Long-Term Disability Appeals
As many as 65% of applicants for disability benefits are denied in the initial stage of the rigorous application process in the state of Michigan. Whether the reason was based on medical or technical grounds, applicants who wish to appeal must do so within 60 days of receiving the “Notice of Disapproved Claim” letter. With proper representation, eligible claimants who are unable to work due to physical or mental disabilities can successfully navigate the complexities of disability appeals to collect their denied benefits.
The Disability Appeal Process
If a disability claim is denied — and more than half are — the appeal is the best chance for the claimant to have the matter overturned or, at the very least, set the case up for a successful lawsuit. The internal appeal process is mandatory before filing a lawsuit, and for the group plan policyholder, the evidence submitted during the appeal is largely all the evidence that will ever be considered by the insurer or by a court. A well-established precedent of law also includes that courts often must limit their review of evidence to that submitted in the administrative appeal and are often limited in their review of the evidence. Given this, it is essential to build the case during the appeal.
Insurers use all sorts of tactics to deny claims; e.g. “independent” medical reviews and exams, vocational reports by experts to which they regularly refer work, surveillance, claims of malingering, claims of non-objective evidence of pain, non-compliance with treatment, not comprehensively reviewing interaction of multiple medical conditions, and/or “cherry-picking” the records for evidence of ability to work. Thankfully, the insurer is mandated to provide the complete claim file along with an explanation regarding why it is denying benefits. It is crucial to go through the claim file looking for procedural irregularities, conflicts of interest, inaccuracies, and outright misrepresentations, and then submit contrary evidence and rationale in support of finding disability. Likewise, claimants should have their best case put forward in regard to their version of events (such as surveillance), their treating physician opinions, other expert opinions, vocational ability, and anything else that may support the finding of disability.
It is important to note that there may be a time limit of as little as 180 days to file an appeal. You should not wait to contact an attorney, and you should keep both the denial letter and the envelope in which it was mailed.
At The Schipper Law Group, we have extensive experience in guiding disability claimants through preparing initial applications and in all subsequent stages of the appeals process that often follow. As mentioned, a majority of applications are denied after the first of what has traditionally been a four-stage process. Previously, Michigan residents were exempt from the “reconsideration” stage of the disability appeal process. This is no longer the case. A formal request for reconsideration must now be submitted before requesting a hearing. The reconsideration step usually takes a few months to complete while the Disability Determination Service re-evaluates your claim.
Reconsideration rarely results in granting benefits. A request for hearing must then be pursued, which averages 1 – 1.5 years or longer before getting their day in court with an administrative law judge. Further, decisions from the judge are often rendered no earlier than 90 days after the hearing date. Entitled disability claimants regularly wait up to two years in total to collect disability benefits that are rightfully theirs.
At The Schipper Law Group, we will advocate for your rights to collect long-term disability benefits due to proven medical conditions that have affected your ability to earn income. As your disability appeals attorney, we will work tirelessly to provide exceptional representation to ensure the successful and timely collection of your disability benefits. Contact us today to request a free case evaluation or call us at (248) 729‑2414.