retain experts to examine you, review your medical files, and issue reports proving that you are entitled to benefits. Call us today for a free consultation with J. Brooke Hern, Esq., chair of the firm’s long-term disability benefits practice. Remember, we don’t get paid unless you get benefits.
For more information on why you need a lawyer to appeal, please read the following article: http://disabilityinsattorney.com/article/why-you-need-a-lawyer-to-appeal/