Posted on Friday, August 15th, 2025 at 9:00 am
If your long-term disability (LTD) insurance claim was denied, you need an experienced LTD lawyer to help you navigate the disability benefits appeal process. This process involves several key steps with strict deadlines, and handling it alone can prove challenging. The best way to maximize your chances of a successful outcome during the disability benefits appeal process is to work with a skilled lawyer who understands the system.
Why Disability Claims Are Commonly Denied
The main reason disability claims are denied is a lack of medical evidence backing up the claim. LTD insurance companies use strict definitions of disability and require detailed medical records to prove the severity of your condition, which is why appealing a disability insurance benefits denial can feel overwhelming without strong documentation and support.
If your claim doesn’t include the necessary medical evidence to support it, the insurance company will likely issue a denial.
Other common reasons for claim denials include:
- Failing to meet filing deadlines
- Failing to follow prescribed treatment plans
- Failing to demonstrate that your disability meets the criteria
Step 1 – Request for Reconsideration
The first step in the LTD insurance claim appeal process is to request reconsideration with the insurance provider. Upon receiving your request, the insurer will have a different employee from the one who initially denied your claim review it and issue a new decision.
Before filing your request, you must review the claim denial letter sent by the insurer. This letter will describe the reason for your denial so you can remedy it in your request for reconsideration. For example, if the denial states that it was due to a lack of medical evidence, you must provide additional medical evidence with your request.
A lawyer can help you review your denial letter and assemble the evidence needed for a successful reconsideration.
Step 2 – Hearing Before an Administrative Law Judge (ALJ)
If the insurer upholds the denial, you can request a hearing before an Administrative Law Judge. During this hearing, you will have a chance to present evidence for why you believe the insurer erred in its denial of your claim. The insurer will also have the opportunity to explain its decision.
After hearing from both sides, the Administrative Law Judge will issue a judgment, either granting the benefits you seek or upholding the insurer’s claim denial.
Step 3 – Appeals Council Review
If the Administrative Law Judge doesn’t side with you during the hearing, your next option is to request an appeals council review. The appeals council may consider both old and new evidence supporting your case. However, it will also examine whether the Administrative Law Judge made any procedural errors.
While the appeals council can approve your claim or uphold the denial, it can also send your case back to the Administrative Law Judge for a second hearing with additional instructions.
Step 4 – Federal Court Appeal
The final stage of the appeals process is a federal court appeal. To file an appeal in federal court, you must typically use up all of your administrative appeals. For example, if the appeals council sends your case back to an Administrative Law Judge, you cannot file an appeal in federal court while the administrative appeal is still active.
If your case is covered by the Employee Retirement Income Security Act (ERISA), you have 180 days from the denial to file your appeal in federal court. There may be different deadlines depending on the exact circumstances of your case, which is one reason why you should always have a lawyer review it.
Tips to Strengthen Your Disability Appeal
After a disability insurance denial, taking the proper steps can strengthen your appeal. Some of the key steps to take include:
- Reviewing the claim denial letter sent by the insurer
- Making sure your doctors include detailed notes in your medical records
- Obtaining copies of your medical records
- Following all prescribed treatments
- Gathering evidence of your work limitations
- Maintaining consistency through your statements provided to the insurer
- Paying attention to appeal deadlines
The best way to strengthen your appeal is to work with a skilled long-term disability lawyer. They can help you through many of these steps or perform them on your behalf to give your appeal the best chance of success.
Contact Our Long-Term Disability Lawyers
Contact Capitan Law at (267) 419-7888 if your long-term disability insurance claim in Philadelphia was denied. Our lawyers have extensive experience dealing with insurance companies and handling claim appeals. During your free initial consultation, we’ll review your case, help you understand why the insurance company denied your claim, and walk you through what to expect from the appeals process.
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