Look, when it comes to AI, we’re fans. Using an AI agent to help write your disability appeal saves time, and can be the all-important difference between submitting an appeal and not. See our prior article, “Can AI Write My Disability Appeal?,” for more details about all the ways that AI can be a tremendous resource for your disability appeal. But like many good things, there’s a catch. We are seeing more and more appeal “rough drafts” that were clearly written by AI from the ground up, and most are missing the key elements of a successful internal appeal to the insurance company. So, before you lean too heavily on AI for your appeal strategy, here’s something worth understanding:
AI has almost certainly never seen a winning disability insurance appeal.
In fact, AI has probably never seen any disability appeal at all.
There’s an iceberg-sized body of internal administrative appeals that your insurance company is working from as they evaluate yours, and AI sees only the tip – without even being aware of the rest of the iceberg. And that can sink your appeal faster than you can say, “Titanic.”
AI Has Read Appeals, Just Not the Kind That Matter Here
Your disability appeal is a package of letters and documents, especially medical records, that you send directly to the insurance company. It lives in their files. And unless you lose, the insurance company won’t share it with anyone. No one else can read it. Including AI.
If you do lose and your appeal is denied AND you file a lawsuit, your appeal becomes part of what’s called the administrative record. That’s the complete written record of your claim that gets filed with the federal court. It can run to thousands of pages. Access, when it’s available, usually requires a federal court login and a fee. The appeal itself is buried deep in the file.
So the actual internal appeals, the letters and evidence packages real claimants submitted, are almost never available for AI to learn from. The ones that won are sitting in insurance company files, never to see the light of day. The ones that lost are buried in court records that are difficult to access even for people who know how to look. Either way, AI hasn’t read them.
What AI has read are published federal court opinions written by judges about disability cases. And here’s where the problem really compounds.
There’s a lot that has to happen before a disability case gets written about in a format that’s easily accessible to the average interested reader, including AI agents:
- The claimant has to lose their administrative appeal.
- The case has to be strong enough to attract an attorney willing to take it on a contingent fee basis. That isn’t always possible even for valid claims.
- The case has to make it all the way through federal court briefing without settling. The majority of cases settle before that.
- The decision has to be a published opinion. Many federal court decisions are unpublished and carry limited precedential weight.
You Can’t Build a Winning Appeal by Relying Solely on Losing Appeals
Given all this, when you feed AI your denial letter and ask it how to win an appeal, it’s not surprising that it focuses on how to win a litigation case, without really being aware that’s what it’s doing. It’s drawing on a small and very specific universe to try to understand your claim: cases that lost the administrative appeal, were strong enough to get an attorney, didn’t settle, and produced a published opinion. That’s a tiny, deeply unrepresentative slice of all disability claims. The appeals that won, the ones you actually want to learn from, are entirely absent. There’s no way to fix that.
What That Means for the Strategic Advice AI Gives You
The practical effects of this lopsided training data show up quickly when you ask AI for help with appeal strategy. Here are the main things to watch out for:
- AI fixates on perceived “procedural errors,” which don’t really exist yet. Ask AI “what should I argue in my appeal?” and you’re likely to get a long list of things the insurance company did wrong during their claim review: missed deadlines, ignored your doctor, didn’t explain its rationale, used an unqualified reviewer. Those are exactly the issues that fill the published court opinions AI was trained on. They can be winning issues in litigation, but they are largely beside the point during the internal administrative appeal. Terrible claim handling doesn’t become an official “procedural error” until after the final appeal denial letter. If you argue “procedural error” during the appeal review itself, the insurance company will either ignore it or fix it. Neither gets you closer to winning your appeal.
- AI assumes every claim is governed by ERISA. That isn’t always true, and applying ERISA rules to a non-ERISA claim can take your appeal off course.
- AI doesn’t reliably track which court decisions were later reversed. Even when a court rules that the insurance company was wrong, and writes a brilliant, published opinion explaining why, the case isn’t necessarily over. The insurance company can appeal to the federal circuit court. The appeals court will either affirm or reverse the earlier decision. And AI usually doesn’t realize this. It tends to treat all published opinions as equally authoritative, even when the court’s reasoning was overturned on appeal.
- AI has a well-documented tendency toward confirmation bias. AI likes you. It wants to validate the approach you’re describing for your claim and appeal rather than push back, even when pushing back would serve you better. Ask AI, “is my appeal strong?” and it will probably tell you yes. It tends to treat what you say in your appeal letter as strongly supported by medical evidence, even if it’s not. AI will make you feel great about your appeal…right up to the moment you receive an appeal denial letter.
- AI underestimates the importance of correspondence the insurance company sends you between receiving your appeal and issuing a final decision. Those letters often contain new evidence the insurance company generated during their review, like a peer review medical report or a vocational analysis. Responding to them isn’t optional if you want your appeal to succeed. Your doctors will need to explain why the insurance company doctors are getting it wrong in their reviews, and may need to run a new round of tests and examinations to support their opinion. But AI tends to read these letters as routine correspondence, and often tries to explain them away rather than develop a substantive response and new information.
The Bottom Line on AI
Use AI to help you understand your denial letter, organize your thoughts, and draft your appeal letter. It’s a genuinely useful writing and organizational tool, and for many people it makes the appeal process significantly more manageable.
Just beware of relying on AI for the disability appeal strategy itself. AI tends to try to build a litigation case for an appeal you have not yet lost. Winning a lawsuit may rely on cleverly worded briefs that attack procedural errors. Winning the step before the lawsuit, the internal appeal to the insurance company, relies on showing rather than telling.
- Show the insurance company the medical records that support your claim.
- Show them the job duties that you were (or would be) required to perform, and
- Show them how to “connect the dots” between the restrictions and limitations you have because of your medical condition and the required job duties you can no longer perform. Finally,
- Add some support from your treating provider(s) who will validate that you are not able to work due to your medical condition.
That’s what it takes to build a winning internal appeal. As a bonus, if the appeal is denied and you do have to file a lawsuit, this kind of evidence can help you win in litigation. Even AI will tell you that!
If you want a reality check from someone who has written winning appeals and seen the inside of this process from every angle, our denial letter reviews are free. You can even feed our free written report to your AI tool, so it’s working from the specific details of your claim instead of general court opinions. Visit our Free Denial Letter Review page to get started.
Image: Hector John Periquin
