What You Need to Know:
- Your long-term disability appeal may be your last chance to submit evidence.
- Missing the appeal deadline may permanently bar you from receiving benefits.
- You must directly address the reasons listed in your denial letter and build a strong, evidence-backed case.
- Dabdoub Law Firm has extensive experience handling LTD appeals nationwide—and we know how to beat the insurance companies.
A Long-Term Disability Denial Is Not the End—It’s the Beginning of Your Fight
Receiving a denial letter after filing for long-term disability (LTD) benefits is incredibly frustrating but it's not the final word. You have the right to appeal, and in many cases, this appeal is the most critical phase of the entire claim process. For most claimants covered by an employer-sponsored policy governed by ERISA (Employee Retirement Income Security Act), the appeal stage is also your last opportunity to submit evidence before a lawsuit.
That means what you do next could make or break your case.
Here are three critical steps you must take to strengthen your appeal and position yourself for success.
1. Submit All Supporting Evidence with Your Appeal
Under ERISA, once your appeal is denied, you generally cannot add any new evidence in court. The federal judge will only review the claim file. This means the documents you submit during the appeal could be the last opportunity to submit evidence in support of your disability.
To build a compelling appeal, you must include a complete and persuasive package of evidence that shows your inability to work due to your disabling condition.
Types of Evidence to Include:
- Comprehensive Medical Records: Include up-to-date clinical notes, imaging (MRIs, CT scans, X-rays), lab results, and prescription history that document your diagnosis, symptoms, and limitations.
- Treating Physician Statements: Obtain letters or completed questionnaires that specifically describe your restrictions and limitations. Your doctor should clearly state why you are unable to perform your job—or any job.
- Independent Medical Examinations (IMEs) or Functional Capacity Evaluations (FCEs): Objective testing, such as an FCE, can provide valuable third-party data on your physical limitations.
- Vocational Expert Reports: A vocational expert can compare your job duties and medical limitations to demonstrate your inability to meet occupational demands—even in other jobs.
- Personal Impact Statement: Explain, in your own words, how your condition affects your daily life. This brings a human element into the record and helps paint a clear picture of your reality.
- Testimonies from Friends, Family, or Coworkers: First-hand observations from people close to you can further validate your symptoms and limitations.
Bottom Line: The appeal file is your last chance—don’t hold anything back.
2. Submit Your Appeal Before the Deadline
One of the most damaging mistakes a claimant can make is missing the appeal deadline. Under ERISA, you typically have at least 180 days from the date of your denial letter to file your appeal. If you miss this window, you may permanently lose your right to further pursue your claim, even in court.
Here's How to Protect Yourself:
- Mark the Deadline Immediately: Count 180 days from the date on your denial letter and mark it on multiple calendars.
- Request the Complete Claim File: You have the right to request a copy of your claim file from the insurance company. This will give you insight into what they reviewed and how they justified their decision.
- Begin Gathering Evidence Immediately: Don’t wait until the last minute. Some documents, like updated medical records or expert evaluations, can take weeks to obtain.
- Hire a Disability Attorney Early: Working with an experienced long-term disability attorney from the beginning ensures your appeal is properly built and submitted on time.
The Consequences of Missing the Deadline:
- No Further Review: The insurer is not legally obligated to accept a late appeal.
- Barred from Filing a Lawsuit: Courts may dismiss your lawsuit if you haven’t exhausted administrative remedies (i.e., the appeal).
- Loss of Negotiating Power: Without an active claim, you lose leverage to negotiate a settlement or reinstatement.
Tip: Always read your denial letter carefully—it should explain the reason for denial and your right to appeal, including the deadline.
3. Directly Address the Reasons for Denial in Writing
Your appeal should not only provide more evidence—it should specifically refute the insurance company’s reasons for denial. A generic appeal letter with a few updated medical records won’t cut it.
The denial letter should list the basis for the insurance company’s decision. Use this as a roadmap to tailor your appeal.
Common Reasons for LTD Denial & How to Respond:
a) Lack of Objective Medical Evidence
The insurer claims your records don’t support the severity of your condition.
Solution: Submit updated records, physician letters, FCEs, and lab results that verify your symptoms and functional limitations.
b) Insurer’s Doctor Disagrees with Your Treating Physician
Insurers may rely on internal medical reviews by physicians who never examined you.
Solution: Have your treating doctor directly respond to the insurance company’s doctor. Consider seeking a second opinion from a specialist.
c) Claimant Can Perform “Other Work”
The insurer argues that you can still perform a different job.
Solution: Submit a vocational expert report and medical evidence showing that your limitations prevent you from performing any work, not just your own.
d) Condition Involves Subjective Symptoms (e.g., Pain, Fatigue)
Disorders like fibromyalgia, chronic fatigue syndrome, and mental health conditions are often harder to measure.
Solution: Supplement subjective complaints with functional evaluations, medication history, and third-party observations. You can also provide a diary tracking daily symptoms.
Why a Well-Written Appeal Makes All the Difference
The appeal letter isn’t just a formality—it’s your chance to take control of the narrative and make your case compelling. A well-prepared appeal includes:
- A clear statement disputing the denial
- A detailed response to each denial reason
- Supporting documentation and evidence
- A strong argument that ties all facts back to the policy definition of disability
A strategically written appeal maximizes your chance of approval and sets the stage for successful litigation if needed.
Why You Need an Experienced Long-Term Disability Attorney
Long-term disability insurance law is complex. The stakes are high and the appeal process is unforgiving.
At Dabdoub Law Firm, we are not general practitioners—we are a national law firm built exclusively for disability insurance cases. Every attorney on our team is dedicated solely to helping people get the long-term disability benefits they deserve.
Here’s Why Claimants Across the U.S. Choose Us:
- 100% focus on long-term disability and life insurance claims
- We’ve challenged every major insurance company, including Unum, MetLife, Hartford, Cigna, and more
- We’ve win cases in federal court
- We’ve recovered millions of dollars in benefits for our clients
- We represent clients in every state—you do not need to live near us for us to help
Call for a free consultation with an experienced disability attorney today. Pay no fees or costs unless you get paid.