After Long Term Disability Benefits Are Stopped, You Need To Appeal.
If you're disabled and can't work due to a serious injury or medical illness and you've been denied long term disability benefits through your employer (or a private long term disabilty policy if you have one) or you were receiving long term disability benefits and these were terminated, you need to file an appeal.
You should have gotten a letter from your long term disability insurance company (like Reliance, Mutual of Omaha, Guardian, Hartford, etc.) that tells you that you have the right to appeal.
They make it sound easy to file an appeal. But what does it really mean?
Caution: An Appeal Is Your One Shot To Win Long Term Disability Benefits.
Under a federal law called ERISA that governs employer sponsored long term disability benefits, the long term disability company has to send you a letter (we usually call this a denial letter) that sets out all the reasons why they denied your claim and say you are no longer disabled.
Some common reasons disability insurance companies use to stop your benefits:
- You no longer meet the policy definition of disabled
- You have not provided evidence of your limitations and medial restrictions
- You can perform some material duties of your regular occupation
- An independent medical examiner or medical records reviewer says you can return to work
But Why Is The Appeal To The Insurance Company So Important?
Because it is your one chance to add to the record - to add all of the information and evidence that supports your claim for continuing (or starting) your long term disability benefit. And you only have a limited time to appeal - the rule is 180 days if your disability policy is covered by ERISA, but the deadlines were extended by the Department of Labor due to the Coronavirus emergency.
How Do You Appeal If You've Been Denied Long Term Disability Benefits?
First, you need to request a complete copy of your claim file - all of the information the disability insurance company has. This will usually include the long term disability insurance policy, medical records, claim forms, job description, disability forms, claim notes, correspondence, emails, recorded statements, everything in your file, whether you or your doctors provided it, your employer did, or the disability claim reviewers created it.
Under ERISA regulations, you are entitled to the complete file (there are penalties if the insurance company fails to provide the file). We typically request 18 - 25 topics or categories of documents, electronic and paper. That is usually somewhere between 400 - 1000 pages of information and evidence.
Once you've analyzed the insurance policy and all of the evidence in the file (pay special attention to the denial letter), you'll need to add evidence - depending on your medical condition and disabilitu, that may be done by working with outside consultants, medical experts and specialists.
Why Is The Appeal So Important In Long Term Disability Benefits?
The appeal is critical because under ERISA, you have the right to sue the long term disability insurance company in federal court.
But that means a federal judge will decide your case. ERISA doesn't provide for a jury trial or discovery like most civil cases where someone is injured. Instead, the judge will decide the case based on the record the long term disability insurance company had - and that record includes your appeal, so you need to put all of the evidence you have into the appeal.
That requires a lot of work, analyzing legal, medicine and insurance law and working with outside experts and specialists.
How Long Should My Appeal Of The Denial Letter That Ended My Long Term Disability Benefits Be?
This is going to depend on a lot of factors, of course. But we just filed a long term disability appeal (after our client's long term disability benefits were discontinued after an insurance medical examiner said she was not disabled.
That appeal was 20 pages (single spaced) of analysis and argument and we included another 90 pages or so of additional exhibits and evidence.
Do You Need An Experienced Attorney To Appeal Your Long Term Disability Claim After It Was Denied?
Yes - there is just too much to do to prepare an appeal. You need to work with a lot of different experts and specialists to give yourself the best chance of winning the appeal and getting your long term disability benefits.
Even the late Justice Ruth Bader Ginsburg called ERISA unjust and increasingly tangled - what more proof do you need?
Call us today at (202) 393 - 3320 to see how we can help you with your long term disability benefits.