Appealing a Disability Claim Denial
A majority of first-time claims for worker’s compensation and Social Security disability benefits get rejected. The approval rates for short- and long-term disability claims filed with private insurance companies are not any better. This reality leaves injured and ill people struggling financially and searching for answers.
The Cleveland, OH, disability attorneys with Agee Clymer Mitchell and Portman can at least fill in few of the information gaps with this list of frequently asked questions about appealing disability claim denials.
Why was my disability claim denied?
State and federal laws require the Ohio Bureau of Worker’s Compensation, the Social Security Administration, and insurers to send claimants letters that explain why a claim has been approved or rejected. Unfortunately, those written communications are not always easy to interpret. Asking an Ohio disability lawyer to help you translate the legalese can reveal whether you were turned down for one of the following common reasons, or for another issue altogether:
- Lack of eligibility: For instance, lifelong teachers who participate in the State Teachers Retirement System may not be eligible for Social Security Disability Insurance.
- Statute of limitations/Missed filing deadline: Worker’s comp programs generally give individuals hurt on the job two years from the date of the incident to file a claim.
- Non-qualifying illness or injury: Private insurers maintain lists of noncovered conditions, and worker’s comp covers only job-related disabilities.
- Insufficient evidence of disability: Case reviewers apply strict criteria and give particular weight to the diagnoses and assessments of the doctors and therapists paid by the program.
Can I appeal?
Yes. You have the right to request several levels of review and even to file a civil lawsuit against a government agency, retirement plan, or insurance company that turns you down for disability benefits.
How long will the appeal process take?
Each case will differ depending, in part, on statutory deadlines for government agencies and company policies for insurers. You should expect to wait at least six months to a year for a decision on an initial appeal. The timeline will expand if the program or insurer requests additional information without issuing a ruling.
What do I need to do in order to appeal?
Like timelines, appeals procedures vary by program and company. The level of the appeal being pursued also dictates certain steps that both you and the organization need to take.
At a minimum, you can expect to do the following:
- Submit a written notice of intent to appeal
- Follow up that notice with a written summary of your grounds for appealing
- Collect and submit additional evidence (eligibility, medical records, etc.)
- Schedule hearings
Will I need to attend hearings on my appeal?
Unless you file a lawsuit, you should be able to rely on your disability attorney to represent you during administrative hearings. You may, however, be asked to meet with your lawyer and representatives of the disability program to answer specific questions. Those sessions work like depositions held in the course of a lawsuit.
Can Agee Clymer Mitchell and Portman help me appeal my disability claim denial?
Ask us. Call (800) 678-3318 or share your story online to request a free consultation with an experienced Ohio disability lawyer.