If you have received the dreaded denial letter from your insurance company, you may believe that your claim for long-term disability is over. However, that is not the case. Many applications are denied based on the initial application for multiple reasons. But you do have the right to file an appeal.
We have discussed the possible reasons for LTD denial in a previous blog post. If you have yet to file your initial LTD application, read the previous blog post to make sure that your application and any follow-up meet the criteria.
Appealing The Denial
If you have already received a denial letter, the first thing to do is to prepare to file an appeal.
All LTD policies allow for one, and sometimes two appeals before a person begin receiving long-term disability benefit payments. In fact, most people receive their benefits after the exhausting appeals process.
First, examine the letter that details why the company denied your application. This letter will also tell you the period you have for filing any type of appeal. You must pay attention to this deadline, or you’ll miss your opportunity for appeal, and winning your claim will be over.
Next, contact the insurance company and request a copy of your claim file in writing. If your policy is through your employer’s Human Resources department, contact them for a copy of your claim file. This will show you what they used to determine your claim denial, and how you can prepare for your appeal.
What You Need to Reverse Their Decision
One thing we do know about insurance companies is that they are in business to make money, not to provide you with benefits. Many engage in what’s known as “bad faith practices” to ensure that you don’t get your benefits and that you eventually give up trying. If you haven’t already, this is the time to consider working with an experienced disability attorney to represent you and your long-term disability claim.
It does take considerable effort to file a successful appeal. This includes gathering additional evidence and documentation, such as:
• Supplementary medical records and information to support your claim
• A letter from your treating physician that describes your condition and how it directly impacts your everyday life
• Personal statements, which are from you as well as from a coworker. This information should describe your life with a disability and detail the reasons why employment is not a possibility. Family members and/or former coworkers can also submit statements that describe your limitations and how the disability affects your ability to do your job.
• Your appeal letter that details why you are entitled to disability benefits under the terms of the policy. This letter must clearly detail the facts of your case so that anyone who reviews your appeal will clearly understand that you are unable to work full time.
One thing to focus on at this stage is the addition of relevant medical records for your file. If your claim file doesn’t have sufficient medical documentation, now is the time to add what’s missing and make sure it’s there. Add as much as you can, and a little more—because it’s your last opportunity to “stack the deck” in your favor. Should a lawsuit become necessary, you will not be able to add anything else. The lawsuit is based on everything in the claim file through the end of the final appeal.
Filing A Lawsuit
It is possible to sue an insurance company over a denied long-term disability policy. However, ERISA requires that you pursue all administrative avenues, and all other opportunities for resolution are exhausted.
Prior to filing a lawsuit, your disability attorney can request that the insurers provide another appeal. This will give your attorney the opportunity to buy additional time to reverse the decision. However, in the process of reviewing your claim for the second time, the insurer may file a complaint with the Texas Department of Insurance (or another state’s regulatory agency.) The good news is that this will be part of the lawsuit detailing how the insurer worked to deny your claim.
Hopefully, your case will resolve in appeals, and you will begin receiving LTD benefits soon after. But if that’s not a possibility, your disability attorney can then file a lawsuit in federal court. While this is a longer process, a lawsuit may be necessary to get the company to pay your claim.
Call Herren Law for Help With Your Long-Term Disability Appeal
If you’ve been denied long-term disability benefits, don’t try to manage your appeal on your own—get help today. The Herren Law Firm can help you with your initial application, any appeals, and a potential lawsuit. We can make sure you have one less thing to worry about while you take care of yourself. Contact us today at 713-682-8194 (or use our online contact form) to schedule your free consultation. There’s no obligation and no up-front fees. We only collect if we win your case.
