When a claim is denied, there is a very short period of time in which to submit an administrative appeal to the insurance company that denied the claim (typically 180 days). If the appeal is not filed within this time period, it may be impossible to later challenge the denial in court. This is why you must take certain steps immediately in order to protect your rights. Here is a check list of some important things that you must do before you file the appeal. If you call (860) 338-5619 and retain our legal services, the Law Office of Iván A. Ramos, LLC will assist you in completing the items mentioned in the check list.
1. COUNT THE DAYS AND CALENDAR YOUR APPEAL DEADLINE: On a calendar, you need to count the days that you have to file the appeal. Write down a reminder of the date on your cell phone calendar and on a regular calendar. Also, ask a friend or a relative to remind you of the date. Make another reminder in the calendars, several weeks before the date that it is due. You should never wait until the last day to mail the appeal. It is usually advisable to mail it, via overnight mail, several weeks ahead of the deadline.
2. MAKE DOCTORS APPOINTMENTS AND UPDATE YOUR MEDICAL CONDITIONS: You need to make appointments with all the doctors that have been treating you, particularly those that know the most about your disability. The purpose of the visit is to make sure that the medical files are updated with the status of your condition. Sometimes conditions have worsened but the medical files do not reflect your current status accurately. You should also ask the doctor if he or she would be willing to write a letter detailing your limitations.
3. REQUEST A FULL UP-TO-DATE COPY OF YOUR DISABILTY PLAN AND OF THE CLAIM FILE: Pursuant to Federal Law, you have a right to obtain a copy of your disability plan and of all the documents that the insurance company has in your claim file. Obtaining these documents is important because it gives you the reasons why you have been denied benefits. From these documents, you will get sense of the theories and strategies that the insurance company will rely on to continue to deny your benefits. You should also check to see if the company has included all the necessary medical documentation in the file
4. REQUEST COPIES OF ALL YOUR MEDICAL RECORDS: Medical records are an essential part of all Long Term Disability Appeals. In your appeal, you must present a full picture of your medical conditions. Once your administrative appeal is filed, you are not allowed to introduce any new evidence in your case. For this reason, it is always a good idea to err on the side of caution and gather as much medical information about your condition as possible. You should also review your medical records and make sure that all the information is accurate. If any information in the records is inaccurate, you can ask your doctor to correct it.
5. DOCUMENT ALL CONTACT WITH THE INSURANCE COMPANY AND KEEP COPIES OF ALL CORRESPONCE REGARDING YOUR CLAIM:
You should keep detailed notes of all telephone conversations that you have with the insurance company and keep copies of all correspondence in your case. This will also give you a better understanding of the strategies and theories that the insurance company might use justify their denial.
6. CHECK YOUR POSTINGS IN FACEBOOK AND OTHER SOCIAL NETWORKS: Insurance companies will go into Facebook, Linkedin, Twitter and other social media in search of information that might weaken you disability case. In many instances, information contained in social media is misconstrued and used by insurance companies to contradict your claim that you are unable to perform certain activities. For this reason, it’s a good idea to remove any pictures or postings that could weaken your case. The bottom line is that should always be careful with what you post the internet.
7. READ YOUR POLICY: Take time to read your long term disability policy carefully. It’s important that you obtain a good understanding of how the provisions in your policy apply to your particular case.
8. BE CAREFUL WHEN YOU SIGN MEDICAL AUTHORIZATION FORMS: Insurance companies have the right to request your medical records. However, on some occasions insurance companies ask claimants to sign authorization forms that cover more than just medical information. You don’t have to allow the insurance company to talk to previous employers or give them permission to obtain financial documents. You should read all medical authorization forms carefully and redact from it any language allowing the company to obtain non-medical information.
9. UNDERSTAND WHY YOUR CLAIM WAS DENIED: The ancient Chinese warrior-philosopher Sun Tzu encouraged his troops to "know your enemy" before going into battle. Likewise, you need to read your denial letter and understand the reasons why your disability benefits were denied. Before you advocate on your own behalf, you need to have a good understanding of your opponents’ argument. If the denial letter is unclear, you might want to write a letter to the insurance company asking for clarification.
10. GATHER INFORMATION THAT DESCRIBES THE NATURE OF YOUR WORK: You need to gather documentation that adequately describes your job duties. You may need this information because in many instances job titles don’t reflect the actual duties performed by an employee. You must also consider obtaining letters from your previous employer stating the difficulties that you had performing your job.
11. OBTAIN DOCUMENTS FROM THE SOCIAL SECURITY ADMINISTRATION: If you are receiving social security disability benefits, it is important that you obtain a copy of your complete file at the Social Security Administration. Although the definition of disability used for awarding SSDI benefits is usually different for the definition used by your insurance company, the information contained in SSA documents is highly persuasive evidence that you are unable to work as a result of your condition.
12. IDENTIFY A FRIEND OR A RELATIVE THAT CAN HELP YOU IN THE PROCESS: Finally, it is always a good idea to have a close friend or a relative help you during this difficult process. Find someone who can help you gather all the information needed to file the appeal and who can keep track of your medical appointments and deadlines.
The Law Office of Iván A. Ramos, LLC strongly recommends that you contact us as soon as you encounter problems with the granting of your benefits. We will provide you with a free initial consultation. If we represent you and you do not get benefits or payments from the insurance company, we will not charge you for our legal fees. You will only be responsible for the costs associated with pursuing the appeal.
Call (860) 338-5619
Our firm will not charge you legal fees, unless we get payments for you.