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Steps to Appealing a Short or Long Term Disability Insurance Denial

Receiving a denial letter from your short or long-term disability insurance carrier can be an upsetting, frustrating, and overwhelming ordeal. During a period when you or a loved one should be prioritizing your health, wellbeing, and recovery over all else, suddenly having to submit new evidence and adhere to strict deadlines can seem like an especially difficult (if not impossible) load to carry.

If you have recently received a denial letter in the mail, do not lose hope. Instead, reach out to one of the skilled attorneys at Murray Law Office and do your best to follow the below steps.

Step 1: Review the Denial Letter Carefully and do Your Homework

Although it may be tempting to disregard or throw away any type of correspondence informing you that financial payments will no longer be made, the denial letter is actually one of the most important pieces of information in an ERISA long-term disability appeal. The denial letter is very important as (among other things) it sets forth the specific reasons behind why you received a denial, will provide the medical records or other information that was relied on by your long term insurance carrier, and provides generic suggestions for the type information a claimant should provide along with their appeal to substantiate their claim.

Your long-term disability insurance carrier is not under an obligation to help you make your case for you, so you must make sure you fully comprehend and appreciate the reasons given for your denial in your denial letter and get your ducks in a row before you respond to them. As it is your burden to prove your entitlement to benefits, successful long-term disability appeals are the ones that address and provide proof for each reason given by the insurance company as to why you are not disabled nor entitled to benefits.

Another important reason to review a long-term disability denial letter is that it will outline the remedies available to a claimant moving forward. If an appeal is available, the denial letter should include the deadline by which the appeal must be submitted (usually 180 days from the date of the denial). If you have the ability to appeal your insurance company’s denial, make sure to calendar this deadline well in advance. You are required to submit your long-term disability appeal by this deadline and you will not be barred from pursuing your case any further if you miss this deadline.

Step 2: Consider contacting an experienced ERISA Short or Long Term Disability Attorney

You will likely have a number of questions after reading through the denial letter. These questions are important, and an ERISA attorney can help to both answer these questions and assist you in determining whether you would like to obtain legal representation moving forward.

Unfortunately, once you have appealed and exhausted all of your administrative remedies, a lawyer will not be able to step in and supplement what you submitted with your appeals with additional evidence after this process has been concluded. As such, your appeal is technically your day in court. Accordingly, it is HIGHLY advisable to seek representation at this juncture as you run the risk of irreparably harm any potential recovery if you try to do your own legal work and fail to submit sufficient proof under the relevant case law that you are disabled.

Given the strict deadlines associated with ERISA appeals, do not wait to contact someone. While an attorney can successfully identify and craft the medical and legal arguments unique to your case, this work is dependent on having the necessary time to do so before your appeal is due. Additional tasks, such as reviewing your policy documents, claim files, and medical records, likewise require many hours to complete and must be finished well in advance of your deadline to appeal.

Step 3: Request your Long Term Disability Claim File

Once you have figured out whether you want to seek legal assistance or do it your own, the next step should be to request a copy of your long-term disability insurer’s claim file. Every claimant under ERISA is permitted to request a copy of all relevant documentation your disability insurance carrier relied on when making a decision. Instructions on how to request your file can be found (usually buried) in your denial letter.

Step 4: Speak with your doctors

Do not stop attending regular doctor’s appointments simply because your insurer no longer considers you disabled. On the contrary, ensuring that your doctors are willing to support your claim can often be the difference between a successful appeal and another denial letter being mailed out by your insurer.

First, share your denial letter with your doctors. If any of them disagree with the reasoning behind your insurance company’s decision, ask them if they would be willing to write a letter of support on your behalf. In general, these letters typically include the specific condition(s) your doctor is treating you for in addition to why they prevent you from being able to work.

Further, it is important to ensure that your doctor notes any impairments or issues s/he observes, such as difficulties sitting, walking, communicating, or recalling information, among others. On top of objective testing, verifying that your doctors are writing down your subjective complaints in addition to any observable deficits are critical to compiling the evidence for a successful appeal.

Step 5: Compile this necessary documentation & Submit the Appeal

Given that the appeal is normally the last opportunity for new information to be presented, it is imperative that everything, i.e. medical records, letters of support, and any additional supporting documentation, is reviewed thoroughly prior to submission. Obviously, the goal of an appeal is to reverse the insurance company’s denial and have a claimant’s benefits reinstated. However, even if the denial is upheld and all appeals are eventually exhausted, having this evidence in the record is essential if a lawsuit is eventually filed on your behalf.

If you or a loved one is experiencing difficulties with an ERISA-related short or long-term disability appeal, please feel free to call the skilled and compassionate team at Murray Law Office or by visiting the firm’s website.