My long term disability claim from my job working in D.C. was denied. Where do I file my long term disability appeal?

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If your long term disability benefits were denied, you have the right to appeal.

If you were working for a private employer in Washington, D.C. and applied for long term disability benefits under a long term disability insurance policy, you have the right to appeal that decision.

If long term disability benefits were provided as an employee benefit from your company, the disability plan will be covered by a federal law, the Employee Retirement Income Security Act (ERISA) and there are certain rights and responsibilities ERISA gives claimants (claimant is the term for the person who is disabled and is making a claim for long term disability).

Your first appeal is to the insurance company that just denied your long term disability claim.

There are several basic rights under ERISA.  First, you should request a complete copy of the claims file - everything that the insurance company considered in it's decision to deny your claim for benefits.

Second - you only have 180 days from the date you received the letter denying your benefits to appeal your case.  

So request that claim file (or have an experienced DC long term disability attorney request it for you) immediately so you can begin to analyze the insurance company decision and the legal and medical basis for that decision denying your benefits.

An appeal after a denial of long term disability benefits is a lot more than filling out a form.

Many people make a critical mistake that can't be fixed later.

Instead of approaching the appeal and denial of benefits like an experienced long term disability lawyer, they just fill out a simple form or write a letter indicating they don't agree with the decision - just like the denial letter says they have a right to do!

Sometimes they will send in a few more recent medical records about their disabling condition.

But they won't schedule additional medical testing, or a Functional Capacity Examination, or a vocational rehabilitation specialist evaluation.  They won't interview co-workers, conduct medical literature searches, perform opposition research on the physician who reviewed their medical records, review specific policy provisions with their doctor to generate highly specific, individual reports from the doctor.

There are 2 basic reasons why someone who is disabled should not file their own appeal.

  1. There is no way to understand ERISA law and procedure unless you have been in this field - you didn't ask for this and have never been through this before - how could you know whether you are making a mistake that ends your disability benefits forever?
  2. You have a disabling medical condition or injury that you need to focus on.  You don't have the stamina, endurance or time to take on this kind of legal work.

 Take it from an experienced long term disability attorney - you only get one shot at your appeal.

That's because if your appeal is denied by the insurance company, your next step is to file a lawsuit against them in federal court (since ERISA is a federal law).  

So your case will be decided by a federal judge - there is no right to a jury trial under ERISA.  And the judge will consider the administrative record of your appeal - all of the information, evidence and medical records you used to support the appeal will be part of that administrative record.

What do you think your chances of winning are if all you did was fill out a form or send in some medical records?

Call our experienced long term disability lawyers today at (202) 393 - 3320 to discuss your long term disability claim in DC.  We offer a number of cost effective ways to help you get the disability benefits you and your family deserve.

            

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