Has your long-term disability claim been denied? You can appeal.
How you go about your appeal can greatly impact your chances of success. It’s important to pursue the appeal in the right way.
You must answer the following questions:
- Why was my appeal denied?
- What do I need to receive a different result?
If your initial long-term disability claim was denied, know that you are not alone. Many good claims are denied. People appeal – and they win! But you must appeal effectively.
The Pekas Smith Disability Attorneys in Arizona explain long-term disability appeals.
Appealing Your Long-Term Disability Denial
My long-term disability claim has been denied – what can I do?
- If your long-term disability claim is denied, your claim doesn’t have to be over. You can appeal.
- There is a limited amount of time to pursue an appeal.
- You may provide additional information for the claims examiner to consider.
- The information you provide should address the reasons for the denial.
- A long-term disability attorney can represent you.
The appeals process begins with internal appeals. At first, you submit the request internally – it doesn’t go to any court. You can provide more information and ask for another decision. Usually, up to two appeals may be required before you can file in civil court.
Tip: When you submit your appeal, send it with a return receipt or tracking information. That way, the insurance company can’t claim they never received it.
Getting your claim file
Success in a long-term disability appeal requires addressing the reasons that the claim was denied. To do this effectively, you must know what the claims examiner was thinking when they denied your claim. You have the right to a copy of your case file.
Your file may include medical records, correspondence, internal guidelines that may have influenced the decision in your case, and any investigation evidence including surveillance records. Having these records can provide valuable insight into what issues need to be addressed as you appeal.
Filing in court
Once you’ve exhausted your internal appeals, you may file a claim in court. Because ERISA, a federal law, applies to most long-term disability policies, your claim will be heard in federal court. Sometimes, going to court is necessary. Remember the insurance company has a financial incentive to deny claims. Filing in court gets you to a neutral third party to decide your right to benefits.
Mistakes People Make When Filing a Long-Term Disability Claim
Here are some common mistakes people make when appealing a long-term disability claim:
- Being emotional in the appeal, rather than stating the facts
- Missing deadlines
- Not having enough medical evidence, not explaining how the medical condition prohibits working
- Getting caught on surveillance doing things they say they can’t do
- Failing to receive medical care, not following the treatment plan
- Accommodations could allow the person to continue to work
- Applying based on a reason that is excluded like substance abuse or a pre-existing condition
Long-Term Disability Appeal FAQs
How long do you have to appeal a long-term disability claim denial?
Usually, for claims governed by ERISA, you have 180 days to submit your appeal. However, you should carefully review your policy documents to see what timeline applies in your case.
How long will it take to get a decision on a long-term disability appeal?
The insurance company must decide on a long-term disability appeal within 45 days. They may extend the deadline if they need more time.
Does long-term disability pay only if you’re hurt on the job?
No. Long-term disability pays if you’re unable to work, whether or not the injury occurs on the job. There may be additional ways to receive compensation and medical care if an on-the-job injury prevents you from working.
What is an FCE in long-term disability?
A functional capacity examination (FCE) in long-term disability is a test that assesses a person’s physical abilities. It can be a valuable tool in examining a person’s ability to work.
What does ERISA have to do with long-term disability?
ERISA is the Employee Retirement Income Security Act. It regulates employer-provided long-term disability insurance plans. The law creates timelines and requirements on the insurance provider for processing appeals.
Lawyers for Long-Term Disability Appeals in Arizona
Pekas Smith Disability Attorneys represents both residents and non-residents of Arizona in long-term disability appeals.
To see how we can help you, contact us for your free consultation.
Why have a lawyer early in the process when appealing long-term disability?
The sooner you have a lawyer in the process of appealing long-term disability, the better. If your case reaches federal court, the court will only consider the information available to the insurance company at the time the final decision was made. That makes it very important to present a thorough case at the beginning of the appeals process.
Our lawyers can help. Whether you are filing your first appeal or needing to take it to the next level, our legal counsel can assist you.