Spokane Long Term Disability Attorneys

Spokane Long Term Disability Attorneys

People buy long term disability to make sure they’ll have money coming in if they can’t work. But when you’re facing the unfair denial of a claim, challenging the insurance company can feel like David facing Goliath.

If you’re reading this, you’ve probably had a long term disability claim denied for reasons you know to be unfair. You are most likely struggling financially due to the inability to return to work. You’re probably frustrated that your disability is not being taken seriously. You are very likely seeking the right person to help you with a long term disability claim.

We are here to help. We offer free legal advice. Call our Spokane long term disability attorneys today.

Don’t wait to call because you’re worried you’ll need cash to pay for a lawyer’s time. Give us a call as soon as possible to schedule your free legal consultation.

How Retaining a Spokane Long Term Disability Attorney Can Help You

People challenging the insurance company sometimes believe they’ll save money by skipping the lawyer. This is usually not the case. Most people who appeal claims without the help of a lawyer lose, due to lack of experience in how to go about making your case. If your claim has already been denied once, it’s critical to seek the experienced support of a long term disability attorney.

Hiring the right lawyer will enable you to build your appeal the right way, minimizing chances of a second denial and preparing your claim should you need to file a lawsuit.

• An experienced long term disability attorney will know how to conduct an investigation of your initial injury or disability to support your claim when making an appeal.
• Our long term disability attorneys have the knowledge to review your insurance policy and argue for the veracity of your claim to the insurance company.
• A lawyer will be able to cut through the tactics of the insurance company uses to deny your appeal. Delegating all communications about your claim to the insurance company will ensure you don’t accidentally say something the insurance company will use against you to deny your appeal.
• Hiring our Spokane long term disability attorneys sends a clear message to the insurance company that they can’t push you around or ignore you, wearing you down until you go away. They will know that if they fail to honor the terms of your disability insurance, they’ll be sued.
• One of the biggest benefits of retaining a skilled attorney to handle your claim is the ability to focus on your health, knowing you don’t have to figure out how to successfully take on the insurance company. This is a burden we can take off your shoulders. Give us a call to find out how by scheduling your free legal consultation today.

Mistakes to Avoid in Your Long Term Disability Claim

There are several things you can do to support your chance of success in your long term disability claim.

Keep Your Records Organized and Don’t Throw Out Communications from the Insurance Company

If your claim is denied, the insurance company must provide you with a letter of explanation for the denial. They must also provide you with your claim file. This is all the paperwork involved in your claim.

Your attorney will request copies of your medical records pertaining to the case, but it’s important to keep any of your own records and receipts of your visits, including any doctor’s instructions, diagnoses, or notes you have been given. Appealing a long term disability denial can feel like drowning in a sea of paper, but your attorney will know what to look for. Help them by providing as much as you can so they can get started while waiting for the insurance company to produce your claim file.

Follow Your Treatment Plan

If you’re struggling through a long term disability, you likely have been given some instructions for supporting your care. This may include getting plenty of rest, it may involve medication, physical therapy, stress-reduction, or any number of treatments. Be sure to adhere to whatever your doctors suggest you do to hold up your part in supporting your recovery.

Disregarding your treatment plan not only hinders you from living your healthiest life, but it also jeopardizes your long term disability claim. Remember that the default response of insurance companies to claims is often denial. They make the process as difficult as possible to reduce the number of claims they must pay. This is how they save money.

Part of the insurance company’s “toolkit” for denying claims is utilizing insurance investigators to check up on you. This is where following your treatment plan becomes non-negotiable.

Let’s say, for example, you’ve made a case for not being able to work, and you’re part owner in a small business. It’s not a good idea to show up daily to “check in,” even for a few minutes. If you do this, the investigator is probably going to catch surveillance video of your car in the parking lot, or you entering or leaving, or answering the landline phone. The insurance company will say you’re still working regularly when you say you can’t.

It doesn’t matter if you only check in for ten minutes a few days a week. They are looking for evidence that you don’t need disability. Don’t hand them evidence that contradicts your ability to work.

Not doing too much is just as important as making sure you do what you should. Follow your doctor’s treatment plan.

Don’t Speak to the Insurance Company

When you file a claim, you’re going to receive a call from an insurance adjuster asking to record your statement. When you are challenging a long term disability denial it’s best to hand over all communications about your claim to our Spokane long term disability attorneys. This will provide a united front with a consistent message. The last thing you need is confusion because you told the insurance one thing and the attorney provided different information. Mixed messaging will put your appeal at risk of being derailed.

Dealing with an insurance company is challenging on anyone’s best day. If you’ve been wrongfully denied long term care coverage, you are likely far from feeling at your best. You’re probably frustrated, stressed, and in pain on top of that. You are most likely physically and emotionally exhausted.

Here are just a few examples of how the insurance company is likely to twist conversations to their advantage.

• Mentioning any difficulties at work, even in small talk can cause them to believe you are capable of working but just don’t like your job and seek disability, so you don’t have to work.
• Talking about any chronic health issues outside the scope of the timeline for this claim may trigger a “pre-existing condition” and denial, depending on the terms of your policy.
• Mentioning an upcoming trip — even if you’re taking it to help you rest and recover —is likely to make the insurance company think you’re looking to fund a “party vacation.” Remember the company is likely to have “selective hearing” and may not register that the vacation was paid for months ago or is a gift from your parents. All they need is a contradiction and they can run with. They’ll also start considering how much walking and recreational activities you’d engage in — even sitting for long periods on a flight or in an automobile can be used to contradict your claims of not being able to sit at your desk.
• Speaking to an adjuster while in a busy location, such as on the landline at work (even if you’re just stopping in for a few minutes) or while out in a noisy place can lead them to decide you’re out and about on your normal routine and not really in need of disability.
• Any mention of a loved one with an illness may make an insurance adjuster think you are seeking disability to fund your taking off from work to take care of someone else.

Adjusters are pros at these interviews. They’ll make an effort to relax you and get you making small talk, and they’ll ask the same questions in numerous ways, searching for inconsistencies.

Think of their call not as a conversation, but a chess match. And anything you say that can be held against you, will. Let a lawyer stand between you and the insurance company. Our Spokane long term disability attorneys know how the game is played. They know what to say and what not to say. This is what they do.

Don’t Wait to Hire an Attorney

If you’re dealing with a wrongful denial of your long term disability claim, don’t put off hiring legal help. You’re only going to have a relatively short window in which to make your claim for appeal, typically six months. Once it closes, so does your opportunity to add any additional information to your appeal for a judge to consider in a lawsuit. Your best bet is to retain a skilled attorney to help you build your appeal from the end backwards, as if it’s going to be denied and a judge will be making the last ruling on it.

Our experienced Spokane long term disability attorneys will strategize as to how to build your claim for its best chance to win your appeal.

Hire the Right Lawyer

People sometimes make the mistake of hiring the first lawyer they come across without paying attention to whether that person is the right fit for their needs, even though they wouldn’t do this when seeking the right doctor.

You probably wouldn’t go to an ear, nose and throat (ENT) doctor for a heart problem. Just like doctors, there are many practice areas in which an attorney may focus. Making sure you retain a long term disability attorney who’s a successful trial lawyer is important in case your appeal is denied and you need to file a lawsuit.

Spokane Long Term Disability Client Story

We are sharing a client story to give you an idea of what to expect in your long term disability claim. Please note that even though we’ve protected our client’s privacy by changing names and dates, the usefulness of the information in this story remains. Please read it through and then reach out to schedule your free consultation so we can discuss your claim.

On a windy March day in Salt Lake City not so long ago, Dina Geller sat down for a free legal consultation with Long Term Disability Attorney Kathleen H. Paukert to find out if anything could be done about the denial she’d received from her insurance company for long term disability.

How much does it cost to hire a long term disability attorney?

“When I got the denial letter, I went online and came across this guy’s blog that said all I need to do is submit a response letter as to why I disagree with the denial. I typed one up,” Dina said, handing a letter across the desk.

Attorney Paukert took the letter and read it. “And why didn’t you send it?” She asked, handing it back.

“Well, I planned to, but my parents came for dinner the evening after I’d received the denial. We touch base through dinner once a week because they know I struggle with my Fibromyalgia. Naturally, the denial was a topic of discussion. I showed my dad the letter I’d written as a response. He asked me to promise to meet with you before sending it. He said he has two friends that challenged disability claims, one won and one lost.”

Attorney Paukert smiled and took the bait, “And which one lost?”

“The guy without the lawyer,” Dina admitted. “But before I get further into it, I need to know how much it would cost to retain your firm. I’ve been missing a lot of work due to the pain, and I’m out of paid sick time.”

“Fair question,” said Attorney Paukert. “We work on a contingency-fee basis, which means we handle all case expenses from start to finish. We only get paid if we resolve your claim successfully.”

“Really?” Dina asked, surprised.

“Really,” Attorney Paukert answered. “And this consultation is absolutely free, so ask away.”

How can a long term disability attorney help me appeal my claim?

“Okay, why should I hire your firm instead of just mailing this letter? What is it that you can do for me that I can’t do for myself?” Dina asked, adding a smile to the question because she didn’t want to seem rude.

“Another great question,” said Attorney Paukert. “Let’s start with that letter and back up. While it’s true that the appeals process involves sending a response back to the insurance company, what will make or break your appeal is how you go about crafting that response — what you put in, and what you leave out.

Dina nodded. “That makes sense. My dad said his friend wrote up a detailed list of every reason the insurance company was wrong to deny him and sent it back. And they thanked him and responded to every point, but still denied the claim! My dad said he didn’t know what his friend left out, but there must be more to it than is obvious.

“I made sure I put in every single thing they failed to consider in my own response letter, but I promised to meet with you before I sent it, so here I am.”

“What your dad’s friend did, unfortunately, was make a classic mistake,” said Attorney Paukert. “Again, the way you approach the insurance company with an appeal is critical. If you come at them head-on, as most denied claimants do, pointing out every one of their errors, you are doing their job for them.

“What I mean by that is, you are giving them a roadmap of every point you plan to contest if the claim is ultimately denied and is pushed into Federal court. This is the final and last option you have if you lose your appeal. It’s not what you might expect a ‘lawsuit’ to look like, either. It’s more of a motion hearing. There is no jury and no one testifies. Not the insurance company and not even you.

“There are only two elements that will be addressed by the court through attorney motions. The first is establishing whether you are in fact disabled.

“If you are, then the question becomes, ‘Did the insurance company act in a way that was arbitrary and capricious?”

The attorney explained, “It translates to whether the insurance company gave reasonable consideration to your claim before denying it. Did they look at the evidence and review doctor notes and peer reviews? What is their reasoning behind the denial? Like that.

“So, when a claimant who’s been denied sends an itemized letter to the insurance company, they say, ‘Thank you very much for sharing your points,’ and they proceed to bolster up their decision to deny even before they notify you that your appeal is being shot down.

“This is because, they are looking at this entire process backward, with the end-goal in mind, which is to get away with denying your claim. They’re not necessarily worried about being dragged through the court proceeding. They’re focused on getting a judge to hold up that denial.

“They work up their response to shoot down each one of your points, and present this rebuttal to the judge. The end effect will show that yes, they denied you, but it was because of ‘this,’ and ‘this,’ and ‘that,’” Attorney Paukert said, ticking off imaginary points on her fingers.

“And BAM, they’ve shown reasonable consideration, and you’re out of luck,” Attorney Paukert concluded.

Dina was speechless. She picked up her letter of protest and asked, “So, I burn this?”

“Not so fast,” Attorney Paukert said. “The key in taking on the insurance company is in how we make our case without showing our hand and pulling the rug out from under our own case. I’m mixing metaphors, but you get the idea.

“Your notes of their errors can help guide us where to shore up your claim, again in the eventuality that we end up in court. We’ll approach crafting our appeal with the potential for a lawsuit in mind as well. We present additional proof for your claim to the insurance company, but we save our specific arguments of where the insurance company is wrong for the judge.

“With care and effort in working up a strategy for our response, we may win your appeal before it goes all the way to court. If not, we’ll be ready for the lawsuit.”

What’s involved in appealing a long term disability claim?

“So, how do we go about making an appeal without showing our hand?” Dina asked.

“I start by reading the denial letter,” said Attorney Paukert. “Please tell me you are saving all documentation you send out and receive about your claim?”

“I am, I have the denial letter with all the other claim paperwork. I was going to throw darts at it,” said Dina.

“Okay, but I need to make a copy first,” Attorney Paukert laughed. “The denial letter is key. It gives us our bearings, providing useful information regarding why your claim was denied. The insurance company is required to provide this information, as well as how the review was done for your claim. Understanding the rationale for denying your claim is our starting point, telling us what the sticking points were that prevented you from moving forward. That is where we start.

“Next, we’ll look at your policy and confirm the insurance company was wrong in denying you coverage according to your policy’s terms.

“Once we confirm that according to the terms of your policy, your long term disability coverage should have been approved, we then begin to build a strategy to respond to the insurance company,” said Attorney Paukert.

“This step begins with requesting that the insurance company send us your claim file — the collection of all documents pertaining to your case. Expect this file to be big; it may be anywhere from a thousand pages to fifteen or more thousand pages. It’s also no likely to be in any particular order.

This is the information that must be sifted through to make your case against the denial. As you can imagine, this yet another area in which it’s imperative to have an experienced attorney. It’s looking for a needle in a needle stack. But a knowledgeable long term disability attorney will know what to look for,” said Attorney Paukert.

“That’s a lot of copies,” said Dina like a deer in headlights. “Am I looking at a couple thousand dollars in copy fees?”

“It’s free. They may not volunteer that information, but it’s free and you have the right to request it. Once we make the request, the insurance company has 30 days to comply.

“While we wait for your claim file to arrive, our firm will request your medical records from your doctors and may schedule additional tests we believe will support your claim.

“When we receive the claim file, we’ll do a deep dive and look for medical information and reviews that support your claim. We’ll also look at any opinions that challenge it, those likely being from the insurance company’s peer reviewers.

“Good or bad, this information tells us what we’re up against. Once we know, we can go about shoring up the proof we need to overturn your denial. And as we’ve discussed, we need to do so without pointing out exactly where we feel the insurance company has gone astray.

“Doctors sometimes are hesitant to get involved in disability claims. They sometimes equivocate, afraid to take a solid stand. We’ll look at what we’ve got by way of your doctor’s notes and see what needs reinforcing. We may call on medical or vocational experts to provide additional supporting opinions and to counter any problematic peer reviews.

Your Attorney Can Keep You from Making Crucial Mistakes in Your Appeal

“You see, Dina, your claim isn’t about proving that you are disabled. That’s where most claimants without attorneys stumble. The insurance company in most cases is willing to concede that you have the diagnosed condition. What they’ll most often challenge is that your disability is as debilitating as you claim.

“This is especially true with Fibromyalgia, which is considered a ‘diagnosis of exclusion.’ This means there are no exact diagnostic blood tests you can take. Instead, doctors rule out other conditions that share symptoms. They reach a presumptive diagnosis of Fibromyalgia by looking at eighteen pain points and your specific complaints and ruling out other conditions with similar symptoms.

“When insurance companies deny disability claims, it’s often due to questioning whether you’re as disabled as you claim. Sometimes, insurance companies will get peer reviews suggesting too much inactivity is going to hurt you more than help. Thus, they may recommend your continuing to maintain your regular activities, which includes a job,” said Attorney Paukert.

Dina nodded but frustration filled her eyes with tears. “They just do not get this disease. The thing is, I have good days, and on those days, I try to get as much done as possible. I can work and I may even be able to get errands and grocery shopping done. But I have more bad days than good, and when I’m down for the count, it’s not unusual to miss three or four workdays in a row. Not home working from a laptop, but flat out in bed.

No full time employer is going to put up with that. That’s what lead me to filing my claim.”

“I know. It’s a very tough disease to deal with. What I’m telling you though, is that we need to come at this from the angle of creating a bridge to connect your diagnosis with your need for disability.

“One thing I recommend to support your claim is keeping a record of your bad days. Record how bad days disable you. Note your level of pain. Note how long you can realistically sit as you would at a desk. Write down whether you experience brain fog and if so, for how long. Does the brain fog keep you from being able to multi-task? Do you need to take frequent naps? Record as much information as you possibly can that shows how your diagnosed condition disables you.

“Keep the log going and be truthful. Do not exaggerate. This is another area in which people trip themselves up. They think making it sound as if they are incapacitated 7 days a week will help their claim, but then, as is often the case with Fibromyalgia, they get that one or two good days a week and they get out and try to accomplish as much as possible before it pulls them under again.

“And guess who’s catching you on video out running errands on your good days?” Attorney Paukert asked.

“The insurance investigator,” Dina said with a sigh.

“Yep. And if you’ve claimed you’re never out of your house because you’re so sick, the insurance company suddenly has a powerful weapon against you: your own words contradicting your actions. This screws up your credibility and jeopardizes your claim.

So, be fairly specific about your pain levels and what you can and cannot do, but don’t be so specific that your journal can be used to try and catch you contradicting yourself.

For instance, you might note that you are capable of shopping for yourself or running errands on most good days, so long as you’re not out too long. That way, they can’t hold it against you if you do go for an easy walk with your husband on a sunny day.

“And if you fill in an entry a day or two later, better to generalize than claim a specific time you were in bed. If you note you were sleeping “all afternoon” on a particular day and surveillance video shows you out at the store at 2:00 pm, again there’s a contradiction. They have the timestamp to show you are ‘lying,’” said Attorney Paukert, using air quotes.  So be truthful and make sure you’re accurate about any times you list. Otherwise, you might just note something like, ‘rough day, spent most of it in bed. Only managed a quick stop at the bank.’

“See the difference?” Attorney Paukert asked. “And be sure to share your notes with your doctors. Once they copy it into their system, you’ve got proof that you’ve reported symptoms and struggles. This adds to your evidence.

“It’s all about supporting your claim, piece by piece, Dina. That’s where we come in. And when we’ve put together the best case we can, we send it all to the insurance company in the form of our response.”

Dina was satisfied with the information she received in her free legal consultation. She retained Paukert & Troppmann, and Attorney Paukert won her long term disability appeal.

Call Our Long Term Disability Attorneys Today

We hope you’ve gotten helpful information about long term disability claim appeals through this page. Since no two claims are the same, we urge you to call our Spokane long term disability attorneys today to learn how we can help you with your own specific challenge.