When you’re unable to work due to a physical or mental condition, you will hope that you will receive long-term disability benefits through your employer’s insurance policy or your own insurance policy. Unfortunately, the denial of valid claims happens all of the time. On the other hand, an initial denial does not mark the end of the road. You can always appeal the decision.
What does the appeals process look like?
The Employee Retirement Income Security Act (ERISA) governs long-term disability claims. Under the law, long-term disability insurance providers must include an appeals process as part of their plan. You have the right to have the decision reviewed by a person who did not participate in the initial decision. The initial decision should have no bearing on your appeal. The person who reviews your claim cannot take the reasoning behind the denial into account when making their decision.
It’s important to keep deadlines in mind. You are typically given 180 days to file an appeal. Your appeal can contain new information. For example, if your condition is growing worse or if you’ve received an updated medical diagnosis, you should include these updates in your appeal.
What happens if my claim is denied on appeal?
Some insurance companies provide a second level of appeals. You must file a second appeal in a reasonable amount of time. Deadlines vary from plan to plan. You will probably have to make a secondary appeal in less than 180 days. If your second appeal is denied or if your insurance plan does not allow for secondary appeals, your last option is to take your case to court.
Help is available
When you’re faced with the challenges of a long-term disability, you shouldn’t have to focus all of your attention on the claims process. A skilled legal professional can help serve as your advocate. Alan C. Olson and Associates are committed to helping you recover the benefits you need.