Should I File An Optional Long-Term Disability Appeal?

If your insurance carrier has denied or terminated your long-term disability claim, you should review your insurance policy to familiarize yourself with your appeal rights and requirements. Specifically, you should determine how many appeals you have the right to or are required to file before you can file a lawsuit against your insurer. Under the terms of most policies, you are only required to file one appeal. Some policies also offer an “optional” appeal.

Why Would I File an Optional Appeal?

That depends on the individual circumstances of the case. Sometimes, it makes more sense to go through the optional appeal. For example:

• Suppose you did not have a definitive medical diagnosis while your first appeal was under review, and additional medical testing disclosed a more specific diagnosis. In that case, you may want to submit this new evidence during the optional appeal.
• If your Social Security Disability claim was approved after the first appeal, you may want to go through the optional appeal to submit evidence of the Social Security win.
• If you have new office visit notes, a new statement from your treating physician, new diagnostic testing, etc., it may be beneficial to file an optional appeal.

When deciding whether you will file an optional appeal, it is important to consider the evidence submitted in support of your claim. In most cases, the court will be limited to reviewing the same evidence that was available for the insurer to review. You must “stack the record” with as much evidence as possible before you file a lawsuit.

However, if a claimant is tired of dealing directly with the insurance company, he or she may decide to skip the optional appeal step and proceed directly to litigation. That way, the claimant is no longer dealing with an insurance adjuster who appears bent on denying the claim and instead asks the court to step in and make the insurance company pay. Claimants should always consult an attorney before foregoing an optional appeal.

How a Long-Term Disability Attorney Can Help

Attorney Nick Ortiz and his team guide and support clients throughout the appeals process. Here are some of the specific steps they will take as they prepare your appeal:

1. Understand the rationale for upholding your long-term disability claim denial.
2. Compile fresh evidence, such as witness testimonies, medical records, physician’s opinions, employment data, and vocational assessments.
3. Request, scrutinize, and analyze your claim file to identify what medical and other documentary evidence exists.
4. Request, scrutinize, and analyze your insurance policy to clarify the interpretation of crucial terms and identify all available coverage.
5. Conduct a thorough evaluation to determine what needs to be proven to qualify for benefits under the LTD insurance policy.
6. Examine legal issues, such as the burden of proof, and determine whether state or federal law applies.
7. Obtain a sworn statement from your physicians to comprehensively explain your condition(s), the resulting limitations, and your prognosis.

While there’s no guarantee that your appeal will succeed on the first or even the second attempt, we are committed to preparing an appeal that is precise, clear, and complete with all necessary data. Our mission is to ensure the insurance company fulfills its obligation by paying the benefits you are entitled to and maximizing your recovery under your LTD policy.

Schedule a Free Case Review

We don’t charge attorney fees or costs unless we secure benefits for you. If your claim has been denied or terminated, the legal experts at Ortiz Law Firm are prepared to assist you in navigating bureaucratic complexities and advocating for your disability benefits. We represent claimants located anywhere in the United States. Contact us at (888) 321-8131 to discuss your claim today.