How to Appeal a Long-Term Disability Benefits Denial

On Behalf of | Jun 1, 2022 | Long-Term Disability |

More often than not, disability insurance carriers deny initial applications for long-term disability benefits. If this happens, you’ll need to move fast if you want to appeal the decision. Deadlines for appeals are usually short, and you’ll have to gather quite a bit of information before you can file.

Calendar the due date for your disability benefits appeal

If your disability insurance carrier sends you a letter denying your claim, read it carefully. This letter will explain why the carrier denied your claim, including language from your plan. It will also provide a list of the additional information that you can provide to support your claim as well as the deadline for you to appeal the denial.

In most long-term disability plans covered by the Employee Retirement Income Security Act (ERISA), you’ll have 180 days from the date of the denial to appeal. If you miss this deadline by even one day, you can be prevented from receiving long-term disability benefits.

Ask the carrier for a copy of your disability claim file

Long-term disability insurance carriers must send claimants a complete copy of their claim file under ERISA. They must provide the file at no charge, no matter whether your file is 10 pages or 10,000.

The file must include all information you submitted as well as the insurance carrier’s medical reviews, any medical records the carrier collected, your long-term disability insurance plan documents, the carrier’s internal emails and notes, and any reports of video surveillance. Given the potential quantity of documents, you should expect the carrier to take several weeks to a month to prepare the file.

Obtain additional medical support

Depending on the reason for denial, you may need to obtain extra medical treatment from your current doctor or a different specialist. Additional evaluations and diagnostic test results can give the carrier more information about your restrictions and limitations. You may need an MRI, X-rays, or functional capacity testing to provide proof supporting your disability claim.

Gather additional evidence that you can’t perform your job

Disability carriers tend to minimize job duties. So you may need to gather more evidence to show that you can’t perform the duties of your current occupation or any occupation. Your carrier will look to a national standard rather than your particular job. However, you can add support for your claim by preparing what’s called a vocational analysis or labor market survey, which will show how your job duties don’t match how your carrier has defined them, whether that’s as light or medium duty.

Draft a personal statement

A truthful personal statement about how your disability is preventing you from working full-time can add support to your claim. To write this statement, describe a typical day in your life, explaining how your disability is interfering with your job duties. You may also be able to get supplemental statements from your co-workers or family members who can describe your medical limitations and your inability to work.

Be sure not to exaggerate. If your story doesn’t match what the insurance carrier observes and the rest of your record, you may wind up in trouble.

Write an appeal letter

This letter ties together all of the evidence you’ve gathered and explains why your disability satisfies the terms of your long-term disability policy. This letter should be detailed and include personal statements from you, co-workers, and family members and extensive medical evidence.

Ask for the help of an experienced long-term disability lawyer

No two long-term disability claims are alike. That means there’s no one-size-fits-all approach to filing an appeal if you’ve been denied benefits. An experienced long-term disability lawyer, like the disability attorneys at Hunter & Everage, can review your denial letter and claim file and help you fill any gaps with the right statements and evidence to support your claim. Contact us today for a free, no-obligation consultation about your long-term disability claim.

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