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Reviewing A Long Term Disability Appeal Claim File

Posted in Long Term Disability.

If You Were Denied Long Term Disability Benefits In Washington, D.C., Your Long Term Disability Claim File is Important

If you have an ERISA long term disability plan through your employer or a private policy that you bought, and you cannot work because of an injury or medical condition, but the insurance company either denied your claim for long term disability benefits or terminated your benefits if you were receiving them – send us a copy of your denial letter, and we will review that for free and give you a plan to appeal.

But don’t wait – under ERISA (the federal law that governs most long term disability plans) you only have 180 days to file an appeal. And a long term disability appeal is NOT just filling out a form or sending in a letter saying you appeal the decision.

It’s a lot more complicated and involved than that – you need to combine the law, the medicine, vocational evidence, insurance company practices and more into an appeal to be successful.

Cases are won and lost at the appeal stage because a federal judge will only review the evidence you submit in the appeal and the insurance company long term disability claim file.

We Request The Insurance Company Claim File Immediately

There are a couple of reasons for getting the long term disability insurance company file as soon as your claim is denied. We have specific requests to make sure the insurance company gives us everything in your long term disability claim file – we typically request 18 – 24 specific items and cover many broad subjects under federal law and regulations.

Here are 3 reasons to get the insurance company’s complete long term disability file:

  1. You only have 180 days to file an appeal under ERISA. So you, or your experienced long term disability attorneys, need to get to work right away.
  2. A typical long term disability claim file is hundreds to thousands of pages. It needs to be organized, reviewed and condensed.
  3. You need to make sure it is complete – does the insurance company have all of your medical records, doctors’ reports, accurate job description, etc.

What is Contained in a Washington, D.C. Long Term Disability Claim File?

With most long term disability claim files, even in straightforward cases, running several hundred to several thousand pages, we can’t list everything, but here is a list of some of the information and documents we typically see in insurance company long term disability claim files:

  • Your Long Term Disability Application
  • Medical Records you submitted from your doctors
  • Job Description
  • Transcripts or notes of statements you made
  • Notes or emails between the insurance company and your employer
  • Claim Analysis notes, emails, and discussions
  • Internal medical reviews of your claim
  • Outside expert physician reviews and reports
  • Consultant reviews and reports
  • Quality Assurance reports
  • Correspondence to your physicians
  • Diagnostic test results

How To Use the Long Term Disability Claim File

We just requested the insurance company long term disability claim file for a gentleman who had just been denied long term disability benefits – it was 941 pages not including the long term disability insurance policies or claims handling procedures.

It takes a lot of work to organize and condense the long term disability claim file to use it in your appeal – we have technology and an in-house specialist do this for our clients.

You then need to review the entire long term disability claim file to see why the long term disability insurance company denied your claim – what was their basis, what evidence did they have, what were they missing – this will give you a sense of the strength of their denial – and where you need to attack the decision.

Donahoe Kearney Makes it Easy for You

If you’re struggling with a chronic, debilitating medical condition or injury that prevents you from working, you need to focus on your medical treatment and rehab.

We make it easy for you to get started. And if you were denied long term disability benefits or these were cut off, we will review that denial letter for free, with absolutely no obligation and analyze a plan to give you for your appeal.

Just call us at 202-393-3320, and we will ask you a few simple questions to get you started and let you know what steps to take next.