How Soon After a Long Term Disability Claim Denial Can You Submit an Appeal?

When you’re unable to work due to illness or injury, long-term disability benefits can provide much-needed financial support. However, the process of claiming these benefits is often complex, and sometimes, claims get denied. This can be a frustrating experience, but it’s crucial to remember that denial isn’t the end of the road. In many cases, you can appeal the denial and potentially have it reversed. In this blog post, we’ll delve into common reasons for claim denials, the appeals process, and actionable steps you can take to increase your chances of a successful outcome.

Common Reasons for Claim Denials

Understanding why claims get denied is the first step toward a successful appeal. Here are some common reasons:

1. Lack of Sufficient Medical Evidence: Insurers need concrete evidence of your disability. If they feel the provided medical records, test results, or doctor’s opinions are insufficient, they might deny your claim.
2. Failure to Meet the Definition of Disability: Each insurance policy has its definition of disability. If your condition doesn’t meet this criterion, your claim might be denied.
3. Pre-existing Conditions: If insurers believe your disability is related to a pre-existing condition, they may deny your claim. However, if your condition has worsened or is unrelated, you could still be eligible for coverage.

The Appeals Process

If your claim gets denied, don’t panic. Here’s how the appeals process works:

Time Frame for Appeals: After receiving a denial, you typically have 180 days to submit an appeal under ERISA regulations. It’s crucial to act promptly within this timeframe.

Levels of Appeal: There are usually multiple levels of appeal available. If your initial appeal gets rejected, you might need to go through further appeals.

Required Documents: You’ll need all relevant documents for your appeal, including medical records, test results, opinions from treating doctors, and a copy of the denial letter.

Working with an Experienced Attorney: Navigating the appeals process can be complex. Hiring an experienced attorney with knowledge of long-term disability claims can significantly improve your chances of an approved claim.

Timeline and Possible Outcomes

The length of the appeal process varies, but insurers generally have a specific period to review your appeal and make a decision. The possible outcomes include:

1. Approval: If your appeal is successful, the insurer will reverse the denial and provide the benefits.
2. Partial Approval: Sometimes, insurers might partially approve the claim, providing benefits for a limited period or under certain conditions.
3. Denial Upheld: If the insurer upholds the denial even after the appeal, you might need to take further legal action, like filing a lawsuit.

Taking Action

If your long-term disability claim gets denied, act quickly. Obtain a copy of the denial letter, review your policy, gather all necessary documents, and consult with an experienced attorney. Although each case is unique, being proactive, organized, and seeking professional assistance can significantly improve your chances of a successful appeal.

Reach Out To Bartolic Law

At Bartolic Law, we’re dedicated to helping individuals navigate long-term disability claims and appeals. Our team can guide you through each stage of the process, ensuring you’re fully informed and supported. Contact us today to discuss your case and explore your options. A denial isn’t the end. With the right help and approach, you can turn denials into payments.