
By Marc Whitehead, Board Certified Disability Attorney
For a free legal consultation, call (800) 562-9830
Call or text (800) 562-9830 or complete a Free Case Evaluation form
If your long-term disability (LTD) claim has been denied, you’re not alone—and you’re not out of options. At Marc Whitehead & Associates, we’ve spent decades helping clients fight back against unjust insurance denials, especially under the notoriously complex ERISA law. Here’s a detailed guide to understanding why claims get denied and how to respond strategically.
Why Are LTD Claims Denied?
Insurance companies are in the business of limiting payouts. Here are some of the most common reasons they deny legitimate LTD claims:
- Insufficient or missing objective medical evidence
- Surveillance or social media posts taken out of context
- Opinions from biased “independent” doctors hired by the insurance company
- Administrative errors—missed deadlines, incomplete paperwork
- Misclassification of your job duties (e.g., calling a heavy labor job “sedentary”)
- No vocational report explaining how your condition impacts your ability to work
- Lack of diagnostic testing that substantiates your condition
Insurers are looking for objective evidence. That means medical tests like:
- MRI or CT scans for spinal/joint damage
- EMG studies for nerve conditions
- Functional Capacity Evaluations (FCEs) to assess physical limitations
- Neuropsychological exams for cognitive impairments
- Psychiatric evaluations for mental health conditions
What Should You Do Immediately After a Denial?
- Read the Denial Letter Carefully
It will explain the insurer’s reasoning and the deadline for your appeal (usually 180 days under ERISA). - Request Your Entire Claim File
You have a legal right to access all the information the insurance company used to make their decision. - DO NOT File Your Own Appeal Without Help
Many people rush to submit an appeal themselves—but under ERISA, this is a critical mistake. Once your appeal is filed, the administrative record closes. If your appeal is denied, the judge will only review what’s already in the file. There’s no opportunity to submit new evidence or testify.
What Does a Strong Appeal Include?
A winning appeal must go beyond a simple letter. It needs to be a fully developed legal and evidentiary package, including:
- Updated, detailed medical records from all providers
- Objective testing results (MRIs, FCEs, neuropsych exams, etc.)
- Signed physician statements explaining how your condition affects your ability to work
- A comprehensive vocational report discussing:
- The physical and mental demands of your past job
- Whether you can do any job that meets the policy’s gainful employment definition
- A legal brief explaining how the insurance company’s denial was wrong under the policy and ERISA
Most claimants don’t know how to:
- Find and hire a credible vocational expert
- Identify the right diagnostic tests for their condition
- Guide their doctors in writing persuasive, legally relevant letters
This is exactly where experienced disability attorneys can make the difference.
What If the Appeal Is Denied?
If the appeal is denied, your only recourse is to file a lawsuit in federal court. But the judge will not hold a hearing or allow new evidence. That’s why your appeal must be complete, strategic, and evidence-rich from the start.
Final Advice and Free Help
Don’t go it alone. The system is not designed to be fair to claimants—it’s designed to favor insurers. We build appeals that are strong enough to win now—or stand up in court if necessary.
Visit us at www.disabilitydenials.com or call us today to schedule your free consultation.
Marc Whitehead is a nationally recognized board-certified disability attorney. He has helped thousands of clients appeal disability insurance denials across the United States.