Disability Appeals

Many disability attorneys are of the firm belief that the default position of disability insurers is to deny a benefit claim regardless of the evidence submitted. That belief is supported by the inherent conflict of interest faced by insurers. If they approve a claim, then they have to pay it, which hurts their profitability. The fact that the claims people can receive additional compensation for denying or terminating claims further substantiates this conflict.

In order for a disability appeal to an insurance company to be successful you obviously have to rebutting every single adverse medical finding made in the prior denial, which I suggest doing with multiple treating and consulting medical sources. What is less obvious is that you also need to do the same thing with respect to the vocational evidence. I took over a case involving a claimant with HIV from another law firm after Prudential twice denied the claim by doing these two things.

I received medical reports and test data from four treating doctors that affirmatively rebutted every medical basis that had been previously asserted as a basis for terminating the claim. Perhaps more importantly, I secured a vocational assessment that helped why the claimant remained incapable of working. The report addressed issues such as how thrice weekly fever would cause unacceptable absenteeism, and chronic daily diarrhea would require extra work breaks, as well as the discomfort of co-workers when faced with the claimant’s constant skin infections and so on.

The vocational report also helped establish the claimant’s credibility. The report confirmed that the claimant enjoyed his job, working 60 to 70 hours a week, and earned over $100,000, plus a bonus in the range of $10,000 to $50,000. Logic dictated that the claimant would want to continue working, which was established by the fact that he did for nearly a decade after being diagnosed with HIV.

Strong medical evidence had been submitted in connection with the claimant’s first two appeals. This indicates that the additional vocational evidence probably led Prudential to reverse its prior decision to terminate the claimant’s long term disability benefits.