Claim Denials

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Client Wins

It’s easy to go numb and become insensitive when you deal with these types of claims day in and day out. But apathy is what we’re fighting against, and it tends to cloud out who we’re fighting for.

We only win when our clients do. These are some recent results we’ve been able to achieve on behalf of injured and disabled clients just like you.

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BRIDGES V. GATEN’S ADVENTURES UNLIMITED, L.L.C.

This was an example of the employer punishing the employee for having an accident and asserting her right to workers’ compensation benefits. My client was driving a charter bus full of school children. One child was in a wheelchair and needed a parent to assist getting him on and off of the bus. At one stop the parent was having trouble getting the child back on, so my client helped. Unfortunately, she hut her lower back in the process.

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ALBERT V. STRATEGIC RESTAURANTS ACQUISITION CO.

In 2013, Louisiana had enacted a new process, called a Preliminary Determination Hearing, to allow an employer a practice trial in front of the workers’ compensation judge and get an advisory opinion on the issues raised by the claimant in the lawsuit.  The decision was not binding, nor could it be appealed.  The losing side had the opportunity to accept the recommendations and avoid the penalty of possible penalties and attorney fees, or could proceed to a trial on the merits.

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SALOMONE V. GREATER GULF COAST AUTO AUCTIONS

This is probably my fondest case over my entire career because it was a true David vs. Goliath story, and a perfect example of how an insurance company can build trust with an injured worker and use that trust to its advantage.

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Let’s Talk About The Help That You Need.

You work hard to care for your family, your community, and your country. Who is going to care for you through an accident or disability? Daren Sarphie will fight to ensure you receive the benefits and support that you deserve.

  • Help Beyond Compensation
  • We Only Handle Cases Like Yours
  • Round-The-Clock Client Service

After the long wait for a decision on your VA disability claim, your claim is denied. It can be very frustrating! Now what?

You’re not alone – many original and supplemental claims are denied. However, many veterans eventually receive the benefits they deserve. However, to get those benefits, you must respond to the claim denial.

VA disability lawyer Daren Sarphie explains what to do if your VA disability claim is denied.

VA Disability Claim Denials

You may appeal a VA disability claim denial. Ensuring your disability appeal is a success requires knowing why your claim was denied, what type of appeal to pursue, and what to include to achieve a positive result.

Lawyer Daren Sarphie represents veterans in VA disability claim denials. Contact us for a consultation and to get legal help with your case.

Common Reasons Why VA Disability Claims Are Denied

Common reasons why VA disability claims are denied include:

Insufficient proof of a disability

A disability may be physical or mental, an injury, disease, illness, or condition. To verify your medical condition, you may present your service treatment records and other medical evidence. When medical information is missing or incomplete, your VA disability claim may be denied.

Disability, not service related

To qualify for VA disability, your condition must be service-connected. That means your disability exists or got worse because of your military service. There are some presumptive conditions, including chronic illness appearing within one year of discharge, illness caused by being a POW, and illness caused by toxic chemicals or other hazardous materials.

Pre-existing condition

A pre-existing condition isn’t automatically disqualifying for benefits. While existed prior to service is a common reason for a claim denial, many pre-service medical conditions can be made worse by military service. With the right medical evidence, you can claim your benefits.

Incorrect disability rating

A claim may be approved but with an incorrect disability rating. The disability rating is based on the medical evidence presented, your compensation and pension (C&P) exam, and information from other sources. When a claim involves multiple disabilities or a pre-existing condition, it may increase the possibility of an incorrect disability rating. (See Schedule for Rating Disabilities, 38 CFR, Part 1, for a schedule for rating disabilities and rating policies.)

Missing information from the application or incorrect paperwork

When information is missing from the application or paperwork is incorrect, it may prevent representatives from approving your claim.

Missed deadlines

Deadlines to appeal or respond to requests for further information are strict. If you fail to respond, miss your C&P exam, or otherwise miss deadlines, your claim may be denied.

What To Do After Claim Is Denied

There are several things you can do after a VA claim denial:

Review your paperwork

Start by reviewing the paperwork that accompanies your disability rating. There should be detailed information about why the rating was given along with an effective date. If there was a determination that the condition was not service-connected, there should be an explanation. Knowing the reasons for the denial can help you determine how to respond.

File a notice of disagreement (NOD)

A Notice of Disagreement is a response to the VA stating why you feel the decision is incorrect. Use VA-Form 21-0958, which allows you to directly address points of contention, including decisions regarding service connection, your effective date, and disability rating. You may raise other issues, too.

Simply filing a Notice of Disagreement is unlikely to result in a different result. You must be specific. Carefully reviewing the legal references used for your disability rating can help you explain why the rating is incorrect and identify what documents may be helpful to submit in response.

Request a senior rating specialist to review your case

A Higher-Level Review allows a more senior representative to review your case. It’s important to note there is no new evidence allowed with a Higher-Level Review.

Using VA Form 20-0996, you may ask for a Higher-Level Review for an initial or supplemental claim and must file your request within one year of your decision date. As part of the review process, you may ask for an informal conference.

File a supplemental claim

A Supplemental Claim allows you to submit new evidence or ask for a review based on new law. Use Form VA 20-0995. You must include your identifying information and the issues you wish to address.

Board of appeals, court appeals

You have one year from an initial claim decision, Supplemental Claim, or Higher-Level Review to request a Board of Veterans’ Appeal. In a Board Appeal, a judge reviews the claim. Using Form VA10182, you may ask for an appeal by direct review, evidence submission, or a hearing.

You may appeal a VA disability denial to the United States Court of Appeals for Veterans Claims, to the United States Court of Appeals for the Federal Circuit, and to the U.S. Supreme Court.

Make copies of everything

As you respond to a VA claim denial, save copies of all your paperwork. This will allow you to correct mistakes, if necessary, and refer to what you have submitted.

How a Lawyer for VA Claims Denials Can Help

How you respond to a VA claims denial can impact whether you are successful in receiving the benefits that you deserve. A lawyer can help you determine what type of appeal to pursue and can explain the benefits and risks of each course of action. Your lawyer may assist you with preparing your paperwork and ensure you provide the appropriate and complete information.

Many veterans are fighting their claim denials and winning! You must take calculated steps to make your appeal a success.

Daren Sarphie is a lawyer handling VA claim denials. There are time limits to pursuing an appeal, so contact us for a case review and get legal help right away.

Why Choose Us?

We’re Here to Help.

When a client is denied their benefits, they are essentially being told that they 
aren’t hurt, that they aren’t in pain, that they can work, and that they are not 
believed. They’re people told this by people who they have never met, and 
sometimes, never spoken to. We can help… so we do.

  • we listen
    We Listen

    We listen to what you’ve been through, what you need, where your challenges are, and what is your ultimate goal.

  • we communicate
    We Communicate

    We explain your rights and your options. We put together a strategy and update you on the progress every step of the way. You’ll always know what’s going on.

  • we fight
    We Execute

    Every claim is like a chess match. We put together a strategy before we even start the game in order to make key moves at the beginning and gain the advantage. By the end, we want to ensure you receive the help and compensation you deserve.

Our Case Process Working With Us is Easy.

We work hard to ensure our clients are always informed on the status of their case. You can rest assured that you have a staunch advocate supporting you on your team.
Free Consultation

Free Consultation

Sarphie Law offers complimentary case reviews. He will attentively hear your story, assess your challenges, and align with your goals.

We Get To Work

We Get To Work

Once you’re on board, we spring into action. With dedicated advocacy and transparent communication, we pursue your benefits vigorously.

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Get Help Now

Let’s Talk About The Help That You Need.

You work hard to care for your family, your community, and your country. Who is going to care for you through an accident or disability? Daren Sarphie will fight to ensure you receive the benefits and support that you deserve.

  • Help Beyond Compensation
  • We Only Handle Cases Like Yours
  • Round-The-Clock Client Service

We Will Review Your Case For Free.

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