Dealing with a Long Term Disability insurance denial can be frustrating. Keep these tips in mind before starting an appeal.
When a Long Term Disability (LTD) claim is denied, it can leave you feeling overwhelmed and unsure of what to do next. After months or even years of working hard and planning for the unexpected, discovering that your insurance provider has rejected your claim may feel like a setback.
However, a denial is not the end of the road. With the right strategy, attention to detail, and legal guidance, you can challenge the decision and pursue the benefits you deserve.
At Herbert M. Hill, P.A., we work with clients across Florida who have had their LTD claims denied. We help them understand why the denial occurred, gather the appropriate documentation, and confidently navigate the appeals process. Below are six important tips to remember if you are considering appealing a denial of LTD benefits.
1. Review the Denial Letter Carefully
The first step is to understand why the claim was denied. Insurance companies are required to provide a written explanation of the Long Term Disability insurance denial. This letter will outline the reasons behind the decision and may reference specific policy terms or medical evidence.
Take time to read through this document thoroughly. Look for the following:
- Claimed lack of medical evidence
- Statements regarding pre-existing conditions
- Disputes about your ability to work
- Administrative or technical errors
Understanding the insurer’s reasoning will help you and your attorney build a targeted response.
2. Pay Attention to Appeal Deadlines
Most LTD policies are governed by strict deadlines, mainly if the policy is subject to the Employee Retirement Income Security Act (ERISA). In many cases, you will have 180 days from the date of the Long Term Disability insurance denial letter to file an appeal. Missing this deadline may permanently bar you from pursuing benefits.
Acting quickly is essential. It is important to use this time to file a response and collect and organize the strongest possible supporting documentation.
3. Request Your Complete Claim File and Insurance Policy
You have the right to obtain your entire claim file from the insurance company. This file includes everything the insurer considered when making the decision, including medical records, notes from internal reviewers, and correspondence. You should also review your policy documents carefully, including:
- How the policy defines “disability”
- Any exclusions or limitations (such as those for mental health conditions or chronic pain)
- Coordination of benefits with other sources of income (such as Social Security Disability)
- Whether you fall under an “own occupation” or “any occupation” standard
Understanding the scope of your coverage and how the insurance company interpreted your claim is essential in crafting an effective appeal.
4. Submit Strong Medical and Vocational Evidence
Medical documentation is the foundation of a successful LTD appeal. The insurance company may have rejected your claim due to a perceived lack of evidence, so now is the time to submit as much relevant and credible information as possible.
This may include:
- Updated records from your treating physicians
- Detailed written statements from specialists
- Functional capacity evaluations
- Imaging results, lab work, and clinical test results
- Opinions from vocational experts regarding your ability to work in your field or any occupation
If your condition is difficult to quantify—such as chronic pain or fatigue—statements from family members, colleagues, or supervisors may also help illustrate how your disability affects your daily life.
5. Continue All Recommended Medical Treatment
If you have been diagnosed with a disabling condition, continuing your treatment plan is critical—both for your health and your appeal. Insurance providers often look for any reason to argue that a claimant is not truly disabled, and one of the most common is the claim that the individual failed to follow prescribed care. When filing an appeal, ensure that you:
- Attend all scheduled appointments
- Follow medication instructions
- Participate in therapy or rehabilitation if recommended
- Keep copies of all related documents and receipts
This not only supports your credibility but also ensures that your medical record reflects the ongoing impact of your condition.
6. Consult a Long Term Disability Attorney
Filing an LTD appeal is not a simple process. From interpreting complex policy language to assembling comprehensive evidence, a claim can be derailed without professional guidance in many ways. Working with an attorney who focuses on LTD appeals can make a substantial difference in your case.
An experienced disability lawyer can:
- Review your denial letter and claim file.
- Identify weaknesses or inconsistencies in the insurer’s reasoning.
- Ensure your appeal includes all required information.
- Work with your doctors to gather supportive records and statements.
- Meet all procedural and legal deadlines.
At Herbert M. Hill, P.A., our team has extensive experience in handling Long Term Disability appeals under both ERISA-governed group policies and individual disability policies. We represent clients throughout Florida and provide each case with personalized attention and care.
Let Us Help You Move Forward
If your Long Term Disability insurance denial has left you unsure of your next step, we are here to help. At Herbert M. Hill, P.A., we understand how critical these benefits are to your well-being and financial stability. We are prepared to review your case, explain your options, and build a strong appeal.
Contact us today to schedule a consultation. There is no obligation, and in most cases, there is no charge for the initial meeting. Let us help you take the next step toward securing the benefits you have earned.
