How to Appeal a Disability Insurance Claim Denial
If you are seeking disability insurance benefits and received a claim denial, you may wonder where to turn. You may feel lost and helpless and think that this is the end of the line as far as receiving benefits that you know you deserve. However, the process of getting disability insurance benefits doesn’t have to end with the claim denial. No, both employer disability and Social Security disability insurance (SSDI) will allow you to appeal a denial if this happens to you. They will help you several times if necessary. Just because you have made a disability insurance claim and received a denial, doesn’t mean that you aren’t disabled and entitled to eventually receiving benefits. Less than one-third of SSDI claims will be approved initially. Now you can find out what to do if you receive a denial and where to turn next.
How do I Appeal a Denial?
- Get a copy of the policy. Go about obtaining a copy of the LTD policy plan documents. Anybody can receive these from the company’s human resources department or even directly from the insurer. If the HR department or insurer fails to provide you with the documents, you will have to request to receive them in writing from the plan administrator at the insurance company. They are required to provide them under ERISA, which stands for the Employee Retirement Income Security Act. This law will allow the plan’s administrator to evaluate the claims that it will have to pay.
- Study your denial letter. The denial letter will note the reasons why your initial claim was rejected and any other information that may be needed to approve the claim. Be sure to mark other things noted in the letter such as how and when to file your appeal.
- Consider the help of a lawyer. If you want a lawyer to handle your case, then you should go forth with it as soon as possible. Finding a lawyer who is well versed in ERISA law is your best option whether you file before the claim or after the denial letter. He or she will be able to obtain additional medical evidence or soliciting opinions from your doctor.
What Else Can be Done?
Under ERISA law, it is known that the federal courts will typically refuse to consider any evidence that wasn’t presented to your insurance company or plan administrator in their internal appeals process. It is important to track down missing records because in some cases, plan administrators will fail to obtain all of the medical records that may be relevant to your case. If anything ends up missing, then you will be able to inform your claims representative and ask for confirmation as to when the records were requested and are received.
You can also find out if tests would help. Further testing such as MRIs, x-rays, or blood tests may be able to help you in your case. The more objective medical evidence you provide, the better your chances will be throughout the process.
Lastly, you can ask your doctors for written opinions. You can ask your treating physicians and specialists to provide written opinions as to what your limitations are dealing with your medical condition. Your attorney will be able to help you craft questions for your doctor based on your case. Call MDL today for a free consultation and review of your case. We can be extremely beneficial to you and work with you in every aspect of your claim.