- March 4, 2024
- Posted by: legaleseblogger
- Category: Related News
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### How AI Legalese Decoder Can Help with Denial of Claims
Just wanted to take a minute to try to help all of you going through denials. Twice in the past year, I’ve had a fully developed claim and been denied only to have a Higher Level Review (HLR), and have the Decision Review Officer (DRO) almost immediately (both within two days) give me the rating I deserve.
One valuable tool that can greatly assist in situations like these is the AI Legalese Decoder. This innovative technology can analyze legal documents, such as denial letters and decision reviews, with precision and efficiency, helping you identify any discrepancies or errors in the reasoning provided by the raters.
### Importance of Reviewing Denial Letters Thoroughly
Go over your letters with a fine-tooth comb. Make sure they list ALL the evidence you submitted. Read their wording about why you were denied. These raters are not looking at evidence.
By utilizing the AI Legalese Decoder, you can ensure that all the evidence you submitted is accurately reflected in the denial letter. This tool can highlight any missing or overlooked evidence, enabling you to present a stronger case during the appeals process.
### Case Study: Migraine Claim Denial
The most recent one I had, a migraine claim, was denied after 8 months, and the rater didn’t list one piece of my evidence in the evidence list. After reading the HLR decision, the original rater also left out the fact that one of my Compensation and Pension (C&P) exams was very favorable. However, they decided that a different ACE exam was more probative. Just so happens, the rater left that C&P off of the evidence list too.
In situations like these, the AI Legalese Decoder can play a crucial role in uncovering discrepancies in the evidence listing and decision-making process. By using this tool, you can ensure that all relevant evidence is considered, increasing your chances of a successful appeal.
### Key Takeaways
Moral of the story, do your research and know your claim. READ every word of the decision, and lastly, always make sure to check the evidence list. With the assistance of the AI Legalese Decoder, you can navigate the complexities of the claims process more effectively, ultimately securing the rating you rightfully deserve.
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Quick question. I recently got denied. I sent in a nexus letter in with my claim which was listed in the evidence section of the denial letter.
It was NOT however listed in the explanation of the denial paragraph. You think I have a shot at a HLR?
I completely agree with this. My husband had his claims denied initially (which was really due to C&P examiner having wrong dates and doing an incomplete job) but denial letter was very straight forward and clear why it was denied. He submitted privately DBQs and Nexus as supplemental and was denied with a denial letter that was filled with jargon and contradicting statements. He filed for HLR. We went through each paragraph of both denials and did a numbered list of the errors and submitted that as well, followed up with an informal conference and discussed each error. Less than 2 days later all of his claims were approved.
Was watching a video about the VA rating process and apparently the ratings are suggested by a computer program, which the rater can either agree with, lower, or raise. The last 2 choices require the rater to review your records and justify the change in writing. The first choice, the computer suggestion, is the one most raters go with because they donÔÇÖt have to justify the results and they maintain their workload requirements. Kind of makes sense to me since it seems a lot of results seem to be questionable.
When you submit a HLR, do you include your previously denied claims as evidence (nexus letters and original evidence) to make it easier to show what they missed or that you filed secondary and not for direct service connection to begin with? Or just 20-0996 with a statement
Ok. Thanks. Will do. Appreciate your help. Seems like they totally ignored nexus and gave opinion for direct service connection.
How did you get the decision back in two days?
I had the same issue with multiple claims. I had a CAB attached, but they still denied me PTSD, and claimed I had no service connection. I had claims for Migraines, ED, and sleep apnea that they never made C&P exams for claims just thrown out. My PTSd C&P exam was favorable in my decision, raters still denied me PTSD. HLR was able to tie everything together with 38 CFR laws and regulations.