Posted on Wednesday, May 8th, 2024 at 9:00 am
If your long-term disability (LTD) claim has been denied, you must submit an appeal letter to the insurance company to have your case reconsidered. This appeal letter is your opportunity to present evidence and arguments showing why you meet your insurance policy’s definition of disabled. A long-term disability appeal letter sample can help guide you in drafting a persuasive letter, which can make the difference between getting your LTD benefits approved or taking your case to court.
Long-Term Disability Appeal Letter
When the insurance company denies your LTD claim, it must notify you in writing and give you 180 days to submit an appeal. This is your last opportunity to get evidence into the record before filing a lawsuit. Under ERISA law, the court can only consider evidence submitted to the insurance company during the initial claim or appeal stage.
Your long-term disability appeal letter should contain several key components:
- Statement of purpose: Begin your appeal letter by clearly stating that you are appealing the denial of your LTD claim and providing your policy and claim numbers.
- Outline of your disability: Provide a brief description of your disabling medical condition, including your diagnosis, symptoms, and functional limitations. Explain how your health problems prevent you from performing your occupational duties.
- Discussion of evidence: Explain why the medical evidence supports your disability claim. Point to specific test results, examination findings, and statements from your treating physicians. Argue how you meet your policy’s definition of disability.
- Rebuttal of insurer’s reasons for denial: Directly address each of the reasons the insurance company provided for denying your claim. If the insurer relied on an inadequate definition of your occupation, missing medical records, or an improper medical review, point out these errors.
- Request for reversal: Conclude your appeal letter by arguing that you’ve submitted overwhelming evidence of disability and requesting that the insurer reverse its decision to deny your LTD benefits.
In addition to your appeal letter, you must include all relevant evidence supporting your disability claim. This should include all medical records related to your disabling condition, test results, treatment notes, physician statements, and expert opinions from medical and vocational specialists if needed.
Long-Term Disability Appeal Letter Sample
Here is a long-term disability appeal letter example to give you a general idea of what to include:
[Your Name]
[Your Address]
[Date]
[Insurance Company Name]
[Claims Department Address]
Re: [Your Name]
[Policy Number]
[Claim Number]
To Whom It May Concern:
I am writing to appeal the [Date] decision to deny my claim for long-term disability benefits. Your determination was incorrect, and the evidence supports my entitlement to benefits under the policy.
I have been unable to work since [Date] due to [Briefly describe your medical condition, symptoms, and limitations]. I have provided ample medical evidence documenting my disabling condition, including [Briefly describe vital medical records, test results, and physician support].
The medical evidence clearly shows that [Explain why the evidence supports disability under your policy’s definition]. [Point to key test results, limitations, and physician opinions].
In your denial letter, you state that [Quote the insurer’s reason for denial]. However, this reasoning is erroneous because [Explain why the insurer’s reason for denial is wrong]. [Provide evidence to rebut the insurer’s determination].
[Summarize the evidence and arguments in support of your disability]. Given the abovementioned evidence, I ask that you reverse your previous decision and approve my long-term disability claim. I am enclosing additional medical records and evidence for your review. Please add these documents to my claim file.
Thank you in advance for your prompt attention to this matter. If you have any questions or need additional information, please do not hesitate to contact my attorney or me.
Sincerely,
[Your Signature]
[Your Name]
Enclosures:
[List the additional documents you are submitting]
More Information About the Letter of Appeal
The above long-term disability appeal letter example is just one way to structure your appeal. The most important thing is to clearly explain, using evidence, why you meet your policy’s definition of disability. You don’t want to summarize the information that the insurance company already has. Instead, you want to present an analysis and arguments for why you’re entitled to benefits under the policy’s terms.
Capitan Law Knows How to Appeal Long-Term Disability Denial
Drafting a winning long-term disability appeal letter requires an in-depth understanding of your medical condition, functional limitations, occupational requirements, and the specific terms of your LTD policy. It also requires carefully reviewing your claim file and the insurance company’s denial letter to determine if any errors were made or if additional evidence is needed.
If your long-term disability claim has been denied, contact us online or call us immediately at [phone number linked=true] for a free consultation. Our attorneys will review your denial letter, explain your legal rights, and discuss how we can help you get the benefits you deserve. Don’t go up against the insurance company alone. Call Capitan Law today to put an experienced Philadelphia long-term disability appeal attorney in your corner.
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