You Can Appeal Long Term Disability Claim Denials

When your long term disability insurance company has denied your long term disability claim benefits, how do you file an appeal to fight that long term disability claim denial?

When your long term disability insurance carrier has acted in bad faith, you can contact your state's Insurance Commissioner or ombudsman to make them aware of the insurer's practices. That may prompt your insurer to address your claim and prevent it from treating other policyholders in bad faith. However, if your insurer does not address your situation, you have every right to fight your long term disability claim denial.

You can do that by contacting a bad faith insurance lawyer or long term disability insurance lawyer who can assess your long term disability claim denial, review your documentation, explain what damages might be available to you and how the appeals process works - so that you can protect your rights.

The administrative long term disability appeal

Long term disability appeals allow you to submit additional documentation and make arguments in support of your long term disability claim. Although federal law which applies to ERISA long term disability claims says that insurance companies must provide a ″full and fair″ review of your denial, you generally have to exhaust your administrative remedies first and only have 60 days in which to appeal to the policy administrator and the only evidence you can submit to the court is what was submitted during the claim and appeal process. Therefore, be sure you put in all favorable medical evidence during your appeal.

All documentation for ERISA long term disability appeals must be submitted during the administrative appeal. The record is closed after that point.

If you lose your long term disability appeal

If you lose your long term disability appeal, your recourse may be limited depending upon whether your claim is individual or falls under ERISA. Here's a look at each:

Individual long term disability appeal insurance claim:

• Cases are generally heard in state court under legal rules and procedures that are more favorable to the long term disability policyholder;
• Bad faith and punitive damage claims may be available;
• Lawsuits are decided by a jury instead of a federal judge;
• Many forms of damages are available;
• Witnesses can be brought in to support the claim and the policyholder may introduce evidence from the claim record, or any new evidence since the case was filed.

ERISA long term disability appeal:

• Case is heard in federal court;
• Claimants are not entitled to a jury trial;
• Judges decide the matter and generally rule by way of summary judgment;
• Awards for attorneys' fees are difficult to obtain;
• No bad faith or punitive damage claims are allowed;
• Damages may be limited to payment of past due amounts plus interest.