How to Appeal a Long-Term Disability Insurance Claim

Have you applied for long-term disability insurance and been denied benefits?

Long-term disability insurance is an income replacement program for employees who become disabled or are suddenly unable to work due to a serious health issue.

With each long-term disability premium paid, employees should feel confident and more secure knowing they will be taken care of in the case of a serious injury or illness.  But all too often, when employees suffer an injury they experience resistance from the insurance company and even denial of their long-term disability insurance claim.

The following information from FinWeb.com covers the four stages of appealing a long-term disability insurance claim.

How to File a Long-Term Disability Claim Appeal

Filing to appeal a long-term disability claim can be a long and frustrating process and requires patience because in many cases, your initial claim will be denied. One way to improve your chances of approval is to have a social security advocate or attorney on your side. The process of appeals involves 4 stages, or levels of appeal. These stages consist of Reconsideration, an Administrative Hearing, an Appeals Council Review, or your case being tried in the Federal District Court.

Reconsideration

Within 60 days of your initial denial, you are required to submit a request for reconsideration. At this point an examiner who has not previously been involved in your case will review your submitted information from the initial claim and any new information you provide. During this process you are not required to be present, but in later stages your presence may be necessary. It is not uncommon at this stage for the denial to be upheld giving you the opportunity to file for an administrative hearing.

Administrative Hearing

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Typically the hearing is held within 75 miles of your residence or it can be conducted by video conference. The hearing is your opportunity to present your disability case to an Administrative Law Judge who will be familiar with your case prior to court. The focus of this hearing is to determine your level of functioning. In helping the judge to make this decision, you will be asked to state your case and witnesses or experts may or may not be called to testify. If your claim is denied at this stage, the judge will notify you in writing. This process may take about 2 months.

Appeals Council Review

If you disagree with the determination made by the Administrative Law Judge you have the opportunity to request a review by the Social Security’s Appeal Council. The Department of Social Security can help you with this process if you are having difficulty. At this point, the Appeal’s Council will review your case and make a decision. If they are in agreement with the Administrative Law Judge’s decision they will deny your claim or return your case back to an Administrative Law Judge. Otherwise, they may make a decision to overturn the Judges’ decision. Either way, you will receive a written letter stating their determination.

Federal Court

The final step of this process is having your claim reviewed by the Federal Court. If you disagree with the decision of the Appeals Council then you are able to file a lawsuit in the Federal District Court. The letter sent by the Appeals Council regarding their decision will instruct you on how to have your case reviewed in court. It is important to make sure you have secured council that is familiar with disability appeals in order to adequately represent your case therefore maximizing the outcome.

Long-term disability insurance companies have a vested interest in the outcome of claims.  Hiring a disability lawyer is in your best interest if your application for long-term disability insurance benefits has been denied.

If you have suffered from a disabling injury and need to file or appeal a short- or long-term disability insurance claim, call our Massachusetts law firm.  We are disability lawyers who have helped many people get the compensation and support they require after an injury or illness.

Contact us today to schedule a consultation.  Your first consultation is always free, and we will guide you in the right direction, whether you need legal assistance or just answers to your long-term disability insurance questions.