Disability Insurance: Appeals

Once you've assembled the new material to bolster your case, write a rational, reasoned, cover letter that:

• Includes the definition of "disability" in your insurance plan.
• Provides an overview of your argument and the evidence. Explain how the information shows that you are indeed disabled according to the definition in your insurance policy.
• Describe each document you're including and show how it supports your claim for disability. For example, "Included is a statement from my doctor that explains how my condition and the side effects of the medication leave me with no energy to do my work. Also enclosed are letters from my roommate, my mother, and a co-worker showing what they have seen as the fatigue got worse and kept me from doing increasingly more of the things I used to do. The letter from my co-worker shows I have difficulty lifting the boxes I need to lift at work. The letter from my roommate and mother even show I have been too tired to work on my airplane models."
• Include in the letter that if this appeal is denied, you will continue to appeal the decision until you are awarded the benefit which is due to you. Many experts believe that insurance companies regularly deny "gray area" claims knowing that many people will accept the denial without question. They contend that letting the insurer know that you do not intend to give up will result in the insurance company reversing the denial and paying the claim. Whether or not that is true, it doesn't hurt to state your intention to press your case.
• It will hurt, not help, to imply or say the insurance company or its employees are liars or crooks, or even that they just want to deny your claim. Without arguing the truth of any of that, don't be tempted by your emotional reaction. This is the time for just the facts, as Jack Webb would have said, the facts that support your position. The same tone and attitude you use to call your insurance company should be used in the letter as well. [See Talking to Your Insurance Company.]
• Don't threaten the insurance company. The only effect it is likely to have is to slow down your claim because even mentioning lawsuit will mean the legal department will be brought in. Showing on your letter that a copy is going to an attorney or an advocacy group is a non-threatening way of letting the company know you intend to rigorously pursue your claim.

Indicate the copied person is an attorney by including "Esq." after his or her name or writing out "attorney at law" or the name of the law firm. Get the permission of the attorney to use his or her name. It doesn't have to be a disability insurance attorney, just an attorney, any attorney. [see Lawyers: How to Determine What Kind You Need for help in finding an attorney if you don't have one.] For example: "cc: Linda Manheim, Esq." Or "cc: Linda Manheim, Esq., Manheim, Morse, and McKenzie"

• Show copies going to people further down the line of appeals. Call the Department of Insurance of the state in which you reside. If you don't have the contact information, see: www.naic.org . Get the name of a person who works as a consumer service worker. (While you're at it, get the person's direct telephone number so you'll have it in case you need it later.) State in your appeal letter that you are sending a copy of the appeal letter to that person at the Department of Insurance. Showing a person's name at the Department will let the insurance company know you're not going to give up. For example, after your signature, write: "cc: Keith Mitchell, Consumer Service Representative, Indiana Department of Insurance."

This should be a rational, reasonable letter. Ask an attorney or a trusted friend or family member to read it before mailing to be sure it says what you want. What you mean by using certain words may not be what readers take from them.

Send the letter in a manner that provides proof of receipt, such as U.S. Mail, certified, return receipt requested or by overnight service.

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