ERISA • Employment Law

How to Appeal a Long-Term Disability Denial

25 Jul 2021

Insurance companies are notorious for being extremely stringent on initial long-term disability claims. They lose nothing by denying claims and making you fight for benefits. There is no obligation for these companies to show any good faith when considering your claim. Therefore, you may be in a position where you have to appeal a denial of your claim.

The first step in the appeal process should be hiring a Philadelphia disability attorney if you do not already have one. The strength and quality of your appeal matters because it forms the record if you have to go to court in the future.

Your attorney may find it helpful to speak with the insurance company. Your denial may have been based on a misunderstanding. If so, you can clear it up and give the insurance company the necessary information. This is the best-case scenario.

The Insurance Company Has an Appeals Process

In many cases, you have to go through the insurance company’s appeals process. While it does not always seem fair, you have to file your initial appeal with the same company that denied your claim in the first place. 

You need to take the appeals process seriously. You must provide the insurance company with information that shows you are entitled to long-term disability. This includes medical records and supporting documentation for your claim. Here are some forms of helpful documentation:

  • Personal statements
  • Witness statements from people you know
  • A statement from your employer if they will give it
  • Evidence that other agencies are paying you benefits
  • Statements from your doctor

Your hope is that this will persuade the insurance company to grant benefits on review. In many cases, it is. Litigation costs the insurance company money, and they may back down if they see that you have a strong record. Even if the insurance company will not reverse their initial decision, the record that you have established on review could help you in the next step.

You Can Sue if Your Appeal Is Denied

If your administrative appeal is denied, you will have no choice but to go to court. The catch is that you cannot introduce any new evidence. The federal judge will take the file from your appeal and make their own decision about whether you are entitled to benefits. This is why you must submit a strong file at the appeal stage. 

Many people who fight their denial are ultimately successful. It is critical to speak with an attorney right after your claim is denied, so you can file a strong appeal within the allowable time frame. Otherwise, you could end up with gaps in the record and nothing you could do if you lose the appeal. It is better to begin fighting hard as soon as possible.

Contact a Philadelphia Long-Term Disability Insurance Attorney

The long-term disability attorneys at The Garner Firm, Ltd. are experienced at taking on the insurance companies to help clients who have been denied benefits. Contact us today for your free initial consultation to discuss your case.

Experienced Counsel

Mr. Garner is an ERISA employee benefits and employment attorney with over a decade of experience. The laws governing employee benefits, the employment relationship, and the workplace are complex.

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