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The cake is baked

Frequently, I get asked to explain the importance of getting an attorney involved during the administrative level of review in a short and/or long term disability claim, rather than once a “final denial” is received. A final denial essentially means the claimant has exhausted all administrative levels of review; therefore there is no longer the option of appealing the denial of his/her claim and the next step in his/her claim would be, in most cases, filing a lawsuit in Federal Court.

Since there is no appeal available to the claimant at that time, there is no longer an opportunity to submit additional evidence in his/her claim. We like to use the expression the “cake is baked” because you are unable to add any additional ingredients to your claim file, or your cake.

It is important to retain an attorney prior to receiving a final denial in your claim so we can ensure the evidence contained in your claim file is sufficient to win in front of a Federal Court Judge if a final denial is received.

Although it may appear you have submitted enough evidence in your file supporting your inability to work, there may be additional evidence obtained directly from your insurance company that you were not aware of. Did your company retain a physician to complete a one-sided medical records only review of your claim? Did that physician contact your treating provider regarding your condition? Did your physician complete a form incorrectly that you may not have seen?

These are all questions that are important to know before receiving a final denial in your claim and we can ensure you get all of the correct answers.