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Employer-Provided Long Term Disability Benefits – Appealing a Denied Claim

Many employers provide long term disability insurance policies for their employees. LTD insurance policies take effect when an employee can no longer work due to any illness or injury, and they pay monthly benefits until the employee can return to work. The monthly amount is usually between 50-70% of the employee’s monthly income.

Most employer-provided LTD insurance plans are governed by the Employment Retirement Income Security Act (ERISA), which favors insurance companies. Unlike most insurance policies, ERISA-governed policies are very difficult to challenge in court. If your claim for employer-provided LTD benefits is denied, you cannot file a lawsuit until you file an appeal to the LTD policy holder. You will have 180 days to file this appeal.

You should seek assistance from an experienced attorney to appeal a denial, as the appeal will need to address many issues depending on the policy, denial letter, and your disabling conditions. However, there are some things you can do to prepare your appeal:

  • Get a copy of the policy, which can be obtained from your employer’s human resources department or from the insurance company that denied the policy.
  • Get a copy of your job description, which can also be obtained from your HR department.
  • Continue treating with your doctors, and find out if they will support your appeal.
  • Educate yourself about Social Security Disability benefits, as many LTD policies will require you to file for SSD.
  • Collect any records that are relevant to your claim, such as:  letters to and from the insurance company; pay stubs; list of treating doctors; statements from your doctor(s); medical test results; medications list; etc.

The appeal needs to be carefully prepared in consideration of the policy provisions, your medical conditions, and your occupation. At Banks Law, our experienced attorneys will ensure that your appeal has the highest chance of success. Please give us a call is you have any questions regarding your long term disability benefits.