ERISA • Employment Law

What to do if Your New Jersey Long-Term Disability Claim is Denied?

03 Sep 2019

If your long-term disability claim was denied, you are likely considering filing an administrative or internal appeal. This can be a complex process, and we recommend retaining an experienced New Jersey long-term disability attorney for assistance. At The Garner Firm, Ltd., we have extensive experience handling long-term disability claims and subsequent administrative appeals. 

You only have a limited amount of time to file an appeal, which is why you need to make a decision on whether to appeal and retain an attorney right away. Failure to meet the deadline means your appeal could be denied. If you received your claim denial letter, there will be a deadline listed. If you do not have the letter, your policy should also list the timeframe you have to bring an appeal. Federal law mandates that your insurer has to give you a minimum of 180 days to file an appeal, but some long-term disability policies may allow a longer timeframe.

Start by Reading Your Denial Letter Closely

One of the most critical elements of filing an appeal is understanding exactly why your claim was denied. The denial letter should contain this information and should also contain information that discusses the requirements for filing your appeal. Just like missing the deadline, an improperly filed appeal could cause you to be denied.   

One of the first steps you should take is to make a written request for your entire claims file from the insurance company. Under federal law, your insurer or the plan administrator has to give you a free copy.

Get Supporting Documentation 

If your denial letter states that your claim lacked “objective” support, you will also want to get any diagnostic test results like X-rays, CT scans, or MRIs. You need all relevant documentation that can help your case. Review your existing case file and determine whether all your medical records are there. You want everything possible — including surgical reports, radiology notes, doctor notes, and any reports from an emergency room visit. If documents are missing, you will need to start requesting them as soon as possible.

Get Your Doctor’s Written Opinion 

It is helpful to have your doctor write a document that outlines his or her opinion on your condition. This should include your physical and mental limitations. Get specific with your doctor and ask pointed questions on how your impairments will affect your daily life and activities. If this particular doctor does not want to assist, find one who does take your case seriously.

Understand What Disabled Means Under Your Policy

Before filing your appeal, you also want to familiarize yourself with what your insurer’s definition of disability is. Insurers can have different meanings, and that can make a huge difference in your appeal. One policy might say that a disability is your inability to perform any job, while another policy might state that a disability is when you cannot work again in your particular profession. 

Contact a New Jersey Long-Term Disability Attorney

If your claim for long-term disability has been denied, contact The Garner Firm, Ltd., right away to schedule an initial consultation so we can review your claim in its entirety. Do not attempt to go into the appeals process without a New Jersey disability benefits lawyer on your side.

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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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