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Winning a Disability Appeal

Holly was recently kicked off her private disability plan. After a year, she won back coverage. In this series, she walks us through the various steps she took and what it was like to navigate this experience.

After months of preparing my appeal for disability coverage and experiencing all the stress that came with the process, I had to wait. Nearly a year of waiting and worrying about the extreme ways my case could turn out, I considered every outcome. I began to come to terms with the possibility that I could be turned down altogether. If so, would I continue the legal fight? if I was offered a settlement, what amount would be acceptable? I’d heard from others who went through this process that settlements are frequently paltry in comparison to the original award.

What was the verdict of my disability appeal?

Nearly a year after learning my coverage had ceased, my lawyer notified me we’d received notification and that we’d won the case. I was to be put back on coverage at 100%. Such an immense relief.

Some strange (and ignorant) part of me hoped to receive an apology from the insurance company for the nightmare I’d been put through. But of course, the first email from the company was asking me for an updated evaluation and medical records demonstrating my condition during the time I was kicked off coverage. While it felt personal, it wasn’t. I’m just a case number to them – and one that is expensive for them.

What was my sobering realization?

I’ve known for years that receiving benefits means constant scrutiny. However, I didn’t realize how dirty these companies are capable of playing (being surveilled, and made to see a doctor hired by the insurer hired to find reasons for my discontinuance, etc.).

How did my appeal demonstrate depth and strength?

The appeal my lawyer penned was like a huge class in migraine. It offered numerous in-depth arguments, medical records, and study after study to prove what migraine looks like. 500 pages including case law to illustrate that their justifications to discontinue me did not warrant my being removed from coverage.

I believe that part of the reason they restored my coverage was because of the depth of knowledge illustrated by my lawyer and the fact that it was clear my lawyer was tough and tenacious.

How much did the disability appeal cost?

They reimbursed me for the months during which I was not covered - but that didn’t cover what I had to pay for my lawyer. They approved me during the first part of what could have been a lengthy and multi-step appeal process. This meant that I didn’t have to go to court. Even though this was a great relief, it also meant I wasn’t allowed to file for reimbursement of lawyer fees. That possibility only happens once you go to court.

Would I do it again?

This process was demanding, expensive, and traumatic. But what’s the alternative when we face chronic and intense pain along with complex neurological symptoms daily. To that end, I think I would go through the appeals process again if I had to. I may’ve alternately chosen to pay the lawyer through contingency rather than a flat fee. Still, I feel it’s important to use a lawyer if possible.

We each have to decide how much we’re willing to pay, and how much stress we are willing to incur. For many, due to the outrageous cost of a lawyer, it makes better sense to coordinate the appeal without representation or to return to work and muscle through - starting over just to likely learn again that working is not possible.

Have you ever lost disability coverage? We’d love to hear about the experience and outcome. Please share your experiences in the comment section below so that we can learn from you.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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