Most people have a long-term disability insurance policy carried by an employer that ensures you, as the employee – in the event that you’re unable to do your job anymore or in the event that you are no longer able to do any job – So, you apply for long-term disability benefits and your claim gets denied.
Now that your claim is denied, What do you do?
The claim specialist calls you and says, “Oh, well, you are entitled to an appeal, and if you just want to send me a note saying that, “I appeal this decision,” what we will do is we will review it all over again, and we’ll fix it. We’ll make the problem right.” To be honest with you, and in my experience, my response to their reply to you is, “Yeah, right. That’s not what’s going to happen.”
Every time they deny you, they are saying that your claim is not compensable. You do not have enough information in their claim file for them to award you disability benefits. Even if you just send them an email that says, “I appeal your denial,” they don’t have anything different. There is nothing different in their file for them to change their opinion or their denial on. What you have to do at this point in time is make sure that you do two things.
#1 – Give them additional information that they didn’t have before that compels them to change their mind.
#2 – Tell them all the different ways they were wrong when they denied your claim in the first instance, and all the different ways that they violated the Employee Retirement Income Security Act when they denied you the first time. Maybe they copied and pasted the nurse disability consultant’s report and they put it into the denial letter. Copy and paste is never a full and fair review process.
There are all kinds of other ways that they could violate the Employee Retirement Income Security Act, so you have to tell them how what they did was wrong. You can’t just rely on common sense because insurance companies don’t have any, unfortunately.
Don’t ever do the one-line appeal letter, ever! You have to give the insurance company enough information to change their minds.
If you need help doing that, give me a call. It is my life’s work to make sure the insurance companies pay what they owe, and people can provide for their families. Give us a call. Shoot us an email. I’ll be happy to help.