If you’re looking to appeal a Long Term Disability Claim, it’s important to be detailed and thorough. Here are six common mistakes you’ll want to avoid.
1. Working without a copy of Your Short and/or Long Term Disability
Policy This policy may be requested from your Employer at any time. In fact, even if you have a copy of your Plan, request a new one at the time you become disabled or are appealing a denial, as the Plan may have important updates which apply to the application of your benefit plan. This contract governs the agreement between you and the Insurance Company (or other entity) and its particular language can significantly impact how your claim turns.
2. Communicating over the Phone
It is vital that all correspondence between you and the insurance company be in writing. The best method of contact is through certified mail. You should always keep a copy for your own records, as well. Of course, this is most important when it comes time to submit your appeal as time frames are involved and you will want to be able to show that you did not miss what could potentially be fatal to your claim deadlines.
3. Filing an Incomplete Appeal
You are usually given 180 days from the time of your denial in order to file the appeal of that denial. This is the time to gather medical records, or update medical records, and get doctor opinions in writing to support your disability claim and negate the basis for the denial. It is important to use as much of this time as you need to use the evidence you are able to gather to your advantage. It is a mistake to hastily appeal a denial. We have been told that insurance company representative may tell you that the only thing you need to do to appeal it to submit a letter in writing stating, “I appeal.” Nothing could be worse for your claim as there will be no new evidence upon which the insurance company could change their decision.
4. Not requesting and reviewing the claim file
Just as you are entitled to request the policy from your Employer, you are entitled by law to request the claim file, or Administrative Record, from the Insurance company. This is the complete file the insurance company has in their possession and upon which they based their decision. At the exhaustion of your claim, this is the entire body of evidence which would be used if a lawsuit is filed. For this reason, it is vital that you find out what documents and information is in the claim file and supplement it with supporting evidence before evidence closes.
5. Missing the Deadline to file or appeal your claim
As mentioned earlier, you usually have 180 days to file your appeal once you receive a denial of Long Term Disability benefits. If you miss this deadline, you may lose your ability to appeal the claim entirely. In addition, it is important to use the 180 days to your advantage. Waiting until the last minute to begin gathering data could hurt your claim just as much.
6. Not getting the help you need to win your Long Term Disability Claim
Long Term Disability claims can become extremely complicated in a hurry. This can be overwhelming to a person unfamiliar with the particular pitfalls common to Long Term Disability claims. Once a denial has been issued, it is near impossible for a lay person to overcome without the help of an attorney proficient in this area of the law.