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Disability Wiki.

Individual Insurance Policy | Appeals

Individual Policies Policies Appeal a Denial

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Appeals Strategy

When you hire the disability attorneys at Riemer & Associates, we sit down with you and formulate a customized strategy for appealing your claim denial. We listen to your needs and concerns and try to make the process as easy and stress-free as possible. Although every client and claim is different, there are certain strategies we follow for every appeal.

  1. We prepare appeals as if they were cases in court. We do this because 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. Many of our appeal letters are over 30 pages long single spaced. We also prepare a lengthy appendix consisting of the medical records and other evidence that we have gathered. These records are organized and numbered for identification purposes. Our aim is to submit papers that are persuasive, awe-inspiring, and leave the impression that we are ready willing and able to litigate if necessary.
  2. We gather and submit all supportive evidence. 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 the opportunity to do so.
  3. We explain in detail why you cannot work. As we do with claim submissions, when preparing your appeal, we spend a lot of time and effort developing and explaining your disability narrative. We want the insurer (and the judge who may later read the appeal during a possible litigation) to understand what type of person you are: that you worked hard your whole career; that you worked for months bearing the pain until you just could not take it anymore; that you tried to modify the job but were unable to; that you tried to return to work, but were unsuccessful; that you exhausted all avenues of treatment; that all of your doctors, co-workers, relatives and friends support your claim; and that your biggest desire is to get better so that your could return to work.
  4. We address all points and concerns raised by the insurer. We spend a lot of time reviewing the insurance company denial letter, its internal claim notes and the reports of its doctors and vocational experts. We note each time that the insurer criticizes your evidence or indicates that certain evidence is missing. Once we have a list of such criticism we make sure that all such criticism is addressed. Damaging criticism does not just magically disappear, time must be spent convincing the insurer that all such criticism is incorrect or based on incomplete evidence. If the insurer claims that evidence is missing, we must obtain such evidence or explain why the evidence is irrelevant. If the damaging criticism is not addressed, the insurer (and a later court) will just conclude that you concede the point.
  5. We change the appeal dynamic. An appeal that merely tells the insurer that you and/or your doctors disagree with the insurer’s denial is probably a loser. As a result, you need to change the appeal dynamic by submitting new evidence. When new evidence, such as new testing, is submitted you could then argue that the denial was based upon incomplete information and that upon complete information there is strong evidence of disability.

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