What You Should Know Before You Read:
- If your long-term disability claim is denied, you have the right to appeal that decision under federal law.
- The appeal stage is your best opportunity to strengthen your case with additional evidence.
- Strict deadlines and procedural rules make this process complex and time-sensitive.
- Dabdoub Law Firm focuses exclusively on disability insurance claims, representing clients nationwide with a proven record of winning in federal court.
Understanding Long-Term Disability Appeals
A denial letter from your insurance company does not mean your claim is over. The appeal process is a critical second chance to present your evidence, correct any deficiencies, and challenge the insurer’s specific denial reasons. However, it is also one of the most technical stages of a disability claim, and the strict rules of the Employee Retirement Income Security Act (ERISA) apply to most employer-provided policies.
Knowing what to do and what to avoid can significantly improve your chances of success.
1. Do Act Quickly and Track Your Deadlines
Time is limited. Most long-term disability policies give you only 180 days from the date of receipt of the denial letter to submit your appeal. Missing that deadline almost always results in a complete loss of rights under your policy.
Do:
- Mark your appeal deadline immediately upon receiving the denial letter.
- Begin gathering documentation as soon as possible.
Do Not:
- Wait until the final weeks to start your appeal. Building a strong submission takes time because more and stronger evidence of disability has to be compiled.
2. Do Request and Review the Claim File
Under ERISA, you have the right to request a complete copy of your claim file from the insurance company. This file includes everything related to your long-term disability claim, such as medical reports, vocational assessments, internal notes, and any other materials used or generated during the course of the claim review.
Do:
- Review every part of your claim file carefully to understand how the insurer justified the denial.
- Identify missing records or misstatements that can be corrected in your appeal.
Do Not:
- Rely on the insurer’s disability denial letter alone. The letter might not address key evidence or may misrepresent your treating physicians’ opinions.
3. Do Strengthen the Record with New Evidence
The appeal is often your last chance to submit new medical or vocational evidence. If an appeal is denied, your next step is bringing a lawsuit in federal court. Courts usually review only what is in the insurance company’s claim file, commonly referred to as the “administrative record.”
Do:
- Obtain updated medical reports, letters from your treating physicians, and statements from family or coworkers describing your limitations and their observations.
- Get support from medical expertsor testing, like functional capacity evaluations or neuropsychological evaluations, when appropriate.
Do Not:
- Simply restate the same evidence from your initial claim. The appeal must demonstrate why the insurer’s decision was incorrect and even unreasonable, supported by objective medical documentation.
4. Do Submit the Appeal in Writingl
ERISA requires that all appeals be submitted in writing. An appeal is a legal argument as much as it is a factual presentation. It’s important to present it in writing,clearly and supported by evidence, but it’s also required by law to be written.
Do:
- Submit your written appeal via facsimile, certified U.S. Mail, or some other form that confirms it was timely submitted.
- Follow up with the insurance company to confirm receipt..
Do Not:
- Rely on assurances by an insurance company’s representative that you can verbally request and appeal or that the company will conduct a new review without requiring you appeal..
5. Do Work With an Experienced Disability Attorney
The appeal process is complex, time-sensitive, and too important not to be done the right way. Once the appeal is denied, the record closes, and new evidence typically cannot be added if the case proceeds to court.
Working with an attorney who has expertise in long-term disability appeals greatly increases the likelihood of getting your benefits approved. An experienced attorney understands both the legal and medical aspects of disability insurance claims, which makes all the difference.
Do:
- Retain an attorney early. It’s never too soon for an attorney to guide your appeal strategy, review your claim file, and build a thorough and complete appeal.
- Choose a law firm that focuses exclusively on disability insurance claims and has a proven record against insurance companies.
Do Not:
- Attempt to handle your appeal alone. Even strong claims can fail due to mishandling of the appeal process.
How Dabdoub Law Firm Can Help
The long-term disability appeals process requires a deep level of experience, a proven strategy, and expertise in ERISA law.
Dabdoub Law Firm represents clients nationwide at every stage of their disability insurance claims, including:
- Filing a disability insurance claim to correct a denial.
- Appealing a wrongful termination of benefits when insurers stop paying despite ongoing disability.
- Negotiating a lump-sum settlement when it is strategically beneficial for clients.
- Litigating long-term disability claims in federal court when the insurer refuses to act in good faith or comply with its obligations under the insurance policy.
Our attorneys have taken on every major insurance company and have a verifiable record of victories in federal court. Because we focus exclusively on disability and life insurance law, we understand how to navigate complex policies, medical evidence, and procedural rules to win benefits for our clients.