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.
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“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.