According to data from the Centers for Disease Control and Prevention (CDC), more than one in four American adults has at least one condition that can be classified as a “disability.” If you are dealing with a disabling injury, illness, or other medical ailment, you may be entitled to long-term disability benefits. Unfortunately, many people struggle to get their claim approved.
As frustrating as a denial can be, it is not necessarily the end of the road. You have the right to appeal, but you need to be proactive. At The Law Office of Paul J. Dombeck, PLLC, we handle all types of disability appeals. Our Phoenix long-term disability attorney provides a step-by-step guide to take if your claim is denied in Arizona.
Five Important Steps to Take if Your Long-Term Disability Claim is Denied
Step #1: Read, Review, and Preserve the Disability Denial Letter
As a starting point, you should read, review, and preserve the long-term disability denial letter that you received from the insurance company. Insurers are generally required to provide written notice that explains the reasoning behind the denial. As a general rule, the denial letter will explain why your claim was denied and outline your rights, including the deadline to appeal. Of course, getting a disability denial letter may feel overwhelming. Still, you should take your time and highlight anything you do not understand. You should also keep the original letter in a safe place and make copies for your records. Understanding the insurer’s reasoning is the first step to challenging it—and it is okay if you do not have all the answers right away. Legal help is available.
Step #2: Request a Copy of Your Claim File (It is Your Right)
Next, you should request a copy of your claim file. It is an important step to take after your long-term disability claim is denied. Your claim file is the complete set of documents the insurance company has gathered and reviewed in evaluating your disability claim. It typically includes everything from your application, medical records, internal notes by the insurance company’s claims adjusters, correspondence, any reports from doctors hired by the insurer, and other evidence used to make their decision. The claim file is important documentation
Know Your Rights: Under ERISA, you have the right to request and receive a copy of your claim file if your long-term disability claim is denied. Remember, reviewing the claim file is a key step to bringing a strong appeal. It helps to show exactly what the insurer considered—and what it ignored—when making its decision.
Step #3: Gather and Organize Supplemental Supporting Evidence
Evidence is key to bringing a successful appeal of a long-term disability denial. One of the most important steps to take is gathering as much relevant information as possible. Some evidence that could be used to support your long-term disability includes updated medical records, any new evaluation from your treating physician(s), and formal letters that explain how your condition adversely affects your ability to work. You may also consider functional capacity assessments or personal statements from coworkers or family.
Long-Term Disability Appeal Tip: To build a strong claim, you should work to proactively fill in any gaps the insurer may have relied on to deny your claim. Being thorough and organized can strengthen your appeal. The more evidence you have, the better positioned you will be.
Step #4: Consult With a Phoenix Long-Term Disability Appeals Attorney
Long-term disability appeals are complicated. The right attorney can make the difference in your case. An experienced Phoenix long-term disability attorney has the knowledge and expertise to truly understand how insurance companies operate. Your lawyer can help you present the strongest, most compelling possible appeal. Beyond that, your attorney will also make sure your rights are protected and deadlines are met. You do not have to carry this burden alone. Your long-term disability benefits are worth fighting for. Do not give up. Our Phoenix, AZ disability lawyer can review your denial letter, answer your questions, gather evidence, and take action to help you fight for the maximum available benefits.
Step #5: File an Appeal (Administrative Appeal Typically Comes First)
Finally, you need to file a formal appeal in a timely manner. In most cases, this will be an internal (administrative) appeal submitted directly to the insurance company. The deadline is typically strict, with ERISA plans it is often 180 days from the date of the denial. With that in mind, you should not wait too long to initiate your appeal. An appeal must be as complete and well-supported. The administrative appeals process might be your last chance to get new evidence into the record. A top-rated Phoenix long-term disability lawyer can help you navigate all aspects of the appeals process—from an administrative appeal to federal litigation.
Why Trust The Law Office of Paul J. Dombeck for a Long-Term Disability Claim
The denial of long-term disability benefits is stressful, frustrating, and can cause serious financial strain on your family. You work hard, and you need your disability benefits. At The Law Office of Paul J. Dombeck, PLLC, we provide personalized, justice-focused advocacy to clients. With experience handling ERISA long-term disability appeals and non-ERISA long-term disability appeals, our firm has the knowledge and expertise you can trust. For a free, no-obligation initial case review with a top-tier Phoenix, AZ long-term disability appeals attorney, please contact our firm today.
Contact Our Phoenix, AZ, Long-Term Disability Attorney Today
At The Law Office of Paul J. Dombeck, PLLC, our Phoenix long-term disability lawyer has the knowledge, skills, and experience to help you fight for your full and proper benefits. Do not assume that a denial is the end of the road. Was your long-term disability claim denied? We are here to help. Contact us today for a free, no-obligation initial consultation. With a law office in Phoenix, we handle long-term disability denials in Maricopa County and beyond.
