What Is a Long-Term Disability Appeal?

A long-term disability appeal is your last chance to establish your disability with the insurance company before having to file a lawsuit. If your long-term disability benefits were terminated or denied, you usually have a right to appeal. It is generally an internal appeal with the insurance company.

If your disability claim is governed by a federal law known as ERISA, insurance companies must give you the right to appeal the disability denial. ERISA gives a minimum of 180 days to submit the first appeal. The 180 days begin to run when you receive the disability denial letter from your disability insurance company. You may also have a right to a second appeal. But the second appeal may have to be filed in less than 180 days.

All long-term disability appeals must be in writing. In many instances, an appeal for disability benefits is the last chance to develop your side of the case. If the final appeal is denied, your next step is to file a lawsuit.

Under ERISA, you are usually not permitted to submit any additional information once a lawsuit if filed. This is why it is so important that you submit all documentation and information that supports your disability during the appeal. This includes all relevant medical information.

You must also get help from your doctors during the appeals process. At the very least, your doctors should write letters that explain why you cannot work. Depending on your medical condition, you may also consider having certain medical evaluations done to prove your disability.

Medical evaluations could include a functional capacity evaluation (FCE) or independent medical examination (IME). For example, an IME can show your physical limitations.

After all appeals have been exhausted, your only remaining option is to file a lawsuit for disability benefits against your disability insurance company. If ERISA applies to your case, you and your doctors may not be allowed to testify in court. Additionally, no new medical information can be presented to the judge. You want to make sure you get all the support you can during the long-term disability appeals process.


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