12 Long-Term Disability Appeal Tips

12 Long-Term Disability Appeal Tips

I’m not a disability lawyer, and I’m not giving legal advice. I’m just a woman with brain cancer who’s got battle scars from fighting an LTD insurance company and some disability appeal tips.

I created this list of tips for disability insurance recipients by asking what I wish I’d known from the beginning.

Because, from what I’ve learned, cancellation is inevitable.

Don’t talk over the phone.

There are a couple of reasons I suggest this. First, it’s stressful to be put on the spot during an unscheduled phone call when your livelihood is at stake. Avoid phone conversations just for your own peace of mind.

Second, the call is likely to be summarized by the disability insurance claim specialist you talk to rather than transcribed verbatim. That leaves a lot of room for someone to “accidentally” leave out important information or conveniently interpret information in a way that can be used to weasel out of paying your claim.

(Ask me how I know.)

So how do you get your insurer to stop making periodic “check-in” calls and email or write you instead? Just tell them to. I emailed the claims specialist handling my case the following message after she tried to get me to switch back to phone communication:

I will not be speaking with any Lincoln Financial Group representative by phone at this time. All answers can be provided in writing via email and/or hardcopy on company letterhead.

February, 2020

Naturally, she wanted to respond to questions I had over the phone, presumably so there wouldn’t be a written record of her answers. Fortunately, I saw the maneuver for what it was and refused phone calls from that point forward, but I wish now that I would have set this boundary from day one.

Know disability policy terms.

Although I had the foresight to buy a long-term disability insurance policy, I didn’t seriously consider what I’d do if I needed it. So I never read the entire policy while I was still healthy.

(Honestly, I don’t even recall if my employer provided full-text of the policy when I signed up during new-hire orientation. I probably would have had to specifically request it.)

No shame if you haven’t read it closely yet either. Life’s short. But do read it now. If you’re not able, have your spouse or someone else close to you give you the Cliff’s Notes so you’ll know what your responsibilities are when it’s time to file the disability insurance appeal.

For instance, with Lincoln Financial Group policies, you’ll probably be required to complete two administrative appeals before you can sue them.

Yes, it’s as ridiculous as it sounds. My disability insurance company, Lincoln Financial, itself decided two more times if they were wrong about me.

Request your file.

My long-term disability (LTD) policy stipulated that my case would be up for re-evaluation after two years. At that time, I’d have to show that I couldn’t perform ANY occupation in order to continue receiving benefits instead of just my OWN occupation at the time I became disabled.

I wish I’d thought to ask for my file before Lincoln Financial Group started their review process.

By the time they cancelled my long-term disability insurance benefits, the file Lincoln Financial Group had on me was more than 700 pages long.

Trying to pin down errors and omissions in that clunker was a nightmare—all complicated by the stress of not knowing how I was going to pay the mortgage.

POV: Waiting at the doctor’s office. Still disabled.

The file your disability insurance carrier keeps is an unwieldy thing that can easily reach thousands of pages in a couple years’ time. (Not everything is relevant. They want it to be confusing.)

If you can identify even a couple of omissions in your record before you’re in financial crisis, you’ll be several steps ahead of where I was when the clock started ticking on my appeal.

In my case, Lincoln Financial Group didn’t even mail my file the first time I requested it. I had to email a claims specialist several times and finally demand she overnight the file and prove she did it by giving me a tracking number. By that time, almost two weeks had passed.

Important note: By law, we policyholders have a deadline for filing our appeal(s). This should go without saying, but always know what your deadlines are and ALWAYS submit on time! By not mailing my file, LFG was eating into my deadline, likely hoping they’d get me to miss it completely.

Review your file.

Once you get the file, dig in. Inaccuracies weren’t frequent, but there were some. The big thing was learning how much my oncologist’s office had left out.

Because I signed a medical records release, LFG requested documents directly from my doctor. And the doctor’s office sent them directly to LFG without my having a chance to give them a once over.

And that’s exactly want your insurer wants to happen. You can insist your doctor’s office provide you copies of the info they send, but you can’t count on them to follow through.

The incomplete records your doctor keeps will help the insurance company paint a picture that works to their advantage. I imagine there are a lot of cases where a patient’s disabilities are not noted in medical records.

A personal example: I suffer from disabling vertigo and am at a high risk of falling. I can’t walk more than a couple of steps without using a mobility device or grabbing something to stabilize me. I also suffer from extreme cancer-related fatigue and can’t walk or stand for extended periods.

But my doctor and the NP never documented this. They never even ask if I could. In fact, the doctor never saw me walk. He only ever saw me seated in an exam room chair.

There was so much information missing from my medical records that the forms he sent to the insurance company made it look like my tumor hardly affected me.

My primary physician’s records were significantly more thorough, so naturally the doctors hired to conduct a review of my case avoided talking to her and downplayed their relevance. The insurance company either didn’t request records from her as frequently or they didn’t include them in my file.

Request documentation from your doctors.

The remedy to the previously mentioned problem was for me to spell it all out for my physicians. And, I’ll be blunt, my oncologist was pretty good at treating cancer and reading lab results, but he was horrible when it came to the softer science of cancer treatment—identifying and documenting his patient’s needs. I’m not saying he’s entirely to blame for that; it’s just a fact.

When you find a physician can’t be bothered to do a thorough job, stop wasting your time on them. Focus on making it as easy as possible for the good ones to document your case.

The more thorough your file before disability appeal starts, the better. When you get an updated file, check to verify the supporting documents you and your doctors send are being added.

Selfie of a woman in a car with a dog behind her in the back seat
Me with my emotional support doggo, Boomer.

Hire an attorney.

The appeals process is essentially legalized torture. If you can find an attorney to mange your claim for a percentage of your benefit check AND you can afford it, it’s probably worth having one on retainer immediately.

Why? Because when the insurance company hires doctors halfway across the country to “independently review” your file and gaslight you, dealing with that additional stress while not having money will wreck your mental health. Trust me.

If you have an attorney intercepting all communication, you can keep the stress to a minimum. And, who knows, maybe even prevent cancellation in the first place.

Research the appeals process.

This tip is most relevant for people who are going to manage an appeal on their own, without any legal representation or guidance, like I did for my first administrative appeal.

The point is to learn as much as you can about how an administrative appeal works BEFORE the clock starts ticking. Forty-five days to write and submit your appeal might seem like plenty of time, but I promise you it’s not.

Not only will you be trying to gather documents, requesting supplemental records from your doctors, and making requests for information from a hostile insurance company, you will also still be living with whatever sickness or injury disabled you in the first place and the inherent barriers and obstacles associated with it.

Create a hard copy file.

Save everything, not just the stuff your LTD insurer sends you. You are likely going to need your most recent year’s taxes, your initial award letter and your amount of benefit letter from SSDI (if applicable) in addition to all the strictly medical stuff.

If your doctor filled out the form for you to get an accessible parking placard, keep that too. You get the idea.

These things will be asked for frequently as part of your appeal, but also? If you need to apply for food assistance or other financial support while your claim is going unpaid, you’ll have everything handy already.

If you have access to a scanner, scan your hard copies. Scan the envelope the documents came in (for a record of the postmark) and the documents themselves in the same file.

Article: Ultimate Guide to Helping a Loved One with Brain Cancer

Save files as a PDF and choose a detailed file name like “Lincoln Financial Group Notice of Cancellation 20JAN2019,” and consider it a gift to your future self.

Mark the date you receive documents.

If your disability insurance company is diabolical enough (ha ha—“if”), they will intentionally delay getting vital information to you, as Lincoln Financial Group did to me on several occasions.

Every physical letter they ever sent was dated about 5-7 days earlier than it was postmarked and 7-10 days earlier than I actually received it. They were either backdating correspondence or holding it before putting it in the mail.

If you should need to prove bad faith on the part of your disability insurance company, having this information will come in handy. Of course, if you’ve already scanned the postmarked envelope, you should be covered.

But in my house at least, empty envelopes have a way of getting separated from the documents they once contained. Writing the date received on the document itself just gives you a little extra insurance. Pardon the pun.

Create an electronic folder.

Again, being organized now will save you time and heartache later. If the documents you download from your web browser save to one folder and the documents you scan save to another folder, and the documents you view on mobile save to an entirely different device, finding what you need when you need it won’t be easy.

Create one central folder where everything goes, and create descriptive subfolders if (okay, when) things start to get unwieldy.

BONUS TIP: Apply labels or use folders in your email application to easily find messages again later. Gmail, for example, will automatically apply labels to messages received from specific email addresses.  

Create a digital back-up.

You know the drill. Make a backup of your files regularly and save them to Dropbox or Google Drive or whatever cloud storage account you have and/or save them to an external thumb or hard drive.

Devices fail, and you don’t want to risk losing all your documentation to a computer that dies on you at the worst possible moment. Even if you can recover the data on your device, you don’t want to lose precious time while the appeals clock is ticking.

Expect doctors you have never met to lie.

Even though I’ve had some harrowing experiences with doctors in years leading to my diagnosis, I still was not emotionally prepared for Lincoln Financial Group hiring “experts” to lie about my condition.

Title image for post "My New Primary Doctor" featuring faceless doctor holding a medical chart.

Doctors who take on this kind of work have cranked up their clinical detachment to 11—to the point they are no longer helpfully objective but harmfully biased.

They don’t think of you as a person when they’re writing up these opinions for the insurance overlords. At best they see you as an interesting set of diagnoses and vital statistics.

The impartial truth is secondary to their bank account balance and ability to land similar contract work in the future. Don’t let the bastards get you. Hell, if you’ve got the fight in you, name them.

That’s all I’ve got for now. Just remember that the overarching theme here is to anticipate filing an appeal. Unwarranted cancellations are the rule, not the exception. Your disability insurance company will always try to get out of making payments. Follow these disability appeal tips and be prepared.

About My Disability Case Against Lincoln Financial Group

About My Disability Case Against Lincoln Financial Group

The legal assistant assigned to my disability case against Lincoln Financial Group called me at the end of last week. She said they just needed a couple of signatures from Dan and me and a copy of my SSDI award letter. Then they’d be ready to ship off the entire appeal. This month is the deadline.

She gave me a quick rundown of everything they are submitting with my file, and—whatever LFG decides on this second appeal—I feel better just knowing there are people out there to push back against the insurance company’s lies and the lies of the doctors, like Samuels and Hartner, who shill for them.

It’s also been really nice not getting any emails or phone calls from the claims specialists that work for LFG since I found legal representation. I don’t know how employees like Ann and Sherry can do what they do to people in my situation. HR at Lincoln Financial must offer certified empathy extraction benefits along with vision and dental.

One thing the disability attorney managed to nail down was a sworn statement from my neuro-oncologist at Barnes-Jewish. “It’s going to be submitted as additional documentation after the deadline,” the legal assistant explained. “But he’s been out of the country for a while, so our hands were kind of tied.”

I’m stunned. Absolutely stunned that they are getting this from Dr. A. He’s good at the cancer stuff, but kind of impossible to pin down. I’d say 95% of my interactions with his office, including treatment and follow-up visits, at the cancer center have been with his NP, his nurses, and his office coordinator. I know that’s normal, but it’s far from ideal—even when you’re not fighting insurance.

Anyway, I asked the legal assistant how much time Lincoln Financial had to reach a decision on the appeal. I couldn’t remember. The answer is 45 days from the date of submission, but with a caveat. Since the sworn statement from Dr. A will be arriving later, LFG may request more time to review the additional evidence and it could be up to 90 days before I hear anything.

“Lincoln isn’t bad for missing deadlines—some other companies we deal with are terrible—but we’ll file a formal ERISA complaint if we don’t hear from them by their deadline,” the legal assistant said.

Do I think LFG will take another 45 days just to review one statement from my doctor? Yes. Yes, I do. Every day they don’t pay a claimant is another day they can earn interest on the stockpiles of cash they make from hoarding money that is supposed to be disbursed to disabled policyholders but isn’t.

My dad, who has always been really good at money, doesn’t pay his bills too soon before the due date for this same reason. “It’s silly to pay the bill as soon as I get it when that money could be making me more money,” he says.

The huge difference of course being that Dad isn’t holding someone else’s money. If he were doing what LFG is doing, we’d all be calling it theft.

Something to keep in mind, because the process for appealing cancelled disability claims is so stinking confusing, is that the appeals process is not anything at all like an actual lawsuit. There’s no independent third party, like a judge, weighing the evidence yet.

Both of my appeals of LFG’s egregious decision (the first one I made on my own, and now this one with my attorney) are appeals to the company itself. It’s nothing more than me saying, “Hey, you guys are wrong. Here’s why. Change your mind or be sued.”

LFG’s employees use language to try and make us all think the appeals process is about reviewing facts and making the right call. They’re spraying Febreeze on a pile of bullshit, guys. Being disabled as defined by your policy isn’t enough to win a disability appeal. You also have to convince them it’ll cost them more in the long run not to pay you.

I knew this in my gut from the day LFG cancelled on me, but I was so blinded by rage in the early stages that it was hard for me to wrap my brain around it. With a little more mental clarity, I see the appeals process for what it really is. Me saying, “Hey, bitches. Look at all this stuff I’ll be taking to the judge when it’s time to sue. Sure will cost a lot of money for you to prepare your defense and then lose anyway.”

Knowing Lincoln Financial will be holding my money hostage for at least another three months, seems like a good time to plug my serial memoir, Who You Gonna Believe.

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