Five Tips for Winning Your Disability Claim Appeal

Posted on Monday, November 1st, 2021 at 1:54 am    

If you’ve filed an insurance claim for long term disability due to a work-related injury, you’ve already heard from countless people that your claim will probably be denied. It is unfortunate but true that most disability claims are rejected the first time they are sent to the insurance company.

Some of these denials are for minor problems with the paperwork or missing documentation that can be corrected if the claimant is persistent enough. But some are wrongfully denied or turned down for reasons beyond the claimant’s control. If you think you are one of those whose benefits were wrongly denied, you should contact a disability claims attorney right away and begin appealing your case.

The following are some suggestions to get you started even before you call Abell and Capitan Law regarding your appeal. As always, your chances of a successful recovery are better if you have a skilled disability attorney in your corner.

Don’t wait. Your time is limited. In most places, you have a limit of 180 days after the claim is denied to file an appeal with the insurance company. If you miss that deadline, you may not be able to bring your case to court because of the legal requirement to “exhaust administrative remedies” before suing in court.

However, most attorneys suggest that you not appeal immediately. The paperwork needed to win an appeal is extensive, and you and your attorney will need most of those 180 days to assemble a winning case.

Take the time to do it right. You may be angry with the denial or afraid of what the lack of income might mean for you and your family. The key to winning an appeal is to demonstrate to the insurance company and later to the courts, if necessary, how the injury has affected your ability to work. A clear and convincing case with all the necessary documents and records is worth the time spent.

Keep track of your medical records. If you have an attorney, their staff will do some of this work, but gathering your records will involve you talking to your doctors, therapists, and other healthcare professionals yourself. You know them best, and in some states, you are the only one who has access to some of your records without a side trip into court.

It is important not to harass your doctors and their people too much, however. As anxious as you are about your case, your doctors have many cases, and records take time to copy and send out. As with your entire case, making haste slowly with your medical records is often the best way.

Be alert for sneaky tricks. Monitor your social media, or better still, turn it off while your appeal is in process. Although it is unlikely that your insurance company will have a private detective lurking in your shrubbery to catch you paving the driveway, many cases are being lost today because of an ill-timed Instagram post. Even if the photo was taken years ago, it could be used against you in your disability claim.

Obey your doctor’s orders regarding medical devices as well. If you are supposed to be wearing a leg brace or using crutches, always do so, even if you feel better. Not only is it better for your recovery, but it also prevents an accidental shot of you relaxing at a pool party from showing up in someone else’s Facebook feed.

Keep your attorney notified of all communications you receive. Once you have retained legal counsel, the insurance company should not be contacting you, but that does not mean they won’t try. Any phone calls, letters, emails, or texts should be handed over to your attorney immediately.

Any doctor’s reports or other medical information that comes to you should also be sent at once to your attorney’s office. Appeals have been lost because someone forgot to send files to their lawyer until after the deadline.

Then What?

The administrative appeal is not the last step in your case. If you lose the administrative appeal, but you still believe your case was wrongfully denied or terminated, you may be able to sue the insurance company in court. It is important to consult with your attorney regarding this before you do so since, in many cases, only evidence presented at the administrative hearing will be admissible in court.

Contact Us

At Abell and Capitan Law, we specialize in long term disability claims and appeals, and we focus on obtaining the best outcomes for our clients. We offer free consultations at our offices nationwide. Call (267) 419-7888 today, and let our team see if we can help you appeal your claim denial.

Written by : Erik Abell & Joe Capitan

Last Updated: June 7, 2022
We’ve fought the big insurance companies.
Call, chat, or email us today to get started.