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Tips for writing an ERISA appeal letter

On Behalf of | Sep 27, 2022 | Long Term Disability Claim Denial

A denial of long-term disability benefits can be a convoluted nightmare. But there is one part of this nightmare that you should approach with the mental clarity necessary to obtain your benefits: The appeal letter.

Writing an effective letter of appeal is like building your own garage. Theoretically, you might be able to do it yourself, but it’s best to at least consult a professional. It’s even better to let that professional build most of the garage for you, while you paint and install shelves. An attorney consultation is in your best interest.

Get the full file

In all likelihood, the denial letter was short on details and it’s the details that will carry your appeal. Contact the insurance company and ask them to send a copy of your entire claim file.

Build your appeal argument

You’ll have to sit down and read the entire file. Write down any details that are missing. Documentation can get lost in the shuffle and it’s not the insurance company’s job to chase down information. In fact, it’s their job to make sure they don’t pay out one more penny than necessary.

Contact your doctor, any specialists you saw, anyone at all involved in your recovery, and have them send over relevant documentation for the appeal. Make sure your doctor understands exactly why you need this information, so they write office notes that detail your disabling condition(s) which will support your claim and appeal.

Did the denial letter mention something you know to be inaccurate? Make a note of it. Phrasing matters in these documents. If you disagree with the language, highlight that in the appeal and explain why.

It’s possible there are legal errors in the denial. An experienced lawyer should read both the denial letter and the file to identify misapplication of the law.

When you write the appeal

Be thorough, citing details from the denial that you dispute and back up your argument with the documentation you collected. Don’t assume the insurance company will find the straw in the haystack. You need to show them the straw and then put it on a billboard.

If the insurer’s issue isn’t the injury itself, but your ability to return to work, explain precisely why you can’t work due to your condition. Don’t assume they know how your job works. If there’s a specific activity that you’re unable to perform, go into detail about the activity, the necessity of the activity in performing your job, and how your condition makes performing that activity impossible.

However, be careful not to resort to exaggeration. This will only hurt you. The insurance company deals with thousands of these cases and can often figure out when the facts are unsupported by what is reported. You should consider asking your doctor to write a report to describe your condition in an objective, clinical way.

Again, an experienced attorney should at least proofread your letter, though letting them do the heavy lifting by writing the letter themselves will drastically increase your chances of success.