Many people depend on long-term disability for financial stability due to serious injuries or health complications that prevent them from working. Receiving a denial after filing your long-term disability claim can feel like a big letdown.
So, what can you do now that the insurance company has denied your claim? The good news is that no is not the final answer. Here’s how to appeal a Long-Term disability denial.
1. Understand the Denial Letter
Even though no is not the final answer, it does add additional hoops to jump through before receiving a final decision on your disability benefits claim. The first step is figuring out why the insurance company denied your Long-Term disability claim.
Here are some common reasons for denials:
- Your condition does not meet the policy’s definition or requirements for a disability.
- The insurance company requires more information to prove the medical condition causes long-term disability.
- The application may have missed timeline requirements or deadlines for submission.
- The insurance company employed investigators who determined your behavior did not align with the details in your application.
- The insurance company believes you can work in another position or field.
Submitting an appeal with new or more detailed evidence can help you overturn the denial. For more complex cases, especially those involving investigators, you need Long-Term disability appeal assistance from an experienced attorney.
2. Review Your Policy and Appeal Deadlines
The denial letter does not always provide an exhaustive list of reasons for the unsuccessful claim. Review your insurance policy to get more information. Some insurance companies use complex language. You could save time by working with an experienced Long-Term Disability attorney.
One critical piece of information you will find is the deadline for filing an appeal. Work closely with your attorney to ensure you meet this deadline.
3. Seek Clarification from the Insurance Company
Armed with policy information, you are now in a much better position to speak with your insurance company. An authorized insurance professional can provide more details about why the company denied your claim. This can help you better understand what you need to provide.
Recent federal changes to the Employee Retirement Income Security Act (ERISA) require insurers to submit your claim files if requested. Leverage this to get a detailed look at your existing file and the documentation the insurance company reviewed. Your disability attorney will also need these documents to build a strong appeal for your case.
4. Gather Comprehensive Medical Evidence
Objective data is the best way to prove to the insurance company that your disability requires long-term benefits. Talk to your doctor and your attorney about additional records you may need. Here are some examples:
- Medical images
- Testing results (blood work, MRIs, and CT scans)
- Medications and their side-effects
- Rehabilitation process and progress
- Doctor evaluations that align with your disability claim
5. Obtain Specialist and Vocational Assessments
Specialist and vocational assessments are critical for cases where the insurance company thinks you can simply work in another position. Specialists provide expert opinions on your condition, further substantiating your claim.
A vocational assessment can also demonstrate your inability to perform your previous job or any other suitable employment. For example, if you experience chronic pain, working in any position would still be challenging.
6. Prepare a Detailed Written Appeal
Your written appeal is your chance to address the insurance company’s reasons for the denial and present new evidence. It is the final culmination of your detailed review and investigation. Ideally, you hire a professional to assist you with this step because it can make or break your case:
- Write a compelling letter: Your appeal letter should address the reasons for the denial, present new evidence, and emphasize your inability to work due to your disability.
- Maintain professionalism: Even if you’re frustrated with the rejection or believe the insurance company violated your privacy, maintain a respectful and professional tone in your appeal letter.
- Hire an attorney. An experienced Long-Term Disability attorney will know what has worked in the past. They can apply that to your letter to improve the chance of successfully appealing your denied claim.
Work with the Experienced Disability Attorneys at Marc Whitehead & Associates
If you or your loved one needs long-term benefits, recovery is likely a long way away. When you hire an attorney, you can focus on your health while we focus on the legal and contractual complexities of the appeal.
For example, if the appeal process becomes contentious, we can handle negotiations and further communication and shield you. Our experienced disability attorneys also provide invaluable assistance in strengthening your appeal and protecting your interests.
Contact Marc Whitehead & Associates for a free legal consultation. We’re here for you and are prepared to provide you with the Long-Term disability appeal assistance you deserve.