Important Steps to Take for an ERISA Disability Benefit Appeal

Hi. Today we're here with attorney Rachel Alters. How are you, Rachel? I'm good, Greg. How are you? I'm good. And we are going to discuss your opinion of the top three things that a person should do if their long-term disability benefits have been denied and they are required to file an appeal. What would number one be? The first thing I would suggest is to call an attorney. And why would you suggest contacting an attorney? Well, I believe it's very important to have an attorney represent you when filing an appeal for an ERISA or an ERISA appeal because you have to make sure that everything that gets put into your administrative record is complete or else when you get to court you are not going to be likely to win your case. Okay. Now, whoever's watching this video would assume that us being lawyers and preparing this we would say contact a lawyer. So it's really, truly important that the people who are considering, you know, they have this requirement to file an appeal that they understand that filing an ERISA appeal is extremely complex. And while it's not just as simple as saying, you denied my claim, I want a new review, that can you explain why they only get one bite of the apple with their appeal and that no other information will ever be allowed? Well, with most insurance companies, they only allow one appeal. There are a couple that allow an additional voluntary appeal, but most of them only allow one bite of the apple. If you don't get everything into your administrative records, such as your doctor's opinions, all the proper medical records supporting your disability and, you know, whether we want, whether it's decided that you should go get a functional capacity evaluation or an independent medical exam, all of those things need to get into your administrative record because once that appeal is submitted and assuming that the appeal is denied, that record is closed. So once you get to court, all the judge can see is that administrative record. You're not allowed to submit anything additional. So if you came up with something fantastic or you got hit by a car the next day, none of that goes in. So you have to make sure that it's complete. It's really important. So now assuming that the potential claimant takes your advice and they hire you, which would be the number one step, what's the first steps that you take as the lawyer to try to win their claim? Well, what I do is I, number one, gather all their medical records to see what kind of treatment they've received from their doctors and what their doctor's opinions are as far as whether they support their disability. Okay. How do you, as the attorney, put their claim in a better position than they would be able to without you? Well, there's many things because I do these all day long and I'm familiar with what the insurance companies are looking for and how they're looking to deny these claims. I feel like I'm one step ahead of a claimant who wouldn't know these things. So for example, I would know that an insurance company is probably conducting surveillance on a claimant. So I would request any surveillance tapes that they have done on the claimant to see what they've seen them do because they're going to use that against them at a later date. Okay. In addition to the video surveillance, I think one of the biggest things that we do for somebody who's been denied is that we guide them through the process. There's a reason you get 180 days to submit an appeal and we guide them through the process of obtaining additional medical evidence way beyond just their doctor writing a simple letter saying, I believe my patient is disabled because that's what everybody does. That's really not enough. So we guide the claimants through the process of obtaining additional medical evidence through going to different doctors, through getting doctors to fill out specific forms that we've personally created that we know the insurance companies are going to want to see. So you have to have an arsenal of tools available, which we've developed over the years, to be able to really put your claim in the best position to win. It's sad when we get people who call us who've already been denied on their appeal and they want us to litigate for them, which we do evaluate those and help people all the time, but we're limited because they didn't have the tools available to them or know about all the different types of medical information, medical tests, medical technology that's out there that could have been put into their claim file that they didn't include. I agree. Well, for example, my cases with my Lyme clients, I send them, we have a list of neuropsychologists who do Lyme testing and neuropsychological testing on claimants who have Lyme to see if they have cognitive deficits. Sometimes claimants wouldn't think to do that and this really helps them build their case and support their claim for future litigation. Right, and I think from us having over 10 lawyers who do nothing but disability and representing thousands of claimants throughout the years, we've seen some of the leading doctors throughout the country who treat all the different medical conditions. We've had the opportunity to see how every single disability insurance company is evaluating these claims and what they want to see as proof of the medical condition and what they don't care about, which is important. So, you know, six months may seem like a lot of time for an appeal, but it's really not. The time goes very quickly. We often want our clients to continue to get additional treatment so we can show that there's been either a continuation of the disability or further deterioration of the medical condition. And we work with you throughout this process and we work with other, for example, why is it important to get statements and drafting these statements from family members or friends? Why do you think that's important in an appeal? Well, I think it gives the personal side and shows the insurance company that, you know, these people are real and they're suffering in a real way. And on a daily basis, not only can they not work, but there's a lot of things they can't do, such as, you know, simply getting in their car and going grocery shopping. And a lot of their family members can attest to the fact that they're really suffering. So there's tons of different things we've done for every single type of medical condition. It's really, really important to get the strongest appeal possible that you can in for your file. We work with clients all over the country. Our fees are very flexible. And very often we don't charge you any fee unless we're able to get your benefits paid. We always offer a free initial consultation. So we invite you to contact us, send us a copy of your denial letter if you've been denied and you're required to file an appeal. We'll set an appointment with you right away and let you know immediately whether or not we can help you. Thank you.