Attorneys Dell & Schaefer informs policy holders on what they should expect if they need to file an appeal for their disability insurance benefits. And why it’s so important to file a strong appeal.

GREGORY DELL: Hi, I’m Greg Dell. Here with attorney Rachel Alters. And we’re going to talk to you about Hartford Disability appeals. Kind of some dos and don’ts. And what you should expect if you need to file an appeal. Now Rachel, I know you’ve handled a couple hundred appeals with Hartford. That number is going to increase greatly because we know that recently this year in 2018, Hartford bought the long term disability division of Aetna.

RACHEL ALTERS: Right.

GREGORY DELL: So that’s going to be really interesting. I know you’ve started to see how that’s going to play out because Aetna had their own techniques. And Hartford has their special techniques. So this video is really geared for the claimant who’s already had their claim denied by Hartford, and they’re considering filing appeal. Or they obviously have a need to file an appeal. So let’s talk about some things that they should expect when filing this appeal. And why it’s so important to get going here to file a strong appeal.

So why is the appeal so important basically? Why should you have help and really put in a strong appeal?

RACHEL ALTERS: Well, the most important reason why you need to put in a strong appeal is with Hartford you only get one shot in an appeal. And what the appeal essentially is is basically your trial in front of the judge because once you get to court if an appeal is denied, all the judge sees is the administrative record. So they don’t get any new testimony. You can’t file anything new. They don’t get to meet the claimant. So everything you want to show the judge as to why the insurance company was arbitrary and capricious needs to be in that appeal. And if it’s not, then you’re out of luck.

GREGORY DELL: Right. I mean, a lot of people do call us after they did their own appeal. And we’re able to help them.

RACHEL ALTERS: Sure.

GREGORY DELL: But those people are at a significant disadvantage compared to the ones that contact an attorney beforehand to do the appeal. And like you said, there is no second chance. And we often give the example that someone could turn in their appeal, get a decision, and god forbid the next day lose their leg in a catastrophic accident. And the court cannot consider that new evidence because the appeal record is closed. So that being said, it’s very important people understand you have to submit a phenomenal appeal. What do you think is the most important element in an appeal against Hartford?

RACHEL ALTERS: There are a lot of important elements. But I think one of the most important elements is doctor support. And to make sure that you have really good written doctor support that supports your inability to work. Whether it’s in your own occupation or if the definition has changed to any occupation. That your restrictions and limitations are supported. And that you have maybe a good voc rehab also expert to corroborate. That that’s really important in a good appeal.

GREGORY DELL: What do you think is special about what you’re able to do in helping a claimant present their medical support versus what a claimant could do on their own?

RACHEL ALTERS: Well, we know what the insurance companies are looking for because we do this all day long. So we know that they’re looking for specific language. They want to see that the medical records coincide with what the doctors are writing in their attending physician statements. So they don’t want to just see that there is a great letter from your doctor, but for six months previous, they’re not writing anything in the record. So when you hire us, we try to ensure that your doctors are documenting properly along the way. And that their attending physician statements or their letters that support your disability coincide, they support each other, and they’re very strong.

GREGORY DELL: Now you mentioned the fact that obviously when someone hires us, you mentioned the six month period. You want the records not just the report that a doctor may generate to match. But I guess that’s one of the reasons we take advantage of the fact that they give you 180 days to file an appeal. And during that time, I know I often encourage my clients to go back to the treating doctor or other doctors two or three visits so that we can continue to build the medical records, and get them documented better than they may have been in the past.

But what do you do in the situation where many claimants call us, and they only have 60 days or 90 days left to do an appeal? And we can’t you know we can’t really change the medical records that much. So how do you work to get great attending physician support?

RACHEL ALTERS: Well, we speak with the doctors. So we can set up phone conferences with the doctors, and speak to them and explain to them the importance of what they need to put in their medical records. And then put into the attending physician statement. And we can actually help the doctors prepare those attending physician statements. And we review them before they go to the insurance carrier.

A lot of the mistakes that happen with claimants is that they give these attending physician statements to their physicians, the doctors fill them out, they send them directly into the insurance company, the claimant has no idea what the doctor wrote, and the claim gets denied because the doctors fill them out improperly because they’re not really trained to fill these out. They’re trained to treat patients.

GREGORY DELL: Right. And the other thing–

RACHEL ALTERS: That’s part of our role.

GREGORY DELL: The other thing is that often, like many of these claimants know, they have that standard form that’s one or two pages attending physician statement. And throughout the years, we’ve built our own attending physician statements that we basically customized to the specific medical condition, to the job qualifications of that person’s job, or maybe just to any occupation type job to guide the doctor to make sure that the insurance company gets all the information that they’re looking for. Like you said, we know exactly what they’re looking for. Therefore, we have to have the doctor hit the buzz words and hit the important things.

So unfortunately, what we often see too is that claimants don’t know how to speak to their doctors in order to get this appropriate support. Or at first, without the involvement of an attorney to help, the doctors don’t want to cooperate. So I think that a lot of people sometimes say, well, my doctor’s going to get scared if you have a lawyer. And I think my view has been 95% of the time, is that the doctors appreciate the fact that now you have a professional helping you. Basically guiding the doctor telling them what they can or can’t do. Basically what needs to be done to help the claimant. As opposed to a claimant who may go in not really sure of what they’re doing, and the doctor’s kind of like, look, just tell me what I need to do. And if I want to help you, I will. Now unfortunately, you have doctors who don’t want to help.

RACHEL ALTERS: Correct.

GREGORY DELL: And when that happens, we have to help guide the claimants to other doctors.

RACHEL ALTERS: Sure.

GREGORY DELL: And that becomes a big problem when you don’t have a supporting physician. So that’s a whole other animal. Something that someone should call us about to discuss. But we have to work around that way because it’s not that your doctor doesn’t believe that you’re disabled. It’s that I don’t want to deal an insurance companies.

RACHEL ALTERS: Right. They scare them away because they badger them so much. And they bother them. So the doctors say, I don’t have time for this. I need to treat my patients. I can’t sit and fill out paperwork every two to three months. And so they intentionally scare away the doctors so that the claimants have no support.

GREGORY DELL: All right. So you talked about the single most important thing is medical support. Another thing that a claimant would never do on their own that we’ll touch on here briefly is a vocational report. What is that? Why can that become important in an appeal?

RACHEL ALTERS: It’s very important in appeal because we hire experts who do this all the time. And what the vocational expert will do is they take the claimant’s job description. They look at the medical records. They look at the ONET, which is the–

GREGORY DELL: Dictionary of Occupational Titles.

RACHEL ALTERS: Which these insurance carriers go by as to whether you can do your own job or any job. And they take all of that information, and they produce a report stating whether or not you’re able or capable of doing your job. And it’s very important because they look at the specific job description, what you’re able to do, if you have to sit for long periods, stand for long periods, if you have a physical job where you’re lifting. And they take all of the medical records and look at your MRI reports and things that have to do with your health to determine whether or not you’re capable. And they’re usually pretty long. And it’s a strong support of the appeal on top of the medical support.

GREGORY DELL: OK. They also often cost a few thousand dollars to get a report like that. Since we handle all of our appeals on a contingency basis where the claimants don’t pay anything unless we win, it’s also an expense that many claimants don’t want to risk because they’re in a financial bind as it is because their claim has been denied. And often, many claimants because they can’t afford it, don’t have the opportunity to put in a vocational report. Also these vocational reports take time to do. Often we’re waiting 60 to 90 days to get one. So you really need to plan ahead. We can’t just call someone and say I need a vocational report by tomorrow.

So the last thing we’ll talk about is how we help to craft personal statements. And basically, in my opinion, since we don’t have a trial because ERISA doesn’t allow for that, that’s basically our clients day in court. The opportunity to take the stand and say, this is how I feel. This is why I can’t work. This is what my day is like. And when you’re the claimant living that every day, you can’t necessarily express it without somebody where it’s our job to bring out really what a day in the life is like and explain to that person.

Because at the end of the day there is a human being. It’s not a machine that’s reading the appeal. And if they feel for you or have an understanding of what you’re really doing, and they don’t have video surveillance that contradicts that, or a statement from some random person who says, no that’s not true, or your social media profile says different than what you’re saying, then that is your day. And while it may not work on the appeal, it will have an impact on the judge down the road who is going to look at the file. So that’s another thing that we often spend a lot of time crafting. Also statements from a family member, past co-workers, those kinds of things.

So these are some of the most important appeal elements that are important for a Hartford appeal. Really they apply to just about any appeal with any company. But Hartford’s very specific because they’re very detailed and have certain requirements that we know about. So if you have an appeal with Hartford, no matter you live in the country, Rachel, myself, any of our attorneys are available to provide you with a free initial consultation. We look forward to the opportunity to speak with you.