Disability insurance is a resource that many disabled Californians may rely on which is why a denial of a disability insurance claim, either from a private insurance carrier, employer insurance carrier or Social Security disability insurance claim, can be of serious concern and unsettling for disabled individuals and their families seeking the badly-needed benefits. Fortunately, appeals processes are in place that disabled individuals should be familiar with.
Disabled individuals who have had a disability insurance claim made to their employer denied can take these important steps to prepare an appeal of that denial:
Sometimes a claim may be denied because of missing or incomplete medical records. While preparing the appeal, the disabled applicant should ensure they have a complete and thorough set of their medical records to submit and should seek any missing records and documents in advance.
Consider additional medical testing
In some circumstances, a claim may be denied because additional testing or evidence of a medical condition causing disability may be needed. When preparing the appeal, the disabled applicant should seek any additional testing that may be needed.
Written opinions from doctors
If the disabled applicant’s claim for disability insurance was denied because they did not have an opinion from their doctor, they should include a written opinion from the doctor treating them for their medical condition in their appeal.
To bolster an appeal for disability insurance, it may be possible for the disabled applicant to include an opinion from a vocational expert concerning the applicant’s ability to hold a job with their disability. Other non-medical evidence, including letters from colleagues and friends, that describe the impact of applicant’s disability on their ability to work may also be helpful.
The Employee Retirement Income Security Act (ERISA) governs employer disability claims. Under ERISA, if a claim for disability insurance benefits has been denied, a detailed, written, explanation for the denial must be provided. It is also important to abide by any timelines and deadlines provided to the disabled applicant in the letter or otherwise. Additionally, the disabled applicant should verify all information submitted as part of their application and appeal for disability insurance benefits have been received by the insurer.
Preparing a strong appeal when a claim for disability insurance benefits has been denied is essential for denied applicants to understand so they can receive the benefits they need.