Long Term Disability Appeal Letter Sample

Long Term Disability Appeal Letter Sample

[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]

[Date]

[Insurance Company Name]
[Company Address]

RE: Appeal for Long Term Disability Benefits – Policy Number: [Your Policy Number]

Dear [Appeals Department Contact Person, if known, otherwise “Appeals Committee”],

This letter is to formally appeal the denial of my claim for long-term disability benefits under policy number [Your Policy Number]. I was informed of this denial on [Date of Denial Letter] and believe it was based on a misunderstanding of my medical condition and its impact on my ability to work.

Summary of My Condition and Inability to Work:

[State your diagnosed condition(s) clearly and concisely. Be specific. Briefly explain how your condition prevents you from performing the duties of your own occupation AND, importantly, any occupation you are reasonably suited for based on education, training, and experience].

Evidence Supporting My Appeal:
I am including the following documentation as additional evidence to support my appeal:

• Medical Records: [List specific reports, test results, specialist evaluations, treatment summaries, etc. that support your claim. Be detailed – don’t assume they remember every document].
• Functional Capacity Evaluation: [If applicable, mention this report and how it demonstrates your limitations].
• Vocational Assessment: [If applicable, explain how this assessment proves you cannot work in your own or a suitable alternative occupation].
• Statements from Treating Physicians: [If you have letters from your doctors supporting your disability, state this here. If not, consider requesting them to strengthen your appeal].

Specific Reasons Why I Believe the Denial Was in Error:
[This is a crucial section. Carefully address the reasons given for denial in your denial letter. For example]:

• If they claimed insufficient medical evidence: Point to specific new evidence you are now providing that addresses their concerns.
• If they disputed the severity of your condition: Highlight reports that confirm the severity and its long-term impact.
• If they argued you could perform other work: Explain why the jobs they suggested are not suitable based on your limitations AND vocational evidence (if you have it).

Request for Review and Reversal:

I respectfully request a thorough review of my appeal, taking into account the additional evidence provided. I firmly believe that I meet the definition of disability as outlined in my policy and that the initial denial was made in error. I am confident that a fair evaluation of all available information will lead to a favorable decision.

Thank you for your time and consideration. I am available to provide any further information or clarification you may need.

Sincerely,

[Your Name]

Important Notes:

• Certified Mail: Send this letter via certified mail with return receipt requested to prove they received it.
• Keep Copies: Make copies of everything you send for your records.
• Consult with an Attorney: Disability law is complex. Consider seeking legal guidance, especially if your appeal is denied again.
• Deadlines Matter: Don’t miss the appeal deadline stated in your denial letter.

Denied Long-Term Disability Benefits? How a Powerful Appeal Letter Can Turn the Tide. Being denied long-term disability (LTD) benefits can feel like a devastating blow, especially when you’re relying on those funds to navigate a challenging health situation. But don’t lose hope – an appeal gives you a critical opportunity to fight for your rights. Crafting a well-structured, evidence-based appeal letter is your key to potentially reversing the denial and securing the benefits you deserve.

Understanding the Appeals Process:

After an LTD denial, you typically have a limited time frame (often 180 days) to file an appeal. This is your chance to present new evidence, clarify misunderstandings, and address the specific reasons cited for the initial denial.

Elements of a Winning Appeal Letter:

1. Start Strong:
   Clearly identify your purpose: State that this is a formal appeal for LTD benefits.
   Include essential information: Policy number, date of denial, your contact details.
2. Present a Compelling Narrative:
   Concisely summarize your condition: Clearly state your diagnosed condition(s) and how they prevent you from performing your job.
   Connect the dots: Explain how your limitations prevent you from working in your own occupation and any other jobs you’re reasonably suited for (based on education, training, experience).
   Avoid jargon: Use clear, concise language that’s easy for non-medical professionals to understand.
3. Provide Strong Evidence:
   Medical Records: Include detailed reports from your doctors, specialists, therapists, etc., that support your disability claim.
   Functional Capacity Evaluation (FCE): If applicable, include this report outlining your physical limitations.
   Vocational Assessment: This report can demonstrate that you’re unable to work in your own or any suitable alternative occupation.
   Physician Statements: Strong letters from your treating physicians confirming your disability and limitations can significantly bolster your case.
4. Directly Address the Denial Reasons:
   Carefully review your denial letter: Identify every reason provided for the denial.
   Refute each reason with evidence: Point to specific medical records, test results, or expert opinions that contradict their assessment.
   For example: If they cited insufficient medical evidence, highlight new documentation you’re providing. If they disputed the severity, emphasize reports confirming its impact.
5. Maintain a Professional Tone:
   Be assertive but respectful: Clearly advocate for your rights while maintaining a professional and courteous tone throughout the letter.
   Proofread carefully: Errors can undermine your credibility.
6. End with a Clear Request:
   Request a thorough review: Ask for a comprehensive reassessment of your claim considering the new evidence.
   State your desired outcome: Clearly state that you are requesting a reversal of the denial and approval of your LTD benefits.

Essential Tips for Success:

• Consult with an Attorney: Disability law is complex. Seeking legal guidance from an experienced attorney can significantly improve your chances of a successful appeal.
• Certified Mail: Always send your appeal letter via certified mail with return receipt requested to prove they received it.
• Keep Copies: Maintain copies of all documents you send for your records.
• Don’t Miss the Deadline: Adhere to the appeal deadline stated in your denial letter.

Don’t Give Up!
A well-crafted LTD appeal letter, backed by strong evidence, can make a world of difference in obtaining the financial support you need during a challenging time. Remember, you have rights—don’t hesitate to fight for them.

Long Term Disability Appeal Letter Sample :

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