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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
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Client Testimonials

  • there are no words that can express the feelings of gratitude and relief I have that you helped us

    “I wanted to thank you again for all of your help. My daughter would not be in treatment without your help. I can never thank you enough, there are no words that can express the feelings of gratitude and relief I have that you helped us, and I believe saved my little girl. Taking her back to Timberline Knolls was very difficult in many ways, I wish UBH could know the damage they have done to her by having her go in and out like this. When she went into Timberline Knolls the first time she was not happy to go exactly, no one wants to go into treatment, but she was open to going in and ready, for the first time, to really look at her issues and work hard to get better. When she had to leave Timberline she expressed that she wished she could have stayed because she felt like she was finally at a place where she was getting better and, though it was hard, she was really opening up and dealing with her issues for the first time, something she has had a hard time doing. I just wanted you to know that she was going down to a really bad place and without you I don't know what would have happened except that she would not be at Timberline Knolls right now getting better and I thought you should know this. With unending gratitude.”

    R.

  • With you in my corner, I felt enabled and no longer alone.

    “Seemingly at the end of my rope with nowhere to turn, a friend suggested I call the National Multiple Sclerosis Society, who referred me to you. From our first contact I began to feel hope where there had been none. You took over all communication with the insurance company. You kept me posted as things progressed and advised me as to each necessary action. What a relief you were! With you in my corner, I felt enabled and no longer alone. Some big insurance companies feel emboldened to take arbitrary action against those who do not have the resources to defend what is rightfully theirs. Thank goodness for people like you who advocate for folks in need. In closing, please know how very much our association has meant. You have restored my faith in the goodness of people and renewed my confidence in the future. I am forever grateful.”

    Shirley G.

  • 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.

  • I am so grateful for all your efforts and I'm sure glad you were on my side fighting for me.

    “Dear Alan - I just wanted to send you a special note of thanks for all your hard work on behalf of me and my case. I am so grateful for all your efforts and I'm sure glad you were on my side fighting for me.”

    Tracy R.

  • We will never forget the good you have done and may you continue to earn gold stars.

    “More than your skilled expertise, uncompromising professionalism and breadth of experience, we have been immensely impressed with the sincerity, generosity and integrity with which you conducted our affairs, acted on our behalf and guided us through the sometimes confusing process. Throughout, we developed a great respect for all of you and it is our wish that both collectively and individually, you experience continued professional success and personal gratification in all that you pursue. We will never forget the good you have done and may you continue to earn gold stars.”

    Lalida C.