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If your long-term disability claim has hit a roadblock with a denial, you’re not alone in your struggle. Many individuals find themselves in a similar situation, unsure of what to do next. However, by being proactive and informed, you can work towards overturning the denial and obtaining the financial support you need during this challenging time. Here are the steps to follow if your long-term disability claim is denied.
Steps to Take If Your Long-Term Disability Claim Is Denied
Please note that this primarily applies to ERISA-governed plans. Most ERISA-governed plans are part of a group employer plan. It is not meant to apply to individual disability plans.
Request Your Claim File
The first thing you must do is request a copy of your entire claim file. This is all the evidence that the insurance company has on your case. This may include:
- All the internal correspondence at the insurance company.
- All the correspondence with their hired doctors and nurses.
- All the correspondence to and from you.
- All the medical records and other vocational evidence developed during the review of your claim.
You need to have all this information so that you can know how to go about filing your appeal.
Evaluate the Reason for Denial
The next thing that you must do is evaluate the reasoning behind the denial. For example, they may have sent you for an “independent” medical examination, and their doctor wrote a report about what you can and can’t do. You want a copy of that report so you and your treating physicians can dispute their doctor’s assessment of your ability.
They may have conducted video surveillance, recording your daily activities on one or more days. You want to have a copy of the video so A) you can determine if that’s you in the video and B) so that you can explain what you were doing when they were recording you.
Next, you want to review their vocational assessment. An insurance company would typically refer your file to a job expert to determine your job responsibilities. However, they may not have even identified the correct occupation, so you may need to have your own vocational professional assess your actual job title and individual responsibilities.
Attack the Reason for Denial In Your Appeal
Finally, in your appeal, you want to attack the reason for denying your claim. The insurance company will set forth all the reasons why it’s denying your case, so you want to go step by step and attack the evidence and the reasoning behind their decision.
One of the ways that you might do so is perhaps through an affidavit where you swear under penalty of perjury about specific facts that may directly refute some of the facts that they’ve put in their denial letter. I’ve even seen some individuals prepare a “Day in the Life of” video where they may have someone, a videographer, follow them around to give insight into the problems that you have on a day-to-day basis, and again, the idea of this is to go against any surveillance video that they may have on you.
RELATED POST: LTD Appeal Guide: How to Appeal a Long-Term Disability Denial
One of your most critical pieces of evidence is updated medical evidence. By the time the insurance company has decided, you may have been to the doctor several more times. You want to get any updated medical evidence on record in your claim as part of your appeal. If the insurance company says there is insufficient medical evidence to support your claim, you may try to go out and get additional evidence, whether it be an MRI or an additional X-ray. These are objective medical findings that can go far to support a physical disability claim. On the mental health side, you might have neuropsychological testing done that will show any cognitive impairments you may have as a result of your condition.
Putting together all this evidence can take anywhere from two to six months, but be sure to act within the time limits stated in your denial letter. In most cases, you have 180 days to file your appeal, but sometimes, the time may be shorter. Check your denial letter.
Ortiz Law Firm Can Help Appeal Your Long-Term Disability Denial
Florida attorney Nick A. Ortiz is an experienced long-term disability attorney who is compassionate and dedicated to the rights of those whose LTD benefits have been wrongfully denied or terminated. If you want more information, he wrote a book called The Top Ten Mistakes That Will Destroy Your Long-Term Disability Claim that you can download for free.
If you are looking for an attorney to appeal your long-term disability denial, we would be happy to review your legal options during a free case evaluation. Complete our free case evaluation request form or call us today at (888) 321-8131. Most inquiries are responded to within 24 hours of submission.
