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How To Appeal a Disability Insurance Claim Denial

Getting disability insurance benefits doesn't have to end if you receive a disability insurance claim denial. Both employer disability and Social Security disability insurance (SSDI) allow you to appeal a denial. Even a private disability insurance provider may allow an appeals process.

A disability insurance claim denial doesn't mean you aren't disabled or won't be able to get benefits eventually. Less than one-third of SSDI claims are initially approved. The Employee Retirement Income Security Act (ERISA) governs employer disability insurance. ERISA allows the plan's administrator to evaluate claims it must pay. This creates a conflict of interest that can lead to valid claims getting denied.

This article discusses how to appeal a disability benefit claim denial. It addresses employer disability insurance and SSDI benefits. It also discusses how to respond to a denial of benefits if you have private disability insurance.

Appealing Your Denial

The law allows you to appeal an initial denial of a claim for disability benefits. This is true whether you have Social Security or insurance policy benefits. The process of appealing your disability insurance claim denial will depend 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 notice of why your claim got rejected. You can also request copies of documents, records, and expert advice used in making the denial decision.

When preparing your appeal, study the denial letter closely. Note any deadlines you must meet when appealing. A missed deadline can result in a waiver of your rights. Next, begin preparing any favorable evidence to submit to your insurer. Keep these tips in mind:

  • Add any missing or incomplete medical records
  • Consider further testing. Lack of evidence is one of the most common reasons for denying a disability claim. Further testing can help bolster your case
  • Submit written opinions from your doctors. If your initial claim didn't include the written opinion of your treating physicians and specialists, supplement the record with this on appeal
  • Add non-medical evidence. Letters from friends describing how your medical condition has changed your ability to work can help your case. A vocational expert can provide proof of how impairments affect your ability to hold a job
  • Verify receipt of all documents you send to your insurer

Suppose your plan's final decision denies your claim. In that case, you may bring a lawsuit to challenge the denial. Often, the judge only considers evidence in front of the insurance company. This is why filling the record with evidence in your favor early in the claims process is so important.

Social Security Disability Insurance

If your claim for Social Security disability insurance (SSDI) benefits has been denied, you have the right to appeal. There are four levels of appeals, which must happen in order. These levels are:

  1. Reconsideration by the state agency that initially denied your claim
  2. Hearing before an administrative law judge
  3. Review by the Appeals Council
  4. Review in federal court

Suppose you wish to appeal your initial denial of SSDI benefits. In that case, you must do so in writing within 60 days of getting your denial letter. Missing this short deadline may waive your right to appeal the denial. When you appeal, supplement your record just as with employer insurance. Follow the steps above to ensure you have as much supporting evidence for your claim as possible.

The Social Security Administration (SSA) guarantees your right to representation when seeking SSDI benefits. You may not have to make any direct payments to your attorney. Instead, you'll pay your representative's fee out of any past-due benefits.

Private Disability Insurance

If you've bought your own disability insurance plan and the insurance company denied your disability claim, pay special attention to your policy's documents. Some will allow you to appeal an initial denial. Others may need more filings before reconsidering your claims.

As a policyholder, it's important to know your rights. An attorney can help you understand your policy.

Get Legal Advice From a Disability Lawyer Today

Millions of Americans rely on disability benefits to get by when they can't work due to a personal injury. If you've gotten a disability insurance claim denial, work with a disability attorney to achieve the desired outcome.

Check FindLaw's directory of disability law attorneys to find a qualified insurance attorney near you. Many legal teams can offer a free case evaluation and help determine your chances of success on your denied claim. A lawyer can help you understand your disability insurance policy and any applicable state or federal laws.

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