Six Tips for Filing An Appeal For Long-Term Disability
Filing for long-term disability benefits and receiving back a denied claim can make you feel quite hopeless. You have suffered a serious injury or medical illness and were counting on those long-term disability benefits to get you through while you fight to get well. Knowing that your LTD claim was denied and there are no benefits coming can completely overshadow the fact that it is not the end of the road. You can still appeal the decision.
Wondering how to go about appealing a decision after a denial of benefits, or maybe just looking for tips on what to do next? The long-term disability attorneys at Donahoe Kearney are here for you. We have experience successfully fighting appeals for Washington, D.C. workers.
Why Was My Long-Term Disability Claim Denied?
There are many reasons why an LTD claim might be denied in Washington, D.C. These include simple errors like missed deadlines or a lack of evidence to support your disability claim, or the disability you are seeking benefits for may not meet the definition.
Missed Deadlines
The long-term disability claim process involves tight deadlines, time limits, and administrative record-keeping. You need to be sure you allot yourself time to get it all done. Disability appeals can be complex and can be well over 100 pages when they are complete. For some insurance plans, your disability claim form must be filed within 30 days of the onset of your disability. If it is filed beyond this deadline, you must attach a letter of explanation.
The specific process will vary based on the type of claim you are making; ERISA, non-ERISA, FMLA (Family and Medical Leave Act), short-term disability, and Social Security disability claims are all different. If your long-term disability claim is denied, you likely have only 180 days to appeal, which is not a lot of time to put together an appeals package.
Many disability applications are denied because of a failure to meet the deadline. Your long-term disability attorney can help you form a solid claim and stay within the time frame for submission.
Lack of Evidence
When you file for long-term disability benefits, you must back up your claim by proving that you have a disability eligible for benefits. This can require a great deal of evidence. Many times, up to 100 pages or more of exhibits and evidence can accompany a disability claim or appeal, including medical evidence, vocational expert testimonials, and other evidence of a disabling condition.
The more evidence you can gather, the more likely the claim will go in your favor. You may not know exactly what you need, which is another area where a disability lawyer can help.
Did Not Meet the Definition
To qualify for LTD benefits, your condition must meet the definition of being disabled under your policy. If you have an “own occupation,” or own employment policy, you must show that you are medically unable to continue doing your specific job. If you have an “any occupation” policy, you must show that your disability renders you incapable of doing any work. The right disability law firm can help you determine the type of policy you have and appeal your disability case.
What Is ERISA?
ERISA is a federal law that governs most long-term disability insurance policies. It clarifies everything from the time frame to file a claim to the rules for filing an appeal if your claim is denied. Like most laws, ERISA can be quite complex, and it is helpful to have someone in your corner who understands how the law works.
If you are facing a long-term disability denial from an insurance provider, the attorneys at Donahoe Kearney, PLLC can help. Call us at 202-393-3320 or use our online contact form for a free consultation and legal advice about your case today.
Are You Prepared to File a Long-Term Disability Appeal?
You have only 180 days to file an appeal for a denied LTD claim. This may seem like a long time, but considering that many such appeals require well over 100 pages of paperwork and documentation, it goes by quickly. You should begin by addressing the information in your claim denial, which will tell you why you were denied and help you understand how to proceed with an appeal.
Helpful Steps for Filing a Long-Term Disability Appeal in Washington, D.C.
These steps comprise general guidelines for filing an LTD appeal. However, even when you follow these steps, your claim can still be denied. Because of this, it is vital to have help from a qualified, experienced disability attorney.
Read Through Your Policy
Insurance policies can vary greatly depending on the individual company. As stated above, some are “own employment” while others are “any employment.” Still, others transition from one to the other after a certain time.
A general rule of thumb is that insurance company adjusters look for reasons to deny claims. They are in it to make money and do not make money by paying out benefits. Knowing your policy inside and out will improve your chances of filing a successful claim.
Figure Out Your Specific Deadlines
Many policies also have specific special circumstances that can change deadlines. Be careful not to miss any deadlines. Even missing by a day can be costly. Sometimes you may be able to include a letter of explanation for a late claim, but not always. Again, you must act quickly if you think you might need to file for long-term disability. Get an early start, and you face a reduced risk of missing an important deadline.
Document All Contact With Your Insurer
You should keep in writing and on file any contact you have with your insurance company. Always ask them to submit any conversation you have in writing. Never agree to a handshake or verbal deals with disability insurance company adjusters.
It may be best to let your attorney handle all contact with the insurance company. You do not have to talk to insurance adjusters at all, and your attorney can help you to avoid critical mistakes that could cost you your right to greater compensation down the road.
Gather Information
Any records you have related to your medical condition are essential. The more evidence you gather to support your disability insurance claim, the better off you are.
Keep all of your medical records, including receipts and after-visit summaries for your doctor’s visits, receipts for prescription medications, medical equipment you use, and records of any procedures you have, whether diagnostic, physical therapy, or surgical. If you receive in-home care, maintain records of all visits. You may even want to keep records of your transportation to and from medical appointments.
Write an Appeal Letter
The appeal process for your long-term disability denial is involved. You will need to make a specific request for your claim file from the insurance provider. Our typical claim file request covers 17 separate topics and categories. The claim file, which is usually many hundreds of pages needs to be analyzed in connection with the initial claim denial letter. You will then need to draft your appeal as though a federal judge was reviewing it.
The appeal will need to include such additional evidence as objective tests backing up your disability, a functional capacity evaluation, other medical records, and anything else that can demonstrate the original denial of disability insurance benefits was unreasonable.
This is because under ERISA disability law, if the appeal is also denied, the next step is to file your case in federal court, and your appeal will form the bulk of the information the judge will use to decide your case. After your initial application, you usually get only one shot to appeal your benefits claim case.
This appeal goes first to the disability insurance company that denied your employee benefits or other disability claims. It should argue the case based on the existing law and a detailed analysis of the insurance company’s denial decision, using its own rationale in the denial letter.
You will probably need to generate additional medical and vocational evidence, working with your doctors and other specialists and consultants to specify your condition, restrictions, and limitations that prevent you from working.
You may use witness testimonials as evidence. These testimonials should come from people with firsthand knowledge of what you are going through and how it affects your ability to perform your job. All of this information then becomes part of the administrative record that a federal judge will use to review your case if you need to go to court.
This all must be done within 180 days of your denial. It is not a good idea to try to write a disability appeal letter yourself. Your chances of success in appealing your disability case are measurably improved if you have the help of a qualified disability law firm in your corner.
Make Sure to Follow Up
The insurance company that denied your disability benefits has 45 days to review your appeal after you submit it. It is important to regularly follow up with them and to gather additional evidence and information just in case they still deny your appeal. This process is ongoing and requires heightened attention to detail. It can be stressful, and if you have an injury that has kept you out of work for more than six months, you may have a lot of income to replace. Stressing over a claim denial can also interfere with your ability to get well.
Getting help is essential, especially if your initial claim was denied. Our disability law firm can help you review your denial letter and help you with the next steps.
Let Us Make the Appeal Process Easy for You
Hiring an attorney can make the overall process of applying for disability benefits and appealing a disability benefits denial easy. We have represented many claimants in D.C. who need someone to guide them through this complex process. At Donahoe Kearney, PLLC, we make it easy for you – we know what needs to be done and how to generate the evidence necessary to stand up to the insurance company and work towards getting you the benefits you need and deserve. Call us today at 202-393-3320 or fill out our easy online form for a free consultation with a member of our legal team.
