Essential Factors when Appealing for a Long Term Disability Claim

An injury or illness that causes long term disability can lead to financial burdens for a lot of people and their families. Very often, however, despite the obvious illness and medical proofs, many disability benefit claims still get rejected by insurance providers, which apply strict scrutiny in evaluating the worthiness of each insurance claim.

An article posted in the website of the Hankey Law Office, P.C., speaks of the same careful examination of claims documents by those applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Furthermore, the firm states that, aside from being a complicated task, it may take months before applications get to be evaluated and either approved or rejected.

Though some applications may really turn out as nothing more than fraudulent claims and, therefore, rightfully rejected, many others get denied simply due to technical reasons, which may mean a signature missed, a skipped box, incorrect process in filing of application, and so forth – mistakes often committed by applicants due to the length and complexity of claims documents.

With regard to approved applications, SS members or policy holders (of private insurance firms) usually complain because of the small amount on their behalf – an amount that may be too little compared to what is stipulated in their policies. Thus, just to be able afford medical treatment, as well as address family needs, some resort to selling their properties after all savings have been depleted.

Delving deeper to determine the real cause of rejection of claims, especially by private insurance firms, many legal and financial experts say that everything is simply based on the firm’s intent to remain profitable. Thus, it tries to find mistakes in applications in a manner that is quite aggressive. There are insurance firms that employ tactics, like much delay in the approval and release of the benefit, undue termination of the claimant’s policy or misclassification of illness or injury. A case of insurance bad faith is how experts call it; it involves the violation of the policy that the insurance provider drafted and which it signed with the policy holder.

In the event of a claims denial, undue termination of the policy or if the insured knows and feels that the amount of the benefit released is so much lower that what he/she should have received, the applicant is allowed to fully examine the denied claim and appeal the decision.

An appeal is a formal request for a re-evaluation of the unfavorable decision arrived at by an insurer. There are essential things, besides hiring a legal counsel who has expertise in insurance benefit claims, that an appellant must do to avoid losing an appeal. These include:

  • Filing the appeal within the allowed time frame
  • Preparing all the necessary and relevant documents, such as medical record, medical abstract, letter from the employer, opinion of a medical expert, and others
  • Readying oneself to argue against any misrepresentation or misuse of evidence or inadequate in-house medical review, by the insurer