When facing a long-term disability (LTD) denial, the path forward can seem daunting. Navigating the appeals process requires understanding its intricacies and preparing adequately. If you are grappling with a denied claim, read through our step-by-step process for appealing a long-term disability denial to guide you toward challenging the decision.

1. Understanding the Reason for Denial 

Before delving into the appeals process, it’s imperative you comprehend why your claim was denied. The insurance company should provide a detailed letter explaining their decision. Common reasons include a lack of medical evidence, discrepancies in the application, or non-compliance with policy definitions of disability.

2. Review Your Insurance Policy

Understanding your LTD policy is paramount. Familiarize yourself with your plan’s specific definitions, provisions, and exclusions. Pay special attention to the policy’s definition of “disability,” as insurance companies often base denials on claimants not meeting this definition.

3. Start the Appeal Process Quickly 

LTD policies typically have strict timelines for filing appeals (often 180 days from the date of denial). Missing this window can jeopardize your chances of reversing the decision. It’s important to start as soon as possible to give yourself ample time to gather the necessary documentation.

4. Gather Comprehensive Medical Evidence 

Medical evidence is the cornerstone of any LTD appeal. Consult with your healthcare providers to ensure that your medical records accurately reflect the severity and extent of your disability. Sufficient evidence might include:

• Doctor’s notes and narratives that support your claim.
• Results from medical tests, scans, and evaluations.
• Documentation of treatments and their effects.

5. Obtain Expert Opinions

In some cases, obtaining supporting opinions from specialists or vocational experts may be beneficial. They can offer insights into how your disability affects your capacity to work in your field or any other occupation.

6. Write a Strong Appeal Letter 

Your appeal letter should be clear, comprehensive, and compelling. Address the specific reasons for the denial mentioned in the insurance company’s letter, address and combat any mistakes or misstatements made in the denial letter, and supplement the appeal letter with new evidence not previously reviewed. Use your medical evidence to counter their arguments and explain why their decision should be reversed.

7. Consider Legal Representation

Given the complexities of LTD appeals, many individuals opt for legal representation. An experienced legal team, like Bonnici Law Group, can guide you through the process, ensuring your appeal is as strong as possible. They can also help with subsequent steps if the appeal is unsuccessful at the insurance company level – often with no fees upfront to start!

8. Submit Your Appeal

Ensure your appeal and all supporting documentation gets to the insurance company before the deadline. It’s advisable to send your appeal via certified mail to have proof of timely submission.

9. Prepare for Further Action

If your appeal is denied, you might have additional recourse. Depending on your policy and its governing laws, this could involve a second internal appeal, litigation, or filing a complaint with a state regulatory agency.

San Diego’s Long-Term Disability Insurance Attorney

At Bonnici Law Group we know that facing a long-term disability denial can be both frustrating and overwhelming. We are here to provide the legal assistance you need to understand why your benefits have been denied and how you can appeal the denial. We’ll keep you informed throughout the appeals process so you know exactly what is happening with your case. Our priority is securing you the benefits you deserve. Call us at (619) 259-5199, or click here for a free consultation.