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Many of our clients think that a long-term disability appeal package is simply a compilation of medical records sent to the insurance company with a cover letter identifying the package as an appeal. While that may be the case for claimants who file their own appeals, the appeal packages prepared by Ortiz Law Firm are much more detailed.
How Long Does It Take to Prepare an Appeal?
Review of The File
First, we review the claim file for accuracy and flag any damaging information we need to dispute in our appeal letters, such as video surveillance, Independent Medical Examination (IME) reports, peer physician reviews, and vocational assessments.
Review of The Evidence
We also review all of the medical evidence we have received for accuracy, then prepare a detailed medical summary to incorporate into the appeal letter. We focus on notes from the medical records that will support the claim, such as limited range of motion, spasms, reduced grip strength, etc., and we reference any MRIs, X-rays, ECGs, EKGs, neuropsychological evaluations, and any other tests or evaluations that support your claim for benefits. We also use discretion as to whether certain records should be submitted, such as when a doctor noted work activity (where there was none).
Legal Research
Finally, we begin the legal research process. Each appeal letter includes a detailed legal analysis in which the attorney will compare your claim to other disability claims that were decided in a United States District Court, U.S. Court of Appeals, or even the U.S. Supreme Court and cite case law that demonstrates that the insurance company was wrong to deny your claim for benefits.
RELATED VIDEO: Why It Takes So Long to File a Long-Term Disability Appeal
How Long Does It Take to Receive a Decision on an Appeal?
Once we file an appeal, our clients always ask the same question: How long will it be until I receive a decision? Pursuant to Federal Law, the insurance company must decide on an appeal within 45 days of receiving the appeal. We typically allow them an additional five days for mail time, making it 50 instead of 45 days.
Also, pursuant to the law, they may receive an automatic extension of 45 days to issue a decision. See 29 C.F.R. §2560.503-1(i)(3)(i). The insurance company does not need our permission to invoke this extension. It is automatic upon their request. Despite these statutory deadlines, other situations can slow things down and extend the insurance company’s deadline to issue a decision.
Requests for Additional Information
Additional time may be needed if the insurance company needs additional information. The insurance company will “toll” the running of the time to issue a decision. Tolling means that the number of days that the toll is in effect is not counted towards the number of “decision days” the insurance company is allowed to issue a decision. Once tolling stops and the counting of days to the insurance company’s decision deadline resumes, they will proceed with making a decision within a reasonable period, not exceeding the number of decision-making days left after tolling ended.
You may be wondering what additional information the insurance company would need if we have already obtained all of your medical records. If your records indicate that you will receive additional treatment soon, then the insurance company may wish to wait and obtain that new evidence.
Independent Medical Examinations
The insurance company may also order an “Independent” Medical Examination (IME). If so, they will have to identify a doctor with the appropriate specialization who practices in your area and schedule an appointment for you with the said doctor. Depending on the doctor’s availability, the IME may not occur for several weeks. If you happen to be unavailable on the proposed date for the IME, then the insurance company will have to contact the IME doctor again for updated available dates.
Once you attend the IME, we must wait for the doctor to prepare their report and forward it to the insurance company. Then, we also have to wait to receive a copy of the report from the insurance company. We will review the report, and if it is unfavorable, we will ask you and your doctors to assist in disputing it. While we may receive your response very quickly, it usually takes about 30 days to receive a response from a doctor (if we receive a response at all).
Peer and Vocational Reviews
It is also possible that the insurance company will request a peer review or vocational assessment of your claim file. Unlike an IME, these are paper file reviews, and the reviewer will only have access to the documentation in your claim file, so you will not have to wait for an appointment. However, it takes time for the reviewer to review your file, write their report, and submit it to the insurance company.
We also have to wait to receive a copy of the report. We will then review the report, and if it is unfavorable, we will ask you and your doctors to assist in disputing it. Again, it usually takes about 30 days to receive a response from a doctor, if we receive a response at all.
The insurance company may also try to engage in “peer-to-peer” communication between the reviewing physicians and the claimant’s doctors, which is usually a letter to your doctor(s) asking if they agree with the reviewer’s assessment. The insurance company will give a specified time frame to receive a response, and the claim will not move forward until the response is received or the specified timeframe for a response has run out.
While many of our clients hope to receive a decision regarding their appeal as soon as possible, we must take the time to dispute damaging information that the insurance company produces during the appeal review process. Should your claim proceed to litigation the judge will only review the information that is in the claim file and we will not be allowed to introduce any new evidence.
Legal Representation in Long-Term Disability Insurance Appeals and Litigation
Although based in Florida, Nick Ortiz and the experienced legal team at the Ortiz Law Firm represent claimants across the United States. If your LTD claim has been wrongfully denied or terminated and you’d like to speak to an experienced long-term disability insurance attorney, contact us at (888) 321-8131 to schedule a consultation. We can help you evaluate your claim to determine if you will be able to access long-term disability benefits and how to move forward with the process.