Disability Denial Reason #1 – Paper Review & IME
At Dell Disability Lawyers, we’ve seen insurance companies give countless reasons to deny long term disability benefits. However, most disability benefit denials tend to fall into one of a few categories – and one of the biggest ones is the paper review and independent medical exam (IME). Learn more about what this review process entails and what your claim file will need to show in order to reduce the risk of denial.
Your Claim File Will Be Reviewed By the Disability Company’s In-House Staff
The disability insurance carrier will have their own nurse or in-house doctor (or a third-party company) review your medical records to determine if you’re disabled. This “paper review” can be frustrating and reveals one major double standard in disability claims evaluation – though the insurance company would never accept a disability claim if the claimant had never been physically examined by a doctor, it will often reject a claim based on its own paper review of your file. Unfortunately, the file review is a common process, so claimants must work within this process to obtain approval.
To get past this process, you’ll need to ensure that your claim is as complete, comprehensive, and unassailable as possible. Any omissions or inconsistencies in your medical records could give the insurance company the opening it needs to deny your claim.
You’ll Need to Do Some Research Before Agreeing to the Independent Medical Exam
If the insurance company isn’t satisfied with the information in your claim file, it may ask you to undergo an independent medical exam or evaluation. The IME involves a contract between the disability insurance carrier and a third-party vendor; this vendor will conduct a physical or cognitive evaluation to determine whether you continue to meet the definition of “disability” under your policy.
It’s important to do some research before agreeing to be seen by the doctor the insurance company has named. If you search this doctor and see that they don’t actually see their own patients – but instead, only do medical reviews – this can be a red flag that the doctor will be a hired gun for the insurance company. In these situations, you can request to be seen by another doctor who may be less likely to skew their review toward the insurance company.
Third-Party Examiners Have a Vested Interest in Denying Claims
Because the third-party examiner is hired by the insurance company, it will often have a vested interest in denying your claim. On the other hand, insurance companies may argue that your doctors have a vested interest in claim approval since they have a long-term relationship with you as their patient. Although some IMEs do come back in the client’s favor, it’s important to always approach this process with some skepticism, and don’t be afraid to request a new doctor or dispute the findings in the IME report.
Disputing the IME Report
Under the new ERISA laws, you’ll have the opportunity to reply to an unfavorable IME report before the insurance company makes a final decision on your claim. But because the standard for reversing a disability claim denial is whether the insurance company’s decision was “arbitrary and capricious,” it’s important to coordinate with your treating physicians to respond in full to everything in the report you disagree with. If your response is too short or doesn’t hit all the points it needs to, the insurance company can later argue that it gave you the opportunity to dispute its findings and you didn’t. This will make it harder to prove that their decision was arbitrary and capricious.
As you can see, handling the paper claim review and the IME can be crucial to obtaining approval of your claim for long term disability benefits. Having an attorney throughout this process can help ensure that your claim file is in order and there aren’t any loopholes the insurance carrier can use to deny your claim. At Dell Disability Lawyers, we’ve helped thousands of claimants secure their long term disability benefits, and we can help you too. To get started, just give us a call to set up your FREE consultation.
Resources to Help You Win Disability Benefits
Submit a Strong Appeal Package
We work with you, your doctors, and other experts to submit a very strong appeal.
Sue Your Disability Insurance Company
We have filed thousands of disability denial lawsuits in federal Courts nationwide.
Get Your Disability Application Approved
Prevent a Disability Benefit Denial
Negotiate a Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Unum is evil
Every month I get paid on a different date
They will do anything to not approve your claim
Reply
Don't trust them, they like to play games
Lyme Disease Disability Claim Denial
Disappointed with NY Life Disability Excuses
New York Life is a joke!
They FULL OF ****
Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company
Disability Benefit Denial Reason #3 - Video & Social Media Surveillance
How Do You Fight a Long-Term Disability Denial?
Disability Denial Reason #2 - Change of Disability Definition & Vocational Review
Disability Denial Reason #1 – Paper Review & IME
How to Apply for Reliance Standard Disability Benefits & Top 5 Reasons for a Claim Denial
Seven Surgeries and The Standard Still Denies Disability Insurance Benefits
Sun Life Wrongfully Denies Disability After Paying For 23 Months
Nurse Denied Long-term Disability Benefits by Lincoln After the Definition of Disability Changed
Lincoln Reverses Decision to Terminate LTD Benefits of Corporate Attorney after Dell Disability Lawyers Appeals the Decision
Transportation Manager with Brain Injury Wins Unum Disability Benefit Appeal
Prudential reverses decision to terminate LTD benefits of MRI Tech with Primary Progressive Multiple Sclerosis and degenerative Disc Disease
Engineer With Depression Wins Prudential LTD Appeal
New York Life Approves Disability Benefits for School Teacher With Multiple Sclerosis
Reviews from Our Clients







5 Ways We Help Get Your Benefits Paid
Our goal is to get your application for disability insurance benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their hired gun doctor.
Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.
If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.
Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.
98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability insurance attorneys have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the little guy against the multi-billion dollar insurance company giants.
We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.
Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.
Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.
Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.
Questions About Hiring Us
We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.
Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.
Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability insurance lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.
Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.
The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.
In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.
No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.
When you call us during normal business hours you will immediately speak with a disability insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.