What You Should Know Before You Read:
- A long term disability denial is not the end of your claim. In many cases, the appeal is the most important stage as it may be your last chance to provide evidence of disability.
- Disability insurance appeals are governed by strict rules and deadlines, especially in ERISA claims.
- The work up of your claim file and evidence often determines whether benefits are paid or permanently denied.
- Dabdoub Law Firm focuses exclusively on disability insurance claims and has a proven track record of success in complex long term disability appeals and federal court litigation nationwide.
Why the Appeal Stage Is So Critical in Long Term Disability Claims
When an insurance company denies a long term disability claim, the appeal process is often your last chance to work up your file with supportive evidence of disability. For most ERISA governed claims, once you are in litigation, you are generally limited to the evidence submitted during the appeal. If key medical records, doctor’s letters or testing are missing, you may not get a chance to provide them after the appeal is denied.
Insurance companies know this and use it to their advantage. That is why long term disability denials are often written broadly or vaguely. The goal is to see whether the claimant understands how to respond or makes mistakes that weaken the record. Following a structured, strategic approach is essential to securing an approval.
The seven steps below outline how to build a strong long term disability appeal.
Step 1: Request the Entire Claim File
The first step after a denial is requesting, in writing, your complete claim file from the disability insurance company. You are entitled to this file, and it is critical to understanding how and why the insurer denied your claim.
The claim file typically includes internal notes, medical reviews, vocational assessments, correspondences, and any evidence the insurer reviewed and relied on in making a claim determination. It often reveals errors, omissions, or biased reviews that are not apparent from the denial letter alone.
Without the claim file, you are appealing in the dark.
Step 2: Carefully Review the Disability Insurance Denial Letter and the Reasons Given
The denial letter outlines the insurance company’s stated reasons for denying your claim. These reasons form the framework of your appeal. Every rationale listed must be addressed directly and thoroughly.
Insurers commonly deny claims by arguing that:
- There is insufficient medical evidence
- The claimant does not meet the policy definition of disability
- The medical records do not support functional limitations
- The claimant can perform their occupation or another occupation
- The condition is subject to a policy limitation
A successful appeal does not ignore these arguments. It picks them apart them one by one using medical and non-medical evidence.
Step 3: Gather Thorough and Clear Evidence of Disability
Strong appeals are built on strong evidence. This includes more than routine medical records. The goal is to clearly demonstrate how your condition prevents you from performing the material duties of your occupation.
Effective evidence often includes:
- Detailed letters of support from all treating physicians
- Functional capacity evaluations or other functional testing when appropriate
- Specialist records that explain diagnosis, progression, and limitations
- Consistent treatment history and medication records
- Documentation of symptom severity and frequency
Treating doctors should explain not only what your condition is, but also detail how it limits your ability to work in practical, real-world terms.
Step 4: Prepare a Personal Statement
Your long term disability appeal should include a written declaration in your own words explaining your disability. This is your opportunity to humanize the claim and provide context that medical records alone cannot capture.
A strong declaration explains:
- What your work and daily life were like before your disability
- How your condition developed or worsened
- What a typical day looks like now
- The physical, cognitive, and emotional impact of your symptoms
- Why you can no longer work reliably or safely
This declaration should describe the real impact your disability has on your day to day life and corroborate the restrictions and limitations listed in your medical records.
Step 5: Write a Persuasive and Comprehensive Appeal Letter
The appeal letter is the backbone of your case. It should clearly explain why the denial was wrong, how the evidence supports disability, and why the policy terms entitle you to benefits.
A strong appeal letter:
- Addresses each reason for denial directly
- Explains how the medical evidence supports disability
- Clarifies occupational duties and why they cannot be performed
- Corrects misstatements or omissions in the claim file
- Applies the correct policy language
- Makes clear legal arguments under ERISA or state law
This is not a form letter. It is a detailed legal and factual argument designed to force the insurer to confront the strength of your claim.
Step 6: Track the Insurer’s Deadline and Be Ready To Enforce It
After your appeal is submitted, the disability insurance company generally has 45 days to issue a decision, with limited circumstances allowing an extension. The law requires an extension be based on a “special circumstance" which must be something out of the insurers control.
The appeal deadlines matter.
If the insurer fails to issue a timely decision, it may open the door to legal action before a formal denial issues. This is called deemed denied–the claim is deemed denied because a timely decision was not given. Once in litigation, you may have a legal advantage because of the statutory violation of the deadline. Delay is a common tactic, and being prepared to enforce your rights can change the insurer’s approach.
Understanding and tracking these deadlines ensures the appeal does not stall indefinitely.
Step 7: Respond to Any Medical or Vocational Reviews the Insurance Company Sends You
During the appeal process, disability insurance companies often obtain medical or vocational reviews from doctors or consultants they hire. These reviewers do not examine you but rather review your paper records and write a report addressing questions posed by the insurance companies. Even if their opinions differ from your treating doctors, the insurance company will rely on them to justify a long-term disability appeal denial.
Insurer-hired reviewers often:
● Cherry-pick medical records
● Mischaracterize treating physician opinions
● Downplay symptom severity
● Ignore evidence of functional limitations
● Apply incorrect occupational assumptions
Under ERISA, the disability insurance company is required to send you a copy of any adverse report or information generated during the appeal review process and give you an opportunity to review and respond to it before issuing a final long term disability appeal denial. It is critical to respond to these reviews.
An effective response may include:
● Point-by-point rebuttals identifying factual or medical errors
● Updated or clarifying letters from treating physicians
● Additional medical records or testing that contradict the reviewer’s conclusions
● Vocational evidence explaining why the reviewer’s job analysis is flawed
The appeal record must clearly show why the insurer’s reviewers are wrong and why your treating doctors’ opinions are more reliable. Failing to respond can significantly weaken your case, especially if litigation becomes necessary.
How Dabdoub Law Firm Helps Win Long Term Disability Appeals
Dabdoub Law Firm focuses exclusively on disability insurance claims. We represent clients nationwide and have taken on every major insurance company. Our attorneys understand how insurers deny claims and how to build appeals that succeed.
We help clients nationwide by:
- Obtaining and reviewing complete claim files
- Identifying errors and misstatements in insurer reviews
- Working with treating physicians to strengthen evidence
- Gathering medical and non-medical evidence in support of disability
- Writing comprehensive appeal letters
- Enforcing insurer deadlines
- Filing and litigating cases in federal court
Our firm was built to win long term disability cases. If your claim has been denied, the appeal is your opportunity to turn the case around. We know how to do it correctly