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Long-term disability claims: how many times can I appeal?

On Behalf of | Apr 19, 2024 | Erisa, Long Term Disability Claim Denial

If you are facing a long-term disability claim denial in California, you know how frustrating it is to go through that. However, there is additional knowledge you should have and resources you should consider.

First, let’s go over what an appeal is. Simply put, if the insurance company denies your long-term disability claim, you may ask them to take another look at it. You can also have an attorney help you by advocating for you in this process.

In California, the number of times you can appeal a denial depends on the insurance policy. Though, there are certain steps laid out for people who appeal long-term disability claim denials.

First appeal

An initial appeal, or administrative appeal, is your first request to the insurance company for reconsideration of your claim.

Remember that if an insurance company denies your benefit, they must tell you why. You can respond to that letter responding to the reasons they give you.

Perhaps they missed something in your medical records, or perhaps they overlooked an important aspect of the claim. Likewise, you may have more evidence to provide.

Second appeal

After that first appeal, you may appeal again if the insurance company denies your request for reconsideration. Here, you can strengthen your case and provide additional information and evidence as well.

After two appeals

If you appeal to the insurance company twice and they deny you a second time, things may get more serious. Therefore it is wise to seek representation, because understanding the law can be helpful in getting the insurance company to approve your claim.

Going to court

You should be able to take your case to court for a judge to decide whether the insurance company was right in denying your benefit or whether they owe you benefits. This is a lawsuit, for which you should seek representation.

These steps are general and do not apply to every insurance company’s policy, so read the policy carefully to understand what process and procedure they have, which you likely signed and agreed to.

You are not alone in this. Many people have been in your situation, and it is frustrating, to say the least. Contacting your attorney can do wonders in certain cases, so make sure you do not give up just yet.