How to Appeal a Disability Insurance Claim Denial
Created by FindLaw's team of legal writers and editors | Last reviewed June 20, 2016
The process of getting disability insurance benefits doesn't have to end if you've received a disability insurance claim denial. Both employer disability and Social Security disability insurance (SSDI) allow you to appeal a denial, several times if necessary. Even private disability insurance that you have purchased individually may allow you to appeal a denial.
A disability insurance claim denial doesn't mean that you aren't disabled or that you won't be able to eventually receive benefits. Less than one-third of SSDI claims are initially approved. Employer disability insurance is governed by the Employee Retirement Income Security Act, or ERISA. This law allows the plan's administrator to evaluate claims it will have to pay, creating what the Supreme Court has identified as a conflict of interest that can lead to valid claims being denied.
Appealing Your Denial
If you've lost work because of a disability, Social Security or insurance benefits can be an essential way to protect both yourself and your family. The law requires that you be allowed to appeal an initial denial of your claim. The process of appealing your disability insurance claim denial will vary depending on whether you have employer disability insurance, SSDI or private disability insurance.
Employer Disability Insurance
Under ERISA, your initial claim denial must come with a detailed noticeof why the claim was rejected. You may also request copies, for free, of documents, records, and expert advice that were used in making the decision.
When preparing your appeal, study the denial letter closely. Note any deadlines you must meet when appealing. A missed deadline could result in your waiving your rights. Then, begin preparing any additional favorable evidence to submit to your insurer. Keep these tips in mind:
- Add any missing or incomplete medical records.
- Considerfurther testing. Lack of evidence is one of the most common reasons for denying a disability claim. Further testing could help bolster your case.
- Submit written opinions from your doctors. If your initial claim did not include the written opinion of your physicians and specialist, supplement the record with this on appeal.
- Add non-medical evidence. Letters from colleagues and friends describing how your medical condition has impacted your ability to work can help build your case.A vocational expert can provide evidence of how impairments affect your ability to hold an occupation.
- Verify receipt of all documents you send to your insurer.
If your plan's final decision denies your claim, you may decide to bring a lawsuit in court to challenge the denial. Often, the judge will only consider evidence that was in front of the insurance company. This is one reason why it's so important to fill the record with evidence in your favor early in the claims process.
Social Security Disability Insurance
If your claim for Social Security disability insurance has been denied, you have the right to appeal. There are four levels of appeals, which must be exhausted in order:
- Reconsideration by the state agency that initially denied your claim
- Hearing before an administrative law judge
- Review by the Appeals Council
- Review in federal court
If you wish to appeal your initial denial for SSDI benefits, you must do so in writing within 60 days from receiving your denial letter. Missing this short deadline may waive your right to appeal the denial. When you appeal, you'll want to supplement your record just as with employer insurance. Follow the steps above to make sure that you have as much supporting evidence for your claim as you can find.
The Social Security Administration guarantees your right to representation when seeking SSDI benefits. You may not have to make any direct payments to your attorney. Instead, your representatives fee will be paid out of any past-due benefits you are owed.
Private Disability Insurance
If you have purchased your own disability insurance plan and your claim for disability benefits has been denied, pay special attention to the policy's documents. Some will allow you to appeal an initial denial, others may require additional filings before reconsidering your claims. Any attorney specialized in disability and insurance law can help you decipher your policy and determine how best to move forward.
Have a Disability Lawyer Review Your Denial Today
Millions of Americans rely on disability benefits to get by when they can't work. If you've received a disability insurance claim denial, you may need to work with a lawyer specializing in disability law in order to achieve the desired outcome. Check FindLaw's directory of disability law attorneys to find a qualified lawyer near you.
You Don’t Have To Solve This on Your Own – Get a Lawyer’s Help
Meeting with a lawyer can help you understand your options and how to best protect your rights. Visit our attorney directory to find a lawyer near you who can help.