If your initial claim for long-term disability benefits was denied, the good news is that you have legal options. But you need to act quickly. At Petro Law Firm, we can help you take the steps you need to file a successful long-term disability appeal.
1. Review Your Denial Letter and Plan Documents
Before you do anything else, take a step back and regroup. An LTD appeal is a complicated matter, and you need to understand exactly what standards and rules apply to your claim. That means you’ll need to take a look at your LTD plan documents and denial letter.
Most LTD claims involve ERISA or employer-sponsored disability plans. For ERISA plans, you’ll need to follow a two-stage appeal process, where you first file an “administrative appeal” with the insurance company. If the company denies your claim again, you can file a federal court appeal. For non-ERISA or privately purchased plans, and you can immediately file a lawsuit in state court.
You’ll also want to review your denial letter. If you have an ERISA claim, your denial letter should give you specific reasons why the company refused to pay your LTD benefits. This information can help guide your investigation and evidence-building strategy.
2. Speak to an Experienced Long-Term Disability Appeal Lawyer
If you search “disability lawyer” online, you’ll find a lot of law firms that discuss Social Security disability benefits. It’s important to remember that long-term disability and Social Security are two very different systems with different procedures and legal standards. Do not assume that every disability lawyer understands how to proceed with an ERISA claim.
Compared to most insurance claims, LTD and ERISA appeals are incredibly complicated, so it’s best to speak to an attorney who has experience in appealing denials.
3. Track Your Filing Deadlines
In an ERISA appeal, you don’t have a lot of time to submit your paperwork. Missing even a single deadline could end up costing you your long-term disability benefits.
It’s also important to realize that simply sending an appeal letter that disputes the insurance company’s findings is not enough. Before these deadlines expire, you’ll need to fully assess your claim, identify missing information, and provide the insurance company with this data.
4. Stack the Record With Supporting Evidence
Medical and vocational evidence is essential to a long-term disability appeal. Both the insurance adjuster and the judge must assess your claims, evaluate their validity based on the evidence, and make a decision. If you don’t have clear-cut evidence, you’ll have a hard time convincing anyone that you deserve long-term disability benefits.
Unfortunately, in an ERISA appeal, you only have a limited amount of time to build up your evidence. Once the insurance company makes its final decision, you cannot provide the federal court with additional information, no matter how important it is to your case.
Your LTD lawyer can help you “stack the record” early on, collecting and submitting:
- Medical and hospital records
- Statements from your physicians and medical providers
- Information about your work and educational history
- Opinions and insight from medical and vocational experts
- Functional capacity evaluations and other information that outlines your limitations and abilities
Again, time is of the essence in a long-term disability appeal. You need to ensure that your evidentiary record is as complete as possible before your filing deadlines expire.
5. File Your Administrative Appeal
Once you have all of your evidence, understand the problems with the insurance company’s rationale, and are aware of the exact procedural steps you need to take, you should file a comprehensive administrative appeal. This appeal should include a legal brief outlining your arguments and copies of all your additional evidence.
After the insurance company receives your administrative appeal, it must review your claim and issue a new decision. If it approves your LTD application, it should start paying your monthly LTD benefits. If it again denies your claim, you can file another long-term disability appeal, this time in the federal courts.
We Can Help You With a Long-Term Disability Appeal
The long-term disability appeal process can be overwhelming. Don’t try to handle it alone. At Petro Law Firm, we can help you avoid simple mistakes that could derail your claim. We pride ourselves on our practical advice, aggressive strategies, and attention to detail. To learn more about how we can assist you with appealing a denied claim, call us today.