Only by reading your disability policy can one determine the exact administrative appeals process for your specific policy. Individual long-term disability plans, those not covered by ERISA, are governed by the statutory and common law of the state in which the policy is issued. Each policy should outline the appeals process for disputing long-term disability claim denials. If your insurer has a specific appeals process, you need to abide by those rules. When you sign a contract for long-term disability insurance, you are agreeing to the terms, which include the appeals process.
If you have been denied long-term disability benefits, your insurer should have explained the reason for denial in writing. If not, you can also contact the claims manager by drafting a letter that requests the exact reason for the claim denial.
If your claim has been denied, you may not have to file an administrative appeal. Instead, you may be able to file a lawsuit without exhausting your administrative remedies.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective of whether the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, handling denials of claims or termination of benefits, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.