After making the difficult decision to cease working due to significant medical impairments, you decided to submit a claim for long-term disability (“LTD”) benefits through your employer-sponsored disability insurer. However, your insurer sent you a letter indicating that it has denied your application for benefits. This is not the end of the road – the next step is to formally appeal the denial to your disability insurer. This is an intricate process with the potential for errors that could jeopardize your LTD claim. The following are five common mistakes that must be avoided when submitting your LTD benefit appeal.

1. Submitting Your Appeal Before Reviewing Your LTD Policy and Claim File

The first step you should take after receiving the denial letter is to request your LTD policy and entire claim file from your disability insurer. You are entitled to those documents free of charge. Your LTD policy is important because it is the document that governs your LTD claim. It also sets forth the terms that you need to satisfy in order to be awarded LTD benefits, including a test of disability. Generally, you must demonstrate that you are unable to perform the main duties of your occupation to receive LTD benefits. Therefore, if you are to successfully appeal a wrongful denial of your LTD benefits claim, it is crucial that you know and understand the criteria you will need to satisfy to obtain those benefits.

Your claim file is equally as important to your appeal submission. The file consists of any documents that you submitted with your LTD application, including medical records, doctors’ statements, and forms you completed. The claim file also includes any documents that your insurer relied upon, obtained, or considered when it assessed your entitlement to LTD benefits under your policy. That typically includes reports from physicians that the insurer hired to review your records and render a decision regarding your ability to work. Disability insurers also commonly rely on in-house vocational consultants that identify the duties of your occupation. Obtaining those documents makes certain that your disability insurer cannot hide anything from you. It allows you to verify that they received everything you submitted with your initial application.

2. Submitting Your Appeal Without Understanding Why Your Claim was Denied

Your disability insurer is required to communicate to you in its denial letter the specific reasons why it chose to deny your LTD claim. Understanding exactly why your claim was denied is pivotal for the purposes of your appeal. That is because to successfully overturn the denial on appeal, you will need to refute the insurer’s evidence and identify what evidence will perfect your claim in the eyes of the insurer.

As referenced above, your disability insurer’s denial will be based on a medical opinion rendered by a nurse or physician who reviewed your treatment records. The denial will also be based on a vocational consultant’s assessment of the duties of your occupation. Oftentimes, those opinions can be based on a misinterpretation or misunderstanding of your medical conditions or the duties of your occupation. Therefore, you will need to point out the errors present in those opinions and provide additional evidence demonstrating why exactly those opinions were flawed.

3. Neglecting to Obtain Supportive Medical and/or Vocational Evidence

A formal appeal letter is only a portion of what you must submit to establish your entitlement to LTD benefits under your policy. Your claim must be supported by medical and vocational evidence that proves you are unable to perform the duties of your own (or any other) occupation. Acceptable medical evidence that can support your inability to work includes medical records and statements from your treating doctors addressing specifically why you are unable to work. That evidence can also include residual functional capacity questionnaires completed by your doctors, as well as the results of a functional capacity evaluation testing your physical capabilities. If your disability is cognitive in nature, your claim can be supported by the results of neuropsychological testing. It is also helpful to provide statements prepared by individuals close to you regarding their first-hand impressions of your symptoms and resulting limitations. Those statements serve to corroborate the medical evidence that you submit with your appeal.

4. Missing the Appeal Deadline

In most instances, you will have 180 days from the date of the denial of your LTD claim to submit your appeal. However, it bears mentioning that appeal submission deadlines for most LTD benefit claims are currently impacted by the ongoing COVID-19 pandemic. The U.S. Department of Labor has extended the timeframe within which you must submit your appeal by instructing disability insurers to disregard the period from March 1, 2020, until 60 days after the declared National Emergency ends. As of the writing of this post, the National Emergency has not ended. The Department of Labor clarified in February of 2021 that an appeal submission deadline could not be extended beyond one year. Therefore, your 180-day window will begin to run either 60 days after the National Emergency is ended or one year after the denial of your claim.

It is critical that you confirm the exact deadline of your LTD appeal because there are severe consequences if you miss that deadline – failure to comply with the deadline will result in forfeiting your claim and any right to LTD benefits.

5. Waiting to Hire a Disability Insurance Benefits Attorney

As the above discussion suggests, disability benefits appeals can get very confusing very quickly. Therefore, it is best to err on the side of caution when attempting to secure your income while battling medical or psychiatric impairments that prevent you from working. You should consult an experienced disability benefits attorney who can guide you through the complex appeal process and be sure that you receive the LTD benefits to which you are entitled.

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