How to Appeal a Long-Term Disability Denial

June 13, 2023

Believing your long-term disability claim would be covered, without issue, when you have either an employee-sponsored or personal long-term disability insurance plan, seems reasonable. After all, if you have paid your premiums in a timely fashion, the insurance company should uphold their end of your business deal. Unfortunately, getting these claims paid is more challenging than one would think. In fact, insurance companies regularly deny them, leaving individuals like you frustrated and worried. The settlement you expected to receive would have compensated you for your lost earnings; you need that money to pay your bills.

In Oklahoma (and across the country) many individuals simply accept the denial from their insurance companies as final. But they shouldn’t.

Long-term disability decisions can be appealed.

Engaging a reputable and experienced long-term disability lawyer to represent you and manage your case can prove beneficial in the appeals process. This professional knows how to address relevant issues and can help to maximize your settlement.

Your Long-Term Disability Lawyer Can Determine Why Your Claim Was Denied

The first thing you need to do if you have had a long-term claim denied is to understand why. The answer to that question will help identify the actions you should take.

Your long-term disability attorney can help with this by reviewing your claim and your policy. They will leverage both their technical knowledge as well as their experience as they ascertain the reason or reasons why your claim was denied.  Some of the most common are:

• Missing filing deadlines
• Not providing complete or necessary documentation
• Insurance company error
• Not being covered for the disability as per your policy
• Disability did not occur at work
• Presence of pre-existing condition
• No proof of the disability
• Proof of behaviors inconsistent with your injuries (for example, social media postings or your communications).

Any or all of these can be a reason for a claim denial; knowing which factors influenced the insurance company’s decision is important in determining how to respond.

Disability Denial Appeal

As a policy holder, you have the right to appeal an insurance claim denial. Simply accepting the initial decision by your insurance company can have a catastrophic impact on your finances, negatively impacting both you and your family. Taking the time and energy to appeal this decision may result in a more favorable outcome.

Consider the following steps to take when embarking on this process.

Engage a Long-Term Disability Lawyer

If your long-term disability claim has been denied, one of the first things you should do is engage a long-term disability attorney.  Insurance policy language is technical, and the process to fight a denied claim can be both time consuming and extremely complicated.  Managing this process alone can be frustrating and fruitless.  A seasoned legal professional can bring considerable value and help you to maximize your compensation.

Be Aware of Time Constraints

Make sure to immediately Identify the deadline to file your appeal. Is your policy provided by your employer? If so, then it is governed by the Employee Retirement Income Security Act (ERISA).  All appeals must be filed within 180 days.  Long-term insurance appeal deadlines are strict; missing the appeal window can negate your opportunity for compensation. An experienced insurance disability denial lawyer will be familiar with the timelines and will ensure your appeal is filed correctly, with all appropriate information, in a timely fashion.

Request Your Claim File

If your claim was denied you should immediately contact your insurance company, in writing, for a copy of your claim file. Insurance companies are required to provide this information. It is important to make sure this request is in writing, as you want to have proof that you took this step. Your attorney will need this documentation to move forward with your case.

Identify the Reasons for Denial

When these documents are received, your attorney will review your policy, your denial letter and your case file to help identify and clarify the specific reason for the denial. In some cases, these issues can be quickly and easily rectified.  For example, if you neglected to provide certain medical records, you can request and submit them to the insurance company. Once they have the background information they need, they may pay your claim. Sometimes the information they request can be confusing, your attorney can work with you to better understand what you need to provide and help you to get that information to the insurance company as soon as possible.  Other times, however, these situations are not so easily rectified. Your lawyer can help you respond to these situations, helping to prove the validity of your claim.

Compile Evidence of Your Disability

Gathering evidence to prove your disability and your claim is critical. Make sure that your claim file contains all medical records associated with your disability. Summaries of conditions are not adequate — you want your file to include everything from any emergency room records, to surgical reports and doctor’s notes.   A letter from your physician about your Residual Functional Capacity (RFC) can be incredibly valuable.  This documentation not only describes your diagnoses and disabilities, but also identifies the impact on your life. Specific attention should be paid to the level of your disability so there is no question regarding your ability to work.

Testimonials from those who live with you or spend considerable time with you can also help to prove your disability.

Your disability insurance attorney can help you gather testimonials, advising you about the type of information they should provide. While these individuals are not medical professionals and cannot comment on the specific disability diagnoses, they can talk about how your life has been changed and identify household tasks and recreational activities you are no longer able to accomplish.  Needing assistance with certain things at home can help prove your inability to work, depending upon the description of your job. In situations where this inability is due to a home-related incident, consulting with Oklahoma City home insurance claim lawyers can be crucial in ensuring that you receive the support and compensation you deserve.

Submit Your Appeal Letter

Drafting a clear appeal letter and submitting it along with supporting documentation is critical. You will want to make sure to include your policy number and your claim number.  Your long-term disability lawyer can help with identifying issues in the insurance company’s denial letter, reasons why it was wrong, legal statutes that can support you and copies of all supporting information (like medical records, doctor’s statements, family testimonials and employment records).  You always want to send your letter via certified mail so that you have proof that it was received. Make sure to keep a copy of everything for your files.

Doug Terry Law Can Help You Appeal Your Long-Term Disability Claim

Just because your long-term disability claim was initially denied, this does not mean you will never be compensated for your losses.  At Doug Terry Law, we know that insurance companies regularly deny these claims; quite honestly, it improves their profitability.  Our firm was founded on the belief that every individual deserves to be treated fairly by their insurance company; we are committed to representing those who have not received the settlements to which they are entitled.

When you engage our team, you can rest assured that we will determine the reason your claim was denied, gather evidence proving your disability (including statements from your physicians), and draft and file your appeals letter within the time frame established by law.

Sometimes, the fix is simple, and we will assist you in rectifying any prior mistakes. Other times, the process is more contentious.  Other times, the process is more contentious. In those cases, our Oklahoma City bad faith insurance lawyer know what to do to help present your situation clearly and accurately and prove that your disability is covered under your policy and that it is preventing you from working.  In the end, if your appeal letter is unsuccessful, we can represent you in litigation to help you get compensated for your losses, including those for bad faith if that was an issue.

At Doug Terry, we leverage our years of experience in serving you, while providing you with the personal, hands-on assistance you need.  Contact our office today at 405-463-6362 to schedule a consultation with our long-term disability lawyer.