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Should I Use the Insurance Company’s Appeal Form if I Want to Appeal a Denial of Long-Term Disability Benefits?

Should I Use the Insurance Company’s Appeal Form if I Want to Appeal a Denial of Long-Term Disability Benefits?

If your insurance company has denied your claim for long-term disability benefits, your first step to challenge that denial is to file an appeal with the insurance company. While you might feel like appealing to the insurance company will just result in another denial, it is a required step in the appeals process for long-term disability benefits governed by ERISA, which is a federal law that governs most employer-sponsored group long-term disability plans. Therefore, you need to make sure that you are submitting the strongest appeal possible to support your claim for benefits.

Many insurance companies that offer long-term disability benefits plans have their own set of forms and procedures for internal appeals. While you should use your insurance company’s form for the appeal, as they likely require it, you are not limited to only answering the questions and submitting the information requested on the form. You can submit an unlimited number of documents and information to the insurance company that you believe will support your appeal. This is typically the best strategy for submitting an effective appeal of the denial of long-term disability benefits.

In addition to the insurance company’s form, you need to submit a formal letter of appeal that addresses the following issues:

·         Why the reasons that the insurance company gave for denying your claim are invalid

·         The provisions in your long-term disability policy that support coverage of your claim

·         A thorough explanation of your medical condition, with all medical records and tests documenting that condition enclosed with the letter

·         A clear description as to how your medical condition restricts you from working

·         Contact information for all of your medical providers and other individuals who can provide information about your medical condition and your inability to work

When you are facing an issue that is as important as long-term disability benefits, the attorneys at Bonnici Law Group have the skills and knowledge to help you build the appeal that is most likely to be successful. We know how crucial this support can be to you when you unable to work and we are here to represent your interests throughout any dealings that you must have with your insurance company. For legal advice about your claim, please contact Bonnici Law Group at 619-259-5199 or help@bonnicilawgroup.com.

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