UPDATE: After writing this article, I went ahead and wrote an e-book for disability claimants who want to handle their own appeals. It includes form letters and disability forms for your doctor to fill out (which I use in my own practice). If you’re interested, check out The Disability Insurance Appeal Guide.
If you apply for long term disability insurance benefits and your claim is denied, you will likely receive a letter from your insurance company telling you that you have the right to appeal its decision within 180 days. You should get a similar letter if you had been receiving LTD benefits and the insurance company cut your benefits off. While appealing the denial within 180 days is vital to preserving your right to sue under federal ERISA law, you should not try to handle this appeal on your own. Instead, you should contact a disability lawyer who knows ERISA as soon as possible after getting your denial letter.
Disability Insurance Appeals and ERISA
Federal ERISA law requires that disability insurance companies offer claimants the right to at least one appeal of a claim denial, and that this right to appeal is stated explicitly in the denial letter. Failure to appeal within 180 days of receiving the denial letter will almost always end your claim and prevent you from suing your disability insurer. Most disability insurers make it seem as though you must submit new medical information if you want to appeal, even though that is not the case (though it is almost always better to do so if you can). In reality, you can appeal based on the same information upon which your claim was originally denied, and your insurance company must appoint a different claims adjuster to review your claim. If the insurance company employed a doctor to review your claim prior to your initial claim denial, they must employ a different doctor to review your claim on appeal. In its most basic form, an appeal of a disability claim requires that new people at your insurance company review your claim to make sure the original denial was not just a bad decision by a single adjuster.
This is not to say that you should expect a fair review on your appeal, or that your chances of being approved on appeal are any better than your chances with the adjuster who originally denied your claim. In practice, only adjusters who truly screwed up your original claim denial will get reversed by a co-worker on appeal. Therefore, it is not in your best interests to try to handle this appeal on your own, as your initial claim denial usually means that you’re eventually going to have to sue your insurance company to get your benefits reinstated. Hiring a lawyer to help you with your appeal ensures that your case will be in the best posture for an eventual lawsuit.
The Disability Insurance Appeal – Why You Shouldn’t Handle Your Own
Your disability insurer won’t tell you this in your denial letter, but the medical information you submit with your appeal is likely the last medical information you will ever be able to submit to support your claim, even if you later file a lawsuit. I cannot stress this point strongly enough. When you sue your disability insurance company under ERISA, the court will only consider medical information that was in your insurance company’s file at the time of its final denial of your claim. The final claim denial occurs after you have used any and all claim denial appeals available. Most insurers offer only one appeal, as this is all that ERISA requires.
This means that if you don’t submit a piece of medical evidence with your appeal (before you file your lawsuit), the court will not consider that medical evidence in your lawsuit against your insurer. You cannot submit new medical evidence in an ERISA disability lawsuit. This is why it is vital that you hire a disability lawyer before you appeal your disability insurance claim denial. Your disability lawyer is in the best position to know what needs to be submitted to the insurer to give you the best chance of winning a disability lawsuit.
If Your Disability Insurance Claim is Denied, Call a Disability Lawyer ASAP!
The sooner you contact a disability lawyer after your claim is denied, the better off your case will be. 180 days may seem like a lot of time to appeal, but if you are waiting on tests like MRIs or CT scans, which may make or break your case, this time can fly by. Your lawyer may be able to extend the 180 days if you are waiting on important test results.
Of course, you should still contact a disability lawyer even if you’ve put off dealing with the appeal and you are running out of time. We understand that people get discouraged and depressed and have many reasons for not contacting us as soon as we’d like them to. Even if you are mere days away from your 180 day deadline, you are better off contacting a disability lawyer than not. Your disability lawyer may be able to meet your appeal deadline and still buy you more time to submit new medical evidence. Don’t lose hope while you are still able to appeal.
If You’re a Disability Claimant in Northwest Florida, Call Me — Disability Lawyer Robert T. Bleach
If your disability insurance claim was denied and you’re in Northwest Florida, you can call me for a free consultation. Use my toll-free number (top of page) if you’re not in the Pensacola area. If you’re shy, you can e-mail me using my contact form. I represent clients in the following major Florida cities:
- Ft. Walton Beach
- Panama City
For a complete list of all Florida counties served, see the box at the bottom right side of this page.