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Tips For Writing An Effective Long-Term Disability Appeal Letter

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For Your Information

If your disability insurance claim was wrongfully denied, you are likely wondering what options you have to secure a different outcome.

Of course, lawsuits are possibilities, but sometimes, you can’t sue immediately. With employer-sponsored, disability insurance, companies require that you exhaust their administrative appeals before you can file your federal ERISA case.

Disability insurance companies may have their own internal protocols for reviewing disability claims that they’ve denied. This allows these companies to ensure that they have not overlooked pertinent documentation, misjudged treating doctors’ statements, failed to investigate disability claims in good faith, etc. Sometimes, this first appeal leads to an individual insurer’s decision to change its initial denial—but not often.

In other cases, the insurance company still chooses to uphold its original denial of your disability claim. Some insurance companies have a second-level internal appeal for group disability policies, where you must timely appeal again through the insurer.

During this second appeal, the group disability insurer may request new items from you, such as more information from your treating doctor, or judgments from its own hired doctor (some of whom lack the proper credentials to accurately evaluate your disability) at its expense—such as independent medical examinations and functional capacity evaluations.

If your group disability insurer upholds your original denial a second time, you generally have the right to sue under ERISA in federal court.

If your group employer-sponsored disability claim is denied on appeal, and even on a second appeal, your insurer must tell you why each time. It should cite legitimate reasons and evidence that support its decision. This will give experienced disability insurance lawyers, such as those at the top-rated firm of DarrasLaw a basis to independently evaluate inaccuracies.

Writing Your Appeal Letter

As you have likely realized, filing a timely administrative appeal is an all-important first step. It involves writing a formal appeal letter and attaching any supporting documentation to it. Though insurers and their requirements vary, these letters should typically include:

  • The reasons the insurance company cited for your wrongful denial
  • Your specific coverage or policy’s language that support your disability claim, including all medical, financial, vocational, and legal case law that supports your position.

When writing your appeal letter, or even when simply documenting an appeal, consider attaching the following, even if it is not requested:

  • Your medical condition. Your tone should not convey anger, but thoroughly lay out all the objective and subjective testing and how the restrictions prevent you from working.
  • Specific reasons, with references to your policy where possible, why you believe your disability claim is covered and, therefore, your denial is wrongful.
  • Contact information for you, your treating doctor, and any people who can validate your symptoms, limitations, and disability.

If you include only the information you included in your original disability claim, you will get the same bad result. Consider, consulting one of the seasoned, top-rated disability insurance appeal lawyers at DarrasLaw to discuss the types of additional documents you may choose to add to your appeal. These may include:

  • Any documents providing additional information that your insurance company has questioned in your denial letter
  • Notes and dates from as many phone and email conversations as you had with relevant professionals that support your disability claim.
  • New or updated medical reports, including your treating doctor’s line by line refutation of the insurance company doctor’s reports.

Other Important Things to Remember

Note the strict timeframes. The denial letter will outline the strict and unforgiving deadlines and specific requirements for filing your administrative appeal. Missing the appeal deadline is fatal—it will make reversing your wrongful denial nearly impossible. A seasoned ERISA disability insurance attorney at DarrasLaw can make sure you meet every deadline and successfully eliminate any “proof of loss” denials.

Don’t ignore details in the denial letter. The broad strokes are important, but pay very close attention to details of your denial letter. Take your time and hire appeal counsel experienced in federal ERISA law. Hire an experienced, top-rated disability insurance lawyer at DarrasLaw to assist you preparing and submitting your appeal.

Don’t panic. No one knows the details of your situation better than you. Adhere to deadlines, reach out to experienced ERISA appeal counsel if you have unanswered questions, but don’t panic. Get help!

Gather information. Request copies of your insurance policy or certificate and your administrative record from your insurance carrier ASAP. Examine the denial documents for any incorrect and incomplete information.

Check the reasons they have given you for why your disability claim was denied. Your insurer will likely have pointed to specific policy provisions and limitations that it feels supports the denial. Check your policy. See whether your policy matches the language, provisions, and limitations the insurer has used to deny.

Carefully compose your administrative appeal letter. Consider creating a cursory list of the issues that your insurer cites and with which you disagree. This can function as a sort of outline for your appeal. Next, try to find evidence or documentation to support each of your positions—the more, the better. This will help you remain organized and well-reasoned, while also easing any frenzy you may feel due to the nature of this process.

Ask for help. Doctors and vocational experts are often happy to write letters in support of an appeal, but you have to ask, and you can’t win without their written support. Your treating doctor or vocational expert needs to provide comprehensive information to better document your disability claim—new chart notes, new tests, etc.

Provide proof of disability. Often, one insurer denies a person while the Social Security Administration approves the same person’s separate disability claim. If you’ve received Social Security Disability Insurance (SSDI), include these documents in your administrative appeal.

Include your friends and family’s declarations and statements. Often, insurance companies hire private investigators to monitor your daily activities to disprove your disability. You may counter this with written accounts from family and friends detailing your disability, treatments, and side effects over a much longer stretch of time than from those close to you.

Meet all deadlines. As mentioned, appeal deadlines are set in stone, and few if any exceptions are granted. Missing a deadline could mean going without the benefits you need.

You Don’t Have to Do This Alone. Reach out to the Top-Rated Disability Insurance Lawyers and ERISA Attorneys at DarrasLaw. We Can Help!

We have provided some important tips for writing your administrative appeal letter. That doesn’t mean you have to go through the process alone, and you shouldn’t.

At DarrasLaw, Frank N. Darras, America’s top individual, and long-term disability insurance lawyer leads our team. His disability insurance litigation firm has seen, evaluated and resolved more individual and long-term disability cases than any other firm in the nation.

If your insurer lets you down, we are here to assist and fight for the benefits you deserve. We can offer immediate help through free claim consultations and policy analysis. Reach out to us, and let’s discuss your options. Call DarrasLaw today at (800) 458-4577 or contact us online.

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