With most policies, an individual has an opportunity to appeal. This is especially true with long-term disability insurance benefit plans provided by employers, which are covered by ERISA. At that point, the claimant needs to contact an experienced disability insurance lawyer knowledgeable of long-term disability claims to help with the appeal because it is a crucial stage in the successful outcome of your claim.
Most likely, almost as a matter of course, the long-term disability insurance company will again deny the claim on appeal. However, the record you are creating on that appeal is critical – all of the medical records that support your long-term disability claim and laying out how the disability meets the definitions under the policy can make a difference.
Explaining the basis for your disability claim in the record is very important even if it ultimately results in a denial because under ERISA plans, the judge can only look at the administrative record and whatever was provided during the appeals and initial claim. Therefore the evidence submitted during the appeal must be exhaustive.
Some long-term disability insurance policies allow for a second appeal and some policies don’t. But, after that, you can sue.