At Riemer & Associates, we provide comprehensive representation during the appeal process at your insurance company.  Under the regulations issued by the Department of Labor, a claimant has up to 180 days to appeal the denial.  We urge you to contact an attorney as soon as possible because it often takes the full 180 days to prepare a comprehensive appeal.  We prepare appeals as if they were cases in court. We do this for two reasons.  First, if you submit a comprehensive appeal you show the insurer that you are serious in your pursuit of the benefits, and have a better chance that the insurer will grant your appeal.

Second, in most jurisdictions in the United States, if you do not submit a piece of evidence to the insurer during the claim and/or appeal process, that piece of evidence will be inadmissible in a future litigation in court.  Therefore, we operate under the premise that there is no second chance.  If you want to submit a piece of evidence in support of your claim, you have to do it during the appeal process.  If you do not use it, you could lose it.

We are aggressive and innovative in our appeal approach.  The following is a description of some of the steps we take to assure that your appeal is as strong as possible:

1. Demanding Documents from the Insurance Company. We write the insurer demanding a copy of: the plan; the policy; the SPD; the claim file; all documents relied on by the insurer in denying the claim; any internal guidelines used by the insurer; the reports of all medical and vocational reviewers; audio or videotapes of the claimant; and notes of any telephone conversations.  We request this information because we need to know about all damaging and potentially helpful information.  We usually receive this information from the insurer within 30 days.  If the information is not timely provided, we send follow-up letters creating a written record of the insurer's lack of cooperation.
   
   
2. Demanding Specific Reasons for Denial. We write the insurer demanding that they provide us with a more specific description of the reasons for denial.  Often the initial denial letter only states that there was insufficient objective evidence in support of your claim.  Our letter demands that the insurer tell us precisely what objective information is missing.  If they tell us, we endeavor to provide it to the insurer during the appeal.  If they do not give us a direct answer, we send follow-up letters creating a further written record of the insurer's lack of cooperation.
   
   
3. Gathering Records. We write your doctors requesting copies of all of your medical records.  Often the insurer does not request your doctor's treatment notes prior to their denial.  These notes may corroborate your symptoms.  It is important that a complete set of your medical records is obtained.
   
   
4. Additional Testing. Sometimes there has been insufficient medical testing done to support your claim.  In such a case, we help you obtain the proper tests by your treating physician or refer you out to a medical specialist.  For instance, individuals with Chronic Fatigue Syndrome, HIV, and Lyme Disease often suffer from cognitive deficits.  We refer such clients out for neuropsychological testing in order to obtain objective proof of such deficits.
   
   
5. Medical Reports. We procure opinion letters from your treating physicians explaining in detail why you are disabled.  We also send your doctors customized questionnaires so that your doctor could provide very specific opinions about your inability to work.  We also help your doctors address the concerns raised by the insurer in its denial letter.  To be successful in the appeal process, every concern raised by the insurer must be addressed.  Nothing can be ignored.
   
   
6. Client Affidavits. We spend a lot of time drafting a comprehensive affidavit for your signature.  The affidavit is your opportunity to describe the duties of your job, to describe your symptoms, and to explain why your symptoms prevent you from doing your job.  We want the affidavit to make your case come alive, to let the reader know who you are, and how your symptoms have affected your life, both at home and at work.  It is much harder to deny your claim when you are seen as a living breathing individual, rather than a claim number.
   
   
7. Client Videotapes and Photos. We on occasion procure and submit videotapes and/or photos of our clients, particularly when they suffer from a disability that is apparent when seeing them in person.  The saying is very true, "a picture is worth a thousand words."
   
   
8. Corroborating Statements. Most of our clients have family, friends and coworkers who have observed their disabling symptoms.  We procure statements from these individuals as an added way of corroborating your symptoms.  Statements from coworkers (especially bosses) are particularly helpful because they provide direct proof of your inability to perform the duties of the job.
   
   
9. Scientific Articles. We often conduct research of scientific articles and journals to help provide additional support for your condition.  We often seek the assistance of your treating physician in this research.

Once all of this information and proof is gathered, we prepare a comprehensive appeal letter arguing why you are totally disabled and attacking all of the reasons for denial mentioned by the insurer.  Although the appeal is formatted in the form of a letter, it is in every sense of the word a legal brief, complete with case cites, legal argument, and citations to the medical evidence.

The information we have gathered is submitted in the form of an appendix to the appeal letter.  The records in the appendix are organized and numbered for identification purposes.  If your claim has to go to court, we are in a position to show the court what was sent to the insurer for review.

Keeping you informed
Throughout the process, we keep you informed of all developments in your claim.  We send you copies of all papers we send out, and copies of all papers we receive.  We endeavor to return all telephone calls promptly.

If you would like more information about appealing your claim denial, contact us online.

To learn about some of our internal appeal successes, click here.