When Your LTD Claim Is Denied

Posted on behalf of Rizk Law on Dec 09, 2013 in Personal Injury

Insurance companies tend to deny almost all long term disability claims initially, regardless of their merit. Patience, persistence, and an experienced attorney can increase your chances for a successful appeal.

Steps to Take in Appealing an LTD Denial

  1. Get a copy of the LTD policy plan documents, including the summary plan description from your company’s human resources department, or request them in writing from the plan administrator of the insurance company, who is required to provide them under a federal law known as ERISA (send via certified mail with return receipt requested).
  2. Study the denial letter, noting the reasons why your initial claim was rejected, any information that might be needed to approve your claim, and how and when to file your appeal, noting deadlines.
  3. If you are planning on hiring a lawyer to handle your LTD case, do it as soon as possible and look for an attorney who specializes in ERISA law.

Gather Evidence in Your Favor

You may need to add evidence in your favor to the insurance company’s administrative record.

  • If medical records are missing, inform your claims representative and ask for confirmation as to when the records were requested and when they are received.
  • Ask your claims representative if further objective testing, such as MRI’s, x-rays, or blood tests, would help your case (the more objective evidence you provide the greater your chances of appeal).
  • Request letters with written observations from family and friends concerning your limitations.
  • Request testimony from vocational experts (especially if you have an “any occupation” LTD policy, which defines disability as the inability to engage in any job, not just your current one).
  • Ask your treating physicians and specialists for written opinions detailing work-related limitations caused by your medical condition (an attorney will give your doctor specific questions to answer in writing a report that are based on the circumstances in your case).

If All Appeals Have Been Denied

If you have exhausted all administrative appeals and your claim has still not been approved, the next step is to file a lawsuit in federal court, with the help of a long term disability attorney.