Family, friends, and even co-workers can and should lend support to your long term disability appeal. The administrators at your long term disability insurance company don’t know what you have been going through. The appeal is your chance to try to change their mind and pay your LTD benefits. The people who know you well are probably asking what they can do to help. There is something very simple that they can do, without having to worry about giving a deposition or being dragged into court.
Your long term disability insurance provider has ruled against you, denying benefits, or maybe they are terminating benefits that you previously had. This is very unfair because you know that you cannot work. Denial or termination of long term disability benefits is very common. If you have your doctor’s support for remaining off of work, you’ll need to file an appeal. While preparing the appeal itself is not something that anyone should try to do on their own, there are definitely steps you can take to help gather support from family, friends and former colleagues. Asking for letters from people can be very useful. These letters can help persuade the insurance company because they are written by people who know you well or have observed the changes in you.
How friends, family and colleagues can help with a long term disability appeal
One way you can help your long term disability appeal is to have friends, family members, or coworkers write letters in support of your appeal. They can tell the long term insurance company why they think you need long term disability benefits. More to the point, they will talk about why they don’t think that you can return to work. They put a different spin on things than your doctor will, because it is written from a non-medical perspective. The letters will talk about their own personal observations of how you were before your illness or injury, and how you are now.
Many people who are out of work during a disability don’t live alone. Many rely on adult children, siblings, parents or friends to help at home. Many people need help with cooking or other household chores that they just can’t do anymore. People who suffer from traumatic brain injuries might need help with remembering things. If you are appealing a long term disability denial, the people who live with you can be great allies when it comes time to prepare a letter. They know what your everyday life is like. The help that you need at home can make it easier for the insurance company to understand why you can’t work anymore. For example, if you used to work as a roofer but now need help with your balance going up the stairs at home, it makes sense that you can’t climb ladders anymore.
Letters from Co-Workers in support of long term disability appeals
In the case of co-workers, they probably haven’t seen you since you have been out sick or injured. While they cannot speak to how you are doing at the moment, their letters can still be very helpful.
The insurance company, like your doctor, needs to understand your job. A job title or official job description is often not enough. This is where your former co-workers or supervisors can assist. They can write letters describing what they know your job duties to have been. For example, if you now suffer from cognitive problems but your job relied on quick thinking and processing large amounts of information in your brain, this should be addressed. If your job involved a lot of lifting and you now suffer from a bad back, someone from work can explain why your job needed you to lift a lot. People who know you from work can also talk about your work ethic, since insurance companies are just looking for reasons to paint you as a malingerer who doesn’t actually want to work. In my experience working with people who are out on disability, nothing can be further from the truth. In most instances, people who are on short or long term disability don’t want to sit at home. They want nothing more than to return to productive employment. Their disability leaves them no choice.
What Should Letters say in support of my Long Term Disability Appeal?
Letters from friends, family and co-workers should sound natural. There is not any formula that should be followed. Just let the writer know what you are trying to achieve. Have them talk about you. They should state who they are and how they know you. They should talk about what they know of you both before and after your disability began. Everyone’s letter will be different.
Here is an example of a long term disability reconsideration letter:
I am writing this letter to support the long term disability appeal for John Smith. I have known John from (year) to present time (year). I am his friend/daughter/co-worker/former supervisor. Before John’s accident, he was always energetic and outspoken in the community. I remember one time after volunteering at a local soup kitchen, he led an effort to advocate for more funding for homeless services because there weren’t enough transitional housing available in our area. Now, he can’t walk to the shop on the corner without help, and I have to help cook for him. Since his accident, it has been difficult watching him lose that spark. He used to love doing things like going out to the movies, visiting museums, taking long walks and riding bikes at our neighborhood park. He also took great pride in his work and got good reviews at work. He enjoyed his career with XYZ Company. Now he is stuck inside all day long because he is in too much pain to do anything. I am writing this letter because John isn’t who he used to be when he was able to work. I can’t imagine him being able to return to work at this time. Please reconsider your decision to have terminated his benefits.
Sincerely, Your Friend/Family Member’s Name Here 123 Main Street Anytown State Zip Code
Do my friends and family have to go to court for my long term disability appeal?
Don’t worry, your family and friends will not be dragged into court if they decide to help you win your long term disability appeal. It is a question that I hear a lot and is a very valid concern. No one wants to ask a friend to testify in court or show up for a deposition. Disability appeals don’t work like that.
Disability appeals are written legal based arguments with supporting documents. They should be prepared by an attorney familiar with the law and with the process. The appeal package is sent to the insurance company for reconsideration. Insurance companies don’t want people to hire lawyers and just want to be able to deny benefits again. They will deny again if you don’t have strong support and a well written appeal. Your doctor should not be writing your appeal for you, just like a lawyer shouldn’t be making medical diagnoses for you.
Since an appeal is a legal brief, essentially, it is written for the insurance company but with a federal judge in mind. If the insurance company denies your claim again, then you have the right to take the matter to federal court. A judge will review the appeal package and decide if the insurance company acted unreasonably. This is a lot worse than having to decide if the insurance company was correct, the only standard is if they were unreasonable. This means that you can lose in court even if the judge would have made a different decision in the insurer’s shoes. In reviewing the appeal package, no new evidence is allowed to come in. This means that you are essentially ‘stuck with’ what went into your appeal. These procedural rules show why it is critical to have the appeal done correctly to begin with.
Since a long term disability appeal is a paper-based procedure, there are no depositions and no witnesses to be called. That is how your friends and family can rest assured that they won’t be dragged into a lawyers office or a courtroom. They can help you from the comfort of their own desk or kitchen table.
What next steps should I take to appeal my long term disability case?
If you have been wrongfully denied long term disability, reading my free book is a good place to start to help you understand the process. If you live in Illinois, I will be happy to take a look at your denial letter free of charge, to point you in the right direction. Get in touch by sending an email to info@cadizlaw or calling 630 250-8813.
Bear in mind that most plans are governed by ERISA and there is a very short amount of time in which to appeal. Six months sounds like a long time but there is a tremendous amount of work that goes into every appeal. Therefore, you can’t put it off and should start thinking about your appeal immediately. Let us know how we can help.