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Tips for Filing A Long-Term Disability Insurance Claim Appeal

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Receiving the news that your long-term disability insurance claim was denied can be devastating. Fortunately, a denial is not the end of the road. If your disability benefits were wrongfully denied, you can appeal to the insurance company to reverse its decision.

Here are tips to help you understand the process and file a strong long-term disability insurance claim appeal.

What is an appeal?

An appeal typically begins with a written response to the insurance company's claim denial that addresses and legal, medical and vocational issues identified by the insurer.

The goal of the appeal letter is to clearly demonstrate to the insurance company that you are entitled to the benefits outlined in your long term disability policy.

Can I file an appeal?

Your appeal options may differ based on the kind of disability insurance coverage you have.

If you received your long-term disability insurance coverage through your employer, your policy is subject to the Employee Retirement Income Security Act (ERISA) of 1974. Unfortunately, ERISA limits a policyholder's consumer and legal protections;

Policyholders with coverage subject to ERISA must exhaust all administrative remedies laid out in the policy when are appealing a denial. If the policy requires two or three appeals, you must follow these steps before you are able to file a lawsuit.

If you have a privately purchased, individual long-term disability insurance policy, you may not be required to appeal several times before filing a lawsuit in federal court. Your appeal options will depend on your specific policy language.

Should I file an appeal?

An appeal is the most common type of action taken to address a disability insurance denial; however, there are other strategies some policyholders can consider.

For example, individual disability insurance policyholders may choose to file a lawsuit, which can allow for real damages, including punitive, emotional distress and extra-contractual. Policyholders may consider a lawsuit if they have been subjected to bad faith tactics by the insurer, such as using an improper or hidden denial standard to deny a claim or intimidating/misinforming a policyholder of their rights under their policy.

Furthermore, this may be the only way for some claimants to collect their wrongfully denied benefits.

This remedy is often considered a last resort, as lawsuits can last years and further delay of retrieval of benefits.

Claimants with group disability insurance policies should note that under ERISA, you cannot seek the aforementioned damages if you file a lawsuit. Instead, you will only be able to sue for your past-due benefits, as well as interest in some cases.

If you are uncertain about whether you should file an appeal, a top-rated, experienced disability insurance attorney can help you determine your best course of action to recover your benefits.

What to consider before filing an appeal

Note the strict timeframe

In many cases, you only have 180 days, or six months, to gather your evidence and file an appeal. Missing the appeal deadline is a grave mistake, as you will not be allowed to add additional evidence of your disability to your official record, and it will be nearly impossible to reverse the denial of your benefits..

Don't ignore details in the denial letter

Pay close attention to the details in your denial letter, as it should explain why your claim was denied and how to file an appeal.

The reason for denial will inform how you should proceed with your appeal and what additional information you will need to gather.

The denial letter will also outline the deadlines and specific requirements for filing your appeal. Under federal law, your insurance company must give you at least 60 days to file an appeal. However, as previously discussed, many long-term disability insurance policies allow you 180 days to appeal.

Request your administrative file

Before you file you appeal, it is imperative to obtain your administrative file from your disability insurance company, as it will contain even more detailed information about your claim than the denial letter does.

Your insurance company is required by law to provide you a free copy of your administrative file.

The administrative record will include reports from the insurer's reviewing doctors, surveillance photos and/or videos, functional capacity evaluation and/or independent medical exam results, notes from any field visits you underwent, and any other information the insurer used to deny your claim.

Examine the documents for any incomplete or incorrect information that could have contributed to your denial. Your appeal is an opportunity to strengthen your claim for benefits by "stacking" the record with favorable information and filling in any missing information in your claim file.

For example, you should make sure your file already contains all of your relevant medical records, which may include physician notes, surgical reports, medication history and objective test results.

If you find there is missing or incomplete information in your file, you should request it promptly from your treating physician and include it in your appeal. It is also important to ensure your treating physician clearly and accurately evaluated your limitations and restrictions as they relate to your ability to work.

In some cases, it may also be helpful to include third-party reports from friends and family. These reports should focus on their first-hand observations of you, rather than opinions on your disabling condition. Such observations could include whether you need help completing tasks like walking, standing, showering, etc.

When to consider an attorney's help

The long-term disability insurance appeal process can be lengthy and confusing for most policyholders, and insurance companies count on this convoluted process to discourage you from filing or to trick you into making a fatal appeal mistake.

An experienced long-term disability insurance can help you determine the appropriate appeal steps for you, gather the necessary medical evidence and craft a persuasive appeal letter.

If you are preparing to file an appeal for your wrongfully denied long-term disability insurance claim, contact our top-rated long-term disability insurance attorneys for a free consultation.

The legal team at DarrasLaw has successfully handled long-term disability appeals of all kinds and at all stages. There is no risk involved in contacting DarrasLaw; if you have questions about your individual or long-term disability insurance appeal, our legal team is here to help.

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