It’s Not Just An Appeal Letter

Applicants whose Long Term Disability Benefits have been denied often believe that all that they have to do is “just file a letter” in order to successfully appeal their claim. This erroneous notion is probably fostered by the way that insurance companies handle the process. Usually, the denial letter states something like: “If you disagree, you have 180 days to appeal our decision and tell us why.” Unfortunately, claimants are unaware that appeals submitted with a simple one or two page letter are in all likelihood going to be denied. In addition, claimants are unaware that once the appeal letter is submitted, no further evidence or documentation can be introduced in the case. Consequently, after the 180 days have passed, many applicants find themselves “stuck” with an appeal that can be easily defeated by the insurance company once the case goes to court.

The majority of the Long Term Disability insurance policies in this country are governed by the Employee Retirement Income Security Act of 1974, a complex federal law, also known as ERISA. Once a disability claim is denied by an insurance company and all administrative appeals have been exhausted, the claimant’s only recourse is to pursue an appeal in Federal District Court. Pursuant to ERISA, the Court cannot consider any new evidence outside of what was submitted by the claimant in the initial 180 day appeal period. This is why submitting a good initial appeal is essential in every case. It is strongly recommended that you hire a lawyer who is familiar with the process. A good appeal letter requires the expertise of someone who is thoroughly familiar with: the law, the plan documents that govern the claim and the medical aspects of the case.

Therefore, once you receive a denial letter, it is important to contact a lawyer as soon as possible. Cases have been won and lost depending on the quality of the administrative appeal. Our law firm is available to complete the initial administrative appeal letter for you as part of our legal services. We do not charge you any legal fees until the insurance company issues the payments that you are entitled to. If you don’t get paid by the insurance company, we do not charge you for our legal fees. You are only responsible for paying the costs associated with pursuing the appeal.

For a free evaluation with a Connecticut or Massachusetts Long Term Disability Lawyer, you can contact us or call toll free (860) 519-5242.

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