So, you got denied for long-term disability? An appeal letter is your next move. It’s a formal way to ask the insurance company to rethink their decision. You’ll need this if your initial claim was rejected.
We get it. Writing one can feel overwhelming. That’s why we’re here to help.
This article is packed with appeal letter templates. We have examples and samples for you. Use them to craft your own winning appeal. Let’s get started.
Appeal Letter For Long Term Disability
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Re: Claim Number: [Your Claim Number]
Dear Sir/Madam,
I am writing to appeal the denial of my long-term disability benefits. I received your letter dated [Date of Denial Letter], informing me that my claim has been denied.
As you know, I was employed at [Your Employer Name] as a [Your Job Title] from [Start Date] to [Last Day of Work]. Due to [Your Medical Condition], I was forced to stop working on [Last Day of Work]. My medical condition significantly impairs my ability to perform the essential functions of my job.
I have included additional medical documentation from my treating physician, Dr. [Doctor’s Name], including updated assessments and test results that further support my claim. These documents clearly outline the nature and severity of my condition, and its impact on my ability to work. I have also included a detailed statement from Dr. [Doctor’s Name] explaining why I am unable to perform my previous job duties, or any other suitable work.
I believe the denial of my long-term disability benefits is unwarranted. I meet the eligibility criteria outlined in the policy, and the medical evidence overwhelmingly supports my claim.
I request that you reconsider your decision and approve my application for long-term disability benefits. I am available to provide any further information or documentation that you may require. I look forward to your prompt response and a favorable resolution to this matter.
Thank you for your time and consideration.
Sincerely,
[Your Signature]
How to Write Appeal Letter For Long Term Disability
Subject Line: Grab Their Attention
- Be exceedingly clear. Use words like “Appeal,” “Long-Term Disability Claim,” your “Claim Number,” and your “Name.”
- Example: Appeal: Long-Term Disability Claim – John Doe – Claim #12345
- A lackluster subject line might get lost in the shuffle; an assertive one ensures it’s seen.
Salutation: Address the Right Person
- If known, address the specific claims adjuster by name, preceded by a formal title.
- If the name is unknown, use “Dear Long-Term Disability Claims Department.”
- Avoid casual greetings; maintaining a professional demeanor fortifies your position.
Introduction: Concisely State Your Purpose
- Declare immediately that this letter constitutes a formal appeal of the denial of your long-term disability benefits.
- Reference your claim number and the date of the denial letter.
- Example: “This letter serves as a formal appeal of the denial of my long-term disability claim (Claim #12345), as outlined in your letter dated October 26, 2023.”
- Brevity is a virtue; get straight to the crux of the matter.
Body Paragraphs: Methodically Dismantle Their Reasoning
- Address each reason for denial cited in the insurance company’s letter, point by point.
- Provide new, irrefutable medical evidence that supports your disability. This might include updated doctor’s reports, specialist opinions, or test results.
- Articulate how your medical condition prevents you from performing the substantial duties of your occupation. Be explicit and leave no room for misinterpretation.
- If vocational rehabilitation was suggested, explain why that isn’t a viable alternative given your specific impairments.
- Cite errors in their interpretation of your medical records or the policy’s terms. Look for inconsistencies and vulnerabilities.
- Maintain a factual, unemotional tone, even when critiquing their assessment.
Supplementing Evidence: Fortify Your Argument
- Specifically list all enclosed documents being submitted with your appeal letter.
- Consider including statements from colleagues, supervisors, or family members attesting to the impact of your disability on your ability to work.
- If applicable, include legal citations or independent medical research supporting your claim that your condition warrants disability benefits.
- Highlight the ways in which the provided documentation directly refutes the insurer’s rationale for denial.
Demand and Deadlines: Assert Your Rights
- Clearly state that you expect a full and fair reconsideration of your claim based on the additional evidence provided.
- Remind the insurer of any relevant deadlines for appeal established by the policy or applicable regulations.
- Include a precise date by which you expect to receive a response to your appeal.
- Underscore the seriousness of your appeal and the potential for further action if denied.
Closing: End on a Strong Note
- Close with a professional and courteous sign-off.
- Examples: “Sincerely,” “Respectfully,” or “Yours truly,” followed by your full name and signature.
- Include your contact information (phone number and email address) below your signature for ease of communication.
- Retain a copy of the appeal letter and all supporting documentation for your records. This due diligence is paramount.
Frequently Asked Questions: Long-Term Disability Appeal Letters
Navigating a long-term disability claim denial can be challenging. This FAQ section provides answers to common questions regarding the appeal letter process, helping you understand how to effectively challenge an unfavorable decision.
What is the purpose of an appeal letter for long-term disability?
The appeal letter formally challenges the insurance company’s decision to deny your long-term disability claim, providing an opportunity to present additional evidence and arguments supporting your eligibility for benefits.
What information should be included in my appeal letter?
Your appeal letter should include your policy number, a clear statement that you are appealing the denial, a detailed explanation of why you believe the denial was incorrect, new or clarifying medical evidence, and specific references to policy language supporting your claim.
What is the deadline for submitting my appeal letter?
The deadline for submitting an appeal letter is typically outlined in the denial letter you received from the insurance company. It is crucial to adhere to this deadline, as missing it could jeopardize your ability to receive benefits.
Should I seek legal assistance when writing an appeal letter?
While not always required, consulting with an attorney specializing in long-term disability claims can be beneficial. An attorney can help you understand your rights, gather necessary evidence, and craft a compelling appeal letter.
What happens after I submit my appeal letter?
After submitting your appeal letter, the insurance company will review your case again. They may request additional information or an independent medical examination. You will receive a written decision regarding the outcome of your appeal.
Related:
Sample Letter To Children In Safe Houses
Sample Letter To Clients From Real Estate Assistant
Sample Letter To Clients About Closing A Business
