Appealing Your Long Term Disability Denial

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You got a denial letter from your long term disability insurance company. Now what?


Under ERISA you probably have 180 days to appeal the denial.


Some disability insurance policies may limit your appeal period, so review your insurance policy and denial letter carefully to make sure. If you work in the public sector and have a disability policy provided by your employer, it is probably covered by ERISA (and should say that in the letter), but check with a lawyer handling ERISA disability denials to be sure. (We review denial letters for free, no obligation, so call us at (202) 393 - 3320 to arrange that).


Filing an Appeal does not mean sending in a form or a letter that says you appeal.


Appeals require a lot more than you just saying you don't agree with the disability insurance company's denial. You need to show why the insurance company was wrong, provide evidence and support and other information that was not considered to prove (to the insurance company) that you are disabled under the terms and conditions of your policy, and cannot work because of a serious injury or medical condition. You can't just say it - you have to show it.

It won't help just to have your doctor say you are disabled.

An ERISA disability case requires a lot more than that. Remember, your doctor probably doesn't know the insurance company's definition of disability under your specific policy or all of the physical aspects of your job. Plus, the insurance company will have their own medical consultants review your medical records and condition - so you may have to show why the insurance company doctor is wrong, biased, or didn't consider important information.


Get the right lawyer.


The entire system favors your disability insurance company. The standard of review allowable under the federal law that governs most long term disability claims (ERISA) and in most insurance policies is a harsh one - you better know how to fight that. Even federal judges have said that someone appealing a long term disability claim is you are better off having an attorney. And you need the right lawyer for you and your family - someone who will listen to you but has a process for appealing your claim, and understands why that is so important (and can explain it to you).


Remember, ERISA long term disability is not like other forms of "disabiltiy" you may have heard about or qualify for - it's not social security, worker's compensation, or retirement disability - this is a highly specialized practice area.


Those areas of the law are very different - different standards, levels of proof, filing requirements, statutes of limitations, etc.


Finally, for ERISA disability appeals, you only have 180 days to file your appeal for benefits. If you don't appeal in that time frame, the denial will stand, and your case will have been denied.


We'll review your denial letter for free, no obligation, as the first step in this process. To arrange to get your denial to us, just call us at (202) 393 - 3320. And order a copy of our free guide Claim Denied: The Ugly Truth About ERISA Long Term Disability.

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