If you’ve been denied long-term disability (LTD) benefits, you’re probably anxious to file an appeal and get your benefits reinstated. But why does it take so long to prepare an appeal?
This is one of the most common questions we get, and it’s a fair one. The truth is, building a strong appeal under the Employee Retirement Income Security Act (ERISA) takes time, care, and strategy. Here’s what goes into the process, and why we often need most of the 180-day deadline to do it right.
The 180-Day Appeal Window: Why It’s There—and Why We Use It
ERISA gives you 180 days from the date of your denial to file your appeal. This time is critical. We use it to gather, review, and prepare compelling evidence that can overcome the insurer’s denial. But why does it take so long?
For most people, they think that an appeal is just a letter that says, “Hey, we think you got it wrong. We want you to go back, take another look at it, and make a new decision.” But that will never work in terms of getting them to change their decision. You have to give them new evidence to get them to change their mind.
This is critical because (in most ERISA cases) you cannot submit new evidence once the appeal is complete. This means that you must develop and submit all supporting evidence now, not later in litigation.
RELATED VIDEO: Why Are You Given 180 Days To File a Long-Term Disability Appeal?
Step One: Getting Your Complete Claim File
Even if you have your medical records or documents from the insurance company, we will submit our own detailed request for your complete claim file. This file includes not only the records you’ve sent them, but also internal documents—such as nurse reviews, peer reviews, and surveillance—that may reveal how and why the insurance company denied your claim.
By law, the insurance company has 30 business days to send us the complete file. Most insurers comply within this time frame, but delays sometimes occur.
Step Two: Reviewing the Claim File
Once we receive the file, we review every detail. Depending on the size of the file and our current workload, this may take several weeks. We typically prioritize appeals based on deadlines and try to review your file within 30 days of receiving it.
We look for:
- In-house nurse or physician reviews that outline the insurer’s rationale
- Vocational assessments and transferable skills analyses
- Surveillance or social media investigations
- Any inconsistencies between the insurer’s rationale and your medical records
This review allows us to identify what went wrong and plan how to fix it.
Step Three: Developing a Strategic Appeal
After reviewing your file, we begin developing a customized strategy for your appeal. This may include:
- Contacting your treating physicians for supportive reports or medical opinions
- Requesting clarifying statements or the completion of a Residual Functional Capacity (RFC) form customized for your condition
- Obtaining additional testing, such as a Functional Capacity Evaluation (FCE) or neuropsychological testing
- Preparing a detailed affidavit, which is your sworn statement describing your symptoms and limitations
- Drafting a detailed legal brief highlighting errors in the insurer’s decision and explaining why you remain disabled under the terms of your policy
Our appeal letters are typically between 14 and 20 pages. We don’t just argue that the insurer was wrong—we provide new, compelling evidence showing that they had no reasonable basis to deny your claim, and we cite case law explaining why we believe the denial was legally wrong.
FREE RESOURCE: How To Appeal a Long-Term Disability Denial
Why It Takes Time
We understand the urgency you’re feeling. You’ve lost income, you’re worried about your financial stability, and you want answers. But several factors are out of our control:
- Medical providers can take weeks to return reports or forms
- Independent exams must be scheduled and conducted
- Delays by third parties, such as testing centers or evaluators
- The time it takes to carefully analyze your file and build persuasive arguments
We could file a quick appeal—but if it’s not fully developed, it’s more likely to be denied. That could lead us to federal court, where we can’t add new evidence and must rely only on what’s in the administrative record.
We understand the emotional and financial burden of waiting. But we believe your best chance of winning benefits is during the appeal process. That’s why we focus on getting it right, not just getting it done.
What You Can Expect from Us
When you hire our firm, we will:
- Communicate regularly with you about the status of your case
- Work with you to identify providers willing to support your appeal
- Strategize with you about additional testing or evaluations
- File a comprehensive appeal that gives you the strongest chance of success
If you’d like the help of an experienced disability attorney, then call us at (888) 321-8131. We can’t guarantee a quick resolution—but we can promise to give your case the attention, time, and effort it deserves.
If you’d like more information about LTD claims, I’ve also written a book called The Top 10 Mistakes That Will Destroy Your Long-Term Disability Claim. I encourage you to download a free copy of this digital book, and we look forward to hearing from you.
RELATED POST: How ERISA Attorneys Help With Long-Term Disability Claims
