It is not a common practice among insurance companies and other providers to deny claims. The denial of disability benefits is an expected outcome in 1 out of 5 applications. Reconsiderations after this are even more prone for denials.
Whenever you submit a claim to the insurance company, you will receive a denial notice if they decide not to give your request. This is a letter and will contain a brief description of your existing medical condition, the considered impairments, medical and nonmedical descriptions, and a short explanation of the denial of disability insurance. Some of the common reasons you might encounter are:
- Your condition does not render you completely disabled and there are still other positions in your company that you can perform.
- The medical documents or any other supporting documents you submitted are lacking, inconsistent or incorrect based on the given list.
- Your existing medical condition is not recognized as a valid disability even with adequate medical documents due to the specifics of your insurance policy.
The letter also sometimes includes a technical rationale, which is a document that contains a complete explanation of the medical issues that caused the decision. This is usually an elaboration of why you are still able to work with suggestions on which positions to take. It will explain your residual functional capacity (RFC) and work history.
Appealing Your Case is the Best Choice
Receiving a denial doesn’t mean that you are not disabled. Most applicants give up after the initial rejection by the company, not knowing that they can still fight to get benefits. Others are aware that an appeal can be made, but file too late. When you get denied, you can ask for reconsideration first. Most of the time, the reconsideration is never successful because the company will only demand that their reasons are just. If you want to have a better chance at getting your claim, filing an appeal is the best way.
Hire Disability Denial Lawyers
It is easy to find out how to appeal disability denial, but it is best to do this with a licensed professional. Getting help with disability denial is necessary because most people are amateurs when it comes to the law. If you want to have the best chance, you need someone with knowledge and skill to guide you throughout the process.
Educate Yourself First Before Making A Move
If you are having doubts about getting a lawyer, you can start by reading up on your options after getting a denial letter. For instance, you can coordinate with your insurance company first. However, you need to be very mindful about the time. There is a deadline for you to file an appeal, so make sure you get a lawyer in time to file one. In order to do this systematically, follow these steps:
- Find out the underlying reason of the disability denial. You will get an explanation in the notice, but you can still get a more elaborate answer from the concerned insurance provider. You usually get this once you contact them for a reconsideration.
- Understand your insurance policy entirely. Read all the stipulations. If there is something that you do not understand, find a good description. If you have a friend lawyer or someone who is knowledgeable about specific terms, let them explain the parts you don’t understand or have doubts about.
- Once you determine that your claim is logical and you have been denied unreasonably, consider hiring a disability denial lawyer. It is better to get someone who specializes in such cases so you get a more hands-on perspective.
Types of Appeal To Pursue
To appeal denial of disability requires you to be aware what kind you are pursuing. The most common is appealing for a medical decision. This is for denials based on medical issues in your application. It can be because your illness is not considered a disability, or that claims are exaggerated. One good example is when you apply for long term disability for a condition that clearly only qualifies for a short term illness.
Another type is a completion of a past denial. This happens when you file one and then stop the process halfway. With the help of a disability denial attorney, you can continue this. You might need to redo some of the steps, but at least a legal representative can help you complete the process. If you have gone over the deadline, you can start from the beginning and still use the same case as basis for your claim. A good lawyer will be able to advice you on what best to do.
The last one is an appeal for other decisions. Some denial issues for disability claims are not related to the medical condition you have. You can also be denied for reasons like income, overpayments, resources and the like.
