Brigette Honaker  |  June 17, 2019

Category: Legal News

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Woman opening claim denied letterIf a consumer’s long or short term disability insurance claim is denied for any reason, they may be able to fight to have the decision reviewed.

Why Do Disability Insurance Claims Get Denied?

According to the U.S. Department of Labor, there are many reasons that a disability claim may get denied. In some cases, claimants may not be eligible for the benefits they have applied for. In other situations, the plan administrator may simply need more information in order to make a decision on LTD benefits.

What Can I Do If My Disability Insurance Claim is Denied?

Regardless of the reason why a disability insurance claim is denied, consumers have a few options. If they do not wish to fight the decision, they can simply accept that they will not be receiving benefits. If they believe that they are actually owed benefits under their insurance coverage, they can choose to appeal the denial. If a consumer wishes to appeal a denied claim, they need to file their appeal within 180 days of being notified of the denial.

How Do I Appeal A Denied Disability Insurance Claim?

First, consumers should review their LTD insurance denial letter to see why their claim was denied. This notice should include directions for how to appeal a decision and can help by providing a starting point for an appeal. According to Wikipedia, the reason for the denial of LTD insurance benefits will be an important part of the appeal since consumers will be required to argue against the plan administrator’s justification for the denial.

Second, consumers may want to request a copy of their claim file. Under federal law, insurance companies are required to provide a copy to consumers for free if they request it. It is important to make this request in writing so there is documentation. After receiving a copy of their claim file, consumers should review this information and the terms of their disability plan in order to understand how “disability” is defined by their insurer.

Once a consumer has a firm handle on their plan terms, they should begin to gather supporting documents. This can include medical records, new medical opinions, letters from friends or family members, vocational expert opinions, personnel files, employer statements, pain journals, disability decisions from other agencies, and more. Any documentation that can help support the appeal could be crucial in swaying the plan administrator’s opinion.

Finally, consumers need to make sure they submit their appeal and all of their information within 180 days of receiving a denial notice. Most appeals will be submitted with a letter. This letter should include an overview of the claimant’s position, an explanation of any evidence of disability based on the policy’s definitions, identification of all supporting evidence and how the evidence supports the appeal, and a statement that the consumer will continue to appeal the decision until it is approved.

What Happens After I Appeal a Denied Disability Insurance Claim?

Once an appeal is filed, it must be reviewed by someone new who has not yet looked over the case. This individual will be responsible for investigating information and consulting with medical professionals if required.

It is important to note that the new review of the claim cannot be the initial claim reviewer or a subordinate of that person. This is to ensure that the initial decision is not considered at all by the new review.

Consumers may want to regularly follow up with their insurance company to check on the appeal and follow the company’s progress.

Plan administrators have 45 days to review an appeal but may take up to 90 days total if special circumstances apply. Once a decision is made, reviews must send consumers a final decision notice that includes a detailed explanation, reference to plan provisions, information about any additional appeals, explanation of rights, and other information.

If continuing to appeal the decision does not produce a favorable outcome, some consumers may want to consult with an attorney and take legal action against their insurer.

Do YOU have a legal claim? Fill out the form on this page now for a free, immediate, and confidential case evaluation. The bad faith insurance attorneys who work with Top Class Actions will contact you if you qualify to let you know if an individual lawsuit or Unum class action lawsuit is best for you. [In general, Unum bad faith lawsuits are filed individually by each plaintiff and are not class actions.] Hurry — statutes of limitations may apply.

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If you were denied a disability claim or had your Unum disability benefits terminated without reason, you may be able to take legal action against the insurer. See if you qualify by filling out the short form below.

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