If you applied for LTD benefits from your group disability insurance carrier and were denied, your next step is to file an appeal. In an ERISA governed claim, the appeal can be the most important step because it is likely your last chance to enter in new evidence in support of your disability.
The following LTD appeal checklist will help guide you in preparing and submitting an appeal:
Carefully review the denial letter
Read through the denial letter to understand why your claim was denied. This will help you understand what kind of information you need to gather in support of your appeal. The denial letter should also include appeal rights—the time frame under which you have to submit your appeal.
The deadline for the appeal is strict. Do not miss it or you may be precluded from perusing your claim further. Under ERISA, the deadline is typically 180 days from the date of the denial letter.
Gather all your medical records
Chances are your medical records were sent to your insurance carrier during the initial claim review. So, during the appeal you may only need to supplement with updated medical records.
However, it is also possible the insurance company did not obtain all relevant medical records. It is best to gather all your medical records and send them with the appeal to ensure you are not missing anything.
Request a letter from your treating physician detailing your disability
Support from your treating provider is one of the most important pieces in a disability claim. It is difficult to prove your claim if your doctors do not support your disability. With your appeal, you should submit a letter or questionnaire from your doctor detailing:
- Your medical condition(s)
- Any physical exam findings or objective testing
- The restrictions and limitations your doctor placed on you
- Your treatment plan and prognosis
Gather reports for any independent testing you have done such as neuropsychological evaluation, functional capacity evaluation and independent medical evaluation
In some cases, it is necessary to obtain outside testing from independent providers to prove your disability. We often use tests such as:
- Neuropsychological evaluation
- Functional capacity evaluation
- Independent medical evaluation
- Peer review
These tests can objectively establish restrictions and limitations and support what your doctors have reported about your medical condition and disability. When supportive, they are very helpful pieces of evidence in a disability claim.
Include personal statements from you and friends/family detailing how your disability impacts your life.
Personal statements corroborating your complaints of pain, cognitive impairment or other symptoms are impactful in a disability claim. They can help boost your credibility and provide insight into how your disability impacts your life.
Submit all evidence with a written appeal letter
Your appeal must be submitted to the insurance company timely and in writing. With the appeal letter, you should include all the medical and non-medical evidence you have gathered in support of your disability. The appeal letter should outline why the insurance company was wrong and highlight the medical and non-medical evidence that supports your claim.
The appeal may be your last chance to build up your file. In an ERISA claim, once the appeal is denied, you may not be able to enter new evidence in litigation. Because the appeal process is so crucial, you want someone who understands the process and what is needed to prove your claim.
The attorneys at Dabdoub Law Firm specialize in disability insurance. We have a track record of getting appeals approved using our disability insurance appeal strategy.
Help from a Lawyer with Expertise in Disability Insurance
This 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, and
- Filing a lawsuit against your disability insurance company.
Hiring an experienced disability attorney is important. 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.