Appealing your long term disability denial is a complicated process.
There are several steps you need to take after you receive a denial letter from your long term disability benefits insurance company, and you need to act quickly. Under ERISA (the federal law that governs most long term disability insurance policies) you only have 180 days to file your appeal.
Here are some of the initial steps to get ready to write your appeal.
Remember - appealing your long term disability denial (to the same insurance company that denied or terminated your benefits) is a lot more involved than filling out a form or writing a letter. A lot of work and analysis will need to be accomplished before you draft the actual appeal.
After analyzing the claim file you've requested from the insurance company (we typically request 18 - 20 categories of documents and information, and claims files can be many hundreds or thousands of pages depending on the nature of your medical condition, the length of time on benefits and other factors), under most long term disability insurance policies, you need to gather and generate evidence that proves the insurance company denial was unreasonable.
That can mean working with medical and vocational specialists, getting additional diagnostic testing for support, undergoing a Functional Capacity Evaluation, getting statements from co-workers addressing your job duties, educating your physicians on the specific terms and definitions of your policy and integrating all of that new information into your appeal.
And you need to draft the appeal as if a federal judge were reading it, because under ERISA, if your appeal is denied, you must file your case in federal court, and the only information the judge will use to decide your claim is the administrative record - most of which is your appeal.
That's a lot of pressure on anyone, much less someone with a serious medical condition - and you only get one shot at the appeal.
A long term disability attorney in DC can help.
In our DC disability practice, we have an entire process for helping people appeal their long term disability denials. We want you to focus on getting better - your medical treatment and rehab.
We request your complete claims file to get started, analyze your claim, make recommendations, and communicate with you to keep you updated every step of the way.
You didn't ask to get sick. Let us help protect you from losing everything you've worked hard for.