How Do I Appeal Long Term Disability in DC?

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After being denied long term disability benefits in DC, your appeal is critical.

If you received a letter from your long term disability benefits insurance company denying or terminating your benefits, click here.

We will review the insurance company denial letter and give you a specific 5 point plan for the appeal at no charge and with no obligation. It's both free and confidential.  We implement these plans, and greatly expand on them for our own clients.

The insurance company letter denying your benefits should be specific.

The long term disability insurance company has to tell you why they denied or terminated your benefits.  Sometimes this is because they had a "peer review" - a doctor somewhere far away who has never seen you but has reviewed your medical records and says you can go back to work.  Maybe they quote the terms and definitions of your insurance policy, saying things like "you are no longer disabled under the policy" or you "do not fit the definition of disabled." Maybe they have vocational evidence that shows you can be working at another job or surveillance evidence that they say shows you do not have the restrictions your doctors have put in place.

Regardless of the reason, here are 6 steps you should take immediately after you receive that letter.

Mark your calendar - you probably only have 180 days to appeal 

Most private long term disability insurance policies provided by your job or purchased on your own are governed by a federal law (ERISA) and have a 180 day time limit to file an appeal - if the appeal is denied you can then file your case in federal court, where a federal judge will scrutinize your appeal.

Even if your policy is not governed by ERISA, it probably has a 180 day time limit.  Don't wait on any of this - this is not much time given the amount of work you need to do for your appeal.  If you don't file in time, you may be out.

Request a copy of your policy

You need to see the terms and definitions as they are set out in the ilong term disability insurance policy - that is what the insurance company is using to evaluate your claim.

Request a copy of your complete claim file

The insurance company has to give this to you, but be careful how you phrase your request.  The claims files we request for our clients have 28 categories of information we ask for.

Request a complete copy of your medical records

You'll need this from every doctor or hospital you've been to for medical treatment for your injuries or condition that prevents you from working.

Talk to your doctor about your disability claim

Your doctor's input and analysis could be critical and he or she will not know how the insurance policy defines disability, light duty, even your occupation.  So you need to schedule time to explain all of this to your doctor.  We talk to treating physicians, specialists and consultants for our clients.

Send us a copy of the letter that denied your long term disability benefits

We'll analyze it for you and give you a 5 point plan for your appeal.  There is no risk or obligation with this offer and it doesn't mean we will agree to work with you, but we hope it will get you started in the right direction if you decide to research, draft and file your own appeal.

Ready to work with an experienced long term disability attorney?

We make it easy for you.  Just call us at (202) 393-3320 to get started.

 

Frank R. Kearney, Attorney-at-Law
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Experienced DC Workers' Comp, Long Term Disability & Accident Lawyer