First and most importantly, my appeal packet was ‘court ready’. In most ERISA cases, court review is under the ‘arbitrary and capricious’ standard, which means you must show that the LTD abused their discretion in denying your claim based on the information in front of them. The court must review your case with the same information the LTD had, nothing further as that is the basis by which the LTD exercised their discretion; it can not be claimed that they abused this discretion for information that is not in front of them. If an appeal is denied, it is very rare that anything else is allowed in the record.
Disability companies count on a loose emotional based appeal.
We put together a structured and well articulated case file designed to draw the evaluator, which may have ended up being a judge, to the inescapable conclusion that my disability is real and any other reading of the file would clearly be ‘arbitrary and capricious’. Lawyers are generally pretty good at this as it is a key part of their training, but it doesn’t take a law degree to be articulate and organized or to know the key issues that need to be addressed. Even if one does use an attorney (which I recommend) you, or a benefits consultant, can do a lot of this work and have it ready for an attorney to review and file.
Below are the contents that were within my appeal file. Every case is different, but in general this is a pretty good guideline. My appeal file was somewhere around 200 pages; sixty five was my attorney’s formal letter, nineteen was my personal statement, and the rest were
Preferably on an attorney’s letterhead. Content dependent upon issues in case. Reviews the stated reason for the termination, applicable ERISA regulations, background of case, review of medical backing up claim, legal rebuttal of LTD assertions, etc.
Personal statement providing background of illness, impact on self and family (including financial), detail limitations of illness with citable backup of assertions, personal rebuttal of LTD assertions.
Medical Statements/Documentation
PCP, CFIDS specialist, Neuropsychologist, Tilt Table, FCE, etc. Include a summary listing with key comments.
Personal Statements/Testimonials
Statements from friends, co-workers, and anyone else that is knowledgeable in some way with your situation, particularly any limitations you have exhibited and how that might impact a work situation.
References/Citable Sources
Include photocopies of original sources for citations in previous documents and other articles of relevance you feel need to be in your file for consideration of your case.