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What happens if insurance denies your long-term disability claim?

On Behalf of | Oct 25, 2019 | Long-Term Disability

Long-term disability insurance can provide you financial support when an illness or injury prevents you from working. The insurance company can cover a part of your lost wages so you can pay your bills. But what happens when the insurance company denies your long-term disability claim?

The Employment Retirement Income Security Act – also known as ERISA – has strict guidelines for any insurance plan you buy through your employer. These rules are meant to ensure you receive the benefits you need. But they can also be complicated when you appeal a denied claim.

Why the insurance company may deny your claim

When you apply for long-term disability benefits, the insurance company will want a lot of paperwork on why you can’t work. If they don’t receive the right documents, or if they feel like what you send them isn’t enough proof, they will deny your claim. ERISA requires that they decide within 45 days of receiving your claim, but they can extend for 30 more days if they notify you.

What the denial letter must include

If they deny the claim, the insurance company must tell you why in writing. The explanation must address the specific reasons that your claim doesn’t meet their coverage. They must also describe how the appeal process works. You can use this information to gather any documents or information that proves your illness or injury prevents you from working.

Appealing a claim denial

Once you receive your denial letter, you can appeal the decision. You have 180 days to appeal.

When the insurance company receives your appeal, the person who denied your claim cannot decide on your appeal. ERISA requires the insurance company to have someone new look over the appeal and decide without considering the original denial.

If the insurance company denies your appeal, you may be able to file a lawsuit against them.

Long-term disability benefits help you pay your bills

When you can’t work, you need some form of income to cover your bills. But insurance companies deny many claims for long-term disability benefits.

If your insurance company denies your claim, you have the right to file an appeal. But filing can be complicated. You may want to seek legal advice when appealing the insurance company’s decision.


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