If your claim for disability under an employer-sponsored health plan is denied, it’s not the end of the road. You can appeal the decision to deny your benefits and have it reversed.
While appealing an unsuccessful disability claim can be a complex and time-consuming process, it is a crucial step toward protecting your rights and, potentially, obtaining the benefits you deserve. Here is what you should expect.
You must first appeal to the insurance company
The first thing you need to do is review the denial letter from the insurance company. It outlines the reasons behind the decision to deny your claim and basic information on how to file a claim. Understanding why your claim was unsuccessful is essential as it will guide your appeal.
When your disability claim is denied, you must first appeal internally with the plan administrator (the person or entity responsible for making decisions on claims). It means following and exhausting the insurer’s appeal procedures outlined in your plan before exploring other options.
You must submit a written appeal to the plan administrator when contesting a denial. It should include any additional or new evidence that supports your claim, like medical records, doctor statements or vocational reports. You should also explain why you disagree with the denial and why you meet the plan’s definition of disability.
There are timelines involved
Appeals must be filed within the deadline specified by your plan. This is usually 180 days from the date you receive the denial letter, but it may vary depending on your plan’s terms. You may lose your right to appeal the denial if you miss the deadline.
Protect your rights and interests
You can take the matter to court if things don’t go your way with your appeal. The court process is presided over by a judge, and only evidence submitted to the plan administrator during the claim and appeal process is considered. Therefore, submitting all relevant evidence during the appeal process and presenting a strong argument is very important.
Seeking informed legal guidance after your disability claim is denied can help build your case and increase the chances of a beneficial resolution.