Top Dos and Don’ts for LTD Appeals – Checklist
Appealing the denial of a long-term group disability benefits decision may seem like a straightforward process. Your long-term group plan administrator surely wants you to think so. However, in reality, appealing a long-term group disability claim denial involves significant risks, unforgiving deadlines, and no instructions on how to bulletproof your appeal. The potential for making a costly misstep abounds. Without realizing it, you could make a fatal claim mistake that dooms your administrative appeal before it even gets rolling. Most disabled workers have no idea that what you don’t include, don’t submit, fail to enclose will never later be considered.
In this blog post, we offer some top dos and don’ts for appealing a long-term group disability claim. For more information and help in filing your initial claim application or administrative appeal, contact an experienced group disability lawyer or ERISA attorney today.
The dos below illustrate best practices for appealing a long-term group disability denial. Keep in mind, of course, that every claim has its own facts and particular circumstances. All of the suggestions below are generally good ideas, but which of them may prove absolutely critical to your administrative appeal will depend on your particular case. A top-rated group disability attorney can help you understand your legal rights.
DO file the most thorough, comprehensive, well-supported initial claim possible.
The best way to obtain the long-term group disability benefits you deserve is to avoid having to appeal a claim denial in the first place. Preparing and presenting the strongest possible version of your claim when you file your initial claim application with the plan administrator goes a long way toward setting you up to obtain benefits. A strong claim will typically contain complete objective and subjective medical documentation of your condition, medication and treatment, an opinion from a reputable treating physician about your disability, and as much evidence as you can collect to illustrate how and to what degree your condition limits your ability to perform the important duties of your occupation or any occupation by which you are trained, educated, or suited.
DO read and understand the insurance company’s reasons given for your disability claim denial.
Your plan administrator must provide you with detailed reasons for denying your long-term group disability claim. READ IT CAREFULLY. Then, read any other materials the administrator’s denial references, such as plan provisions or laws on which the denial rests. Successfully appealing a long-term group disability denial requires a thorough and clear understanding of exactly why the benefits provider turned down your claim. You may have trouble understanding the highly technical language in which many long-term group disability claims denials are written. That’s okay. Just call an experienced ERISA lawyer for a free case review and thorough explanation.
DO meet ALL administrative appeal deadlines.
A federal law, the Employee Retirement Income Security Act, better known as ERISA governs most administrative appeals of long-term group disability claim denials. The law sets the minimum time your plan must allow for you to appeal a claim denial at either 45 or 180 days. Plans usually set one of these time frames as your deadline. Do not miss it. Failing to timely file can end your administrative appeal before it even gets started.
DO prepare a comprehensive appeal submission that addresses every reason for the claim denial.
Your administrative appeal submission must address, in detail and with proper and convincing supporting evidence and documentation, every single reason given (or even implied) in the explanation you received for your claim denial. You cannot simply appeal by writing a letter saying, in essence, “Please look at my initial submission again.” You must back up your legal, medical, financial and occupational arguments and, if possible, show overwhelming proof that the administrator’s reasons for denying your claim are arbitrary and capricious.
DO seek the help of an experienced group long-term group disability appeals lawyer for any of the tasks above.
Do not trust any plan administrators when they tell you that you can handle filing an initial claim or an administrative appeal on your own. In our experience, for most people, that is just plain false. If any of the dos above, as we have described them, sound potentially difficult, overwhelming, or confusing for you to perform on your own, they are, and you need an experienced ERISA lawyer’s help. Ideally, you should get a long-term group disability lawyer to help you with your initial claim submission. If that ship has sailed, however, ask a seasoned ERISA lawyer to help you prepare your administrative appeal.
Following the advice above will put you in a good position to obtain the long-term group disability benefits you deserve… but only if you avoid making any of the fatal mistakes below that could undermine your efforts.
DON’T underestimate the critical importance of your administrative appeal.
You only get one shot at submitting all of your medical, occupational, and financial evidence to support your administrative appeal. Lawyers call this “making a record.” It is critical you get it exactly right. Your administrative appeal must contain all of the information you need to push back against the reasons given for your claim denial. After that submission is denied and you file your Federal ERISA complaint the Federal judge will decide your case based on what happened before the claim was denied and what was submitted on appeal.
DON’T wait to get started on collecting all the information you need for your administrative appeal.
From the moment you receive your long-term group disability claim denial, the clock begins ticking on your either 45 day or more probably 180 days to appeal the decision. In almost every case, in our experience, disability claimants need to start working immediately to gather all of the information they need to prepare a thorough, comprehensive, timely, and convincing administrative appeal.
DON’T play lawyer.
No matter what the plan administrator tries to tell you, appealing a long-term group disability denial is an intensive process that nearly always requires exacting ERISA legal knowledge and experience doing administrative appeals that most people simply do not possess. This is no time to assume you can get up to speed on ERISA, which is a notoriously complicated statute. Nor is it a time to assume you can save money by trying while disabled to take on the administrative appeal alone. Trying to do so without an experienced long-term group disability attorney virtually always amounts to a costly decision in which insurance companies deny valid claims and leave disabled people with nothing. Let an attorney with experience in long-term group disability claims help you properly prepare your administrative appeal.
In this day and age, long-term group disability insurance companies will look for any reason to delay and deny a claim. Fight back against their arbitrary and capricious claim denials by following the tips above and seeking the advice and help of an experienced group long-term group disability attorney to prepare and pursue your administrative appeal.