What Do I Do if My Short-Term or Long-Term Disability Claim Has Been Denied?

Many employers offer benefits in addition to wages. Besides health, dental, life, and accident insurance, some employers also offer short-term and long-term disability insurance. This insurance is designed to replace some of your regular income in the event you become unable to continue performing your job due to health reasons.  Short-term disability insurance is designed to replace your income in the short term – usually around six months. Long-term disability insurance is designed to replace your income over the long term. Ideally, it will pay benefits until you reach your retirement age.

Insurance companies don’t make it easy to apply for benefits. If you have jumped through their hoops and managed to get the insurance company to open a claim, only to have your claim denied, you still have a chance to get your claim approved. But appealing initial denials can be tricky, and if you’re not careful you can jeopardize your rights to have the denial overturned and your claim approved. There are a few important things you should consider when deciding how to respond to a denial of your claim.

First, in most cases you only have 180 days from the date your claim was denied to submit an appeal. If you fail to submit your appeal in time, the insurance company does not have to consider it. Additionally, if you do not submit an appeal within 180 days, your right to file a lawsuit against the insurance company may be lost. In short, a failure to submit an appeal in time means your claim is over.

Second, you should request a copy of your claim file from the insurance company as soon as you receive the denial letter. In most cases, the insurance company is required by law to provide a copy of your claim file and any other information it used to deny your claim. Many times, the claim file is incomplete and does not contain information, documents, and medical records that you supplied to the insurance company or that the insurance company should have obtained with the authorization you signed. Knowing what is missing from your claim file is important so that you can supply that missing evidence when you submit your appeal.

Third, your appeal should be thorough and include recent evidence. For example, your appeal should include medical records documenting office visits that may have occurred after the insurance company denied your claim.  Also, many insurance companies will send you a one-page blank form and encourage you to use that form for your appeal. Don’t fall for that. You are not required to use their form, which is almost always insufficient to make the arguments and include all of the evidence that makes a good appeal.

Finally, your appeal should address the specific reason why your claim was denied. That reason should be clearly stated in the denial letter. For example, if the insurance company denied your claim because you did not submit certain documentation, your appeal should include that documentation. Your appeal should specifically explain why the insurance company’s decision to deny your claim was in error and supply the evidence that proves it.

Disability appeals are tricky and complicated. Having a thorough understanding of the process and what makes a successful appeal can mean the difference between a denial or approval. We handle short-term and long-term disability appeals every day. If your claim has been denied, and your appeal deadline clock is ticking, we are here to help.