How Do You Appeal a Long Term Disability Insurance Denial? It Depends.

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http://www.disabilitydenials.com/long-term-disability-appeal.html

In this video Marc Whitehead, a Board Certified Disability Attorney, discusses how you can appeal your Long Term Disability Insurance denial.

If an Insurance Company denies your claim for Long Term Disability Benefits you have the right to appeal their decision and the insurer must allow you recourse to a full and fair review of a denied claim. This is true whether you have a private disability policy or your employer has provided an ERISA governed policy.

An Administrative Appeal is a formal request for a reconsideration of an unfavorable decision, made by the insurer. Such as a denial, reduction or termination of benefits. The process involved in a Long Term Disability appeal, depends on the type of LTD policy your claim is under.

You may be an employer funded disability plan which falls under federal ERISA regulation or you may have a private or individual disability policy which you bought yourself. Private LTD claims are regulated by state insurance laws. The laws regulating each type of disability insurance claim are very different.

Appealing ERISA Disability Insurance Denials:
Employee Retirement Insurance Security Act (ERISA) is a federal law that regulates most group disability insurance benefits provided by employers, professional associations, or Unions. ERISA Long Term Disability Appeals must follow an extensive Administrative Appeals procedure. You will have a deadline of 180 days in which to file your initial appeal.

The Administrative Appeals process is critical. The Appeal becomes the frame work for a successful outcome of your entire case. You need to fully develop the record with pertinent evidence, such as medical records, medical expert opinions, Vocational Expert opinions, Letters from employers and friends, Medical literature, and photographs.

You need to effectivley argue against the insurance companies in house medical reviews and any misuse or misrepresentation of the evidence by the insurer.

If your claim is not approved once the administrative appeals process has been exhausted. The next step is to file a lawsuit. ERISA disability lawsuits are held in federal court before a judge and not before a jury of your peers. Once a lawsuit has been filed it is most often the case that you will not be allowed to add any new information to the record. That is why to avoid losing your appeal, it is strongly advised that skilled legal help is acquired to assist you during the appeals process.

Appealing Individual or Non-ERISA Disability Insurance Denials:
Appealing these types of claims are done differently. Private disability policies are contracts between you and the insurance company. Because of this, these policies and claims denials are governed under state contract and bad faith law.

Unlike ERISA base claims which require you to exhaust strict administrative appeals, private policies generally don’t. If your claim is denied, you have the right to appeal the LTD claim denial to your insurer. Be aware that this appeal is often nothing more then an internal review with the same insurance carrier that denied your claim in the first place.

When an acceptable settlement with the insurance [...]

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