Do I Need a Lawyer for a Long-Term Disability Appeal Letter?

There are several steps you need to take after you receive a denial letter from your long-term disability benefits insurance company, and you need to act quickly. Under ERISA (the federal law that governs most long-term disability insurance policies) you only have 180 days to file your appeal.

Here are some of the initial steps to get ready to write your appeal. Remember, appealing your long-term disability denial (to the same insurance company that denied or terminated your benefits) is a lot more involved than filling out a form or writing a letter. A lot of work and analysis will need to be accomplished before you draft the actual appeal.

1. Analyze the Claim File:
   • Request the complete claim file from the insurance company. This file can include hundreds or thousands of pages, depending on the nature of your medical condition, the length of time on benefits, and other factors. Typically, you should request 18-20 categories of documents and information.
2. Gather and Generate Evidence:
   • Prove Unreasonableness: Under most long-term disability insurance policies, you need to gather and generate evidence that proves the insurance company’s denial was unreasonable. This might include:
     • Working with medical and vocational specialists.
     • Getting additional diagnostic testing for support.
     • Undergoing a Functional Capacity Evaluation.
     • Obtaining statements from co-workers addressing your job duties.
     • Educating your physicians on the specific terms and definitions of your policy.
     • Integrating all of this new information into your appeal.
3. Draft the Appeal for a Federal Judge:
   • Write the appeal as if a federal judge were reading it. Under ERISA, if your appeal is denied, you must file your case in federal court. The judge will decide your claim based solely on the administrative record, most of which is your appeal.

All of these steps are a lot of pressure on anyone, much less someone with a serious medical condition – and you only get one shot at the appeal.

At Donahoe Kearney, we have an entire process for helping people appeal their long-term disability denials. We want you to focus on getting better.

We request your complete claims file to get started, analyze your claim, make recommendations, and communicate with you to keep you updated every step of the way. You didn’t ask to get sick. Let us help protect you from losing everything you’ve worked hard for.

Don’t wait – if you received a letter denying or terminating your benefits, you want to get started right away – we’ll evaluate the insurance company’s denial without charge and give you our recommendations on what to do next.

Get the Right Lawyer to Appeal Your Long-Term Disability Denial

If you have been denied long-term disability benefits or your benefits have been terminated, and you have a serious medical condition or injury that prevents you from working, you probably have too much to lose by trying to appeal yourself.

And under ERISA (the federal law that governs most long-term disability plans provided as an employee benefit through your job) your appeal is the most critical component. Here’s why your appeal letter is so important:

• The appeal goes to the disability insurance company that just denied or terminated your benefits (that sounds crazy that the same company gets your appeal, but that is the initial step).
• You can add evidence – medical records, opinion letters, reports from experts and specialists, diagnostic test results, etc. that supports the fact that you cannot work due to your illness or injury, and that the insurance company will have to consider.
• You need to argue your case in your appeal, based on the law and the analysis of the insurance company’s decision to deny benefits under the policy and their denial letter.
• You can add witness testimonials from people who know your condition, what you are going through, and what your job requires
• You can rebut the evidence the insurance company used to deny or terminate your long-term disability benefits – did they have a physician review your records, do they have surveillance video they say shows you can work, do they think your job is physically less demanding than it is, or that you could work in another, similarly defined job?
• Your appeal is part of the administrative record that a federal judge will use to decide your case for long-term disability benefits if your case goes to court.

There are certain types of cases that people can handle on their own, especially if they have a minor injury (and we tell people that every day). But this isn’t one of them.

If you have a medical condition, illness, or injury that is severe enough that you can’t work for 6 months, it is probably permanent and may prevent you from working for the rest of your life, even with good medical care and treatment.

That is a lot of income to replace – which is why you have long-term disability insurance that you either purchased or were provided by your company as part of your employee benefits and compensation package.

And most people don’t know how complex and difficult long-term disability cases are (most lawyers won’t even handle these cases).

But don’t risk everything you’ve worked hard for on a system that combines law, medicine, regulations, and insurance – get the right lawyer to help you and your family, so you can focus on getting better.

Get The Information and the Help You Need Today

You’re making a big decision for yourself and your family, and we are here to provide the information you need to make the right choice. Click here to download our free report ‘Claim Denied: The Ugly Truth About Long Term Disability’ today at no cost or obligation. After reading this free report you will be 100% more prepared to navigate your future with a long-term disability claim.

Ready to Speak to An Attorney Today?

We’re here to help, so call us today at (202) 393 – 3320 or click here to schedule a call to talk about your long-term disability issue. We have a number of options to help you wherever you are in the process, even if you’re just applying and have questions or concerns.

And if you received a letter from your insurance company denying or ending your long-term disability benefits, email the letter to us at info@dkllp.comand we will review it at no charge, in confidence, and with absolutely no obligation.

We’ll give you options and what we think your next steps should be based on the specifics of that denial letter.