How to Successfully Appeal a Long-Term Disability Denial

Successfully Appeal a Long-Term Disability Denial

Outside of medical concerns, financial stress is the most overwhelming aspect of disability for most sufferers, as work typically becomes extremely limited, if not practically impossible, to perform. In these circumstances, some form of income replacement is necessary to keep the disabled and his/her family afloat. If a person planned ahead, he or she may have a private long-term disability insurance policy, or one provided by an employer, that is designed to provide financial assistance when an impairment prevents a person from working.

However, disability carriers are known for using all rationales and means necessary to deny a disability claim. Thus, receiving a disability denial letter is to be expected at the outset of most cases. Receiving a notification that a disability claim was denied is not the end of the story.

Disability applicants are entitled to appeal a long-term disability denial, and should absolutely pursue and exhaust available avenues for claim reconsideration. A discussion of strategies disability applicants denied long-term benefits can use to successfully obtain approval for their claim will follow below.

Timeline for Appeal

Insurance companies realize that claimants do not understand the myriad rules to appeal a long-term disability denial, especially if they go it alone when a disability claim is denied. One important issue to understand at the outset, and a factor that argues strongly in favor of hiring a disability lawyer early in the process, is the time restrictions a disability applicant has to take legal action to challenge a denial of benefits. There is just a two-year window to file a claim in court, which starts when the applicant receives a “clear and unequivocal denial” of the claim from the insurance carrier. What constitutes a clear and definite denial of a disability application is commonly up for argument, which means the window may start later if the insurance company did not act in accordance with the law. However, it is possible to pursue an appeal through the insurance company directly, as an alternative. Thus, once the denial letter is received, the question becomes how to approach an appeal of a long-term disability denial – internally or through the court system.

Internal Appeal vs. Litigation

Internal disability claim appeals can have as many as three to four layers before fully exhausted, and can take years to complete, putting the ability to use court intervention in jeopardy. That said, if the internal process is chosen to address a long-term disability denial appeal, there are some measures an applicant can take to strengthen a claim and increase their chances of receiving approval. Some of the key factors an applicant should focus on include:

Gaining a detailed understanding of why the appeal was denied through a careful review of the reasons listed in the denial letter, the policy and laws governing the coverage, and the claim file compiled by the insurance company; and
Providing any missing information the insurance company requested to better assess the claim, such as clarifying medical diagnoses, functional limitations, work history, demands of the job, or medical evidence from a recent examination.

If it appears that the filling in of such gaps will facilitate claim approval, the internal appeal process is the way to go. If, however, the applicant is coming up on the two-year window, was denied after a medical examination by the insurance company’s doctors, or the insurance company is taking the stance that the current medical treatment is not reasonable, a lawsuit is likely the only path to move forward with an appeal of a long-term disability denial. An experienced disability lawyer will know whether an internal appeal is worthwhile, or if bypassing this step, which can cause considerable delay, is the most effective way to ensure success.

Seek Legal Advice

Receiving approval for a disability claim can truly give life back to a disabled individual, and should be fought for as long as possible. Disability lawyers understand the pressure disabilities bring to the sufferers and their families, and can offer the legal advice needed to get the financial and services support necessary for your recovery and/or management of your condition. Do not accept the insurance company’s last word regarding your benefits, and reach out to a qualified disability lawyer to get your questions and concerns answered.