Yesterday, a potential client called to ask us to review the disability denial letter her insurance company sent.
Our commitment to the community is to review all insurance company letters for free, so people who’ve been denied benefits don’t have to pay out of pocket just to get an opinion about what the next steps might be for their claim.
In our caller’s case, she had two problems: 1) her claim was denied and 2) she owed the insurance company money from a social security disability claim she received.
As promised, we reviewed the denial letter for free and told her what we thought had happened and needed to happen next:
· Her claim was denied at a common transition point, when the policy definition of “disabled” changed from “can’t do your own occupation” to “can’t do any occupation.”
· She needed her doctors to explain why she was unable to work even a sedentary job. Without the strong support of at least one of her doctors, there would be no way to win the appeal.
· The next step should be for her to talk with them and explain that her claim had been denied because the insurance company said she could work a sedentary job. If they disagree with that, see if they will continue to support her claim.
· Since she had been approved for social security disability benefits (SSDI), she could also request her SSDI file from the Social Security Administration to see if there are any medical/vocational reviews in there that might help support her claim with the disability insurance company.
· She should request her claim file from the insurance company, too. The denial letter said they “found” sedentary jobs she could do, so there should be a report in her file explaining how they “found” these jobs.
· She did owe the overpayment money, so she should contact the insurance company before the deadline they gave her and ask if she could repay that in installments.
We said that if she gets these three things, we’d review them for free:
· A letter from her doctor expressing support for her claim and briefly explaining why she can't work a sedentary job.
· Her SSA file, so we could look for a medical report.
· The “jobs we found for you” report from her insurance company claim file.
We make this offer a lot. For us, it’s a way to get the information we need to fully investigate a valid claim, without asking potential clients to pay for a review, only to hear that we are unable to represent them after we know all the facts of the case.
In this case, though, our potential client told us that she knew her doctors would not support her claim, because they thought she probably could return to work at a less physically demanding job.
Then came “the ask.” She wanted to know whether we could send a letter to the insurance company anyway, telling them that we represent her and were working on her appeal, asking for more time for her to repay the money she owed. She would gladly pay us for that letter.
We said no.
Not because we didn’t want to help, and not because we didn’t think she should ask for more time to repay what she owed them.
We said no for you. You’re the next client to call, or the one after that. You’re the one whose doctor does support your claim, and has tried to explain why to the insurance company, only to have their letters ignored because they were not “new medical information” or some such nonsense.
We said no to the “just say you represent me” letter because anecdotally, we believe insurance companies know us. They know we file more appeals and lawsuits than any other firm in Virginia. When they see a letter on our letterhead, they know we mean business.
We are able to offer free denial letter reviews because we only accept cases where we think we can build a strong enough case to convince the insurance company they were wrong, and we are very successful in doing that.
When we say “we represent this person,” insurance companies know that we think they have denied a valid claim.
That’s not a reputation we intend to risk just to get paid to write a letter saying “we represent” a client who knows she does not have a valid claim.
We said no to her so we can potentially say yes to you. The offer still stands:
We’ll review any insurance company letter for free. We’ll tell you what we think is happening with your claim and what we see as the next steps. If we can represent you, we’ll tell you our plan for moving forward. If we can’t, we’ll let you know why. If we need more information, we’ll tell you exactly what we need to make a decision about your case.
Give us a call to get started, or email your denial letter to [email protected]. We’ll have a few questions about your job and your disability and then we’ll review your letter to see whether we can help you.
Believe me…we want to say yes!