How Do You Appeal a Long Term Disability Insurance Denial? It Depends. - YouTube

How do you appeal a long-term disability insurance  denial, it depends. Hi, I'm Marc Whitehead,  

a board-certified disability attorney. If  an insurance company denies your claim for  

long-term disability benefits you can appeal  the decision. This is your right and the  

injurer must allow you recourse to a full and  fair review of a denied claim. This is true  

whether you have a private disability policy  or an employer provided ERISA govern policy.  

What is it administrative appeal? The appeal  is a formal request for a reconsideration of an  

unfavorable decision made by the insurer, such  as a denial, a reduction, or a termination of  

benefits. The process involved in a long-term  disability appeal depends upon the type of  

LTD policy your claim is under. You may have an  employer-funded group disability plan which falls  

under federal ERISA regulation or you may have a  private or individual disability insurance policy  

which you bought yourself. Private LTD  claims are regulated by state insurance laws.  

The laws regulating in each type of  disability insurance claim are very different.

ERISA, the employee retirement income securities  act is a federal law that regulates most group  

disability insurance benefits provided by  employers, professional associations, or unions.  

ERISA long-term disability appeals must follow  an extensive administrative appeals procedure.  

You will have a deadline of 180 days  in which to file your initial appeal.  

The administrative appeals process  is critical. The appeal becomes  

the framework for the successful outcome of your  entire case. You need to be vigilant and fully  

develop the record with pertinent evidence, such  as; medical records, medical expert opinions,  

vocational expert opinions, letters from employers  and friends, medical literature and photographs.  

You need to effectively argue  against the insurance company's  

in-house medical reviews and any misuse or  misrepresentation of the evidence by the insurer.  

If your claim is not approved once the appeals  process is exhausted the next step is to file  

a lawsuit. ERISA disability lawsuits are held  in federal court before a judge and not before  

a jury of your peers. Once a lawsuit is filed  it's most often the case that you cannot add  

any new evidence to the record that's why to  avoid losing your appeal it's strongly advised  

that skilled legal counsel represents you  throughout the administrative appeals process.

Individual or non-ERISA long-term disability  appeals are different. Private long-term  

disability policies are contracts between you and  the insurance company as such these policies and  

claims denials are governed under state contract  and bad faith law. Unlike ERISA based claims  

which require exhaustion of strict administrative  appeals private policies generally don't. If your  

claim is denied you have the right to appeal  the private LTD claim denial to your insurer.  

Be aware that this appeal is often nothing  more than an internal review with the same  

insurance carrier that denied your claim in the  first place. When acceptable settlement with an  

insurance company can't be reached bad faith  insurance claims litigation becomes necessary.  

Bad faith occurs when an insurer unfairly  or improperly withholds payment warranted  

under the policy. This includes thoroughly and  promptly investigating all evidence in support  

of your claim. In a lawsuit against the insurance  company for a denial of a private LTD benefit  

you have certain rights that are  not available under ERISA law.  

First, you're allowed a trial by jury. Second,  you may engage in discovery seeking new evidence  

and finally, most states allow you to  seek compensatory and punitive damages.  

It's important to have a qualified attorney  represent you in your long-term disability  

insurance appeal because you're in no condition  to work our firm will help you gather all the  

necessary documentation, prepare and file a  proper conclusive appeal, talk with your doctors,  

obtain statements from witnesses, consult  with qualified vocational experts,  

and use the latest science and technology to  investigate and build the details of your case.  

Long-term disability bills can be complicated.  Claimants are most often successful when they  

have a strong representative from  experienced disability attorneys.  

Marc Whitehead and associates is a national  disability law firm representing disabled  

individuals in all 50 states. More information  about this topic can be found in my free eBook,  

'Disability Insurance Policies-How  to Unravel the Mystery and Prove Your  

Claim.' Visit www.disabilitydenials.com for a  free downloadable copy or call 1(800)562-9830  

to discuss your particular disability issue.  I'm Marc Whitehead, thanks for watching.