A long-term disability claim denial can feel like a dead end, especially when you depend on those benefits for basic financial stability. Below are common mistakes that you might encounter, and understanding them can help you take the next step.
Letting the denial go unchallenged
Most employer-sponsored long-term disability plans fall under the Employee Retirement Income Security Act, commonly referred to as ERISA. This federal law controls the appeals process, and federal courts have generally limited judicial review to the evidence submitted during the administrative stage.
Under this law, you have the right to at least one administrative appeal. During this stage, you can add new medical records, functional capacity evaluations and other supporting materials that were not included in your original claim.
This step carries lasting importance. If your case later moves to federal court, the judge will generally look only at the administrative record. As a result, any evidence you leave out during the appeal may not become part of the case at all.
Overlooking strict appeal deadlines
ERISA plans must provide at least 180 days from the date you receive your denial notice to file an administrative appeal. This window may seem like a significant amount of time, but the process of gathering evidence can consume that period quickly.
If you miss the deadline, you lose the ability to appeal. Courts consistently hold that when you do not complete the administrative process under ERISA, you cannot move forward with a lawsuit, even when the claim itself has strong support.
Reaching out to the insurer alone
Many claimants contact the insurance company after a denial to ask questions or share additional details about their condition. These conversations may feel routine, but the insurer can log your statements and reference them later to support its position.
A casual remark about your symptoms, daily routine or physical capabilities could be interpreted differently than you intended. An attorney who is familiar with ERISA cases can assist you by communicating on your behalf and framing the appeal around the specific grounds cited in the denial letter. They can also help with the other factors of your claim, such as gathering medical documents, and set expectations for your case.