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Today, we will discuss the steps you should take if you’ve received long-term disability benefits and the insurance company has terminated your claim. Here are the three steps to take following the termination of your long-term disability claim.
Step 1: Request Your Claim File
The first thing you need to do is request your claim file from the insurance company. Make sure the request is broad and asks for everything in your file. For example, you may ask for the following:
“The full disability insurance Claim File together with computer records, correspondence, and attorney or legal department review documents relating to the disability insurance claim and appeal. This includes, but is not limited to, hard copies and electronically generated or stored copies of all documents that reflect the administrative review process and procedures used by the insurance company and its representatives, the insurance company’s benefit manual, medical records, medical reviews, and investigative reports.”
The insurance company typically has up to 30 days to provide you with a copy. This should contain all your medical records, as well as any records that the insurance company requested from their own doctors. It should also contain any surveillance video they’ve conducted and all the information you need to review before preparing your appeal.
Step 2: Develop Your LTD Appeal Strategy
Next, you need to prepare a plan for your appeal. Build a case by planning an attack with all the evidence they’ve provided.
- If they hired a non-examining physician to review your file, you must challenge the doctor’s findings about your case.
- If they send you to an “independent” medical examination, work with your own doctors to refute the IME doctor’s findings.
- They may have provided a vocational assessment, which evaluates the jobs you can do. You may need to hire your own vocational expert to challenge theirs.
- Lastly, perhaps they conducted surveillance, and the footage is inaccurate or of the wrong person. You should be prepared to challenge what they have on video.
RELATED POST: Advanced Strategies In Long-Term Disability Appeals
Step 3: Prepare and Submit Your Appeal
Finally, the third step is to prepare and submit your appeal. Review the denial letter carefully to determine the deadline to file an appeal, which tells you how much time you have to submit your written appeal. Often, you are given 180 days, and you will typically need the entire 180 days. However, we have seen situations where an appeal must be filed within 30, 60, or 90 days. Submit all the evidence you’ve prepared and supplement it with your own—this may include updated medical records, assessment forms from your own physicians, and perhaps even affidavits from you, friends, and family.
FREE RESOURCE: LTD Appeal Guide: How to Appeal a Long-Term Disability Denial
Another element to filing the appeal is providing legal reasoning as to why their decision was made incorrectly. That’s where we can really assist you. We help challenge the legal rationale behind the decision to deny your claim and provide legal reasoning for why the decision to terminate your benefits should be overturned. If you want assistance from an experienced long-term disability attorney who handles claims nationwide, call Ortiz Law Firm today at (888) 321-8131.