What to Do If Your Long-Term Disability Claim Is Denied

Long-term disability (LTD) insurance replaces part of your income if you cannot work for an extended time. Most LTD coverage is provided through employers and governed by ERISA, the federal benefits law, which shapes how denials are appealed.

Step 1: Read the denial

Under federal claims rules, the denial must explain the specific reasons, cite the plan provisions relied on, describe information needed to perfect the claim, and explain the appeal process (29 CFR 2560.503-1).

Step 2: Request the claim file

You have a right to free copies of documents relevant to your claim, including medical reviews by the insurer's doctors. Also request the full policy and plan documents.

Step 3: Meet the appeal deadline

ERISA disability plans must give you at least 180 days after a denial to appeal (29 CFR 2560.503-1). Mark the deadline. The insurer generally must decide within 45 days, with one possible extension.

Step 4: Build the record

In many ERISA cases, a court later reviews only the evidence in the claim file, so the appeal is your chance to add everything:

• Updated medical records and test results
• Detailed opinions from treating doctors about functional limits
• Functional capacity evaluations
• Vocational expert reports explaining why you cannot work
• Statements from you, family and coworkers
• A Social Security disability approval, if you have one
• Rebuttals to the insurer's reviewing doctors

Common reasons for denial

• "Own occupation" vs. "any occupation" definitions; many policies switch to a stricter definition after 24 months
• Lack of objective evidence
• Pre-existing condition exclusions
• Limitations on mental health or self-reported conditions
• Surveillance or social media

Step 5: Lawsuit

If the final appeal is denied, you can sue under ERISA in federal court (29 U.S.C. 1132). The standard of review depends on the plan language and state law. Policies set deadlines for suing, so check them.

Individual policies

LTD policies you bought yourself are not governed by ERISA; state insurance law, including bad faith rules, may apply. See insurance claim denials.

An employment lawyer experienced in ERISA disability cases can make a large difference, especially at the appeal stage.

Sources

1. Cornell Law School LII: 29 CFR 2560.503-1, Claims procedure
2. Cornell Law School LII: 29 U.S.C. 1132, Civil enforcement
3. U.S. Department of Labor: Employee Benefits Security Administration