Understanding Long Term Disability Appeal

By Carol Jackson


There are times when an insurance claim is being denied by the company provider. They sometimes find reasons, especially those in fine prints, to deny the claim. To do a long term disability appeal, you must first understand why it has been denied before writing an appeal letter.

Gather knowledge on your insurance policy to aid you in your appeal. Be persistent in learning what you need to learn. You also need to be patient in gathering evidence to counter the reasons and claims of the insurance company. Remember to finish before the appointed deadline for appeal.

What reason they come up with may be, understanding it should be a priority before you can build a substantial case. Their denial letter and each section on it should be read thoroughly. Call them and inquire as to what each of them mean. Remember, you are doing this so you will have important information. It would be prudent if you are polite in conversing with them.

If there are parts that you know yourself are incorrect, highlight them for further evidence. When their reason for denying it is because the medical records you submitted are insufficient, ask what other documents do they substantially need. Also add if there are specific lab tests and medical results they particularly need in your records. It might be that what your physician wrote on the medical certificate was not enough for them. Inquire as to why that is so your physician, and even you, can expound it to them.

Companies would use the reason that your disability would not really affect any of the work that you do. They list the details on the letter they sent you. As a counter, you may tell them the responsibilities you do in the company. Ask human resources personnel to give you a copy of the specifications and description of your job so you can include it in your pile of evidence.

It would also help if you can get and record the findings and results of your physician. Let him help you in listing out the limitations on your physical and mental abilities your disability results to. Ask him how this can affect your everyday routine at home, at work, and at social functions.

Scour the disability section of your insurance plan contract and look for their definition of disability in there. Sometimes what you think you know does not match their print. Their disability may pertain to either inability to perform any work or inability to come back to your own work.

If it matches your situation, then read the copy of your insurance policy. Do cross match between you insurance contract, their denial letter, and with what you have gathered and found out. This may help you in winning the appeal and get that insurance claim.

Ask for a lawyer to help you so that the company would not have any reason to deny your claim again. Reviewing your counter claim and affirming it for substantial evidence is how they can help you. You part is to attach all evidence documents you filed up to the appeal letter. Due to this, delays are avoided and errors are reduced in your paperwork. They also have ways in crafting the appeal letter to persuade the company in retracting the decision.




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