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Common Appeal Mistakes for Long-Term Disability Claims

A lot of claimants make the mistake of "appealing" the decision by either sending a letter that says, "I appeal," or by having their doctor send a letter that says something along the lines of, "I have been Mary’s doctor for a long time, she is really sick, there’s no way she can work, so she is disabled."  

  1. Insurance companies do not listen to “sob stories.” You can’t appeal to their heart – they don’t have one. The only thing they look at is the policy language, and if they can use that to justify denying benefits, they will. If you can’t be objective about your condition, call us – we know how to present your medical records in a way the insurance company will “get.” That includes working with your doctor to clarify specific restrictions and limitations instead of leaving it at “he’s really sick, he cannot work.” (That just sounds like “claim denied” to an insurance company.)
  2. Insurance companies only listen to medical records and physician opinions that directly address the reasons why they denied or terminated your claim. This gets complicated, but if the insurance company denied your claim because they said you could sit for 6-8 hours per day, you won’t win an appeal by proving to them that you have difficulty standing and walking.
  3. Using a lawyer who does not know ERISA can kill your claim. All disability attorneys are not created equal, and you should consult with an ERISA-trained attorney before moving forward with an appeal. Many Social Security Disability attorneys are great at navigating the Social Security Administration system but know nothing about ERISA. But they and their client think, “Hey, it’s a disability claim, how different could it be?” It’s really different in some important ways, and as a result, we see sadly non-ERISA attorneys investing huge sums of YOUR money in securing expert witness testimony (when often a simple letter from your doctor will do just fine) and writing complex appeals that never even address the ONLY THING the insurance company wants to know: why can’t you work? 
Ben Glass
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Ben Glass is a nationally recognized car accident and ERISA disability attorney in Fairfax, VA.