Your Denial Letter Is Not Final
A denial of your long-term disability (LTD) claim does not mean you have exhausted your options. The insurance company that denied you is required by law to tell you why, and that reason becomes the basis for your next move. Most denials can be challenged through an internal appeal process, and some can be taken to court if the appeal fails.
The timeline matters when ready. You typically have between 180 and 365 days from the denial date to file an appeal, depending on your policy and state law. That window is firm—missing it usually closes the door to further review. Your first task is to locate your denial letter and read the stated reason, because everything that follows depends on understanding exactly what the insurance company rejected.
Key Takeaways
- Your denial letter must state the specific reason the claim was rejected; if it does not, that is grounds for appeal on its own.
- You have a legal right to an internal appeal, and most policies require the insurance company to complete it within 45 days.
- Gathering new medical evidence—updated doctor statements, test results, or specialist reports—is the most common way to overturn a denial.
- If the internal appeal fails, you may be able to file a lawsuit, but only if your policy is governed by federal law (ERISA) or state insurance law.
- An attorney who handles disability denials can review your case for free and take it on contingency, meaning you pay nothing unless you win.
Read Your Denial Letter for the Specific Reason
Insurance companies must state why they denied your claim. Common reasons include: insufficient medical evidence that you cannot work; a gap in treatment (you stopped seeing doctors); a pre-existing condition exclusion in your policy; failure to meet the policy's definition of disability; or non-compliance with the company's requirements (such as refusing a medical examination).
The reason stated in your letter is the target for your appeal. If the letter is vague—saying only "claim does not meet policy requirements" without explaining which requirement—that vagueness itself is a defect you can challenge. Request a full explanation in writing if the letter does not clearly spell out the reason.
Keep the original denial letter and any attachments. You will need to reference the exact language when you file your appeal.
File an Internal Appeal Within Your Time Window
An internal appeal is a formal request asking the same insurance company to reconsider its decision. This is not optional—it is a required step before you can pursue any other remedy. Your policy documents should explain how to file; if you cannot find them, contact the insurance company's claims department and ask for the appeal procedure in writing.
Most policies require you to submit your appeal within 180 days of the denial date. Some allow up to one year. Do not assume you have time—check your policy or call the company to confirm the important date for your specific plan. Submit your appeal in writing, by certified mail if possible, so you have proof of the date received.
In your appeal letter, state clearly that you are appealing the denial, reference the claim number, and explain why you believe the denial was wrong. Do not straightforward repeat what you said in the original claim. Instead, address the specific reason the company gave for the denial and explain why that reason does not explore to you.
Gather New Medical Evidence to Support Your Appeal
The insurance company denied your claim based on the medical records it reviewed. To overturn that decision, you usually need to provide evidence it did not have before. This might be a new doctor's statement, recent test results, a specialist's report, or documentation of treatment you have started since the denial.
Contact your treating physicians and ask them to write a detailed letter addressing the reason for the denial. For example, if the company said your condition does not prevent you from working, ask your doctor to explain specifically why you cannot perform your job duties. If the company cited a gap in treatment, ask your doctor to explain why you stopped treatment and why you have resumed it now.
Include any medical records generated after the original claim was filed. If you have started a new medication, undergone surgery, or begun rehabilitation, those records are evidence of ongoing disability. Organize all documents chronologically and label them clearly before you submit them with your appeal.
Understand What Happens During the Appeal Review
Once you file an appeal, the insurance company must assign it to a reviewer. Federal law (ERISA) and most state insurance laws require the company to complete the review within 45 days. Some policies allow up to 60 days. The company must send you a written decision explaining whether it upheld or overturned the denial.
The reviewer may be the same person who made the original decision, or it may be someone new. Either way, the company is required to consider all evidence you submitted, including the new medical records. If the company upholds the denial, the decision letter must explain why your new evidence did not change the outcome.
If the appeal is denied, ask the company in writing for a complete copy of the file it reviewed, including any medical records it obtained on its own and any internal notes about your case. This file becomes critical if you decide to pursue further action.
Know When You Can File a Lawsuit
If your internal appeal is denied, your right to sue depends on what type of plan you have. If your LTD insurance is provided through your employer as an employee benefit, your policy is likely governed by ERISA (the Employee Retirement Income Security Act). ERISA allows you to sue in federal court if the insurance company wrongfully denied your claim.
If you purchased LTD insurance on your own (not through an employer), your policy is governed by state insurance law. Most states allow you to sue in state court for breach of contract or bad faith denial.
A lawsuit is expensive and time-consuming. Before you file, consult an attorney who handles disability denials. Many will review your case for free and can tell you whether you have a viable claim. If they believe you do, they often work on contingency—meaning you pay nothing upfront and they take a percentage of any settlement or judgment.
Consider Hiring an Attorney Early
You do not have to hire an attorney to file an internal appeal. Many people successfully overturn denials on their own by gathering strong medical evidence and writing a clear appeal letter. However, an attorney can be valuable if the reason for the denial is complex, if the company is not responding to your requests, or if you are preparing for a potential lawsuit.
Some attorneys specialize in disability denials and understand the common reasons insurance companies use to reject claims. They can identify weaknesses in the company's reasoning and help you build a stronger appeal. If you do hire an attorney, make sure they have experience with LTD claims specifically, not just Social Security Disability.
If you cannot afford an attorney upfront, ask about contingency arrangements. An attorney working on contingency is paid only if you win, which aligns their incentive with yours. Ask about their fee structure—typically 25 to 40 percent of the recovery—before you sign an agreement.
Frequently Asked Questions
How long does an internal appeal usually take?
The insurance company has 45 days under federal law to complete the review, though some policies allow 60 days. In practice, many companies take the full time allowed. You should receive a written decision within that window. If you do not, contact the company and ask for a status update.
Can I appeal more than once if the first appeal is denied?
Most policies allow only one internal appeal. After that, your options are a lawsuit (if your policy allows it) or filing a complaint with your state insurance commissioner. Check your policy documents or ask the insurance company directly whether a second appeal is permitted.
What if I have new medical evidence but I am past the appeal important date?
If you missed the important date, you may still have options depending on your state and policy. Some states allow late appeals if you have good cause for the delay. Contact an attorney when ready, because the window to act is narrow. Do not assume you are out of time without legal information.
Does filing an appeal stop my benefits from being cut off?
Filing an appeal does not automatically continue your benefits. However, some policies require the company to maintain your benefits during the appeal if you filed the appeal before your benefits ended. Check your policy or ask the company whether your benefits will continue while your appeal is pending.
What is the difference between an internal appeal and going to court?
An internal appeal is a review by the insurance company itself. Going to court means filing a lawsuit in front of a judge, which is separate from the company's process. You must complete the internal appeal first—courts will not hear your case until you have exhausted that step.