Any long term disability matter starts with a claim for benefits. This is a written request sent to the plan administrator, or the employer’s human resources department. Employees facing long-term disabilities should consult their Summary Plan Description to see where the claim should be filed and what should be included.
If your long term disability benefits are denied or terminated, the plan administrator must give you a written or electronic notice that provides:
- Why your claim was denied (including any disagreements with medical professionals or vocational experts)
- Which specific part of the plan the denial is based on
- Notice that you are entitled to receive all documents related to your claim at no cost
- Copies of the rules, policies, protocols, and other guidelines used in denying your claim
- Descriptions of the appeals process and time limits going forward
A careful review of the long term disability benefits denial notice can mean the difference between a successful appeal and further benefit roadblocks. If the reason for the denial was based on inadequate medical documentation, or a lack of objective measurements for the effect of the disability, an appeal may simply mean you need to provide further information or documentation.
When the decision is based on a disagreement with medical professionals, the policies and protocols may provide insight into what more needs to be done to win the appeal.
Should You Hire a Disability Benefits Lawyer for the Second, Voluntary Appeal?
Some insurance companies provide a second level of administrative appeals, called either a second appeal or a voluntary appeal. If a voluntary appeal is available, the denial notice on the first long term disability benefits appeal will include information regarding the secondary appeal process and the time limits. Under ERISA, the employee must be given a reasonable amount of time to file a second appeal (sometimes less than 180 days). However, the plan still only has the same 45 days to address both levels of appeal.
Many employees choose to file a first or second appeal on their own, waiting to hire an attorney until the matter is headed to court. However, hiring an attorney for the mandatory or voluntary appeal gives that attorney a chance to review the bases for denying the claim and to provide additional proof, improving the chances that a claim will be granted and strengthening the case if it does head to court.
Need Help with a Denial or Termination of Benefits? Speak to an LTD Lawyer Today
At Bross & Frankel, our long-term disability attorneys are here to help. We will review your denial and your condition, and help you make your strongest case. Contact us or call us today at (866) 865-0245 for a complimentary consultation.