Depending on your disability benefits plan, the plan administrator may have the authority to adjudicate your appeal with new and relevant medical information. Gathering the appropriate documentation is not an easy task but doing so puts you in the best position to appeal. The below steps may help.
Tip #1: Get an Independent Medical Evaluation (IME)
Your IME must be done by a specialist in the field that pertains to your disability. Your plan administrator may or may not require an independent medical evaluation in its initial review of your claim, but obtaining one on your own may help. Your plan administrator must take into consideration that medical provider's assessment under the "arbitrary and capricious" standard. After, the plan administrator may require its own IME to verify the evaluation you provided.
Tip #2: Obtain a Functional Capacity Evaluation (FCE) From an Occupational Therapist
An FCE helps to demonstrate how well you can physically perform the essential functions of your occupation. Depending on the plan's terms, your disability may be assessed against your particular job or a family of similar positions. As such, a thorough functionality assessment will provide evidence to the plan administrator that shows how your disability impacts your ability to function in the role you performed before becoming disabled.
Tip #3: Secure Relevant Medical Notes from All Medical Providers
Your medical providers' assessments and notes, especially from those who treat you for your disability, can help demonstrate the extent of your disability, the tests performed to confirm diagnoses, and the opinions of physicians and specialists who saw you. This evidence may be vital in overturning a disability benefits denial decision as courts often defer to the opinions of treating physicians over those of medical professionals hired by the plan administrator in some contexts.
Tip #4: Submit Documentation and the Appeal Letter to Your Plan Administrator
If you have provided sufficient evidence demonstrating that you are disabled under the plan's terms, the plan administrator may rule in your favor of restoring your disability benefits. If not, or the plan administrator continues to require additional documentation, securing the particularized advice of an attorney may be the best avenue to continue appealing your denial. Your case may need to be adjudicated in a Colorado court.
Don't hesitate to contact Patricia Bellac at PSB Law Firm, LLC, 303-622-3883, for assistance with your private disability insurance plan claims and appeals.