If your long-term disability claim resulted in a denial, you have the right to appeal. Here’s how to gather important documentation to support your appeal and write a long-term disability appeal letter to your insurance provider.
1. Read and understand your disability denial letter
Your disability denial letter is the first step in approaching your long-term disability appeal.
It should give you the following information:
- Why your claim was denied
- The timeframe in which you must gather all supporting documentation
- When your disability appeal letter will be due
Denials for long-term disability insurance claims can happen for many reasons and are far too common. Your insurance provider might cite insufficient medical evidence, failure to meet a policy definition of disability, or even missed deadlines. But rest assured, you have the right to appeal and make your case heard.
Review your disability denial letter carefully, and make a list of issues that you disagree with or think you have documentation to challenge.
2. Request your claim file
The claim file for your disability case is where you’ll find all records that could be used to decide your case. When you appeal, the contents of that claim file will determine the results of the appeal.
If you are filing an appeal on a long-term disability policy governed by ERISA, the contents of your disability claim file must be provided to you at your request for free.
Not sure if your plan is governed by ERISA? Learn about the difference between ERISA and Individual Disability Insurance here.
Some sample language that might help you in forming your request for your claim file:
“Please send me a copy of the claim file for my long-term disability insurance policy. I will notify you at a later date when I intend to appeal.”
When requesting your claim file:
- Send your request directly to your disability insurance provider
- List any claims number(s) and copy any claims examiner(s) listed on your denial letter
- Request your claim file via certified mail or fax so you have proof of delivery
- Keep a record of your requests, including how and when you made them
It is common to receive a claim file and realize there is missing information that would help to clarify the issues surrounding your claim. Take note of anything missing from your claim file and follow up with your insurance company with specific requests for any missing information.
3. Obtain a copy of your insurance policy
In addition to your claim file, you will benefit from having a copy of your long-term disability insurance policy.
If you obtained your policy through your employer, then you can usually get this from your Human Resources representative for your current or former employer.
If you purchased your policy on your own, then you need to request the policy from the agent that helped you purchase the policy or directly from the insurance company itself.
4. Collect any other supporting documentation
This step is a bit more difficult to summarize because it will vary for every case.
Additional documentation that could be helpful:
- Any relevant medical records that were not submitted in your original claim (this includes any doctor you have seen for the condition that you are claiming)
- Any and all supporting medical tests, exams, screenings, appointments, etc.
- Personal statements from friends and family stating facts about your condition
- Written opinions from your doctor and other medical professionals
- Employment records that demonstrate how your condition has affected you at work (e.g. annual reviews, accommodations, citations, awards, letters, and anything else that might be related to how your condition has impacted your work
If your policy is governed by ERISA, this is the last time you will be able to add to your claim file. If your case goes to court, you will only be allowed to show the judge information contained in the file.
Under ERISA, you will not be able to add any additional evidence once the appeal process is completed. It’s best to err on the side of submitting more rather than less information with your appeal.
Wondering whether a piece of evidence is worth including in your appeal? Reach out to us today, and we will give you feedback.
5. Find decisions from other agencies about your disability
If other agencies have determined you are disabled and unable to work, be sure to include this in your appeal letter.
For example, if you’ve been approved for Social Security Disability Insurance (SSDI) or VA (Veterans) Pension or Compensation, this could work in your favor for your long-term disability appeal.
Include any relevant information from other benefits processes with your long-term disability appeal. This could be anything from a simple approval letter to a detailed disability analysis.
6. Write your long-term disability appeal letter
By now you should understand why your claim was denied, what evidence is missing, where to get it, and how it all applies to your appeal. It’s now time to start writing your disability appeal letter.
Your disability appeal letter should include:
- Your case or claim number
- The plan or policy number
- A list of each and every flaw you found in the insurance company’s denial
- Facts as to why the denial was wrong (include medical evidence or doctor’s personal statement)
- Citations to statutes, regulations, or court cases that back up your position
- Copies of any additional information you want the insurance company to consider with your appeal. Let us review your disability appeal letter to ensure you’ve covered all the bases.
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.
Important: Be sure to meet all deadlines!
Under ERISA 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 your time to get the information in your claim correct, 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 to enforce your claim.
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. If you need help at any point during the process, just give us a call.