{"id":352943,"date":"2016-04-04T10:46:35","date_gmt":"2016-04-04T15:46:35","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/injury\/accident-injury-law\/how-to-appeal-a-disability-insurance-claim-denial.html"},"modified":"2024-03-09T17:36:21","modified_gmt":"2024-03-09T22:36:21","slug":"how-to-appeal-a-disability-insurance-claim-denial","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/injury\/accident-injury-law\/how-to-appeal-a-disability-insurance-claim-denial.html","title":{"rendered":"How To Appeal a Disability Insurance Claim Denial"},"content":{"rendered":"\n
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How To Appeal a Disability Insurance Claim Denial<\/h1>\n\n
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\n By Lark Lewis, J.D.<\/a> | Legally reviewed by Katrina Wilson, Esq.<\/a>\n | Last updated\n
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This article has been written and reviewed for legal accuracy, clarity, and style by FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with our editorial standards<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n\n

\n \n <\/i>\n Fact-Checked\n <\/summary>\n\n
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The last updated date refers to the last time this article was reviewed by FindLaw or one of our contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please contact an attorney in your area<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n<\/section>\n\n\n

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Key Takeaways<\/h2>\n

Disability insurance benefits might not have to end if you receive a denial letter. You can usually seek an appeal after a disability insurance claim denial.<\/p>\n\n <\/div>\n <\/div>\n<\/div>\n\n\n

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 for an individual plan.<\/p>\n

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.<\/p>\n

But if you have a denied claim, it’s smart to call a disability insurance claim denial lawyer<\/a>\u00a0first. An attorney can fairly represent you in a dispute against large insurance companies. Even a small mistake could jeopardize your disability claim, so get legal advice before talking to an insurance agent.<\/p>\n

Disability Claim Denial Is Common<\/h2>\n

A disability insurance claim denial doesn’t mean you aren’t disabled or won’t be able to get benefits eventually. Denials are fairly common for short-term and long-term disability<\/a> benefits.\u00a0<\/p>\n

For example, less than one-third of SSDI claims<\/a> are initially approved. Large insurance companies like Prudential have faced lawsuits<\/a> related to claim denials.<\/p>\n

The\u00a0Employee Retirement Income Security Act<\/a>\u00a0(ERISA) governs employer disability insurance. ERISA allows the plan’s administrator to evaluate claims it must pay. This creates a\u00a0conflict of interest<\/a>\u00a0that can lead to valid claims getting denied.<\/p>\n

Appealing Your Denial<\/h2>\n

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.<\/p>\n

Employer Disability Insurance Appeals Process<\/h3>\n

Under ERISA, your initial claim denial must come with a\u00a0detailed notice<\/a> of why your claim was rejected. You can also request copies of documents, records, and expert advice used in making the denial decision.<\/p>\n

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.<\/p>\n

Keep these tips in mind:<\/p>\n