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Dawson and Rosenthal
Dawson and Rosenthal

How to Appeal a Denial of Long-Term Disability Insurance 

Long-term disability insurance provides an income when severe injury or illness keeps you from working. Having this insurance is critical when your earning capacity is altered. However, not every long-term disability claim is approved.

Filing an appeal is the next option to recover the benefits you need. It can be overwhelming and frightening when your claim is denied. How to successfully approach a denied disability claim in San Diego is not always straightforward and is often a demanding process.

Determine Why a Long-Term Disability Claim is Denied

Insurance companies should provide a reason for the denial to allow claimants a better opportunity for appeal. Claims are often rejected for the following reasons:

  • A claim is missing necessary information or missed specific deadlines
  • The illness or injury is not covered by your policy
  • The insurance company considers your condition as pre-existing
  • The time limits have not been met to qualify for long-term disability
  • No medical treatment is required, or follow-up treatments have been ignored
  • Enough evidence of illness or injury was not submitted or does not exist

Insurance companies have strict guidelines and policies in place when determining an award of long-term disability. Paying these claims is also costly to the insurance company. Knowing when to consult a disability lawyer for your long-term disability claim is critical.

Review Your Long-Term Disability Policy and the Denial Letter

First, review your policy to understand what it covers. Request a copy of the policy from your employer or the insurer if you don’t already have it. Federal law requires plan administrators to supply a copy.

Next, determine what other documentation you need from the denial letter and your policy. Often, missing information is the reason for denial. Unfortunately, it may also be that the insurance company does not find merit in the claim.

Instructions to file an appeal and the deadline for filing should also be documented in the letter you received. Missed deadlines will likely severely impact the opportunity to appeal and secure the claims you may be entitled to.

Gather Supporting Documents

If inadequate or missing documentation impacts your claim, gather the information immediately. It is also vital to ensure medical records are requested and received. Learn more about the essential documentation for a successful long-term disability claim. Administrative error on the insurer’s part may contribute to a denial.

Documenting a claim is not always straightforward, requiring careful consideration of any questionnaire’s answers about your condition. Consider the following actions or documentation to add to the validity of a claim:

  • More testing or imaging to back up your claim when a lack of evidence exists
  • Your doctor’s statement and opinion on any limitations to your ability to work
  • Observational letters from friends and family witnessing the impact of the injury and illness
  • Expert witness testimony describing the effects of the condition on your vocational abilities

The more documentation to support a claim, the more likely it will be approved.

Has My Disability Claim Been Evaluated Fairly?

Recognizing how insurance companies treat claims provides a better understanding of the significance of experienced guidance in the disability claim process. Working with a denied disability claim lawyer will not guarantee a specific outcome in a claim.

However, it ensures your rights are represented and the appropriate laws are applied, potentially providing a more favorable outcome in your disability claim from the start. Contact Dawson & Rosenthal, P.C. today to schedule a free consultation.