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You Can Fight Back Against Denied Disability Claims

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Minneapolis, MNIf you are dealing with a disability claim with an insurance company this may be one of the most important stories you’ll ever read because the fact is, it ain’t over till it’s over.

Attorney Kristen Gyolai has successfully represented hundreds of people that thought it was the end of the road when they received ‘disability denied’ letters in the mail. The fact is, says Gyolai, insurance companies actually count on a certain percentage of people with denied claim letters to give up and go away.

“A lot of people think well this is the insurance company’s decision, but the letter does very clearly indicate they have the opportunity to fight back. That’s when they should consult a lawyer,” says Gyolai from the Fields Law Office in Minneapolis, Minnesota.

A ‘disability denied’ letter is full of potential pitfalls that only a disability lawyer understands. Don’t think it’s all over. And for heaven’s sake, don’t write the appeal letter yourself.

“I truly believe insurance companies make it seem as if they are very reasonable and it is easy to appeal on your own. They don’t want people to get an attorney who knows how to gather the right information and build up evidence for a successful appeal,” says Gyolai who has an easy and comfortable way to communicate the issues.

And don’t dilly-dally.

“The denial letter will say you have 180 days to appeal this decision, but everything we can do to build up the case takes time,” says Gyolai. “It could take 180 days to do a winning appeal. Don’t sit on a denial letter for 2 months. You can’t call the lawyer at the last minute. We need that time to build a winning appeal.”

You Get One Shot at an Appeal
Claimants only get one chance and one chance only to appeal. Gyolai has seen situations where individuals send off a one or two sentence letter telling the insurance they disagree and want the claim approved.

That’s a very bad move says Gyolai.

“The reason we say that is because with these claims they get one shot at that appeal and putting additional evidence into that administrative record,” she says. “After that appeal is done and the insurance company makes their final decision the administrative appeal process has been exhausted.”

The only option then would be to file a lawsuit.

“In the lawsuit phase, with these particular claims, you do not have the opportunity to introduce additional evidence or any witnesses.

“If someone appeals on their own with just a statement saying ‘I disagree’ and that person later decides to file a lawsuit that is the only thing in their administrative record,” says Gyolai.

Lawyers Gather Every Scrap of Evidence
A good disability lawyer will be sending the insurance company more than a page or two.

“Here’s the visual for you,” says Gyolai. “The information we gather might be a stack of 500 pages or more. Compare that to a few lines on a piece of paper saying the ‘I disagree with the insurance company’s denial of my claim.

“We start by requesting the entire file from the insurance company. That’s everything the insurance company has at its disposal, all the information they used to deny the claim,” says Gyolai. “We use that file as a springboard for the appeal. We look at everything there and essentially say to the insurance company you had everything in there you needed to make a favorable decision and you failed.

“Next we gather information that is not already in the file,” she adds.

“That additional evidence might come from the claimant’s doctor, or it might be an opinion from a vocational expert, or a functional capacity exam. It could be additional medical records that the insurer never ordered from another health care provider. Sometimes we order a file from a former employer that could give us more information.

“The individual who received the letter thinks oh this is so simple the insurer will be reasonable and it will listen when I tell them they have reached the wrong decision when I send in my letter telling them I am appealing and all of a sudden the insurer will approve the claim,” says Gyolai.

Well, chances are the insurer is not going to give in to a one page appeal.

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READER COMMENTS

Posted by

on
My husband passed away before he was able to get attorney to appeal social securitys denial.. I recently requested his death record from kern county... In which took 5 months to recieve due to lack of official paper to print record on.. A budget problem with state. However. The cause of death was clearly stated and they denied him saying sleep apnia study they conducted ..wasnt significant enough to back up mds and the hospital coronory specialist dx from his flatlinning prior to filing for dsblty. He was so worn out down unable to work as the coating lead in his cobstruction occupation that he went without his rx's for 10 days before he just collapsed at his daughters while in bathroom and was found dead in the bathroom with heart failure was first dx diabetic dx 2nd sleep apnea 3rd dx and his children my children were 17 16 and 13 when he filed for disability.. I had been contacted by social security.. They assured me he would recieve it and asked for my and my childtens information..i sent copies of birth cert social security marrriage and hospital records.. Then out if blue they said he had to go to a slerp center ocer night they scheduled to have a study of his sleep monitored.. He couldnt sleep there it was very odd cold and confining.. He had no clue they would deny him based on 3rd dx or due to inibility to sleep
. also wasnt allowed sleepefication because of that secondary condition.. We all needed the income he had worked all his life for.
Its still been keeping my family down in a very limited life now. I feel i shpuld be able tobring this to trial.. On his behalf and fory childrens back benefits they needed then and need reciprocated back now

Posted by

on
New York Life stonewalled me on receiving ongoing disability benefits when I could not reply to their demand to produce IRS statements because I could not file due to non receipt of W2 form; which employer turned into a $157,00 1099 filed with IRS late with his attorney's help; clearly fraudulent. Employer disabled me with abuses, disabling attacks, assaults, life threats, hostile workplace violence. Doctor gave me letter to stop work or he would kill me. I fled for my life. New York Life took advantage of the victim; permanently disabled from all the abuse.

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