Crafting an effective long term disability appeal letter can be a challenging task. With a step-by-step approach and careful attention to detail, you can increase your chances of success.
We recommend that you get in touch with a long term disability attorney to help guide you through the process. The experienced team at the Maddox Firm can turn your long term disability denial into an approval, and will work closely with you and your doctors to make sure your long term disability appeal is done the right way.
Whether or not you decide to use a long term disability lawyer from the Maddox Firm, you want your long term disability appeal letter to be as effective as possible. A long term disability appeal is your last chance to make sure the insurance company gets it right. If your appeal is denied, there is no recourse except litigation. Litigation can take many months or even years from inception to resolution. Getting the appeal right is a lot faster and cheaper.
If you decide to go it alone, this article will provide you with a guide to crafting an effective long term disability appeal letter.
Timelines
In general, an appeal will take several months to resolve. There are timelines for you, and there are timelines for the insurance company. Do not miss any deadlines set by regulations or by the disability insurance company. A missed deadline will result in a denial of your appeal.
You Generally Have 180 Days to Appeal
Generally, you will have 180 days from the date of the disability claim denial or termination letter to appeal the decision. Carefully check the denial letter for timelines and dates, and mark them in your calendar.
When appealing a claim denial or termination, it is best to wait to send everything at once. Once you provide medical documentation to review, the insurance company’s time to respond will start ticking. For that reason, if you can help it, do not send in information piece-by-piece. You will run the risk of getting a decision on your appeal before you are able to provide all of the information.
The Insurance Company Generally Has 45-90 Days to Decide
Once your appeal letter and all supporting documentation has been submitted, the insurance company will have 45 days to make a decision. If the insurance company has a good reason that is out of their control, they may extend the time period for an additional 45 days. The total time from submission to decision should be no longer than 90 days.
The insurance company will ask for extensions of this period of time. If you agree to an extension, make sure the period of time agreed to is clear. The new date agreed upon will be the insurance company’s new due date.
Step-by-Step Guide
Follow this process step-by-step to craft an effective long term disability appeal letter and overall appeal submission. If you do not get a long term disability attorney to help you, consider asking a family member or friend to help you through the process. A long term disability appeal can be overwhelming for anyone. The more help you have, the greater your chances of success.
Step 1: Review Your Denial Letter
The first step in crafting an effective long term disability appeal letter is to review your denial letter carefully. The denial letter will outline the reasons why your claim was denied, and it will provide you with information about the appeals process.
It is essential to review the denial letter thoroughly to understand the reasons for the denial. This will help you to address these issues in your appeal letter. Take notes and highlight the key points that you need to address in your appeal letter.
Step 2: Request the Long Term Disability Insurance Company’s Claim File
The second step in crafting an effective long term disability appeal letter is to request your claim file. The claim file contains everything relevant to you and your claim. It will contain every medical record the insurance company obtained, all of the insurance company’s correspondence with you and your employer about you, and the reports of insurance reviewers, physicians, and vocational experts. Review the reports of the reviewers, physicians, and vocational experts carefully. If they got anything wrong, you and your doctors should describe exactly what the insurance company personnel got wrong.
Step 3: Gather Relevant Medical Documentation
The next step in crafting an effective long term disability appeal letter is to gather all relevant medical documentation. This documentation should support your claim for disability and demonstrate the severity of your condition.
Examples of relevant medical documentation include medical records, test results, and physician notes. You may also want to include letters from healthcare providers or other medical professionals who have treated you.
It is important to provide as much medical documentation as possible to support your claim. This will help to demonstrate the severity of your condition and increase your chances of success.
Most importantly, if additional testing might demonstrate your disability, get that testing scheduled as soon as possible. If your deficits are cognitive in nature, think about obtaining a neuropsychological evaluation. If your deficits are physical in nature, think about obtaining a functional capacity evaluation.
Step 4: Gather Relevant Non-Medical Documentation
In addition to medical documentation, you may also want to gather relevant non-medical documentation. This can include letters from your employer, colleagues, or other individuals who can attest to the severity of your condition and the impact it has had on your ability to work.
You may also want to provide documentation of any accommodations that were made in your workplace before you stopped working, or documentation of mistakes you made or difficulties you faced prior to stopping working. This can demonstrate that you attempted to continue working despite your condition.
Step 5: Craft Your Appeal Letter
Now that you have gathered all relevant documentation and understand the appeals process, it is time to craft your long term disability appeal letter.
Your appeal letter should include the following information:
Introduction: Begin your appeal letter by introducing yourself and explaining that you are appealing the denial of your LTD claim. Provide your contact information, including your name, address, and phone number.
Explanation of the Denial: Explain why your claim was denied, as outlined in the denial letter. Address each point specifically and provide additional information to support your claim.
Description of Your Condition: Provide a detailed description of your condition and how it has impacted your ability to work. Be specific with your symptoms. Use medical terminology to describe your condition and include information about any symptoms or limitations you experience.
Medical Documentation: Provide all relevant medical documentation to support your claim. This should include medical records, test results, and physician notes. You may also want to include letters from healthcare providers or other medical professionals who have treated you.
Non-Medical Documentation: Provide relevant non-medical documentation to support your claim. This can include letters from your employer, colleagues, or other individuals who can attest to the severity of your condition and the impact it has had on your ability to work. You may also want to provide documentation of any accommodations that were made in your workplace before you stopped working.
Explanation of Your Previous Job Duties: Provide a detailed description of your previous job duties and explain how your condition prevents you from performing those duties. Use specific examples to demonstrate the impact of your condition on your ability to work.
Explanation of Your Efforts to Work or Mistakes at Work: If you attempted to work after your condition developed, explain the efforts you made to continue working despite your condition. This can include any accommodations that were made in your workplace, such as a modified schedule or changes to your job duties. And it can include examples of mistakes or hardships you faced as you attempted to continue working.
Conclusion: Conclude your appeal letter by summarizing your case and requesting that your claim be reconsidered. Provide your contact information again and thank the insurance company for their time and consideration.
Step 6: Review and Revise Your Appeal Letter
Once you have drafted your appeal letter, it is essential to review and revise it carefully. Take the time to read through your letter multiple times to ensure that it is clear, concise, and free of errors.
Consider asking a trusted friend or family member to review your letter as well. They may be able to provide valuable feedback and help you to identify any areas that need improvement. If you received help such as this, make it clear to the insurance company reviewer that you received such help. A well-reasoned appeal letter could itself be evidence that you can perform the duties of your prior work if it is not clear that you had extensive help in its preparation.
Step 7: Submit Your Appeal Letter
Once you are satisfied with your appeal letter, it is time to submit it to your insurance company. Make sure to follow all of the instructions provided in your denial letter regarding the appeals process. This may include submitting your appeal by a specific deadline and using a specific method of delivery.
It is important to keep a copy of your appeal letter for your records. This can help you to keep track of the appeals process and ensure that you have all necessary documentation if you need to appeal again in the future.
Step 8: Follow Up on Your Appeal
Make sure the long term disability insurance company got the appeal! Make sure that each of records you included are readable. Start a conversation with your appeals specialist.
Most importantly, specifically ask for any reports created during the appeal process. If an insurance company doctor or vocational expert creates a report regarding your claim, you are entitled to the report. If these reports are inaccurate, ask your doctor to respond to the inaccuracies. If the insurance company doctor says that a piece of evidence is missing, provide the piece of evidence.
How the Maddox Firm Can Help
If you decide to engage the Maddox Firm to help with your appeal, we will go through each of these steps with you.
We will make sure you understand the denial letter fully. We will respond to each error made by the disability insurance company.
We will obtain the entire insurance company claim file. If anything is missing from the file, we will make sure the insurance company finds it and provides it.
We will help you and your doctors gather medical evidence to demonstrate your disability. We will schedule relevant testing, such as a neuropsychological evaluation or functional capacity evaluation. We will help your doctors communicate with each other so they each have a full picture of your conditions and symptoms.
We will help you and your family gather non-medical evidence. We will guide you in the preparation of statements and affidavits from you, your family members, and co-workers.
We will draft a detailed appeal letter that will leave no stone unturned. We will make sure the insurance company actually understands the medical and non-medical evidence in front of them.
We will follow-up. After the appeal submission, there can be many rounds of rebuttals between insurance company doctors and your treating providers. We will help your doctors through that process.
The experienced team at the Maddox Firm has been there many times before. We know your conditions and symptoms, and we know your insurance company. If you trust us with your appeal, we will make sure the insurance company gets it right.
Contact us today to schedule a consultation.