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LTD Appeal Process

LTD Appeal Process

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The LTD Appeal Process begins when the disabled person contacts us to handle their internal appeal after their Long Term Disability (“LTD”) insurance claim has been wrongfully denied or terminated. Often, LTD claims are terminated after 24 months, when the policy definition of “disability” changes from “own occupation” to “any occupation.”

Sometimes, LTD claims are terminated after the insurance company conducts surveillance or sends the disabled person to a Functional Capacity Evaluation (“FCE”), conducted by a Physical Therapist who almost always concludes that the claimant is not giving full effort and is able to work full time. And sometimes, insurance companies terminate a LTD claim for completely arbitrary reasons, even though there has been no improvement in the disabled person’s medical condition or ability to work.

The First Step: The First Step is that the disabled person makes contact with us either by phone or by using the Contact Form on this website. You will speak with a licensed attorney with substantial experience handling Long Term Disability claims, appeals and lawsuits. We will answer any questions you have about the LTD Appeal Process. There is no obligation or charge for this initial consultation.

During this consultation, the circumstances and details of your LTD claim will be discussed and your questions will be answered. If we can help you, and if you want to hire us, we will forward a Contingency Fee Contract for your signature, as well as an Authorization which will allow us to obtain a copy of your Claim File from the insurance company.

Once you sign and return the paperwork, we will request a copy of your claim file, as well as all other information that the insurance company relied upon in reaching its decision. The Claim File includes all of the medical records and reports that you submitted, a copy of the LTD policy, your application for LTD benefits, claim notes and all correspondence regarding your claim.

It usually takes 20-30 days for the insurance company to copy and forward your Claim File. Once your claim file arrives at our office, it usually takes our team 3-5 business days to organize the file and input your information into our system. After that, you can expect that an experienced LTD attorney will review your claim file within one week. You will then be contacted, and the details of your LTD claim will be discussed.

Our attorneys will outline our proposed Appeal Plan and then, with your input, we will begin to execute the Appeal Plan.

It usually takes 4-8 weeks to execute the Appeal Plan, sometimes longer depending on the degree of cooperation we receive from your treating physicians, and whether we are requesting an Independent Medical Examination or Vocational Rehabilitation Report. The Appeal Letter is then filed, along with updated medical records and other supporting documentation.

The insurance company has 45 days after it receives the Appeal Letter in which to make its decision. This deadline can be extended by an additional 45 days if such election is made in writing within the first 45 days. If the insurance company fails to meet the deadlines imposed by federal law, we will discuss with you whether filing suit immediately strengthens your legal position. The LTD appeal process has two outcomes: either your appeal is successful, and a check is issued for past-due benefits and your claim is reinstated, or your appeal is denied, and filing suit is the next step.

If, at any time during the LTD appeal process, you have any questions or concerns, we are easy to reach by telephone or e-mail, and will respond in a timely manner.


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