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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.

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Disability Company Reviews

(650)

Showing 8 of 650 Reviews

MetLife

MetLife for disability? Avoid the surgery unless it's life-threatening

Reviewed by Jeff on August 22nd 2024 Verified Policyholder | August 2024 date of disability

The worst company I ever dealt with, never received a call from my claim manager.

Reliance Standard

Short Term Disability Claim/Inconsistent to NO Communication

Reviewed by GaKRN on August 22nd 2024 Verified Policyholder | June 2024 date of disability

When I did call & reach a live person they were kind & helpful. The person assigned to my claim left one phone message & I have not spoken to her since. Information she re... read more >

Unum

Unum Closed My Case Today

Reviewed by Scott C. on July 5th 2024 Verified Policyholder | March 2023 date of disability

Unum will keep you around, if they pay you 100 a month. But as soon as have to pay more than 2700 a month, they will drop you. We will be going to the attorneys office fir... read more >

Hartford

Ran me Around for Months

Reviewed by David on July 5th 2024 Verified Policyholder | January 2024 date of disability

Scammers. Immoral horrible people.

Reply

Sent on July 5th 2024 by Attorney Gregory Dell

David:

It’s horrible that Hartford did that to you.

Prudential

Denied but Not Denied but I am Denied

Reviewed by KDDK on July 5th 2024 Verified Policyholder | August 2022 date of disability

I went out in Aug. 2022 for neck pain. After seeing a neurologist I had to get an ACDF C5-7, it was also determined I had carpal tunnel in my right hand and bulging disk i... read more >

New York Life

Claiming They Are Not Receiving Paperwork

Reviewed by Macey on June 26th 2024 Verified Policyholder | February 2024 date of disability

After suffering from medical issues from my delivery in February, I had to have a colostomy bag placed. Now New York Life is trying to claim my condition was pre-existing ... read more >

Hartford

Truly Horrible and Immoral Company with No Customer Service

Reviewed by William M. on June 26th 2024 Verified Policyholder | June 2020 date of disability

My experiences with Hartford have been nothing short of cruel. They started off by claiming that having Glioblastoma, which has an expected life span of about fifteen mont... read more >

Hartford

Sent my Direct Deposit to a Strangers Bank Acct

Reviewed by Brad on May 2nd 2024 Verified Policyholder | February 2024 date of disability

I went on short term disability and The Hartford put my direct deposit into someone else’s bank account. Somehow they messed up a number or two and they are refusing to ... read more >

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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... Read More >

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Prudential reverses decision to terminate LTD benefits of MRI Tech with Primary Progressive Multiple Sclerosis and degenerative Disc Disease

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Reviews from Our Clients

S.S.

I am a physician in my 30s who was practicing in my hospital based medical specialty until my Multiple Sclerosis diagnosis began to severely limit my physical ability to work.

My husband and I were obviously in distress at these very unwanted life changes and frankly overwhelmed with the possibility of a long and traumatizing legal battle ahead of us. We knew we were legally entitled to benefits through the separate private individual and employer based ERISA disability insurance policies we had, but even cursory research and discussion with colleagues made it clear that insurance companies will strategize with their own legal teams to find ways to not pay out benefits. We found many before us who had fallen unwittingly into legal pitfalls that prevented them from ultimately obtaining benefits. We realized we needed to seek legal counseling.

We found Dell Disability Firm through their youtube channel where their associates have videos discussing the legal intricacies and latest developments in private disability law. I was impressed by their dedication to the field and reached out through their website to request a free consultation.

We were delighted to hear that Mr. Steven Dell himself would be willing to take our case and felt assured that we would be represented by the best of the best.

We have not been disappointed in our expectation and have, in fact, been consistently very impressed. Steven Dell is clearly both knowledgeable and wise about dealing with these issues but more importantly, has shown kindness and impeccable honesty at each step of the way.

Merlin has demonstrated a very high capacity for organizing and handling the endless myriad of documents and communications between us and the insurance companies. She has also been very compassionate, accessible and forthcoming in dealing with our many anxiety fueled emails and telephone calls to her and we are very grateful for her involvement.

For over 7 months, we have been working closely with Steven Dell and Merlin Bryan from Dell Disability Lawyers as they have guided us through the process of review and initial application for benefits from our two insurance policies (Hartford and Ameritas).

We are happy to announce we just received approval of claim from the Hartford insurance company.

At this time we are still working with this firm as we await the final decisions from Ameritas policy that we are hopeful will have a similar outcome.

As anyone with a chronic and progressive illness can tell you, time becomes a very precious commodity. Through their representation, Dell Disability Associates has allowed us to focus the majority of our time enjoying the time and function I have left while resting assured that our disability case laid in competent and caring hands.

The truth is that no amount of money can make up for what we have lost, but it is a huge comfort to have a team like Dell Disability Lawyers at our sides to help us ensure we will be able to continue to care for ourselves and our families.

We highly recommend Dell Disability Lawyers, Mr. Steven Dell and Ms. Merlin Bryan to handle your disability insurance claim.

Thank you Steven, thank you Merlin!

We will certainly plan on leaving another review for completeness once we have our final decision from Ameritas.

Paula B.

I have been working with Dell Disability Lawyers for the past 5 years concerning my disability as it pertained to my employer. I have been more than pleased with them the entire time. They have always kept me informed of any paperwork needing completed or any changes coming ahead. Nothing has been a surprise. I would recommend them to you to help with your disability case if you’re trying to dip into the policy you’ve been paying for.

Michael M.

I am a physician who has been disabled for over 10 years. During this time I have been represented by Cesar Gavidia and his assistant Danielle Lauria. Their representation on my behalf has allowed me to concentrate on dealing with my disability/disease process and all associated complications and not having to deal with all the things that are necessary in a disability claim. Based on my personal experience from many years of practicing medicine I would consider their work product, insight and effort in the disability claim procedures to be superior. I would recommnend them, which I have done, with my highest level of confidence. In short, you well served with this practice.

Dan P.

I had to retire from my career due to a bad back that restricted me from performing my duties. I had LTD insurance and after a few years of receiving monthly benefits from this insurance company, they notified me that my benefits were terminated stating that I don’t qualify due to my duties not fitting into some “national job description” and a nurse had deemed me eligible to go back to work. Its a crushing feeling to have this told to you over the phone with hardly any information given. Luckily, I came across Dell Disability Lawyers and spoke with Attorney Palamara who calmed me down and stated they would take my case. Within a couple of months my benefits were restored, and I had piece of mind. I cannot thank Attorney Palamara and the staff enough at Dell Disability for their professionalism, no nonsense approach, personal and timely communication and quick ability to litigate my case.

Jen S.

I wanted to thank Mr. Symonds and his legal assistant Sonia for their professionalism, guidance and dedication towards my LTD claim. Going through the denial process on my own was going to get me sicker and knew it was time for help right away. I reached out to Dell Disability Lawyers for assistance and not too long after my call, I was connected with Sonia – Soon after that, I was talking about my case with Mr. Symonds. After a long and tedious process with the LTD insurer, we won the case. The wait can absolutely be lengthy, but in the end, it was all very much worth the fight. Thank you both so much for all that you have done for me! I also want to thank those who assisted in keeping me updated, as needed. Highly recommended for anyone who is going through the brutal process of an LTD denial.

Carl G.

I would like to thank Dell Disability Lawyers for taking care of my case and help me get the insurance coverage that I was rightfully in need of. Specially, I would like to thank Lawyer Alexander Palamara and RIGHT-HAND legal assistant, Sonia Nogueira, who made this process less stressful. They answered all my questions and kept me informed every step of the way.

Don’t get me wrong. They never promised or told me that I was going to win my case, as no one can guarantee that for you. What they did do, was letting me know that they were working hard for me and to keep positive. Something that I recommend everyone to do is to subscribe to their YouTube channel. That will give you an idea on how they operate and why they (for most of their cases) win their cases.

Since I was awarded disability, I am still having surgeries and thanks to Dell Lawyers, I’ve been able to cover all those expenses.

Warm regards to everyone at Dell.

Clarisa B.

I’m so very Grateful and Thankful for the team at Dell. They worked tirelessly to get the best outcome for me. I’m so glad that I found them!!

Carole S.

Exceptional efficient and professional service from Jay Symonds and Sonia Nogueira. They were both so helpful and knowledgeable and navigated me through a very stressful and difficult situation with New York Life.

K. S.

Awesome team. Jay and his team, Sonia and Francesca, truly care. This team is very Professional and quick to respond. Jay always provided answers in detail to my questions. I strongly recommend Jay Symonds.

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