Approval in Holiday, Florida
Another approval for short and long-term disability insurance benefits, this time out of Holiday, Florida.
Client came to us suffering from three types of aphasia, pursuant to a stroke, with right side weakness, and ulcerative colitis. The insurance company denied the short-term claim based on lack of information. The limited information the insurance company had received didn’t substantiate a disability claim.
When our office took over the handling of the claim, we immediately went to work gathering medical evidence, not only from the one doctor from whom the insurance company had received records, but also the VA, another medical center, and an independent medical exam.
Initially, when looking at the client’s disabling medical conditions, it was rather confusing that the client’s primary doctor didn’t appear to have enough medical evidence to support the claim. We quickly learned that obtaining medical evidence and support for the disability claim from that particular doctor’s office would be more challenging than usual. In fact, the office staff actually complained to the client that our office was harassing them by simply following up on requests for medical records – requests requiring obtaining multiple extensions from the insurance company because of their delay.
We were ultimately able to obtain medical evidence and support from the previously mentioned sources and provide the short-term disability department with the information, which resulted in an approval for his short-term disability benefits. But the most surprising part of this case was when the long-term disability administrator called us requesting a phone interview with the claimant — who suffered from aphasia — to ask him questions that could affect his long-term disability approval. It turned out this request preceded the review of the file, and upon being informed that the client suffered from two different forms of disabling aphasia, the administrator was more than willing to allow the client’s spouse to respond to her questions with the client on the line. With the help of his spouse and Mr. Coffman as counsel, the phone interview was successful, and the client was approved for his long-term disability benefits as well.
There are two things to remember from this case:
- Even when an insurance company’s request appears completely unreasonable on its face, there may be a perfectly reasonable explanation and it is always an excellent idea to get more information before reacting.
- The insurer gathering information on your behalf to help your claim cannot be relied upon to pursue the evidence to prove your claim with the diligence you or your attorney will.