Common Mistakes Made When Appealing a Long Term Disability Denial

When appealing a denied claim for long-term disability benefits, many individuals make critical mistakes that can significantly harm their chances of success. At Bartolic Law, we have seen these errors time and again and understand how to navigate the appeals process effectively. Here’s a guide to some common pitfalls and how to avoid them.

Delaying the Appeal

One of the most frequent mistakes is waiting too long to start the appeal process. Insurers typically allow only 180 days to file an appeal after a denial, which may seem like plenty of time. However, gathering the necessary medical records, obtaining expert opinions, and crafting a compelling appeal can take significant time.

Tip: Begin working on your appeal immediately after receiving a denial notice. Early action allows sufficient time to build a robust case.

Inadequate Medical Documentation

Insurance companies often deny claims due to insufficient medical evidence. Relying solely on your treating physician’s notes without comprehensive documentation can weaken your appeal.

Strategy:

• Ensure you have detailed, up-to-date medical records.
• Seek additional tests, if necessary, to substantiate your condition.
• Obtain written statements from treating physicians that clearly outline your limitations and inability to work.

Not Understanding the Insurance Policy

Many clients fail to thoroughly review their insurance policy, missing critical requirements or limitations that could impact their appeal.

Solution:

• Carefully read your policy’s definitions, exclusions, and provisions.
• Pay particular attention to terms such as “disability,” “any occupation,” and “own occupation.”

Overlooking the Importance of Legal Representation

Attempting to handle an appeal without experienced legal help can lead to critical missteps. A seasoned attorney can provide invaluable guidance and ensure all procedural requirements are met.

Emphasis:

Seek legal advice immediately upon receiving a denial. An attorney with experience in long-term disability appeals can:

• Analyze the insurer’s denial reasons.
• Gather and present compelling evidence.
• Craft a persuasive argument tailored to your policy’s specifics.

Failing to Gather Comprehensive Evidence

The appeal process is akin to a paper trial, where the strength of your evidence is paramount. Missing pieces of evidence can severely undermine your case.

Steps to Take:

• Collect all relevant medical records.
• Obtain opinions from both treating and independent doctors.
• Include any vocational assessments that support your inability to work.

Preventative Measures:

• Always ensure your treating physicians provide thorough and detailed reports.
• Cross-check all evidence to ensure it aligns with the definitions and requirements outlined in your policy.

Contact Us for Help

Appealing a denied long-term disability claim is complex and fraught with potential pitfalls. At Bartolic Law, we emphasize the importance of immediate action, comprehensive documentation, and legal representation. By avoiding common mistakes and following best practices, you can significantly improve your chances of a successful appeal.

The better your appeal, the less likely your case will drag out in court. Leverage our knowledge to navigate the challenging landscape of long-term disability appeals and secure the benefits you deserve.

For professional legal assistance with your appeal, contact us at Bartolic Law. We turn denials into payments and help you regain control of your financial future.