If your insurance company has denied your long-term disability claim, you have the right to appeal. Writing an effective appeal letter can significantly improve your chances of overturning the denial.

In this article, we’ll discuss the key elements of a successful appeal letter for a denied disability claim. We’ll also provide helpful tips and a sample appeal letter as a guide for getting started.

Here’s what we’ll cover:

Understanding long-term disability appeals

Before diving into the specifics of writing your appeal letter, it’s important to acknowledge that filing a long-term disability appeal can be stressful and overwhelming.

Most long-term disability policies are governed by ERISA law. The ERISA appeal process is complicated by design, involving rigid deadlines and no second chances if you make a mistake.

Although filing a long-term disability appeal can seem daunting, remember you’re not alone. A qualified lawyer with expertise in ERISA can handle all the details for you and can make all the difference in the outcome of your appeal.

Read more: How to Appeal a Long-Term Disability Denial

Review your denial letter

When your claim is denied, the insurance company will send you a letter that outlines why your claim was denied. You must review your denial letter carefully to identify the areas where your initial claim may have fallen short.

You should also request your claim file from your insurance company to check for inaccuracies or missing information.

Common Reasons for Denial

Understanding why your claim was denied will help you determine what to address in your appeal letter. Some typical reasons for a denied claim include:

  • Insufficient medical evidence
  • Lack of documentation supporting the extent of your disability
  • Missed deadlines or incomplete forms
  • Discrepancies in your medical records

Gather supporting documentation

One of the most critical aspects of an effective disability appeal letter is providing relevant documentation to support your claim. Below are the types of evidence you should consider including.

Medical records

Medical records are the backbone of any disability claim. Ensure you have up-to-date records from your healthcare providers that clearly outline your diagnosis, treatment plans, and the impact of your medical condition on your ability to work. If possible, include:

  • Doctor’s notes and evaluation reports
  • Diagnostic test results
  • Treatment plans and progress notes

Personal statements

In addition to medical records, a personal statement detailing how your disability affects your daily life and ability to work can be compelling. Use this opportunity to share your story and paint a vivid picture of your challenges with your medical condition.

Witness statements

Letters from family members, friends, colleagues, or supervisors who can attest to the changes in your abilities and lifestyle due to your disability can also be valuable. These testimonials provide an additional perspective on your situation and help support your case.

Proof of SSDI approval

If you’ve been approved for Social Security Disability Insurance (SSDI) benefits, include these documents. This can strengthen your long-term disability appeal because the Social Security Administration (SSA) and many insurance providers have similar criteria.

How to structure your appeal letter

A well-structured appeal letter is important to clearly communicate your arguments and evidence. Consider the following structure:

Opening statement

Begin your letter by clearly stating your intention to appeal the decision and provide your policy number or claim reference. This sets the stage for the rest of your letter.

Explain your situation

Briefly summarize the circumstances of your disability and the reasons for your initial claim. This provides context for the reviewer and helps them understand your perspective.

Address the reasons for denial

Refer to the denial letter and address each reason for denial with specific evidence. For example, if your claim was denied due to insufficient medical evidence, provide additional records or clarify any discrepancies.

Present new evidence

Introduce any new evidence that wasn’t included in your initial claim, such as relevant medical documentation and testimonials. Highlight its relevance and explain how it supports your case.

Conclusion and call to action

Conclude your letter by summarizing your key points and reiterating your request for a review of the decision. Politely ask for a response within a reasonable timeframe and provide your contact information for any further inquiries.

Tips for writing an appeal letter

Writing an appeal letter can be challenging, but following these tips can help you craft a compelling argument:

Be clear and concise

Avoid lengthy explanations and focus on the most pertinent information. Use clear language to articulate your points.

Stay professional

Maintain a professional tone throughout the letter. Avoid emotional language and stick to factual statements.

Proofread

Carefully review your letter for grammar and spelling errors. A well-polished letter reflects your attention to detail and professionalism.

Seek assistance

Consider seeking help from a long-term disability attorney who specializes in ERISA long-term disability claims. They can provide valuable guidance and ensure that your letter is well-structured and includes all necessary evidence.

Sample long-term disability appeal letter

To help you get started, below is a basic template for a long-term disability appeal letter. Customize it to fit your specific circumstances and include all relevant details. 

Important: Submit your appeal letter via certified mail or fax. Be sure to follow up with the insurance company to confirm they received it and document who you spoke to and when.

[Your Name]

[Your Address]

[City, State, ZIP Code]

[Your Phone Number]

[Your Email Address]

[Date]

[Insurance Company Name]

[Insurance Company Address]

[City, State, ZIP Code]

Re: Appeal for Long-Term Disability Claim Denial

Policy Number: [Your Policy Number]

Claim Number: [Your Claim Number]

Dear [Claims Adjuster’s Name or Appeals Department],

I am writing to formally appeal the denial of my long-term disability claim referenced under Claim Number [insert Claim Number]. I have reviewed the denial letter dated [Date of Denial Letter] and would like to provide additional information and evidence to support my case.

[Briefly explain your situation and the reasons for your initial claim.]

The denial letter cites the following reasons for denying my claim [insert the specific reasons for denial as stated in the letter from your insurance company]. I would like to address each of these points in detail:

  1. [Reason for Denial #1]. To address this, I have included [Explanation of Additional Evidence and How It Supports Your Claim].
  2. [Reason for Denial #2]

Given the above considerations, I respectfully request a thorough review of my claim and the accompanying documentation that I have provided. I believe that a careful reconsideration will demonstrate that my claim is valid and should be approved in accordance with the terms of my insurance policy.

For your reference, I have included copies of all relevant documents that support my appeal, including [list the items, such as medical records, receipts, policy documents, or any other pertinent information]. I am hopeful that this additional information will clarify any misunderstandings and facilitate a favorable resolution.

Please confirm receipt of this appeal and inform me about the next steps in the review process.

Thank you for your attention to this matter. I look forward to your prompt response. Please feel free to contact me at [your phone number] or [your email address] should you require any further information or clarification regarding my appeal.

Sincerely,

Your Name

Be sure to meet all deadlines

Under ERISA law, you only have 180 days to appeal, so you should start the appeal process as soon as possible. It takes time to collect additional evidence, and if you are using disability lawyers, they will need time to do their part as well.

Take the necessary time to gather the correct information in your claim, but keep in mind how important it is to be timely as well. Under ERISA, if you miss your appeal deadline, then you are barred from taking any further legal action on your claim.

Read next: Avoid These 6 Common Mistakes in Your Long-Term Disability Appeal

You don’t have to do this alone

The appeal process can be daunting, with strict deadlines and requirements, and the paperwork can be tedious. At Roy Law Group, we go up against insurance companies every single day and disability law is all we do. If you’d like advice on your appeal, don’t hesitate to contact us.

This article was originally published on October 18, 2017, but has since been updated for accuracy and relevancy.

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