When you have long-term disability insurance, your insurer should pay you benefits if you become unable to work due to a covered medical condition. This is true whether you bought the policy on your own or your employer provided long-term disability insurance coverage to you.
Sometimes, however, an insurer denies a claim. If this happens, you will need to go through the appeals process — and you should not go through it alone. At Atlanta, GA, long-term disability denial lawyer at Julie A. Rice Law can help.
Our firm has decades of collective experience turning denials into approvals to get you the income you need when you can no longer earn a paycheck. Give us a call today to schedule a consultation and learn more about how we can help you
Steps to appealing a denied long-term disability claim
If you receive a denial from your long-term disability insurer, there are a few key steps to take right away. You should:
- Review the denial letter carefully: Your letter from your insurer should explain why your claim was denied, any issue with your file, such as missing records, and any company policies that affected your eligibility for benefits, such as a missed deadline for reporting your disability
- Notify your insurer that you are appealing: You’ll see instructions in your letter for how to appeal. While the specifics can vary by policy, you will typically have a limited time, such as 180 days from the date of the denial. If your policy is covered by ERISA, this is the deadline that the insurer must stick to. You’ll want to write an appeal letter within that time frame.
- Put together a strong appeal: If you were missing information or the insurer noticed specific deficiencies in your application, gather this information to provide it to the insurer. You should also get a copy of your policy and, when possible, your claim file so you can see what information the insurer has and what the specific requirements are to get covered. You want to show your insurer you meet the policy definition of disabled, and you want clear and convincing evidence of that fact.
You will need to make sure that you include all of the key information needed to bolster your claim, as ERISA guidelines may prevent you from providing evidence later if you didn’t submit it to your insurer during the initial internal application and appeals process.
If your appeal to the insurer does not work, you can pursue additional remedies under ERISA if your plan was a workplace policy, as well as under other laws protecting insured policyholders, regardless of whether you bought your plan as a private party or through your employer.
You can even go to court in certain circumstances to hold your insurer accountable for unfairly denying your claim.
Getting help from an Atlanta long-term disability denial lawyer
It can be complicated to navigate the appeals process, and the stakes are high — especially because ERISA imposes strict requirements regarding the internal appeals process and the evidence that you can present in court if you must make a federal claim.
Contact Julie A. Rice Law today to get help from a caring and knowledgeable Atlanta long-term disability lawyer who can fight for you to get the full benefits your policy should offer during your time of need.