Your appeal should be in writing and clear as to its intent. For example, you may start your letter with a sentence that says something like, “Please accept this letter as my formal appeal of your adverse decision dated [date of denial/termination letter].” You should make your appeal letter more of a cover letter, telling the insurance company why you disagree with its decision, and what information the claims handler will find in your appeal packet (the documentation mentioned below) that will change the denial into an approval.
Remember: any information you fail to submit with your appeal may never be heard or considered by a court of law in a lawsuit, or litigation. You should carefully consider all of the information you would like to include with your appeal before sending it via certified mail, fax or e-mail.
You should further enclose updated medical evidence and physicians’ opinions as to your limitations, all of which should work to satisfy the disability policy and plan’s definition of disability. Your doctors’ opinions may be in the form of a narrative statement or Residual Functional Capacity form, also called a Medical Source Statement. You should not rely upon your claims handler to draw an accurate conclusion about how your condition impairs your ability to work solely from the medical records alone. You may ask your doctor to thoroughly explain in writing how your medical conditions impair your ability to perform work activities or even routine activities of daily living. This will create a clearer picture of the difficulties you are having and why you are not able to sustain competitive employment.
You may further document the side-effects of the medical treatment itself and how negative side-effects impair your ability to work. For example, you may be taking medications that have a very heavy sedative effect making it impossible for you to stay awake. What you do to treat your medical conditions can have just as much of an effect on your ability to perform work activities as the sickness or injury itself. As such, make sure you and your doctors identify any medications you are taking or treatments you are undergoing, as well as the side-effects from the same.
Note: You should not limit yourself to written reports solely from your primary care physician. Although you will likely have one main family doctor who treats you for your overall health, you might also have had treatment from specialists for certain conditions. Ask for support from these specialists as well. The more evidence you have and the more doctors you have to identify your limitations and restrictions, the stronger your claim becomes.
You can also get statements from people other than your medical doctor to support your claim that you cannot work. For example, if you suffer from a sickness (as opposed to an acute injury), your employer certainly should have some knowledge that something changed over time that caused you to be unable to work. You could, therefore, obtain written support from your employer about your dwindling performance. Also, request a copy of your personnel file. This type of information may show a history of good performance reviews, with the only negative reviews coming towards the end of your employment.
Who else can you think of? Brainstorm! Keep the evidentiary support going. Obtain written statements from friends and family in your personal life. While they may not be medical experts, a spouse, pastor, family member, close friend, or former co-worker can all provide excellent insight into the struggles you face on a daily basis.
You may also consider submitting a professional vocational assessment, or an evaluation from a “job expert”, of why you cannot work with your medical impairments.
Legal Representation in Long Term Disability Insurance Claims
Although based in Florida, the Ortiz Law Firm represents claimants across the United States. If your LTD claim has been wrongfully denied, delayed or terminated and you’d like to speak to an experienced Long Term Disability Insurance Attorney contact us at (888) 321-8131 to schedule a consultation. We can help you evaluate your claim to determine if you will be able to access Long Term Disability Benefits and how to move forward with the process.