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What Do You When Your LTD Claim Has Been Denied

Filing a long-term disability (LTD) claim is a complex process. You may receive a denial whether you made mistakes on your form or even if you were extremely thorough, timely, and careful.

But an effective administrative appeal can reverse a wrongful claim denial, and result in your receiving important past-due LTD benefits. If an LTD insurance provider subject to the Employee Retirement Income Security Act, or ERISA, has denied part or all of your claim for disability benefits, that “no” is not the end of the claim line. You have the right to appeal the claim denial so that you receive the insurance benefits you need and deserve.

Below are some tips you can use if your LTD claim has been denied.

Tip 1. Know what type of coverage you have. ERISA requirements do not generally apply to individual policies, which means that administrative appeal rights differ from what ERISA requires of group plans, or may not exist at all.

Tip 2. Do not act alone. A plan administrator may assure you that you can handle the Group LTD administrative appeal process on your own. It is expected that you have little experience handling a Group LTD ERISA claim and the administrator may try to exploit your wanting the appeal process to be as quick and efficient as possible so that you can focus on recovery. But that will put you at a severe disadvantage, which brings us to the next tip…

Tip 3. Hire a lawyer who focuses on LTD claims. An experienced individual and LTD claims lawyer can help you properly navigate individual and LTD claims and appeals.

ERISA generally guarantees you at least 180 days from the date of the group claim denial to file an administrative appeal. You and your LTD lawyer may well need every one of those 180 days to prepare an effective, comprehensive, and persuasive administrative appeal. One of the lawyer’s responsibilities is to cite current law, regulations, court decisions, and your LTD policy language from the jurisdiction where you reside along with framing your ongoing restrictions and limitations against the physical and mental demands of your occupation. This will help in preparing a solid argument on your administrative appeal and later in Federal Court before a judge.

Tip 4. Learn how you can help. Once you’ve aligned with the LTD lawyer, he or she will offer the direction of how you can support your claim with documentation.

This means supplying relevant, objective, and full medical, occupational, financial, vocational and employment records. These pertinent documents will help craft arguments that respond to every reason the LTD insurer gave for the claim delay or denial. Furthermore, if you feel your LTD insurance company improperly handled your claim, you and the lawyer can collaborate on drafting procedural objections you want to raise. All this data will be helpful in the event your lawyer tells you to…

Tip 5. Prepare for the possibility of a court filing. Even amid COVID, a judge may hear your case. Should you need to go to court (virtually or in-person), a federal ERISA judge will decide your case based on what you submitted in your initial claim application and your administrative appeal.

Remember a ERISA trial is unlike other legal proceedings. You may not introduce new evidence, call or cross-examine witnesses, demand a jury trial, or exercise other rights. Your lawyer will be limited to arguing your case based on what happened before the claim was denied and what happened on appeal.

The sooner you contact an experienced ERISA LTD claims attorney, the better your chances of submitting the strongest-possible administrative appeal and reversing the wrongful claim denial.

DarrasLaw always provides free disability policy analysis and free claim consultations to determine whether your individual or group policy entitles you to short and/or long-term disability benefits. Call us today at (800) 898-7299 or contact us online.

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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