If you are appealing a long-term disability denial from your insurance company, or you are concerned that they will discontinue your payments, you need to take the following steps to make sure you get your full entitlement for long-term disability (LTD) benefits.
How to Appeal Long-Term Disability Denials
1. Find Out the Deadline to Appeal Your Denial
Benefits providers can differ about deadlines for appealing a denial. Some may be fairly lax about the deadline, but others may automatically exclude you from further benefits if you miss the deadline.
Your best option, regardless of your benefits provider, is to find out when the deadline is for your appeal. If you received a benefits denial letter, the deadline should be listed in the letter. The deadline may be outlined in one of two ways. The first is a timeframe for appealing, for example, 30 or 60 days. The second is a specific date after which the appeal may be denied.
2. Defend Your Rights
In addition to sending a denial letter to you, your insurance company will also send a letter to your employer. The letter will tell the employer that the insurance company believes you are able to work and that they are denying your claim for long-term disability (LTD) benefits.
The letter from the insurance company usually triggers a letter from your employer asking when you will return to work. You need to let your employer know in writing that you are appealing the insurance company’s denial of your LTD benefits.
Upon receipt of your letter, your employer will usually do one of two things. They may allow you to appeal your denial by giving you unpaid sick leave, or they may demand that you return to work to keep your job.
If they choose to demand that you return to work, you need a new note from your doctor stating their opinion that, despite the insurance company’s position, they continue to give you medical leave from work. The updated doctor’s letter will entitle you to at least get unpaid sick leave to appeal the denial of LTD benefits.
3. Get Your Paperwork in Order
To fully understand how to get all the LTD benefits you are entitled to, you need to gather several documents.
- You need the denial letter which outlines the reasons for which your claim is being denied.
- You also need information from your group insurance provider that outlines your LTD entitlements.
- If your claim is over six months old, you need to get a ‘Claim File’ from your insurance company.
- If you belong to a union, you need a copy of their collective agreement with your employer.
- You should also get your medical file from your doctor as it relates to the condition(s) that caused you to make your LTD claim.
4. Check the Denial Letter to See if You Need to Submit Additional Information
Your insurance company’s denial letter must include the reasons why they are denying your claim. Very often, those reasons revolve around missing information. Many letters will list specific information that you must provide to support your claim. If you submit that information, the insurance company may review their denial of your benefits.
If this is the case with your denial letter, you must get all the documented information the letter outlines. This can include information from your doctor; other treatment providers and/or from your employer.
Sometimes the letter is vague about the reasons for denial or appears to not list any reasons. If that’s the case with your letter, you are within your rights to ask the insurance company for specific reasons for the denial. Also, the insurance company’s claim file may have information that is helpful in understanding why your claim was denied.
5. Assemble Your Documentation, Prepare Your Claim Letter & Submit It
Ultimately, your appeal letter needs to state your request for an appeal of the insurance company’s decision, include your relevant documentation, and be received by the insurance company before the deadline.
You may be tempted to present your ‘case’ for reversing the denial of the claim. But be careful not to get too technical or ‘legal’ in the approach and wording of the letter. You are not a legal or employee benefits expert. The more points you make to support your position, the more places they have to find a fault.
Instead, explain in your own words how the documents you are submitting address the issues the insurers raise in their denial letter.
How to Make Sure Your Appeal is Seen & Heard
Even if you do everything properly in assembling, writing and submitting your appeal, just one slight mistake or missed item can cost you your entitlement. For guidance to ensure that you put together the strongest, most complete appeal, and in starting a lawsuit if your appeal is denied, please contact MA LTD Lawyers Law.