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What does the LTD appeal process look like?

by | Aug 28, 2023 | Long-Term Disability

When you received notice that you were being granted long-term disability (LTD) insurance coverage through your employer, you likely hoped you’d never need it. Now that you’re dealing with a serious illness or injury, you’re grateful for the opportunity that this coverage provides. Yet, if you’ve submitted an application and have been denied, you’re likely also (understandably) panicking.

You have no choice but to appeal the denial because you need the money to help cover your medical bills and lost income, but you have no idea what to expect. While every situation is somewhat unique, it can be helpful to understand how the appeal process typically works for LTD plans governed by ERISA. Plans governed by state law or a collective bargaining agreement may be subject to a somewhat different process.

Preparing the appeal

Start by looking at the information included in the notice of denial you’ve received. It should provide the reason(s) for the denial, including the provision the insurer is basing the denial on. If the claim was denied because of missing or unclear information, that should be easy enough to remedy. However, what should you do if it’s been denied because your condition isn’t considered a disability or isn’t eligible for coverage? Maybe the denial says your condition isn’t covered under your plan based on your diagnosis or the information provided by your doctor. That is a more complicated situation and you may benefit from seeking legal guidance accordingly.

Typically, you have a minimum of 180 days to file an appeal. However, the sooner you do it, the sooner you can receive your benefits if your appeal is successful. It’s more important to collect all the information needed before you send in your appeal than to rush it without adequately determining what the administrator needs to approve the claim this time around.

The appeal review and decision

The appeal must be reviewed and decided on within 45 days, or the insurer must give you an estimated decision date if more time is needed. An appeal can’t be denied for different reasons than the initial denial unless the insurer notifies you of new information it’s received and gives you a reasonable opportunity to respond to it.

If you believe your claim was wrongly denied and/or the process wasn’t handled as required, it’s wise to seek legal guidance. Of course, you can also get legal guidance at any point in the claims and appeals process to help you get the benefits you need and deserve as efficiently as possible.