WHEN TO APPEAL YOUR DISABILITY INSURANCE CLAIM DENIAL
Have you had your long term or short term disability insurance claim denied? Are you wondering where to go from here and whether you can appeal it?
We’ve got you covered. The good news is that many people who lose disability claims end up successfully winning their cases later. But you’ll need to know exactly what to do and in what time frame to do it in.
Additionally, it is always a good idea to seek legal representation at this stage. Some people have successfully claimed disability on their own without the help of a lawyer. However, the SSI system itself can be incredibly confusing.
Read on for more information about appealing your case.
If I’ve Had a Short Term Disability Claim Denied, What Is My Appeal Window?
If you’ve been denied short term disability, you only have 60 days to appeal the decision in writing. This is typically the same in all 50 states, though you may want to check with your state’s SSI office just to be sure there aren’t any extras you are not aware of.
Typically, however, 60 days is the maximum amount of time you’re allowed to appeal the case.
What About A Disability Insurance Claim?
Some individuals apply for short term disability claim through their insurance company. This allows them to access disability benefits that are typically a larger payout each month than benefits given to you from Social Security.
An insurance company is given 45 days to complete their assessment of your claim and decide if you meet the criteria for their disability insurance. They may also request more time, up to 30 days, to continue to review your file.
The insurance company will decide if you’re disabled based on a variety of factors. This includes your doctor’s reports, your insurance coverage, and your insurance level.
Because of the nuance of disability insurance claims, you can be denied for things other than not being “disabled enough.” This is typically because you were not on the correct insurance or the plan you were on did not cover disability.
In the latter cases, they are correct to deny your disability claim. However, they will give you instructions on how to appeal. Typically, you’ll have 180 days to do so.
Why Are Disability Claims Denied?
Disability claims are denied for a host of reasons. They may be because those reviewing the claim did not receive the correct information. They may also be because the attending physician did not fill in all of the forms correctly, or incomplete information about your case was given.
Additionally, for many disorders and diseases, a diagnosis is not proof that someone is disabled enough to be unable to work. For example, people with lupus SLE can run the gamut when it comes to how they’re able to function. Some people may be completely disabled, while others are able to continue a successful career.
Because of this, some people who work in disability claims may try to “catch people out.” Some private insurance companies hire personal investigators or look through the individual’s social media to see if they are really as ill as they claim.
As social media doesn’t portray the whole picture of someone’s life, this can be inaccurate and troublesome to those who do need disability benefits.
How Long Will the Appeals Process Take?
In most states, the first thing you’ll do is submit your appeal for reconsideration with the Disability Determination Service (DDS). Depending on how busy the department is, this can take just a few weeks to a few months. In this case, you’ll have your file reviewed by another medical consultant and another examiner, who are independent to those who denied your case.
If that is also denied, you’ll move forward to a hearing with the administrative law judge, or ALJ. It can take a year or longer to receive a hearing with the ALJ, which can be incredibly frustrating, especially if you do need the money.
If you’re denied there, you’ll then go to the federal appeal process, and that can also take over a year for a hearing. Some people find themselves waiting several years for the decision, as a federal judge sees many types of cases, and disability isn’t the only one.
How Can I Strengthen My Appeal?
Be honest when you fill out your appeal. Do not exaggerate, but make the examiner aware of how difficult it is in your condition to perform daily tasks that would require you to work.
You should also get a statement from your doctor, letting them know that you are not able to work. Sometimes, your first appeal and the initial claim will still be denied even with this letter. But, as you move forward up the chain, this can make or break the case.
Make sure your doctor discusses what exactly your symptoms are and how they’re preventing you from working in a meaningful way.
If you’re denied SSI, it is a good idea to search for representation, though some people may wait after their second denial. While it can be costly, having a lawyer on your side who knows all about disability law is priceless.
If you’ve found yourself denied disability after your initial disability insurance claim, contact us immediately. We work with disability cases as one of our specialties. We have a long track record of helping people just like you get the disability benefits they both need and deserve.
Contact us for a free consultation, and to discuss how to move forward with your case.
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