Receiving a denial for your long-term disability (LTD) claim can be disheartening, especially when you’re already dealing with a debilitating condition that prevents you from working. However, you have the right to appeal the decision. Writing a compelling appeal letter is crucial in getting your claim approved. In this guide, we’ll walk you through the process of crafting an effective long-term disability appeal letter and provide a sample to help you get started.
Understanding the Long-Term Disability Appeal Process
Before diving into writing your appeal letter, it’s essential to understand the LTD appeal process. Typically, you have 180 days from the date of your denial letter to submit an appeal. Review your denial letter carefully to understand the reasons behind the decision and gather any additional evidence that supports your claim, such as medical records, doctor’s notes, and witness statements.
The appeal process can be complex, and following your insurance company’s specific guidelines and deadlines is crucial. Failure to do so may result in your appeal being denied on a technicality. Take the time to read through your policy documents and any information provided by your insurer regarding the appeal process.
It’s also important to note that the appeal process is your opportunity to provide new and compelling evidence that supports your claim. This may include additional medical records, test results, or expert opinions from your treating physicians. Be sure to gather all relevant documentation and submit it with your appeal letter.
Key Elements of a Successful Long-Term Disability Appeal Letter
A well-written appeal letter should include several key elements:
- A clear statement of your intent to appeal the denial
- The policy number and claim number
- A brief overview of your medical condition and how it prevents you from working
- A point-by-point rebuttal of the reasons for denial
- Additional evidence supporting your claim
- A polite and professional tone throughout the letter
When drafting your appeal letter, start by clearly stating your intent to appeal the denial of your long-term disability benefits. Include your policy number and claim number for easy reference.
Next, briefly overview your medical condition and how it impacts your ability to work. Be specific about your diagnosis, symptoms, and any limitations preventing you from performing your duties. This section should be concise but informative.
The most critical part of your appeal letter is addressing the specific reasons for denial outlined in your denial letter. Respond to each reason point-by-point, providing evidence that refutes the insurance company’s decision. This may include medical records, doctor’s notes, test results, or expert opinions that support your claim.
When presenting additional evidence, be sure to explain how each piece of documentation supports your case. For example, if you include a letter from your treating physician, explain how their opinion contradicts the insurance company’s reasons for denial.
Throughout your appeal letter, maintain a polite and professional tone. Avoid emotional language or personal attacks, as this can undermine the credibility of your appeal. Instead, focus on presenting clear, factual evidence that supports your claim.
Sample Long-Term Disability Appeal Letter
[Your Name]
[Your Address]
[Your City, State ZIP Code]
[Date]
[Insurance Company Name]
[ATTN: Appeals Department]
[Insurance Company Address]
[City, State ZIP Code]
RE: Appeal for Long-Term Disability Benefits
Policy Number: [Your Policy Number]
Claim Number: [Your Claim Number]
Dear [Appeals Department],
I am writing to formally appeal the denial of my long-term disability benefits. I received your letter dated [Denial Letter Date] stating that my claim was denied because [Reason for Denial].
I strongly disagree with this decision and believe that I qualify for long-term disability benefits under my policy. I have been diagnosed with [Medical Condition], which has significantly impacted my ability to perform my job duties as a [Your Occupation]. My treating physician, [Doctor’s Name], has provided detailed medical records and notes that support my claim.
In response to the reasons for the denial, I would like to provide the following information:
[Reason for Denial]:
Provide a detailed explanation of why the first reason for denial is incorrect. Include specific examples and evidence that support your claim, such as medical records, test results, or expert opinions from your treating physicians. Be sure to explain how this evidence contradicts the insurance company’s decision.
[Additional Reasons for Denial]:
Address any additional reasons for denial in the same manner as the first.
Enclosed, please find additional evidence that supports my appeal.
I kindly request that you reconsider your decision and approve my claim for long-term disability benefits. My medical condition has had a profound impact on my ability to work, and I believe that I meet the criteria for benefits under my policy. If you require any further information or documentation, please contact me at [Your Phone Number] or [Your Email Address
Thank you for your time and attention to this matter. I look forward to a prompt resolution of my appeal.
Sincerely,
[Your Signature]
[Your Name]
Enclosures:
[List of Enclosed Supporting Documents]
Tips for Writing an Effective Long-Term Disability Appeal Letter
When it comes to writing an impactful long-term disability appeal letter, you’ll want to adhere to the following tips:
- Be specific and detailed in your rebuttal of the reasons for denial. When addressing the reasons for denial, provide as much detail as possible.
- Use clear, concise language and avoid emotional statements. Write your appeal letter in clear, easy-to-understand language. Avoid using complex medical terms or legal jargon, making your letter challenging to follow. Additionally, refrain from using emotional language or personal attacks, as this can undermine the credibility of your appeal.
- Organize your letter in a logical manner, using headings and bullet points. Structure your appeal letter in a logical, easy-to-follow format.
- Keep copies of your appeal letter and all supporting documents for your records.
Seeking Help from a Long-Term Disability Attorney
If you find the appeal process overwhelming or need assistance crafting a strong appeal letter, consider seeking help from a long-term disability attorney. An experienced attorney can review your case, help gather evidence, and craft a compelling appeal letter.
Hankey Marks & Crider has a team of knowledgeable attorneys who understand the complexities of the appeal process and can guide you through each step, from gathering evidence to submitting your appeal. With their help, you can increase your chances of a successful appeal and obtain the benefits you deserve.
To learn more about how Hankey Marks & Crider can assist with your long-term disability appeal, contact their office at (317) 634-8565 for a consultation.