Receiving a disability denial letter can be discouraging, especially when you’re trying to recuperate. The denial means you’ll have to deal with the insurer to find out why and what to do next. The letter will explain why your claim was denied, that you have the right to appeal, and include a deadline by which you must file that appeal. These deadlines are strict, so don’t ignore them, or your claim will be denied.
Do not be discouraged if you receive a denial letter. Long-term disability claims can be complex, so enlisting the help of a Houston disability attorney can make the process easier and increase your chances for approval.
The Appeals Process
With most insurers, you’ll need to go through the appeals process before you can file any legal action like a lawsuit. Appeals give the insurance company another chance to review your claim and any additional information they did not review before.
The insurer may also request additional information from you, including additional medical records. They may also request an independent medical examination from their doctor, or a functional capacity evaluation to determine if they can work at any job.
In many cases, insurance companies issue more than one denial, but you still have an opportunity to appeal a second time. Once again, you’ll receive a strict deadline by which you must file your appeal, so make sure you submit your appeal timely.
Additional Documentation
Your first step is to request a copy of your claims file from the insurer. You’ll see what the company is working with, and what you need to do to file your appeal. If you have already enlisted the help of a Houston disability attorney, they can help in getting your copy of the file.
Your file should contain as much information as you need to support your claim and show that your condition warrants long-term disability. This can include:
• Medical reports from your medical providers, such as your primary care physician, along with any specialists who are involved in your care and treatment.
• Letters of support from your healthcare providers, vocational evaluation experts, and others directly involved in your claim.
• Information that clarifies or further explains anything that was overlooked or not correctly determined in the denial
• Any other information that clears up any legal mistakes or other misunderstandings that led to the denial of your claim
Once you’ve completed your due diligence and gathered additional information, work with your disability attorney to begin your appeal. You may need additional information, and your attorney can help you obtain the rest for your claim, and then draft your letter of appeal.
When Can I Sue?
If your long-term insurance is employer-provided, you’ll need to go through the entire appeals process first. After you’ve exhausted all your appeals rights, you can then file a lawsuit under ERISA (Employment Retirement Income Security Act.) However, if you bought your policy yourself, the policy is regulated by insurance laws in the State of Texas.
The evidence submitted for your claim and appeals will become part of the lawsuit.
When you’ve decided to pursue litigation, work with an attorney who has experience with disability claims and understands the process.
Your Houston LTD Disability Attorney
If you need help filing a long-term disability claim or are having trouble with the insurer paying your benefits, we’re here to help.
We’ve helped over 4,000 Houstonians receive the LTD benefits they need. The Herren Law Firm can help you with your application, appeals and help you through the process, and give you one less thing to worry about. 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 a fee if we win your case.
