If you have received the dreaded denial letter from your insurance company, you may believe that your claim for long-term disability is over. However, that is not the case. Many applications are denied based on the initial application for multiple reasons. But you do have the right to file an appeal.

We have discussed the possible reasons for LTD denial in a previous blog post. If you have yet to file your initial LTD application, read the previous blog post to make sure that your application and any follow-up meet the criteria.

Appealing The Denial

If you have already received a denial letter, the first thing to do is to prepare to file an appeal.

All LTD policies allow for one, and sometimes two appeals before a person begin receiving long-term disability benefit payments. In fact, most people receive their benefits after the exhausting appeals process.

First, examine the letter that details why the company denied your application. This letter will also tell you the period you have for filing any type of appeal. You must pay attention to this deadline, or you’ll miss your opportunity for appeal, and winning your claim will be over.

Next, contact the insurance company and request a copy of your claim file in writing. If your policy is through your employer’s Human Resources department, contact them for a copy of your claim file. This will show you what they used to determine your claim denial, and how you can prepare for your appeal.

What You Need to Reverse Their Decision

One thing we do know about insurance companies is that they are in business to make money, not to provide you with benefits. Many engage in what’s known as “bad faith practices” to ensure that you don’t get your benefits and that you eventually give up trying. If you haven’t already, this is the time to consider working with an experienced disability attorney to represent you and your long-term disability claim.

It does take considerable effort to file a successful appeal. This includes gathering additional evidence and documentation, such as:

• Supplementary medical records and information to support your claim
• A letter from your treating physician that describes your condition and how it directly impacts your everyday life
• Personal statements, which are from you as well as from a coworker. This information should describe your life with a disability and detail the reasons why employment is not a possibility. Family members and/or former coworkers can also submit statements that describe your limitations and how the disability affects your ability to do your job.
• Your appeal letter that details why you are entitled to disability benefits under the terms of the policy. This letter must clearly detail the facts of your case so that anyone who reviews your appeal will clearly understand that you are unable to work full time.

One thing to focus on at this stage is the addition of relevant medical records for your file. If your claim file doesn’t have sufficient medical documentation, now is the time to add what’s missing and make sure it’s there. Add as much as you can, and a little more—because it’s your last opportunity to “stack the deck” in your favor. Should a lawsuit become necessary, you will not be able to add anything else. The lawsuit is based on everything in the claim file through the end of the final appeal.

Filing A Lawsuit

It is possible to sue an insurance company over a denied long-term disability policy. However, ERISA requires that you pursue all administrative avenues, and all other opportunities for resolution are exhausted.

Prior to filing a lawsuit, your disability attorney can request that the insurers provide another appeal. This will give your attorney the opportunity to buy additional time to reverse the decision. However, in the process of reviewing your claim for the second time, the insurer may file a complaint with the Texas Department of Insurance (or another state’s regulatory agency.) The good news is that this will be part of the lawsuit detailing how the insurer worked to deny your claim.

Hopefully, your case will resolve in appeals, and you will begin receiving LTD benefits soon after. But if that’s not a possibility, your disability attorney can then file a lawsuit in federal court. While this is a longer process, a lawsuit may be necessary to get the company to pay your claim.

Call Herren Law for Help With Your Long-Term Disability Appeal

If you’ve been denied long-term disability benefits, don’t try to manage your appeal on your own—get help today. The Herren Law Firm can help you with your initial application, any appeals, and a potential lawsuit. We can make sure you have one less thing to worry about while you take care of yourself. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation and no up-front fees. We only collect if we win your case.

When you have a condition that’s obvious, it’s easy to show and discuss your symptoms with your physician or other healthcare providers. But when you have physical symptoms that don’t seem to be caused by anything specific, things can get complicated.

Somatic Symptom Disorder, also called SSD, is one that is considered mental in nature but causes physical symptoms, which can include pain. The symptoms can cause considerable distress that can disrupt a patient’s daily life.

The Basics Of SSD

An individual who wakes up with a headache one morning, or develops one during the day, may believe they have a serious illness such as encephalitis. The headache may have any number of causes, from caffeine withdrawal to work-related stress, both of which are treatable and manageable. But instead of determining where the headache is coming from, the person focuses solely on the headache and seeks medical care.

When one doctor doesn’t provide a suitable diagnosis, the person visits multiple physicians seeking answers, convinced that the headache is something more serious. Medical tests don’t indicate any particular problem, leading to an obsession with more doctor visits and additional testing. Seeking the correct answer may lead to debilitating anxiety and distress that makes normal functioning difficult, including:

• Chronic worry over a serious illness
• Concern over serious medical conditions when testing shows there isn’t
• Fear of damage or injury with physical activity
• Believing that your medical exam and treatment were inadequate
• Frequent doctor visits that don’t supply answers and increases anxieties
• Having symptoms that aren’t consistent with the normal effects of a particular medical condition

Note that symptoms such as pain are real, even though there is no detectable cause. Some cases may involve issues with nerve impulses that send signals involving pressure, pain, and other sensations to the brain. These symptoms may be difficult to diagnose, and a physician may or may not prescribe medications for the symptoms.

If no underlying cause is detected, a physician may refer a patient to a mental health provider for additional evaluation. Cognitive-behavioral therapy (CBT) and psychiatric medications may be prescribed to address anxiety related to the physical symptoms.

Applying For Disability

When a condition prevents you from working and living normally, you may decide to apply for disability. Because a somatoform disorder isn’t readily visible and not detectable by normal medical testing, positively proving the condition can be much more difficult. However, it’s not impossible.

The Social Security Administration (SSA) does recognize somatoform disorder as a disabling condition in its blue book under Section 12.07, along with a list of requirements.

Working with one physician for treatment instead of visiting many doctors shows that you are actively seeking treatment and not “doctor shopping.” While the search for answers may lead to multiple doctors, developing a strong relationship with a single psychiatrist and/or physician and regular treatment goes a long way in proving your case for disability.

The SSA will also consider what types of jobs you can continue to do, whether your own or another type, with the help of a mental residual functional capacity (MRFC). While the SSA’s examining physicians will create an MRFC report from your records, you should also have one created by the psychiatrist who is currently treating you. The SSA will favor a psychiatrist who specializes in somatoform disorders over any type of physician who doesn’t.

Get Help With Somatic Symptom Disorder Disability From Herren Law

Applying for disability benefits from the SSA brings increasing challenges to prove your case. With the help of an experienced disability attorney, you can make sure you have the evidence you need, your application is properly executed, and stand a better chance at getting the benefits you need.

Call The Herren Law Firm today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation, and we’ll take your case on a contingency fee basis, with no up-front charges. You don’t owe a fee until we win your case.