“How am I supposed to read this denial letter? What is it saying? What does that mean? And what am I supposed to do with it?” These are some of the questions I often hear from my clients. If you’ve already filed your claim for long-term disability benefits and you have been denied, it’s important that you sit down and you study that denial letter.
Here are a couple of things that you need to be paying attention for. The first thing you want to look for is what is the rationale for why the insurance company thinks that you could work, what are the main duties of your job that your insurance company is looking at, and what does the insurance company say that you can do, and what does it agree that you can’t do.
The second thing is what policy provisions is the insurance company relying on to say that you are able to work and that you do not qualify under this plan?
The third thing that you want to make sure that you pay particular attention to is what are the rules in your plan for how to appeal this decision? Where do you send the appeal to? What information needs to be in the appeal? Who do you send it to? When is it due by? All of those things are in the letter denying your long-term disability claim. You have to make sure that you know exactly what that is.
When you’re going through the appeal process, you approach every single reason, rationale for why your claim is denied, and you provide additional evidence and more supporting documentation. Whether it’s in a medical article, a doctor’s written opinion, a physician’s statement, or whether it’s an affidavit from you — You need to have an opportunity to address that weakness in your case, and provide documentation to the insurance company, so that the insurance company looks unreasonable when they deny your claim again. That will set you up for success in your appeal.
Give us a call, send us an email. We’d love to talk to you.