My ERISA Disability Claim Has Been Denied. What Happens Now?
My name is Brandon Osterbind. I am an injury and disability attorney in Central Virginia and I help people whose long-term disability claims have been denied. I have good news for you. This is not the end of the road.
You can submit an appeal
If your long-term disability through your employer has been denied, there is still hope. Often, people don’t provide all the information that is needed in the claim. In the denial letter that you received from the insurance company, there will be an explanation section at the very end that will tell you how you can appeal your claim.
Be sure to meet the deadline
It will also tell you the time period within which to appeal your claim, which is usually 180 days. If your appeal is not submitted within 180 days of that denial letter, then your claim will be forever denied. There will be no opportunity for you to revisit that decision. That decision has now become final.
What you need for your appeal
Your appeal process ought to look something like the following. You need to gather all your medical records. You need to talk to your doctors and get them to write physician’s statements or medical narratives detailing why your medical condition limits your ability to work.
You need to talk to your friends, your family members and your coworkers. Get them to write statements for you. Write your own statement about how your condition affects your ability to work. And there may be some other things that you can do as well that will help you bolster your appeal.
Your appeal letter
You also have to write an appeal letter to the insurance company, explaining to them why they are wrong. You have to detail your medical condition and what the symptoms are.
And you have to explain to the insurance company in no uncertain terms why you are unable to work and why the medical evidence supports your position and not the denial letter that they gave you. Getting all of this done is a lot of work for 180 days, which is roughly six months.
Get it done on time
You have to gather all that information, submit that appeal to the insurance company, and make sure that all your Ts are crossed and your Is are dotted. There’s a lot you’ll have to do in that short period of time.
So be sure to start early. Start working on your claim as soon as you get that denial letter. With that, you have a view into the mind of the insurance company. That’s because in their denial letter, they’re required to tell you why they denied your claim.
What you must do
And that is what you should focus on during your appeal. Ask yourself how you can rebut the information that the insurance company has listed in the denial letter. There is actually a very specific administrative process. And if you do not follow it, you will lose out completely and your long-term disability claim will be denied forever.
Don’t let that happen to you. Make sure that you follow the advice in the denial letter. Make sure that you submit the documentation that will rebut their arguments. Make sure that you do it within the time frame that they’ve told you to do it in.
And finally, make sure that you do it in a way that is compelling and convincing. It needs to change their mind so that they’ll award you your long-term disability claim.
If you need help…
Perhaps you need help with your long-term disability denial. If you want me to look at your denial letter and tell you what to do, I’ll be happy to do that. Give me a call. Look me up on the Internet, at www.osterbindlaw.com. Send us an email.
We’d be happy to sit down with you and discuss your claim. We’ll help you make sure that you’re getting everything done so that you can be awarded long-term disability benefits and stay on claim for as long as your doctors say that you’re disabled.
