Yes! AI can absolutely be a tremendous free or low-cost resource to help you write your disability insurance appeal. We have not yet seen a case where AI wrote a worse appeal than someone writing an appeal entirely on their own could write. On the other hand, we’ve seen plenty of cases where an AI-written appeal sounded great but focused on the wrong issues. At best it just moved things sideways, not any closer to winning benefits. If you are writing your own disability appeal and thinking about how best to use AI, here are some things to keep in mind:
What AI Does Best in Disability Appeals
If you are not familiar with disability insurance denials and don’t love writing technical appeal letters, AI can mean the difference between abandoning your claim and submitting an appeal that restores your benefits. Used correctly, it’s a fantastic resource, and there are some key things it does well.
- An AI agent can help you read and make sense of your disability denial letter, and may be able to identify issues for the appeal that you missed.
- Remember to remove any personal information before uploading your denial letter into a public AI agent.
- Spend some time asking AI the right questions about your denial letter. “Read this and tell me why my claim was denied” is a good start. Depending on what answer you get back, refine your prompts to ask more and more specific questions about who reviewed your claim, why they disagreed with your doctors, what specific details from your medical records they focused on, etc.
- “What do I need to do for my appeal?” is another good, general question to ask. Again, depending on the response, spend some time digging deeper and refining the responses until you have a clear action plan for your appeal going forward.
- After understanding why your claim was denied and what you need to do for your appeal, an AI agent can help draft the appeal letter.
- Make sure to include your claim number and state that you are appealing the decision dated [date of denial letter].
- Fully explain the context for your claim. Have your AI agent “interview” you to learn the details about what happened that took you out of work, which specific required duties you were and are unable to perform, what your treatment plan and prognosis for returning to work are, and what your doctors say about your claim.
- Make sure to include a list of all the additional evidence you are including with the appeal. No matter how great your AI-written appeal letter is, we can’t say it enough, you will not win an appeal without submitting additional evidence.
- An AI agent can stay with you through the appeal review process, helping to interpret any additional correspondence from the disability insurance company.
- Always start with the same building blocks: protect your privacy, ask “what does this letter mean and how should I respond?” and refine as necessary until you have a clear plan.
- Stay within the deadline to respond, or tell the insurance company that you need more time. Never miss a due date!
Things to Watch Out for When Using AI for Your Disability Appeal
AI agents seem to get most of their disability appeal “training” from reading legal opinions. While these can give important context for your claim and help guide your appeal, they can also lead AI (and you!) astray during the internal administrative appeal phase, because the rules are different.
- AI often assumes that a disability claim is governed by ERISA, the Employee Retirement Income Security Act. It assumes that both you and the insurance company are playing by ERISA rules. That’s not always true.
- AI is reading legal opinions at the very end of the appeal process, and those are often heavily focused on procedural errors that the insurance company made during the appeal review process. While those can be winning issues in litigation, you are not there yet.
- The internal administrative appeal is primarily about what YOU are providing as proof of your claim, not about what the insurance company is doing wrong in administering your claim.
- The bottom line is that there are very few procedures the insurance company has to follow during the initial claim review process (we call this the “they are allowed to get the denial decision wrong” trap).
- AI tends to mix up the procedural guidelines for appeal reviews (which are substantial) with the procedural guidelines for claim decisions (which are sparse as long s the insurance company maintains procedures that are “reasonable” and gives you a decision on time).
- It’s most important to address substantive errors that the insurance company made when denying your claim, especially details that they cherry picked or ignored in your medical records.
- You can absolutely call out any significant claim handing errors, but just know that those alone will not win the appeal for you. AI often seems to forget this.
- AI often seems to miss the significance of the letter(s) the insurance company sends you in between receiving your appeal and sending an appeal decision letter. These letters usually have the “new evidence” the insurance company generated during their initial appeal review (usually medical or vocational reports). While the letters say a response from you is optional, it’s not optional if you want to win the appeal.
AI is a game changer as long as you know its limitations and how best to use it for your disability appeal. And if you want a sanity check from a real person, our denial letter reviews are free. We’ll read the denial letter, tell you what you need to do for the appeal, and explain how we can help. You can even feed our free report to your AI agent to keep your costs low and have the best of both worlds! Visit our Free Denial Letter Review page to get started. (And no, AI did not write this article!)