When a physical or mental condition leaves you unable to work, you would expect to receive long-term disability benefits under your employer’s insurance policy. However, the denial of valid claims occurs all of the time. The good news is an initial denial is not the final word. You have the opportunity to appeal.
The appeals process
The Employee Retirement Income Security Act (ERISA) requires long-term disability insurers to include an appeals process as part of their plan. Under this process, you have the right to request a review of your claim by someone who was not part of the original decision. The person who reviews your appeal can’t take the initial decision into account or consider the reason given for the denial of your claim.
You should pay attention to the filing deadline. The insurer must give you at least 180 days to file your appeal. You may include new information as part of your appeal. For example, if your condition has worsened or if you’ve received a new medical diagnosis, it can be helpful to address these issues on appeal.
Second or voluntary appeals
Some insurance providers allow for an additional level of administrative appeals. These are known as second or voluntary appeals. You must file your second appeal within a reasonable amount of time. The deadline can vary from plan to plan and is often less than the 180 days you are given to file your initial appeal. If your second appeal is denied, your last option is to take your claim to court.
You don’t have to go it alone
When you’re challenged by a long-term disability, the last you need is to worry about the claims process. You should consider working with a legal professional. A professional can help you put together the strongest possible claim for benefits and advocate for your interests every step of the way.