How Many Long-Term Disability Appeals Can I File?

The number of appeals available after a long-term disability (LTD) denial depends entirely on your specific insurance policy — most claimants have either one or two mandatory appeals before they can file a lawsuit. Knowing how many you have is not just administrative housekeeping; it determines your strategy, your timeline, and how urgently you need legal help.

What the Administrative Appeal Phase Actually Is

The administrative appeal phase is the period between a denial or termination and any lawsuit. Before you can take your claim to federal court, ERISA — the law governing most employer-sponsored disability plans — requires you to exhaust all available administrative appeals directly with the insurance company.

This exhaustion requirement is why the number of appeals matters so much. Each appeal is also your opportunity to add evidence to the administrative record, and in ERISA cases, courts are generally limited to reviewing only the evidence that was in that record when the insurance company made its decision. Evidence not submitted during the appeal phase typically cannot be introduced in a lawsuit.

If your long-term disability claim has been denied or terminated, Ortiz Law Firm can help you understand your options and build the strongest possible appeal. Call (888) 321-8131.

When You May Not Have to File an Appeal at All

Not every denied claimant is required to go through an administrative appeal before suing. If you purchased your disability policy directly from an insurance agent or broker — an individual policy rather than a group plan — ERISA’s exhaustion requirement typically does not apply, and you may be able to file a lawsuit immediately after your first denial.

The same is generally true if your policy is sponsored by a government employer or a church employer directly, rather than through a union or employee organization. If you are unsure whether your plan is governed by ERISA, that question should be answered before you spend time and effort on an administrative appeal that may not be required.

The Three Most Common Appeal Structures in LTD Claims

Based on Ortiz Law Firm’s caseload, most long-term disability plans fall into one of three structures:

• Two mandatory appeals (most common — roughly 65% of claims). You must complete both appeals before filing a lawsuit. If the first appeal is denied, you have a second opportunity to strengthen your record before heading to litigation.
• One mandatory appeal (approximately 30% of claims). You have one shot at the administrative level. If that appeal fails, you proceed directly to a lawsuit. The stakes are higher from the start because there is no second chance to add evidence before a court reviews the file.
• One mandatory appeal plus one optional appeal (approximately 5% of claims). After the mandatory appeal is decided, you can choose whether to file a second administrative appeal or go straight to court. Each path has strategic trade-offs.

How to Decide Whether to File an Optional Appeal

When your plan includes an optional second appeal, the decision of whether to use it depends on the strength of your current record and what new evidence is available. Filing the optional appeal makes sense when there is meaningful new evidence to submit — for example, a more definitive diagnosis that emerged after the first appeal, new diagnostic test results, or an approved Social Security Disability claim that can be added to the file.

Skipping the optional appeal and proceeding directly to court makes sense when the record is already strong, when new evidence is unlikely to materialize, or when a claimant has reached the point where they no longer want to deal with the same insurance company that has already denied them twice. Going straight to court puts an independent judge in the decision-making seat rather than another insurance adjuster.

The right choice varies by case. Consulting an attorney before making this decision is advisable, because whichever path you choose, the evidentiary record closes at the end of the administrative phase.

Why the Number of Appeals Affects When You Should Hire an Attorney

In ERISA claims, courts are generally not permitted to consider evidence that was not submitted during the administrative appeal phase. That means what gets built into the record during your appeals is what a judge can work with if the case goes to litigation.

If you have two mandatory appeals, there is some room to attempt the first appeal independently and hire an attorney for the second. But if you have only one mandatory appeal, the full weight of the case rests on that single filing. Any evidence not submitted during that one appeal may be permanently out of reach in court. The sooner an attorney is involved, the more complete the record they can build.

Don’t navigate your only appeal without experienced guidance. Ortiz Law Firm has handled thousands of long-term disability cases and knows how to build a complete, compelling administrative record. Call (888) 321-8131.

What an Attorney Does During an Appeal That You Cannot Do Alone

An experienced LTD attorney does far more than organize paperwork. Ortiz Law Firm’s approach to working up a claim involves gathering targeted evidence that most claimants would not know to include or how to obtain. Specific actions include:

• Conducting an in-depth client interview or questionnaire to understand the full scope of functional limitations
• Requesting, reviewing, and analyzing the complete claim file to identify what evidence is present and what is missing
• Requesting, reviewing, and analyzing the full insurance policy — not just the summary plan description — to identify all applicable definitions, coverage provisions, and appeal rights
• Gathering medical records, physician opinions, witness statements, employment records, and vocational assessments
• Taking sworn written statements (affidavits) from treating physicians or obtaining customized physician opinion forms tailored to the claimant’s specific condition that go beyond a diagnosis to document specific functional limitations and prognosis
• Recommending additional medical testing based on the diagnosis that may not have been ordered yet
• Challenging peer review physician reports and independent medical examination findings
• Submitting a legal brief identifying errors in the denial letter
• Monitoring ERISA deadlines — once the insurer receives an appeal, it has 45 days to respond, extendable by an additional 45 days only if it requests the extension in writing within the first 45-day window

All of this goes into the administrative record. If it is in the record, an attorney can use it in court. If it is not, no one can.

Key Deadlines You Cannot Afford to Miss

Several deadlines apply throughout the LTD claim and appeal process, and missing any of them can eliminate rights that cannot be recovered:

• Deadline to file your initial claim — set by your policy, often within a specific number of days after disability begins
• Deadline to submit proof of loss — the final date by which you must provide all supporting documentation for your claim
• Deadline to file each administrative appeal — typically between 60 and 180 days from the denial letter, depending on your policy; your denial letter should state this deadline explicitly
• Statute of limitations to file a lawsuit — once administrative remedies are exhausted, there is a separate deadline to file in court, which also varies by policy and jurisdiction

Check your denial letter and your full plan document immediately after any denial. Do not rely on memory or a summary brochure for these dates.

Not sure how many appeals you have or whether you should handle your appeal alone? Ortiz Law Firm offers consultations to help you understand exactly where you stand. Call (888) 321-8131.

Frequently Asked Questions