Changed practice after eleven years and I am dreading starting over.
Appeals succeed far more often than first requests, because the first review is often automated.
Get the criteria document. Every refusal is scored against a checklist and the letter never includes it.
Has anyone got this through on appeal, and what did the letter actually say?
Interdose restlessness is distinct from the original symptom and worth naming separately.
Same here.
Sleep first. Bad night, bad day, more symptoms. Fix that before changing anything else.
Worth asking what specifically was measured. Pain scores move with mood and function does not.
Reference ranges differ between labs, so comparing two reports is close to meaningless. Tolerance was my main issue with a claim rejection too.