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The Do's & Don'ts

Appealing A Long Term Disability Denial

Appealing the denial of disability benefits under the Employee Retirement Income Security Act (ERISA) is both a right and an obligation. Before you can sue for benefits, you must appeal the denial, and every bit of information you plan to include in a lawsuit must be part of the record during the appeal. Supplying the following information to your health plan doesn't mean your appeal will be granted; rather, it creates the only record and documentary evidence upon which you can base any subsequent litigation if your appeal is denied. Please note that because every claim is unique, this is not an exhaustive list, merely a reminder of the most important materials for appeal. If you have any questions about how to file and what to include in your individual appeal, consult legal counsel.

Appeal Checklist Do's - What you should do when appealing your disability claim denial:

  • DO get your claim file. You can't put together a puzzle without all the pieces. Request your claim file and policy from your insurance carrier before initiating the appeal process. The claim file should include all medical records reviewed, internal notes and memos, outside doctor reviews, surveillance video and any other information the insurance company used to make a decision on your claim. Review all of this information so you know what to focus on in your appeal.
  • DO supplement your medical records with personal statements from your treating physicians. Medical evidence alone may not lead to the conclusion about whether or not you can work. The reasons you can't work should be explained thoroughly by your doctors in letter form.
  • DO get written support from any and all treating physicians, not just the doctor treating you for your "main" disability. The more people you have explaining your limitations and restrictions, and how your life has been adversely impacted by your illness, the stronger your claim becomes. You should get records and letters of support from your general practitioner, specialists (orthopedic surgeons, rheumatologists, neurologists, cardiologists, psychiatrists, etc.), chiropractors, acupuncturists, physical therapists and any other health professional who can weigh in on your ability to work.
  • DO get written support of your former employer whenever possible. Other than your doctor, no one else is more qualified to say whether or not you can work. Obtain a copy of your personnel file. A history of good performance reviews, with the only negatives coming in the time immediately preceding the end of your employment, certainly shows the insurance company that something changed over time that is now causing your inability to work.
  • DO use the decisions of other agencies paying you disability benefits. An approval by State Disability, Worker's Compensation, Social Security Disability, a disability retirement plan, CalPERS or any other source of disability related income is valuable evidence you can use to prove your inability to work.
  • DO get written statements from people in your personal life. While they may not be medical experts, a spouse, other family member, close friend, or former co-worker can all provide excellent insight into the struggles you face on a daily basis. The insurance company hires private investigators to attempt to catch you involved in activities you say you can't do. You can use the same tactic by having people from your personal life tell stories about the difficulties they've witnessed.

Appeal Checklist Don'ts - What you should NOT do when appealing your disability claim denial:


  • DO NOT send in your appeal before reviewing your claim file and policy.
  • DO NOT submit your appeal with just a letter written by yourself. You are not a medical expert! You want your doctors to do the heavy lifting, so make your appeal letter more of a cover letter, telling the insurance company why you disagree with their decision, and what information they will find in your appeal packet that will change their minds. In an ERISA governed policy, once a decision is made on your final appeal, your file is closed. Any information you leave out may never be heard or considered by a court!
  • DO NOT rely on a generic job description provided by your employer or the insurance company. Being disabled is being unable to do the essential functions of your occupation, so if the job description the insurance company uses isn't a full and complete list of your actual duties, then your chance of getting your claim approved decreases dramatically.
  • DO NOT ignore the side-effects of the treatment of your disabilities, and how those impact your ability to work. Very often, what you do to treat your condition(s) can have just as much of an effect on your ability to get through a workday as the disease/injury itself. Make sure you and your doctors mention any medications or treatments and what side-effects they have.
  • DO NOT send your documents in by regular mail, and try and stay off the phone as much as possible. All communication should be in writing, in traceable forms such as certified mail, fax or e-mail. If you can't prove it, it never happened.
  • DO NOT miss the deadline to appeal. In most cases, failure to appeal before the given deadline means you waive your right to pursue the claim any further. No appeal equals no lawsuit.
  • DO NOT appeal on your own if you are not physically or mentally capable. You can hire experts, often on a contingency fee basis, which means you only pay if they obtain a benefit for you.

What Sets Us Apart?

  • Free Case Consultations Provided
  • 160+ Years' Collective Experience
  • Thousands Of Cases Successfully Handled
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Client Testimonials

  • I am a life you have touched. May God bless you richly.

    “After suffering with constant pain for nearly seven months, losing the job I loved and then being denied my long term disability, I was extremely discouraged when I began looking for help. With a few phone calls from Mr. Kantor to my insurance company, my long term disability was reinstated . The financial burden was lifted and I have hope again. I am a life you have touched. May God bless you richly.”

    Susan H.

  • Thank you for all of your hard work, support and belief in our case.

    “Hi Elizabeth - You have been such an important part of my and Jennifer's past year, and I want to send you a note to wish you a wonderful holiday. Thank you for all of your hard work, support and belief in our case. Thank you seems like two small words and not enough, but they are heartfelt and mean so much.”

    J.H.

  • Thank you for being lawyers with a heart.

    “Thank you for being lawyers with a heart.”

    Miriam T.

  • Thank you a zillion times for your patience and time and absolutely helpful information.

    “Thank you a zillion times for your patience and time and absolutely helpful information. You've helped me understand my position with my disability insurance and payments so much better. There is some real comfort in feeling anchored in knowledge…of what is and what might be in the future. Thanks to you!”

    B.

  • You have restored my faith in the goodness of people!

    “Thank you Glenn for accepting my case. I had all but given up on finding an attorney that was willing to take this case, and although you may not remember, I enclosed a note to you when I sent my [ins. co.] file asking you to please help me. You did that sir, and I can't thank you enough. My thanks to you Corinne for pursuing my case with vigor. I don't know much about how these legal things are handled, but I could tell by your communications with me, making sure I was always informed, that you were on top of it all. Also, you were ALWAYS available to me to answer questions, and your compassion for me and my situation is so much appreciated. I have had limited exposure to the legal system and attorneys, but I have never been able to just call and talk to them, as I could with you. I always had to speak with someone in the office that couldn't really answer my questions. My sincerest thanks and best wishes for you both You have restored my faith in the goodness of people!”

    Dick H.