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How to Appeal a Long-term Disability Denial

Understanding how to appeal a long-term disability denial is critical to your disability case. The appeal stage is typically your last opportunity to submit evidence - medical and nonmedical - to the insurer in support of your disability. In most cases, once you appeal is decided, your claim file closes.

How do I file an appeal with my disability insurance company?

Under ERISA, you have at least 180 days to submit an appeal. This should be outlined in the insurance company's denial letter.

The time frame is very important. You may not be able to submit an appeal simply by the passage of time.

Your appeal must be in writing. With your appeal, you should submit evidence from your doctors, your physical therapists, your psychiatrist or psychologist, and anyone else who treats your medical conditions. You can also submit nonmedical information that supports your disability and why you cannot work, such as a letter from a co-worker or friend describing your struggles.

Once your appeal has been submitted, under ERISA, the insurance company has 45 days to make a decision. The insurer is allowed to take one, 45-day extension for “special circumstances.” They must specify in writing the special circumstance that requires an extension.

As disability attorneys, we watch these deadlines very carefully. If the insurer is beyond the time frame to make a decision, we take action.

What will happen after I submit my appeal?

An insurance company is required to conduct a full and fair review of your claim. This means someone new, who was not involved in the initial review or denial, will review all the information in your file. They should also send your file for a medical review. This can be done by either an in-house physician or an outside physician contracted by a third party.

Most insurance policies give the insurance company the right to have you examined by a doctor or professional of its choosing. This means the insurer could send you to outside testing, such as:

  • a medical examination,
  • a neuropsychological examination,
  • a functional capacity evaluation.

An insurer may also conduct surveillance or do an internet/social media search on you. Additionally, they do a vocational review to determine if you are qualified for, and physically/cognitively capable of, working in other occupations.

If any of the evidence or information the insurer obtains or generates during the appeal is not favorable to you, they should give you an opportunity to review it and respond to it. You should respond to it and have your doctor respond to it as well. This is your last chance to submit any information that will help your claim.

Why is the appeal stage so important?

The appeal stage is your last chance to build up your case. If your appeal is denied, the next option is to file a lawsuit against your insurance company. At that point, the file is closed. This means that during litigation, you will not be able to submit new evidence or additional information to prove your disability.

Why do I need a disability insurance attorney?

The disability insurance attorneys at Dabdoub Law Firm have handled thousands of appeals with great success. We have filed appeals against every major insurance company involving a wide variety of medical conditions.

The experienced disability insurance attorneys know what kind of evidence is helpful to an appeal. More importantly, we know what kind of evidence is helpful to a judge who may be deciding your case if the appeal is denied.

We build up the file with medical evidence and non medical information. If necessary we send clients for outside testing to establish disability using an independent source. We have strategies and tactics with proven success that we have developed over years of handling disability insurance appeals.

Do not let your case be diminished by a bad appeal. Call today to speak with one of our lawyers who specialize in disability insurance. We spend every day working to get our clients long term disability benefits approved.