Understanding the Appeals Process
Filing a long-term disability insurance appeal can seem daunting, but understanding the steps involved can make the process more manageable. The first step is to review the denial letter you received from your insurance company, which should outline the reasons for the denial and the deadline for filing an appeal. Typically, especially in an ERISA governed disability claim, the deadline is 180 from the date of the denial letter.
Missing this deadline can result in losing your right to appeal or pursue the claim further, so it’s crucial to act promptly. The next step is to gather all necessary documentation, including medical records, doctor's notes, and other evidence supporting your claim and disability. This documentation will form the backbone of your appeal, demonstrating the severity of your condition and its impact on your inability to work.
Once you have your documentation in order, you will need to submit a written appeal to your insurance company. This appeal should include a detailed explanation of why you believe the denial was incorrect, supported by the evidence you have gathered. Be sure to follow any specific instructions provided by your insurance company regarding the format and content of the appeal. It’s often helpful to consult with an attorney who specializes in long-term disability insurance claims to ensure that your appeal is as strong as possible.
Timeline of the Appeals Process
ERIS sets out the timeline for both you and your insurance company when it comes to when an appeal must be submitted and how long it can take to be decided. You have up to 180 days from the denial letter to submit an appeal to your insurance company.
Once you submit the appeal, the clock starts ticking for the insurance company to make a decision. ERISA requires a decision be made within 45 days of receipt of the appeal. There is one 45-day extension allowed for a “special circumstance.” The special circumstance must be something outside the insurance company’s control that has prevented it from making a timely decision. Waiting for a medical review or vocational review is not a special circumstance – those are fundamental parts of the appeal review that are required of the insurance company. However, insurance companies like to use those as excuses to buy more time and extend their decision making. If your disability insurance company is claiming it needs more time to make a decision on your appeal due to a “special circumstance,” contact an experienced disability insurance attorney today and discuss your options. Do not let the insurance company drag out your appeal unnecessarily.
Tips for a Successful Appeal
Clear and concise communication is essential for a successful long-term disability appeal. This includes effectively articulating your condition, its impact on your ability to work, and the evidence supporting your claim. Ensure all documentation and evidence you submit is well-organized, clearly labeled, and easy to navigate. This includes medical records, doctor's notes, and other supporting documentation.
Follow up after the appeal is submitted and ask questions to your insurance company. You can ask things like:
- Is there anything else you need to approve my claim?
- What about my evidence is not clear that I cannot perform my own occupation or any occupation?
- What about my doctor’s letter indicating I suffer from a medical condition that causes restrictions and limitation is unclear?
Staying Organized
Staying organized is crucial throughout the long-term disability appeals process. This includes keeping track of all documents, deadlines, and correspondence related to your case. This also includes creating proof of documents and letters submitted to the insurance company, whether it is by email or fax. Having those confirmations is important in the event the insurance company claims they did not receive something.
In addition to organizing your evidence, keeping track of deadlines and ensuring all required documentation is submitted on time is important. Missing a deadline can result in delays or even the denial of your appeal. Keeping a calendar or planner with important dates and deadlines can help you stay on track and ensure that you are fully prepared for the hearing. Staying organized and proactive can significantly increase your chances of a successful appeal.
Contact Dabdoub Law Firm
Navigating the long-term disability appeals process can be complex and challenging, but you don’t have to go through it alone. At Dabdoub Law Firm, we specialize in ERISA and long-term disability law and are dedicated to helping individuals nationwide.
Help from a Lawyer with Expertise in Disability Insurance
Disability insurance law is complex. Hiring an experienced disability attorney is important. Because all disability lawyers at this law firm focus on disability insurance claims, we have expertise in disability insurance law.
That means having:
- Experience with every major disability insurance company;
- A proven track record of success in winning major disability lawsuits;
- Recovered millions of dollars in disability benefits for clients;
And we never charge fees or costs unless our clients get paid.
The firm can help at any stage of your disability insurance claim, including:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; or
- Filing a lawsuit against your disability insurance company.
Because federal law applies to most disability insurance claims, our lawyers are able to represent clients across the country.
Call to speak with an experienced disability attorney. Consultations are free.