Should You Write Your Own Long-term Disability Appeal Letter?
You applied for disability and were denied! Should you write your own disability appeal letter or hire an attorney to help you?
While it is possible for you to write your own disability appeal letter, most do not feel comfortable doing so. There is a lot that needs to be understood and put together to write an excellent disability appeal letter. You should consider working with an attorney to get the best possible letter and strategy crafted.
If however, you are committed to writing your own disability appeal letter, here are some tips to follow.
Read And Understand Your Denial Letter
Your long-term disability denial notice should give you a detailed description as to why you were denied. It will also provide you with deadlines for appealing your decision as well as requirements for filing. Here is the timeline you need to know for your appeal.
Request Your claim File
Request your claim file from your insurance company via certified mail, return receipt requested. Federal law states that the insurance company must provide you with a copy for free. Looking through your c-file, it may become obvious to you that you are missing certain pieces of evidence that would support your claim. Start making a list of what is missing from your c-file and what you need to get to stack the record in your favor. Do not take half steps on this; you want to overwhelm the insurance company with evidence. Even if some of the evidence is underwhelming, you will not be able to add evidence after the appeal has been finalized.
Obtain A Copy Of Your Insurance Policy
While you are waiting on your c-file, request a copy of your long-term disability insurance policy from your company’s human resources department. Federal law states that you must be provided a free copy, and they are used to requests like this, so do not feel like you are imposing. This is your claim and you have a right to that information.
If you are unable to obtain a copy for any reason, be sure to include that in your request for your claim file. And get ahold of us, we can help you get past these types of barriers.
Your insurance policy will tell you what the insurer considers disabled and what requirements you must meet to receive disability benefits. These are going to help you understand how to frame your talking points and appeal strategy.
Collect All Documentation
Include all relevant documentation from your doctors (this includes any doctor you have seen for the condition in which you are claiming), medical tests, personal statements from friends and family stating facts about your condition, statements from your doctor, and other pertinent forms in your appeal letter.
The goal is to make sure the insurance company has everything it needs to make a decision.
If you have any new supporting information, include it as well.
Do not forget employment records stating how your condition affected you at work, including accommodations that needed to be made for your productivity.
Find decisions from other agencies about your disability
If you also applied for Social Security Disability or a for a retirement disability plan and were approved, submit these approval letters with your appeal as well. This shows that other agencies have found you to be disabled. In some cases, this must be addressed in denials. They, the insurer would need to provide a basis why they do not believe you to be disabled from work when Social Security believes you to be.
Compose Your Letter
Before you compose your letter come up with a list of issues from your denial that you disagree with or think you have documentation to challenge. When composing your letter, include the items from this list along with the documentation. Your letter should also include:
- Case or member number of the claimant
- The reason the claim was denied
- Short description of the disability
- Corrections of any errors found in the original claim
- Facts as to why the denial was wrong (include medical evidence or doctor’s personal statement)
- Copies of the original application, denial letter, and medical documentation.
Meet All deadlines
Your insurance is required you to provide you time to complete your appeal letter and send it to the insurance company. If you miss this deadline, then you will be unable to appeal. Even though you have up to 180 days to fully complete the appeal process, it is best to get started as soon as possible. If you wait until the last minute to start working on your disagreement with your insurer, you very well might end up leaving out evidence that would have decided the claim in your favor…simply because you did not have time to collect it!
Let Us Review It
Writing your own disability appeal letter is possible, though it may be overwhelming. If you need help or have questions, you can contact us. We specialize in long-term disability cases and will help you. We will be happy to review your work and give you ideas.
Avoiding Common Disability Appeals Mistakes
Even if you make no mistakes at all in your long-term disability claim, you still may end up finding yourself denied. If you have been denied your disability, you are now up against a wall, and a clock is ticking away – slowly but surely closing the door on your opportunity to obtain these benefits. Many claimants find themselves searching google, and blogs like this, for answers and direction on their disability appeal. For that reason, we are laying out a list of the most common disability appeals mistakes we come across.
If you know the mistakes of others, you can avoid them. And if you need help, reach out to us today. We are successful in over 95% of our cases!
Not Providing Adequate Disability Documentation
One common mistake in Disability claims and appeals is believing that solely because your employer says you are too sick to work, you should be eligible to receive disability. This reasoning is not, strictly correct. You do have to have a medical reason for being unable to perform your job. Without a medical reason for being unable to work, the basis of your disability is very subjective and hard to overcome.
For this reason, your long-term disability claim and particularly your disability appeal needs to include any medical records you have that might be related to your injuries or illnesses.
You Must Follow Your Doctor’s Advice
Performing activities that your doctor tells you not to do may adversely impact your disability claim. You cannot purposefully harm yourself or do harm to yourself for the purpose of staying disabled. Likewise, you cannot lie about how much or little your injuries or illnesses impact you.
If you do not follow the doctor’s orders, it is a simple argument for an insurance company to say that you are disabled by your own choice, you are, in essence, potentially doing self-harm intentionally. Had you followed doctor’s orders, you would be on your way to recovery. So their logic will argue, anyway.
You should keep in mind that it is also common for insurance companies to hire investigators to follow you around to catch you doing something you are not supposed to be able to do. Needless to say, make sure you are following the doctor’s orders precisely during your disability appeal.
Do Not Rely Solely On Your Company’s Human Resource Department
Your company Human Resource department may have the best intentions for you by providing you with advice, but they are not trained in disability claims. They also do not have any influence on the decision of the insurer. Being responsible for your own claim is in your best interest. If you need advice from someone who handles these cases every day, contact us.
Sending letters, or other documentation, through the mail using First Class Mail means that you are one “he-said / she-said” away from a claim that falls apart. If you send letters, send them confirmed. Keep a log, request a receipt. Be borderline paranoid that your communications will be lost in transit. Why? Because communications in long-term disability cases do get lost, with alarming regularity.
Make sure you keep a log of your meetings, and even your phone calls with doctors, agents, insurers, even if you need someone to give you a ride because of your injury. To help you understand what this might look like, here’s a guide to keeping a disability journal.
Do Not Forget To Account for Side-Effects and Secondary Injuries
Sometimes, in the hurry to file what we believe would be a self-evident claim, we forget to take into account the full scope of barriers that are present in a disabling condition. For example, if you have lower back pain, and have to take (prescribed) pain medication daily to manage your symptoms, the way the pain meds impact you should also be part of your claimed impairments. Drowsiness, dizziness, mood swings, low blood pressure, and more…should be in this discussion. In addition to the back pain.
In a similar manner to medication side-effects, secondary injuries should also be something you point out and elaborate upon in your appeal documentation. For example would, if you have a back injury and it causes you to stoop down, the injury could be causing your legs to hurt and for you to not be able to stand because of the leg pain. Leg pain, stooping, and other impairments that are secondary to your primary impairment need to be explored in your claim and appeal.
Waiting Too Long to Appeal or Being Too Hasty
Timing is everything. If you file your disability appeal too soon, you almost assuredly will not have all of the evidence you need to be approved. If you wait too long to appeal, you will miss the deadline and be denied again. Whatever timeline you operate on, just make sure you do not miss your window to appeal!
Not Asking For Help
To avoid these common disability appeals mistakes, ask for help from a legal professional.
An attorney who specializes in ERISA appeals will help make the process less stressful and will help you meet your deadlines.
If you feel you need assistance filling out your ERISA disability appeals or if you have any questions, contact a legal professional.
ERISA Appeal Basics: Timelines You Need To Know
The Employment Retirement Income Security Act of 1974 (ERISA) was enacted to establish a set of minimum standards for pension plans. Covered in this scope of regulation was and is long-term disability policies provided by employer plans.
The good and bad of ERISA is that, in an employer-sponsored long-term disability policy, each step of the initial claim and appeal must follow very well-defined steps. Good, because it gives a timeline that all sides must follow, and bad in that it does not allow for grace should you miss deadlines, even if you did not know there were deadlines in the first place.
The purpose of this article is to help you to understand precisely which timelines are important for you to remember in your ERISA appeal. Whether you are going-it-alone or you have hired a highly capable and experienced team to help, you need to keep these deadlines in mind or risk losing your case.
Your Initial Application for Long-Term Disability
After your initial application for long-term disability, ERISA requires that the insurer of the policy (UNUM, Hartford, etc.) make a determination within 45 days.
If the insurer has a reason to need longer, they can delay their decision for up to 30 additional days. However, they do have to provide you a reason for the delay. The reason provided should specify why they needed the extension and what items, in particular, they need to make a determination on your application.
Often, an insurer will need additional information from you; if they request more information from you, you have 45 days to respond to their request for evidence. This is also a key point that people often start to look for resources and to retain an ERISA appeals attorney.
After receiving the information back from you, or your attorney, the insurer of your disability policy has up to 30 days to issue a determination.
Denied! The Timeline of an ERISA Appeal
After the back and forth process of your initial application, you may end up finding yourself denied nonetheless. When we said ERISA is good and bad – this pattern is a reflection of that statement. For the simple fact that an insurance company will only lose (monetarily) the benefits they would have owed you in the first place, they have no reason NOT to deny you for every grey area and technicality in your policy. If you have been denied for long-term disability benefits, this is not the end of the road for you and this situation can be fixed, with help. We’ll discuss the details of this in other articles. For now, we are talking about the timeline of your ERISA appeal.
When and if you were denied, you likely discovered this through an adverse benefits determination sent to you in the mail. The timeline associated with the appeal of your determination is very challenging and something you do not want to delay in getting started on.
You have only up to 180 days following a receipt of a notification of an adverse benefit determination to make an ERISA appeal (29 C.F.R § 2560.503-1 (h)(3)(i)), but it is imperative to start as soon as possible! In short, you need to spend these 180 days getting as much information into the administrative record as possible. The reason being that if your appeal is denied, a follow-on lawsuit will only be able to make a determination based on the information that you submit now. You will not be able to add more information to the record later.
Note: This is another critical point to engage an experienced ERISA appeal lawyer.
When you have finished stacking the record on your claim and submitted your ERISA appeal letter, the insurer will have 45 days to make their decision on your appeal. Again, they may require an extension, but they have to explain their delay.
What Now!? My ERISA Appeal was Denied Too
If after your initial long-term disability benefits application, and your ERISA appeal, you remain denied for benefits, you have two options.
The first option, some policies allow for a second appeal. You should reach out to an ERISA appeals attorney as soon as possible to figure out if you have another appeal you can work on.
The second option is filing a lawsuit. Again, you will want to begin talking to an attorney about this option as soon as possible at this point.
Summary – How Long Before I Can Get My Disability Benefits?
If you have just filed your long-term disability benefits claim, you could get a determination within 45 days! However, if your insurer needs an extension, it could be another 30 days (75 total days). If the insurer denies your application, you have 180 days to appeal (255 total days), and the insurer has 45 days to determine your appeal (300 total days). The insurer may need an addition 45-day extension on your appeal determination which means your decision could be drawn out to (345 total days) from the day that you initially filed.
If you have a second appeal in your policy, you will have more than a year from your initial application before a final determination! This timeline alone is a poignant reason to engage the support and experience of an ERISA appeals attorney. Getting these claims approved at earlier stages will save you a lot of effort and frustration in the long term.
Tips for Writing an Unum Long-Term Disability Appeal Letter
If you have received a denial letter from Unum long-term disability the good news is that you can appeal this decision.
The first step is to start thinking about how to approach your appeal letter.
In this article, we will give you tips on how to start framing your Unum long-term disability appeal letter.
Read Your Denial Letter
First. Read your denial letter thoroughly. Reading your denial letter will tell you the reasons for your denial. It will guide you to your next steps. And if you decide to reach out to a good ERISA disability lawyer, it will help guide that evaluation and conversation.
Gather More Evidence
For a majority of the situations in which long-term disability applicants are denied, it is because there is not enough (or the right kind of) medical evidence to prove their claim.
Gathering medical records from your primary doctor, urgent cares and emergency rooms that have treated you for your condition, labs, and imaging will boost up your evidence and prepare you for the initial appeal and any future actions you may need to take to obtain your benefits.
Request Your Claim File and Unum Long-term Disability Policy
Talk to your company’s HR, or talk directly to Unum, you need to get your hands on a full copy of your disability policy. It’s likely that the key to your overcoming the denial is a misinterpretation or misunderstanding regarding your application, but sometimes there are pieces of the policy itself that are in error.
You should also request from Unum a copy of your initial claim file. The practical purpose of this step is so that you can look through it to see if anything is missing or if there were any mistakes in the original application.
Include Pertinent Information in Your Letter
Things you should include in your letter are:
- Your name
- Your claimant number (sometimes your social security number)
- Why you are contesting your denial. Be factual not emotional.
- Point out any missing or incorrect information in your denial letter.
- Describe any mistakes made in your denial.
- Copies of the initial application, denial letter, and medical evidence.
- Facts why the long-term disability denial is wrong (include evidence).
Follow Appeal Instructions and Meet Deadlines
You want to be sure to follow any appeal directions provided to you by Unum. Following the included instructions and any deadlines will keep your appeal from being denied because of a technicality.
You have 180 days to appeal your Unum long-term disability denial. If you miss this deadline, an automatic denial of your appeal will happen.
There will also be several forms you will need to fill out and submit with your long-term disability appeal letter. Do not leave these out.
Get Decisions from Other Agencies
If other agencies such as Social Security or VA pensions determine you to be disabled, these decisions can be powerful and help with your appeal. If you have not applied for either of these, then you may want to think about applying.
Hire a Long-term Disability Lawyer that Works with Unum
The appeal process can be a long and difficult one. Having an attorney experienced in fighting Unum over long-term disability denials will help the process be less overwhelming. An Unum disability lawyer can help you write your appeal letter, gather additional medical evidence, and can represent you if you end up going to court.
We specialize in long-term disability claims. Call us today for a free case evaluation!
Straight Talk About The Need For You To File a Disability Appeal
You have recently applied for your long-term disability, but your claim was summarily denied! Well…it couldn’t get worse, right?
Unfortunately, disability denials are too common. In fact, there’s a good chance you’ll be stuck in one during your long-term disability journey.
But the silver lining here is that you can overcome them, with help.
First things first: You need to Understand Your Denial Letter
Your denial letter will state why your claim has been denied. It’s possible that the terms in the letter make it hard to understand beyond the basic concept (denial). If you’re having a hard time making heads or tails of it, reach out to us, and we’ll help you start working on a plan of attack to overcome the decision.
Fundamentally, the insurance provider believes you do not qualify for long-term disability benefits. This is often because they claim your medical evidence is unsubstantiated or otherwise doesn’t fully demonstrate that your injuries or illnesses bar you from being able to work. In fact, they may go so far as to say that you can work and should be able to hold down a job.
Of course, they don’t know you from Adam, so how could they say that? Sometimes, they say it, to see how you will respond.
ERISA Protects a Process, But Not Necessarily You…
Why would an insurance company deny benefits they know you deserve? Simply put, there is very little incentive for them to say, “Yes.” And a lot of incentive for them to say, “No.” If they say no and you do not appeal, they never have to pay out the benefits on your claim. Moreover, if you ultimately prevail, they’ll be out little more than what they would have originally paid out to you in the first place. So, dollars and cents here… Say No and save thousands, or Say No and lose nothing, or say Yes and pay out thousands. It’s a sick type of arithmetic, but you gotta wonder why else would denial rates be so high?
ERISA Speeds Up the Process
While ERISA lays out a process for administering disability claims, and in so doing also somewhat creates the scenario that we just talked about (wherein the incentive for the insurance provider is to deny at first), it does offer grace in that it formally speeds up the appeal process compared to other types of disability claims.
Unlike Social Security disability or VA service-connected disability, whose claims can take up to 1 year and appeals can take more than two years (3 total years), your ERISA regulated long-term disability claim and appeal should be over within months, at most. In the worst case scenario you will end up suing the insurance provider for the benefits you should rightfully be getting, but even then, the timeline is not likely to last as long as an SSDI or VA appeal!
Speed Up Your Appeal By Getting Out of Your Own Way
Do you know the best way to take advantage of every opportunity ERISA will provide for your appeal? Get help. An experienced ERISA disability lawyer specializes in streamlining and stacking your appeal. You will not miss deadlines, you will return fully developed arguments to your insurance provider, and you will even hold their feet to the fire for their mistakes when they make them. In short, you can turn the tables. You already know they are hoping you don’t appeal. They also anticipate being able to beat you in an appeal because many others like you do not hire professional help until it’s too late.
Do something they haven’t game planned, and penciled in their calculations, hire a disability attorney to take the fight right back to them.
We’re here to help you today, reach out to us.
Do Social Security and ERISA have the Same Appeal Process?
When most people start searching the internet for help with their disability claim, they come across a deep well of information about Social Security Disability.
Unfortunately, there is much less information about ERISA Long-Term Disability claims and appeals.
Sometimes, the differences are very confusing. Here’s what you need to know.
Social Security and Long-Term Disability are Completely Different
If you are actively looking for help with your long-term disability claim and denial, reading up on Social Security disability blogs is going to offer very little help. There is a caveat; you may qualify for SSDI – a program through social security that operates like an insurance policy for disability as well. For more information on that, reach out to us here, and we can break it down over the phone or in an email.
Covering the basics here, Social Security disability comes in the form of two government-administered programs. One is a social safety net – it is meant for those who cannot work and do not have a recent work history. This program, SSI, provides a limited amount of financial assistance <$1k per month.
The other program, SSDI, is similar in function to long-term disability. SSDI provides compensation like an insurance policy. The compensation is for those who cannot work due to an injury, but have a recent work history and have paid into the program. The monthly award is based off several factors, but essentially, your previous income.
Long Term Disability policies are insurance policies that a private insurer guarantees should you meet a certain criterion (disability from work). Often they are part of your employer-sponsored benefits. If so, your policy is likely covered by a law known as ERISA.
Governance of Long Term Disability vs. Social Security
Though the programs are different themselves, and for different populations, the way in which the programs are administered is perhaps the most glaring difference between disability benefits providers.
If you have a long-term disability policy through your employer-sponsored benefits plans, it is very likely to be governed by ERISA. ERISA regulates these benefits and gets very granular in describing how they must be administered. ERISA even goes so far as to say an insurance provider must decide your appeal within 30-45 days!
Social Security benefits are governed under a different statute, and in fact, they have a whole court system designated to support appeals of denied claims. They maintain their own administrative law judges, and whereas ERISA dictates a certain timeline for claims and appeals, Social Security has no such guarantee. It is very common for an SSI or SSDI appeal to take more than a year. In fact, if there’s a backlog of claims (such as during a downturn in the economy), the backlog in appeals can move more than two years out!!
Remember, There Are Different Types of Disability
This is the point of this brief article. You need to recognize there are several types of disability claims, and if you are trying to fight against a long-term disability denial, you should stick around blogs like this. While there are many excellent VA and Social Security claims blogs, their type of disability law is not what you are looking for.
If you feel you’re getting conflicting information in your online search for answers… this may be why.
If you want the straight scoop on your claim or denial, reach out to us today, and we will help you make heads or tails of it.
How Disability Attorneys Use ERISA Guidelines to Help you Win Your LTD Appeal
Experienced disability attorneys know how to make the right arguments to bring your long-term disability claim under control.
In fact, if they specialize in ERISA claims they will be there to help you prevail in court, too!
If you are struggling to deal with a long-term disability appeal, it’s time for you to reach out to an experienced ERISA disability attorney.
The Basics: What is ERISA?
ERISA is a federal law that provides guidelines for insurance companies on how to administer certain employer-sponsored benefits. Short and Long-term disability benefits being central tenets of these plans, they are covered, or governed and appealed, under ERISA law.
Here’s our article on ERISA benefits if you need more of a primer.
The point here is that we convey the importance of working with an experienced long-term disability lawyer. They will keep you on track (and the claim alive by helping in the following ways:
Managing ERISA Timelines
- In Long-term Disability claims and appeals, ERISA defines strict timelines that must be followed for claimants and insurance providers. If you miss these timelines, your case or claim will likely be denied or underrepresented. Either way, you will likely not get the benefits you have paid for. One of the most effective things your attorney will do for you is to make sure you hit all your timelines, and to hold the insurance companies feet to the flame by ensuring they meet all their deadlines too!
Using Strategy in Developing & Delivering Evidence
- You will likely need substantial medical evidence to win your disability appeal. Good disability attorneys will make sure all medical records are collected before any necessary hearing, or request in the case. In preparation for a potential future lawsuit against your insurance provider, your attorney will be working feverishly to “stack the record” on your behalf too. This means, they will work to get all possible supporting evidence into the disability appeal so that it can be presented at a later date, should your insurance provider keep denying you.
Identifying Key Insurance Company Mistakes and Exploiting Them
- Your insurance company may have made a mistake! No kidding, they denied you, right? But in seriousness, they may have made a mistake as far back as laying out the terms of your long-term disability policy. In fact, they may have denied you for a reason that has since been disallowed by law, or court decision. Your disability attorney will be able to spot these mistakes and find ways to get them to help your claim.
Leveraging Experience With Judges in ERISA Lawsuits
- If you practice enough ERISA law, you get to know the judges, the insurance companies, their lawyers, and everyone else. This is not new territory for these people. Nor is it for us! Sometimes, what it takes to fix these disability claim challenges, is knowing who it is you’re fighting, and what they need to see to get them to stop fighting you. There is no substitute for experience.
Defending You From Predatory Insurance Company Tactics
- Insurance companies will not only bring in evidence against you; they will seek it out…sometimes even bringing video surveillance to “prove” your disability is not a debilitating as you claim. Your attorney will fight these low-ball tactics and delve deeper into the investigation to discredit this information. We will fight back against these tactics.
You CAN Win an ERISA Appeal
Remember, everyone is allowed to appeal their claim if they are initially denied. If you are denied your long-term disability claim, the insurance company wants you to throw your hands up and give up. Don’t! There is no good reason not to fight them, especially if you have a strong advocate in your corner.
We are here to help you win your case. Reach out to us today!