After handling hundreds of long-term disability claims against Reliance Standard, attorneys Greg Dell and Alex Palamara share their expertise and explain the intricacies of filing an ERISA appeal. Dell notes that 99 percent of the denied Reliance Standard disability claims handled by their firm are ERISA appeals, primarily because Reliance writes these long term disability insurance policies as part of group employee benefit packages. This makes for a lot of action involving Reliance Standard policies – thus the need for disability insurance attorneys/lawyers to look out for those who may be at a disadvantage in the process. With a wealth of experience representing clients with claims against Reliance Standard, disability insurance attorneys Dell & Schaefer are experts in the process. So, they’re well-equipped to offer tips on people who need to file an appeal. Here’s a look, from the perspectives of disability attorneys Greg Dell and Alex Palamara, at what’s involved in filing an appeal and why it’s in your best interest to file one. Even more crucial is to realize the consequences of attempting the appeal on your own and then having to backtrack later by bringing in an attorney. Quite often, the damage already done can be very difficult to undo, requiring considerably more effort and reducing your chances of success.
Why is it so important to submit a strong appeal from the beginning?
According to disability attorney Alex Palamara, your ERISA disability appeal is the last opportunity you have to strengthen your claim for a lawsuit. That’s because, once Reliance Standard denies an appeal, you cannot submit any more information into your claim. That’s a really big deal because whatever information you’ve submitted in the claim at the time of denial is all that the judge in your case will ever see.
“Let’s just say there’s medical documentation of an MRI or whatever testing that you had done, but you did not submit it with your appeal prior to the final denial,” says Palamara. “The judge will never see that information.” Therefore, the appeal has two purposes: to get your claim active again after initial denial, and to strengthen your case for the potential lawsuit that’s coming down the road.
Obtaining (and understanding) the claim files
When a disability attorney takes on a denied disability claim, the law firm requests the claim file from Reliance Standard, which includes every single thing that the insurance company relied on to deny the claim. This is the first most important thing in the preparation of an appeal, and they are required by law to hand it over on request. This is a major advantage of an ERISA appeal.
However, it’s crucial to know what to look for in that file in order to make a comprehensive, thorough and targeted appeal. (Remember, this is your only chance to get the pertinent information into that claim.) There are no do-overs, as unfair as that may seem. And here’s the rub: most claim files can be anywhere from 500 to thousands upon thousands of pages, according to Alex Palamara.
“You’re looking for a needle in a haystack,” he notes. “The most important things you’re looking for are the reviews that Reliance conducted on your claim, because these reviews are what they’re hanging their hat on to deny your claim.”
Sometimes, the crucial element in the file is an independent physician review, which may specifically state an opinion of whether or not you are disabled. This can come in the form of an independent medical examination or a “functional capacity” evaluation. These evaluations are typically three to 10 pages long but can be buried within potentially thousands of pages of a claim file.
At this point, the job of the disability attorney is to literally poke holes in the reviews and find issues with their conclusions, a medical condition they’re overlooking, or discrepancies with the medical documentation they’re citing.
Analyzing the claim files and strategizing new evidence introduction
The goal now becomes tangible and targeted: introducing enough new evidence to convince Reliance Standard that you are indeed disabled. Disability attorneys Greg Dell and Alex Palamara reveal how their law firm does this:
- First, they use their collective experience from handling thousands of similar claims to identify what kind of additional medical support is needed for the specific medical condition in question.
- Next, (and this is important), they provide the medical file reviews to the client’s treating physician to review and opine upon. Providing simple, easy and guided paperwork to help the physician make your case can be decisive in the final outcome. They draft an intending statement that’s specific to the client/patient’s disability, include direct questions that the physician can answer, and draft an attending physician’s statement to which he or she can respond.
- The attorneys can also consult with one of many outside medical experts they’ve worked with across the country, seeking reliable opinions on what is missing from the files, what the best approach may be, and how to undisputedly prove that the client is indeed disabled.
Presenting the Occupation
The definition of a particular disability is often “dumbed down” to the benefit of the insurance company. This means they try to remove the nuances from an individual’s job description and claim that the person is still able to perform work, resulting in a denied disability claim.
But every job has specific requirements that likely will not show up in the insurance company’s dictionary of occupational titles. For example, a person who is a driver by occupation may appear to have a sedentary job that’s not affected by a disability, but that job could easily involve lifting heavy items from the back of a truck. Even a desk job involves much more than just sitting there all day.
A competent disability attorney can work with a vocational expert to explain and verify the requirements of the job, thereby cancelling out the insurance company’s attempt to deny responsibility. Attorney Greg Dell explains that the lawyers go to great lengths to produce a personal statement/occupational description to really detail what happens throughout a day in your particular job.
Personal Impact Statements and Video Evidence
After establishing the medical and occupational parameters of the ERISA appeal, it’s essential to get a personal statement and supporting statements from co-workers and family members into the record. Remember once again that ERISA laws governing claims stipulate that testimony and new evidence is not permissible after your appeal has been officially declined.
So, now is the time to get it included in the record, thereby solidifying your potential lawsuit should one become necessary. If it’s in your initial appeal, the judge is required to read your personal impact statement as well as all statements by witnesses, friends, family and coworkers. This humanizes your case and makes the details harder to ignore.
Attorneys like Greg Dell and Alex Palamara will ensure these statements have maximum impact and will often include recorded statements or video evidence of the disability and how it impacts your ability to perform gainful employment.
There’s always a chance that the appeal will fail, resulting in a denied disability claim. But you can now feel confident that your claim contains everything necessary for winning a lawsuit.
Greg Dell and Alex Palamara offer a free initial consultation to determine the merits of your case, during which they will review your claim denial from Reliance Standard. If you need to file an appeal, make sure to call disability insurance attorneys Dell & Schaefer to increase your chances of a successful outcome.