If you are denied disability and can’t work, the first thing you should know is that you are not alone.
It is very common for long-term disability claims to be denied at first, but you can appeal the decision.
Denials for long-term disability insurance claims can happen for many reasons.
Whether your insurer is citing insufficient medical evidence, failure to meet a policy definition of disability, or even claiming missed deadlines, you have options. Here is how you can appeal your denied long-term disability benefits decision.
Long-Term Disability Appeals Process
Read and Understand your Denial Letter
Knowing exactly why you were denied will help you understand what you need to do to add to your claim to overcome the insurer’s determination. In your denial letter, you should get some justification as to the reason(s) your claim was denied. The reasons may not be correct, thorough, or even reasonable, but they should be stated clearly enough that you can get an idea of why the insurer made their decision. Knowing why the insurance company said “no” to your disability application, sets the playing field for you to get to work.
If they cite lack of medical evidence, you can start by stacking the deck on that item. If they cite that you are not disabled per the policy definition, you can start tackling those issues. And so on for each item in the determination. At this point, you can reach out to a professional long-term disability attorney and get some help as well.
Write an Appeal Letter
It is important to officially notify your insurance company that you intend to appeal. However, timing and substance of notifications are also essential considerations. If you tell your insurance company you are appealing too soon in the process; you could risk any ambiguities in your statement leading them to deny your appeal simply due to a misunderstanding.
For example, you said you were appealing, they understood your notification as the finalized appeal, and made a determination on the evidence on hand. Technicalities like this are a disability advocate’s dread.
Remember, no matter how nice your insurer is, they know every trick in the book and will take advantage of a well-meaning but unknowing appellant trying to navigate their appeal on their own.
If you are absolutely set on drafting your appeal letter, here are some tips:
Request your claim file from the insurance company via certified mail, return receipt requested. Federal law states that the insurance company must provide you with a copy for free.
Obtain a copy of your insurance policy: Request a copy of your long-term disability insurance policy from your company’s human resources department. Again, federal law states that you must be provided a free copy. If you are unable to obtain a copy for any reason, be sure to include that in your request for your claim file.
Collect all documentation: Have all relevant documentation from your doctors (this includes any doctor you have seen for the condition in which you are claiming or any related condition). This includes medical tests, personal statements from friends and family stating facts about your condition, and statements from your If you have any new supporting information, include that as well. Employment records stating how your condition has affected you at work are another piece of documentation you should add.
Find decisions from other agencies about your disability: If you also applied for Social Security Disability or a for a retirement disability plan and were approved, submit these approval letters with your appeal as well. This shows that other agencies have found you to be disabled.
Contact the insurance company’s claims agent to ask what else you should include: The claims agent may request that you get blood tests, x-rays, or other tests. This could also include keeping a pain journal.
Before you compose your letter come up with a list of issues from your denial that you disagree with or think you have documentation to challenge. When composing your letter, include the items from this list along with the documentation. Your letter should also include: Case or member number of the claimant, reason the claim was denied, short description of the disability, corrections of any errors found in the original claim, facts as to why the denial was wrong (include medical evidence or doctor’s personal statement), and copies of the original application, denial letter, and medical documentation.
Let us review your appeal letter to ensure you are putting the best possible disability claim appeal together! Contact us here to get a second set of eyes on your work.
Review the recent article we wrote on drafting a disability appeal letter.
Meet all deadlines
You have up to 180 days to appeal and send in any additional evidence. You want to start as soon as possible though. It takes time to collect additional evidence, and if you are using disability lawyers, they will need time to do their part as well. Here is an article breaking down the timelines you need to remember for your long-term disability claims and appeals.
Obtain a lawyer
The appeals process can be daunting, and the paperwork can be tedious. Long-Term Disability lawyers will help you fill out your paperwork, collect additional medical evidence, stack your administrative record, and contact anyone that they need letters or forms from to help your case.
If you are overwhelmed or just have questions, we are willing to help.