Most people, when they file an appeal, it’s really basic. We’re talking a one or two paragraph appeal that basically says, “Look, insurance company. I really think you got this one wrong. I think there is more than enough evidence to support my case. I want you to go back, take another look at it, and I think you will see that there’s enough evidence to approve me. So, I hereby appeal, go back and take another look at it.” Now, that is wholly insufficient.
The insurance company wants to show that they’re taking a good, hard look at your case. So they take your claim file and they assign it to a different adjuster than the adjuster that handled the initial determination. In essence, it’s as if they’re taking your case from Susie’s desk and they’re putting it on Janet’s desk and they’re saying, “Hey Janet, did Susie get it right?”
Well, what do you think that Janet’s going to do nine times out of ten? Nine times out of ten she’s going to say, “Yes, my colleague, Susie, got it right.” Especially if you have not provided them with any new evidence, upon which they can use to overturn their previous determination. That’s why you have to give them something new in the way of medical evidence or other opinion evidence to get them to change their mind.
When we prepare an appeal the very first thing that we do is request a copy of your insurance policy to determine what your rights and responsibilities are, in terms of proving up your case. The next thing that we do is we request an entire copy of your claim file. We then take that claim file, we break it down, and we reverse engineer it to determine what we need to provide to the insurance company. That way we can work with you to strategize and get updated medical records and, perhaps, forms or letters from your doctors to address the reasons why the insurance company denied your case.
That’s just one part of it. Another thing that we do is work with you to obtain your statement, typically in the way of an affidavit, or what we call a sworn statement. In the statement, we identify what your impairments are, and not just what your impairments are, but what your limitations are a result of. That is additional evidence that we can use to show the insurance company why it is you can’t do your job. This is a new piece of evidence that may get the insurance company to change its mind.
Finally, we do a comprehensive legal analysis, where we take the reasons why they denied you, which should be set forth in the denial letter, and we show why their reasons are insufficient as a matter of law. We may site legal cases to compare your case to others where the insurance companies may have made similar mistakes in the past. Just to give you an idea, our appeals tend to be anywhere from 16 to 20 pages long, summarize all your medical records, all the opinion evidence, and all the legal reasons why we think their decision is insufficient. That’s a lot different than a simple one or two paragraph appeal.
If you’d like to talk to an experienced attorney who might help walk you through this process, then I encourage you to give us a call at (888) 321-8131. I’ve also written a book about long-term disability cases. It’s called the Top 10 Mistakes That Will Destroy Your Long-Term Disability Claim, and it is available to download for free.