Receiving a denial for your long-term disability claim can feel overwhelming, but it doesn't have to be the end of the road. Many denials are reversed upon appeal, provided you approach the process strategically. Understanding why your long-term disability claim was denied and taking steps to strengthen your case are key to securing the benefits you need. With a tenacious and well-informed approach, you can tackle this challenge and improve your chances of success. Below, we outline critical steps to help you through the disability appeal process.
Understanding the Denial of a Long-Term Disability Claim
Common Reasons for a LTD Denial
Disability claims are often denied due to insufficient medical evidence, failure to follow prescribed treatments, or the wrongful application of a policy limitation or exclusion.
- Insufficient paperwork or incomplete records failing to demonstrate restrictions and limitations do not prove the severity of the condition, leading to denials.
- Noncompliance with treatment plans can suggest the disability is not as limiting as claimed, making it critical to show adherence or provide valid reasons for gaps.
- LTD policy limitations and exclusions can lead to denials and are often wrongly applied by insurance companies. It is important to understand what the policy defines as the exclusion or limitation and determine if it is appropriate in your case.
Addressing these pitfalls with targeted documentation, objective medical evidence, support from treating providers and clear explanations during your appeal will give you a stronger position to contest the denial.
Reviewing Your Denial Letter
Your denial letter holds the key to understanding why your claim was rejected and what you need to fix. The denial should outline what policy language was relied upon in the denial so it may be beneficial to review your LTD policy as well.
The denial letter outlines the specific shortcomings in your case, such as insufficient medical records or unconvincing vocational expert opinions. These details point to the areas requiring more robust evidence, so thoroughly dissect the letter and take notes about what needs addressing.
If your medical evidence was deemed inadequate, work on securing updated or additional detailed records. Similarly, if your insurance company used medical reviewers’, or vocational reviewers’, opinions to support the LTD denial, gather your own independent evidence and challenge the insurers' evaluations. By using the denial letter as a roadmap, you can strategically build your appeal.
Preparing for the Appeal Process
Gathering Additional Evidence
When preparing for an appeal, advancing your case requires assembling accurate, detailed, and relevant evidence. Updated medical tests or treatment reports should directly demonstrate the severity of your condition. Expert opinions, especially from your treating physician or specialists, can provide insight into how your disability affects your ability to work. Focus on addressing the reasons outlined in your denial letter with targeted evidence that reinforces the facts—medical and non-medical—of your claim. Showing active efforts, such as undergoing new treatments or assessments, can further strengthen your case. Quality and relevance of the evidence are key to undoing the reasons behind the initial denial.
Understanding Appeal Deadlines and Procedures
Deadlines are crucial in the disability appeal process, and missing them can end your chances of contesting the denial. Your LTD denial letter should include a section on appeal rights. Under ERISA, you have 180 days to submit your appeal. Start by calendaring that deadline.
Next, work on gathering documentation that supports your disability and rebuts the insurance companies’ position that you are not disabled. This could include:
- Letters and questionnaires from your doctors and other treating providers
- Updated medical evidence, testing, lab results, and imaging reports
- Personal statement from you detailing your daily struggles, and what prevents you from working
- Symptom diary
You may also need to gather outside evidence such as:
- Functional capacity evaluation
- Cognitive testing
- Independent medical evaluation
- Vocational report
Crafting a Strong Appeal
Writing a Compelling Appeal Letter
Once you have all your medical and non-medical evidence in hand, your next step is to compose a comprehensive appeal letter. Your appeal letter is your opportunity to directly address the reasons for your original denial and present compelling new evidence. It must be in writing and clearly state your intention to appeal the long-term disability claim denial. You should provide a concise yet thorough explanation of why the initial decision was incorrect.
Personalize the letter by describing how your disability impacts your daily life, while also including medical documentation and third-party testimonies from family or coworkers. Tying the evidential upgrades to the exact shortcomings identified in the denial letter makes your case stronger. By structuring your arguments strategically, you present a focused and persuasive appeal that answers the evaluators’ concerns.
Seeking Professional Help
Navigating the appeal process can be intimidating and complex. However, it is also the most important part of a long-term disability claim because it is your last chance to provide supporting evidence of your disability. If your disability insurance company denies the appeal, your final step is to take legal action. In most cases, during litigation, you are unable to enter new evidence. That means whatever is in your claim file at the time of the long-term disability appeal denial is all you have to present to the judge.
Long-term disability attorneys specialize in presenting strong cases by gathering evidence, managing deadlines, and countering insurance company tactics. Partnering with experts in long-term disability appeals can significantly improve your chances of a favorable result.
Help from a Lawyer with Expertise in Disability Insurance
Dabdoub Law Firm was built to be a disability insurance law firm. That focus means:
- All of our lawyers specialize in disability insurance claims;
- We have experience with every major disability insurance company;
- We have won important long-term disability lawsuits.
Our disability lawyers can help you with:
- 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.
It is important to hire an experienced disability attorney, and at Dabdoub Law Firm, we’re here to help. Because federal law applies to most disability insurance claims, our lawyers do not have to be located in your state.
Call (800) 969-0488 for a free consultation with an experienced disability attorney. Pay no fees or costs unless you get paid.