Long Term Disability (LTD) Attorney Iván A. Ramos understands that dealing with a debilitating injury or illness is very difficult on both the afflicted, and their families. He also realizes that the last thing you want to do during an illness is to try and assemble a complicated legal appeal with which you have little to no experience. With that in mind, RamosLaw is proud to provide an appeals checklist to help you get a better idea of what steps you should take before you file an LTD appeal. It’s extremely important to have an experienced LTD lawyer like Ivan Ramos assist you throughout the process. In an effort to ease financial and emotional burdens, Attorney Ramos does not charge legal fees to his clients until the insurance company issues payments.
As part of his services, he’ll draw up the vital appeal letter to the insurance company for you, and collect all of the required medical documentation. (Note: appealing entails much more than ‘just filing a letter’ stating you disagree with their decision. See: Preparing Your Appeal Letter.)
Once a claim has been denied, you (usually) have 180 days within which to submit an administrative appeal to the insurance company that issued the rejection. If you file your appeal after the pre-set deadline expires, you may lose completely your right to later contest their denial in court. Here is the aforementioned check list.
Regularly Check your Calendar Leading Up to your Appeal Deadline
As the old saying goes, timing is everything. And there are few instances where that axiom applies more than in getting your properly completed LTD appeal in on time. Set a reminder on your smartphone, place an X on your calendar, and enlist a close friend or relative to prompt you as the date on which your appeal must be filed draws near. Whatever you have to do to avoid forgetting, do it. It’s also important to remember not to wait until the last day to submit your appeal. In fact, it should be sent via overnight mail several weeks before it’s due.
Make an Appointment with your Doctor and Update your Medical Condition
It’s an absolute must that you visit the doctors who have treated you; especially those who are aware of your disability. It is paramount that your medical files contain the most recent status of your injury or illness. If your condition has worsened since the last time you saw your doctor, your medical files will not accurately reflect your updated status. Also, it is advisable to request that your doctor write a letter specifying your physical limitations.
Request a Full, Current Copy of your Disability Plan and Claim File
Federal law states that you have a right to a copy of your disability plan, along with any and all documentation your insurance company has accumulated in their file on you. You should certainly take advantage of your right to acquire them, as it will allow you to see the reasons why your insurer decided to deny your benefits. These documents will give you-and your attorney-an excellent insight into the strategy that your insurance company plans to follow. Of course, it goes without saying how invaluable that data would be. Also, it’s key to note whether their file on you contains the required medical records.
Request Medical Records
As you might expect, medical records are indispensable in all LTD Appeals. You will be required to provide a comprehensive medical status as part of your appeal. And it’s infinitely better to produce as much relevant information and favorable evidence as possible at the outset. To reiterate what was stated earlier, nothing new whatsoever is allowed to be introduced once your initial administrative appeal is filed. It’s also advisable to double-check with your doctor to ensure that everything in your medical records is correct. If not, request that the appropriate adjustments be made.
Keep Copies of all Correspondence
It’s important to keep every piece of mail sent to you by your insurer, and take comprehensive notes on any telephone conversations you may have with them as well. You never know what might end up being helpful to your case, and at the very least these records will grant you and your attorney an even greater insight into your insurance company’s motivations and strategies.
Sensor your Postings to Social Media Insurance companies typically leave no stone unturned in their efforts to avoid paying benefits. As such, they’ll certainly review your Facebook, LinkedIn, Twitter and other social media accounts to uncover information that will help to strengthen their case against you. That’s why it’s wise to go through your accounts and delete anything, no matter how trivial, you believe that might weaken your position. Otherwise whatever your insurer can find that they then can use against you, will indeed be used against you. Regardless, it’s always a good policy to think twice before posting anything on the internet.
Read your Insurance Policy
While having an experienced attorney on your side is always an excellent idea, it’s also wise to spend time carefully studying your LTD policy. The better you yourself understand the process, the better off you will be.
Be Careful when Signing Authorizations
Insurance companies are authorized to request your medical records. Although at times, they go beyond that and ask claimants to sign consent forms that allow them to access non-medical information. You’re under no obligation to grant insurers permission to converse with previous employers, or to acquire all of your financial documents. Review all medical authorization forms carefully, and eliminate language that calls for providing any documentation that is not relevant to your claim.
Understand Your Denial Letter
It is advisable to read and understand your denial letter to fully absorb the reasons why your benefit claim was rejected. It’s always wise to comprehend your opponents’ strategy prior to composing your own. If you find the denial letter to be unclear, you can request of your insurer to write another letter to clarify their position.
Be Sure to Thoroughly Explain the Nature of Your Work
Make sure to amass documentation that sufficiently defines your job duties. This might come in handy because sometimes a job title doesn’t reflect the work an employee actually does.
Request Your File From The Social Security Administration
Are you receiving Social Security disability benefits? If so, request a copy of your file from the Social Security Administration. (SSA) While the definition of “disability” used for awarding SSDI benefits is frequently not the same as that used by your insurer, the information within your SSA file is still highly influential evidence that your condition prevents you from working.
Ask a Friend or Relative to Help You with the Process
It can be a Herculean task to accomplish all of this on your own. That is why we recommend asking a close friend or relative to assist you during this challenging time. It would be very advantageous to recruit someone to help you gather the information you need to file your appeal, and to assist you with keeping track of your medical appointments and deadlines.