Many chronic diseases have the potential to flare and fade without much notice. Thus, living with a chronic disease can force changes into your life. For instance, many people suffering from flaring rheumatoid arthritis might be forced to stop working. When this happens, seeking public and private disability benefits may help the financial burden caused by the flare.
Unfortunately, insurance companies have made a regular practice of refusing to pay disability benefits. Once denied, you almost always have the right to appeal the adverse decision.
Here are some valuable tips to consider when preparing your appeal for a group disability insurance benefit under ERISA. Please note that because each claim is unique, this is not a complete list, but simply a reminder of important materials for an appeal.
• Before initiating the appeal process, request your claim file and policy from your insurance carrier or employer. You will need to review your policy: without it, you don’t know the rules!
• Consider what evidence you have to prove that you are not capable of performing your job because of your disability, and include this in your appeal packet. Remember that in an ERISA governed policy, once a decision is made on your final appeal, your file is closed. Any information you leave out may never be heard or considered by a court!
o Personal Statement (make your appeal letter more of a cover letter, telling the insurance company why you disagree with their decision, and what information they will find in your appeal packet that will change their minds)
o ALL Doctors’ records (including side-effects of the treatment of your disabilities, and how those impact your ability to work)
o Attending Physician Statements o Job description (do not rely on a generic job description provided by your insurance company- they might not use a full and complete list of your actual duties)
o Performance reviews o Statements from supervisor/co-worker/subordinates, caretaker, family and friends o Social security award
o Independent medical examination
• Communicating with the insurance company: Try and stay off the phone as much as possible! All communication should be in writing, in traceable forms such as certified mail, fax or e-mail. If you can’t prove it, it never happened. Although it’s not always possible, while you are on the phone try to get the name, title, phone number and email address of everyone you talk to. Speaking with different insurance representatives can become confusing and overwhelming. Keep a journal of your conversations so that you can refer back to them later.
• Your appeal has a deadline; don’t miss it! In most cases, failing to appeal before your deadline means that you will be unable to pursue your claim any further.
Supplying your insurance company with the information mentioned above does not guarantee that your disability claim will be approved; however, it does create a documented record of evidence to which you can rely up on if any subsequent litigation ensues. If you have questions about what to include or how to file your appeal, contact Kantor & Kantor at (800) 446-7529 or log on to www.kantorlaw.net.