When your long-term disability insurance has been denied, you almost always have the option to appeal the decision. But it’s crucially important that you get it right—because it may be your only chance.
We understand the intense pressure to act quickly, but firing off a quick “I appeal” letter is about the worst thing you can do for your long-term disability claim.
Insurance companies sure make it sound easy, though, don’t they? Even as they denied your claim for long-term disability benefits, your claim manager probably told you something along the lines of, “Don’t worry about this, it’s easy to appeal, just write us a letter saying you want to appeal, and we will do a new review of your claim.”
Your disability insurance company may have even “helpfully” included an appeal form with your denial letter. There’s probably a space for you to answer the prompt, “Why are you appealing this denial?” They may give you one whole paragraph’s worth of space to answer!
Don’t fall for it.
Most long-term disability policies give you only one chance to appeal. The next step if your appeal is denied is to file a lawsuit. And here’s the catch: nothing new can be added to your long-term disability claim file once the insurance company has “stopped the clock” by sending you an appeal denial letter.
In litigation, the judge usually will not be deciding whether or not you’re disabled. Instead, they’ll be deciding whether the disability insurance company’s decision to deny your claim was reasonable given the information they had at the time. And when it comes to your claim file, the insurance company always has the last word.
Here’s the thing: what you have to say about your long-term disability insurance claim does not matter to the insurance company. You can write the most comprehensive, most heart-wrenching, totally 100% accurate letter explaining point-by-point why the disability benefit denial was a terrible mistake, what your doctors have told you, and why you remain disabled. The long-term disability insurance company doesn’t care.
To be fair, this is probably not because they are monsters; it’s because their system is not set up to care. Their system is only set up to evaluate what your doctor(s) say about your claim. Your letter may be moving to them, but it’s not evidence. Medical records and physician opinions: that’s the evidence you must provide to win your appeal.
Your appeal is your one chance to add all the evidence you might want a judge to consider if the insurance company denies your long-term disability appeal and refuses to pay your benefits. Make it count.
Need help? We’ll review your denial letter for free.
When you’re staring at a long-term disability denial letter, there are a few steps to take next:
You should be able to tell:
Based on what you learned in Step 1, make a plan for what you are going to do to counter the long-term disability insurance company’s denial. Be clear about what you are trying to prove. Based on the policy definition of “Disabled,” are you proving that you cannot do your own occupation? Or that you cannot do any occupation, even a sedentary job?
I told you earlier that the long-term disability insurance company doesn’t care what you have to say about your claim, and that’s true. But your appeal letter is the one place you can connect all the dots that explain why you can work.
Remember the best writing advice: “show, don’t tell.” Rather than telling the long-term disability insurance company why you are disabled, show them the evidence:
Don’t forget to talk about the legal arguments in your long term disability appeal, too!
And remember, with this letter, you’re not just talking to the long-term disability insurance company. You’re potentially talking to the judge who will be evaluating the insurance company’s decision if they deny your appeal.
Don’t let a denial letter discourage you; allow our expertise to guide you toward a successful claim resolution.
This video should help:
We offer a Free Denial Letter Review where our experienced legal team will examine your case and provide a personalized strategy for moving forward.
Most of the time, we believe those who’ve been denied disability benefits can handle the appeal themselves. (If we do recommend you hire a long-term disability attorney after reviewing your denial letter, we’ll let you know). This is why after your free review and personalized strategy, our highly experienced long-term disability attorneys also offer paid consultations to have a one-on-meeting in person or Zoom meeting to give answer any questions or concerns that you have and put you on a clear path of what to do after receiving your denial letter.
Our firm is committed to providing our clients with a comprehensive understanding of their case and empowering them to make informed decisions.
BenGlassLaw is a national ERISA law firm based in Northern Virginia and handles more long-term disability claims than any other firm in the Northeast region. Ben Glass and his ERISA team are recognized across the nation as long-term disability and life insurance denial experts.