Prepare And Send Your Appeal Letter
I find that this last step causes people the most anxiety. You may feel like if you dont write a good appeal letter, it could result in your claim being denied again.
Let me set your mind at ease. In the vast majority of cases, the appeal letter has almost no bearing on the decision. At this stage, the insurance company makes its decision based on the medical records and doctors opinions.
So, your appeal letter only needs to do three things: request the appeal, attach the required documents, and arrive at the insurance company before the deadline.
Ideally, you would review the key facts and then apply the law to show why they should approve your claim. But, I recommend against trying this on your own. Writing this type of appeal letter is hard to doespecially if you dont have experience.
You are better off avoiding legal analysis and focusing on writing about any gaps in information. This could include:
- Clarifying any misunderstandings about your medical treatment or employment
- Reviewing all the things you did to try and stay at work
- Discussing how your symptoms affected your duties
Once you have sent in your appeal letter, you will usually get a response in 30 to 60 days. If there are delays, its likely because the insurance company is waiting on their doctors to review the medical information you sent in.
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No Reason Disability Denial
Finally, heres an example of the worst reason for denial. In fact, I call it the no-reason denial:
As you can see, this letter provides no clear reasons. Therefore, there are no specifics for you to focus on in your appeal. The insurance company doesnt say what gap in information led to the denial. However, this denial mentions another letter. So, I would start by looking for that letter to see if it has more specifics.
Another option is to ask the insurance company representative to give more detailed reasons. But keep in mind, they may not agree to that.
In a case like this, you may need to review the insurance companys claim file to see what is really going on. Sometimes in a no reason denial situation, the insurance company has completely closed its mind to your claim. Your best option in this situation is often to move on and take your appeal to court.
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Know What Kinds Of Arguments Work
When writing your brief, keep in mind that the Appeals Council finds certain kinds of arguments more persuasive than others. What kinds of arguments work? Here are some of the best.
- The ALJ failed to explain what weight he or she gave to your treating doctor’s opinions. Social Security Administration regulations provide that an ALJ should weigh various factors in deciding how much weight to give a doctor’s medical opinions regarding your limitations, including whether they are consistent with the other evidence of record. The regulations state that the ALJ, in his or her decision, must provide “good reasons” for the weight assigned to these opinions. If the ALJ gives little weight to your doctor’s opinion, ignores the opinion entirely, or doesn’t explain the weight he or she gave to the opinion, you may have a good argument that your claim should be sent back to the hearing level.
- The ALJ didn’t obtain testimony from a vocational expert. If the ALJ decides that you’re not disabled at step 5 of the disability process, he or she must cite examples of specific occupations that you can perform, along with how many of those jobs exist in the U.S. This can be accomplished only through vocational expert testimony. If no VE testified at your hearing, but the ALJ found you disabled at step five, the Appeals Council may order the ALJ to hold a hearing with a vocational expert present.
Carefully Review Your File
After receiving your file from your insurance company, it is important to go through your entire file once again. If your initial appeal has been rejected, there is new information that has been added to your file. This is important to find the real reason why your claim has been denied and will help you write your second appeal letter accordingly.
In addition to this, you might come to find some information you had not considered important before. There are different things the insurer might have considered illogical such a past activity that contradicts your disability claims. It is important to put everything into the right timeline and support your claims with appropriate dates and the right documentation.
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Describe How You Are Unable To Work
This is the most vital part of the appeal letter, include a paragraph explaining how your disability prevents you from working any jobnot just your old job. Service Canada emphasizes strongly on the severity and longevity of your conditions, as well as how it has affected your employability.
Due to my developing condition, I am dealing with physical pain on a daily basis. I also suffer from mobility difficulties because of the same problem. I am forced to walk very slowly, and at a deep stood. I need to take breaks every 10 minutes and I also have a hard time getting up from a seated position. Apart from it, I also have to sit in a specific position so that I dont irritate the nerves and suppress any muscles. As a result of my condition, I was unable to commit to a regular schedule of a gainful job.
Hire A Reliable Attorney
A qualified Social Security disability lawyer can help you in filling and submitting SSA forms, gathering relevant evidence, as well as managing other activities related to your appeal. On your own, you may feel overwhelmed given the complexity of the process. With a lawyer by your side, you are able to avoid any mistakes and ensure that you file an appeal without wasting any time.
Summarize Your Supporting Documents
Explain what information you have included and why it is relevant. Point out whether this is new information that Service Canada did not consider when they reviewed your initial CPP Disability application.
I have attached updated medical records and letters from my doctors which support my appeal. The aforementioned documents show that my condition has worsened since I first applied. My treating physician has also written a letter explaining my swelling and pain, and how my advanced arthritis has limited my movement and my speed. Since you did not have this information when you first made a decision on my case, I thought it would be relevant and helpful this time.
Very Important To Enclose All Documents
It is very important to enclose all documents and information that pertain to the case in the claims process and the appeal letter. If the appeal is denied, the person may sue the insurance company.
If this happens, any information used to make the case for the appeal must have been already submitted in the claim and subsequent appeal letter. If any information is left out such as hospital records or doctors records, it will not be allowed in court.
The law is heavily in favor of the insurance companies. To win short term disability benefits, the person must present a strong disability appeal that is supported by evidence. The letter can be short and simple.
It will not, in itself, change the decision of the insurance company. However, evidence will. All the information should be accurate and honest. Falsehoods will go against the claimant, even if they are unintended.
The letter should include:
Here is a sample letter for requesting an appeal for denied short term disability benefits.
The letter should be sent by certified mail, so the sender has proof of the time and date the letter was sent and received. All enclosures should be copies of documents, and no original documents should be sent.
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Talk To A Disability Lawyer
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Submit The Right Paperwork
When you are filing a reconsideration appeal, you are required to submit a specific form. This is known as the Form SSA-561. In addition, you must also provide a Reconsideration Disability Report. This report essentially augments your original claim by furnishing new and relevant information pertaining to your application.
A third form that is also required when filing for disability reconsideration is . As the name suggests, this is a medical release form that allows SSA to access the medical records related to your disability.
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The Social Security Disability Reconsideration Time Frame
Once the SSA has made a decision regarding your reconsideration appeal, they will send you a letter in writing notifying you of the decision that has been made. The letter will explain whether or not your appeal was successful as well as details regarding how the SSA came to the decision regarding your disability claim. On average, it will take between three to five months to complete the Social Security Disability reconsideration process and receive this letter of decision. Here are some tips on how you can get your reconsideration request approved.
If your reconsideration request is denied, you may go on to appeal the decision further. The next step of the appeals process is to take your case before an administrative law judge at an appeal hearing. If you have not yet hired a Social Security Disability attorney and your claim is denied at the reconsideration level, you should consider retaining an attorney to represent you during the hearing process. Your chances of successfully appealing your disability claim are greatly increased with proper representation at your hearing.
You Concealed A Material Fact On Your Application
If the benefits application for long-term disability asks for the name of every doctor youve seen in the past 10 years, provide that information.
There could be a doctor who you only saw once because you didnt like their bedside manner, or maybe because they didnt assess your condition in a way you thought was accurate. Regardless of the reason, your medical history is a material fact and it all needs to be included.
Failure to disclose any material fact on your application could give the benefits provider the right to void your policy.
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How To Understand A Denial Letter
Your denial letter may seem at first to be a lot of legal mumbo jumbo, but key phrases provide clues as to why your application was denied. For example, you may see words like non-severe or does not meet an impairment listing. These phrases tell you why your claim was denied and why you may need a lawyer for a Social Security disability appeal.
If the letter says non-severe, for example, that means that you did not qualify because the Social Security Administration believes that you do not have a severe medical or physical condition.
If the letter says, does not meet an impairment listing that means that your condition does not meet or equal a disability or impairment listed in the SSAs blue book the Listing of Impairments . However, just because your condition does not meet an impairment listing, that does not mean that you are not disabled or that your condition is not severe. Nor does it mean that you cannot qualify for benefits.
There will be specific language in your denial letter that talks about your ability to return to your past work or whether according to the SSA, you can do other work. If you are able to do your past job, or if the SSA determines that you can do other work , that is grounds for the SSA to deny a disability claim.
Enforce Your Employment Rights
When your claim is denied, the insurance company will send a letter to your employer. The insurer will tell your employer that you are able to work and dont qualify for long-term disability.
Upon getting this letter, your employer will likely call or write to you to ask when you plan to return to work. So, you need to inform your employer, in writing, that you disagree with the insurance company and are appealing their decision.
For many employers, thats all you need to do. They will allow you to be on unpaid sick leave while you are appealing the long-term disability denial.
However, some employers will take a more aggressive approach. They try to rely on the insurance companys opinion that you can work, and demand that you return to work. They will warn that failure to return to work will be viewed as abandoning your job, or something to that effect.
If you are dealing with an aggressive employer, then you need to have your doctor write a new off-work note directly to them. This note or letter needs to clarify that that doctor continues to put you off work, regardless of the insurance companys opinion.
Once you give the employer an updated sick note, it will trigger your rights to ongoing accommodations under employment and human rights laws. A reasonable accommodation is to allow you to continue on unpaid sick leave.
For more information, see Employment rights and disability benefits.
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Identify The Deadline For Appeal
Nothing else matters if you miss the deadline to appeal your long-term disability denial.
Some appeal deadlines are soft, so missing them is no big deal. Others are hard. In other words, miss them and youre screwed. Its not easy to tell the difference. So, you should assume that you have hard deadlines.
But how do you know the deadline?
If you got a denial letter from the insurance company, then the deadline for appeal is usually included in the last few paragraphs of the letter. If the insurance company didnt send a denial letter, then you need to ask them to up tt the denial in writing.
The appeal deadline will either give you a specific date . Or, it will state a certain number of days from the date on the denial letter . If you are given a number of days, then you need to look at a calendar and count them out to find your deadline.
Here is an example of what the appeal deadline looks like:
In this example, the insurance company gives two deadlines. The first is 30 days to give written notice of intent to appeal. The second is a full 90 days to get all the documents for the appeal.
Disability Insurance Appeal Letter Template Samples
Assortment of disability insurance appeal letter template that will completely match your demands. When composing a formal or organisation letter, discussion style as well as style is essential to making a great impression. These layouts offer excellent examples of the best ways to structure such a letter, and also consist of sample content to function as a guide to format.
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Social Security Disability: The Reconsideration Stage
If you apply for Social Security Disability and your claim is denied, you should not give up hope of receiving the Social Security Disability benefits that you are rightfully entitled to. You have the option of going on to file an appeal of the decision. The first step of this appeal process is a request for reconsideration.
Many people make the mistake of assuming that it is better to file a new Social Security Disability application than it is to go on and file a request for reconsideration on an existing claim. This is not the case. If you simply begin the application process for Social Security Disability benefits from the beginning, your claim is likely to be denied again no matter how many times you decide to reapply.
How To Write A Long Term Disability Appeal Letter: Top 10 Tips
Posted byMichael Jordan Long Term Disability LawyerOn01-01-2020
When long term disability claims are denied, there is usually an option to appeal. At first, an appeal may seem promising. In practice, however, very few appeals are successful. This is likely because appeals are not to a neutral independent decision maker who will fairly and objectively assess the claim, but rather to the same company that denied the claim in the first place. In many cases, the person who conducts the appeal is the same person who denied, or is a colleague that sits a few desks away. But dont give up! Some appeals are successful, and there are other options to consider if the appeal is denied.
Before writing an appeal letter, you should first consider when it is appropriate to appeal, and also whether to contact a long term disability lawyer before appealing. If you do decide to appeal on your own, follow the tips below.
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