If your disability claim has been denied, you will likely be given the opportunity to “appeal” the decision by providing additional information for the insurance company to review. In our experience, while there is a small possibility that an appeal will reverse the decision, in most cases, it simply further delays the matter, with many more months of no payments being made and creating further frustration and financial pressure on you. The best advice we can offer if you are considering appealing is to first discuss your claim with an experienced disability lawyer so that at least you know what your options are and can consider what action to take. The biggest reason to bypass the insurance company “appeal process” is to push the matter forward to more senior people in the insurance company who are experienced at dealing with disputed claims, rather than continuing to try and persuade the lower level claims manager. By proceeding with legal action, you are forcing the insurance company to take your claim more seriously.
If you want to try to appeal, the principles that apply to the manner in which you presented your claim initially still apply. Be honest, avoid exaggeration, and ensure that your doctors are prepared to support your claim. If your medical information is vague or inconclusive, the chances of succeeding with your claim are much lower. Doctors and other health care providers are often frustrated by the need to repeatedly provide supportive medical information and are often offended by the insurance company’s refusal to accept their opinions. Remember your doctor is mostly busy with attending to the needs of their patients’ health care and they often don’t have the time to get engaged in a substantive way with the insurance company process. A disability lawyer’s sole focus is on gathering the necessary information to make out the best possible case.
5 Errors to Avoid
1. Exaggerating Your Symptoms
The denial rate for disability claims among the private and public sector has received considerable publicity. In an effort to jump start your claim, or give it some extra punch, there could be a temptation to exaggerate the symptoms of your disability on the claim form. You may have had your disability for some time and fear that your claims adjuster will not understand why you cannot work. Your pain may be intermittent, and you may fear that the insurance company will not understand that this prevents you from working. Exaggerating your symptoms can ultimately lead to your claim being denied. It is important to remember that your claims adjuster and your insurance company have years of experience handling disability claims, and they are eager to weed out what they consider “invalid” claims. Exaggerating your symptoms could result in your claim reaching the “invalid” file.
2. Understanding Your Disability
It is very important that your doctor conduct a thorough medical examination and refer you to the appropriate specialist. Your doctor should be the one to make an assessment of your disability and provide specific information about why you cannot work. With this in mind, it is crucial that any medical information you give to your insurance company be complete and accurate. You may be tempted to understate your disability in the hopes that a smaller claim may prompt your insurance company to start disability payments. However, any information you provide about your disability will be used to make a decision on your claim, so that information should be accurate and supported by your doctor’s findings.
4. Failing To Put Faith In Your Lawyer
Most experienced lawyers welcome the input and active participation of their client. However, a claimant who fails to give their lawyer room to maneuver in order to successfully follow your claim will ultimately run into trouble. It is important to appreciate the value of an experienced lawyer when it comes to following a disability claim through to resolution. A good lawyer can add that experience and make the process easier for you only if you put faith in your lawyer and allow them to do what they do best.
5. Giving In
If you cannot work due to a disability and have already gone through the arduous claims process only to find your claim is denied, you may feel you are ready to admit defeat. As we’ve already seen, many disability claims are denied when first submitted. Individuals with no experience with disability claims can, understandably, feel intimidated by large insurance companies and overwhelmed by their claims process. Many experienced lawyers acknowledge that these feelings are a strong indicator that it is a good time to find a lawyer. A lawyer who has experience with disability claims can help level the playing field. The bottom line is that you shouldn’t give up. Perseverance may yield results. If you feel you cannot do it alone, seek help from a professional.