The Disability Insurance Denial Letter. After a long term disability insurance claim is filed, the insurance carrier will either grant the claim or deny the claim. If the claim is granted, the insurance company will begin to pay monthly benefits. If the claim is denied, the claimant will receive a “denial letter.” This letter is very important because it will list what evidence the insurance company reviewed when making its decision, who reviewed the evidence, for example, an in house Nurse Case Manager, a doctor hired as a consultant or only non-medical reviewers such as a Senior Claims Adjuster. Most major insurance carriers such as Unum, MetLife, Cigna and Aetna follow this procedure. The denial letter should state the reasons the claim was denied and what medical evidence the carrier needs to prove disability. The denial letter will also give important information for an appeal, including where and when the appeal must be received.
The Time Limits for Filing Your Administrative Appeal
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The denial letter will give the time limits for filing the appeal. If the policy is governed by ERISA, the appeal deadline is 180 days. Most non-ERISA policies also give the claimant 180 days to appeal, but it is very important to read the denial letter carefully, so no deadlines are missed. If an appeal deadline is missed, the claimant will be unable to appeal. If the claimant does not “exhaust” or use all appeals available, the claimant will not be able to file a lawsuit. If you have questions, ask disability attorney, Marc Whitehead by visiting disabilitydenials.com or you can download Marc Whitehead’s free E-book, Disability Insurance Policies-How to Unravel the Mystery and Prove Your Claim.
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