What Happens After Your Claim Is Denied
When your long-term disability (LTD) insurance claim is denied, you have the right to challenge that decision. The appeal process is separate from the original claim review — it goes to a different person or team at your insurance company, and you can submit new medical evidence they did not see the first time. Most plans give you between 180 and 365 days to file an appeal, depending on what your policy says.
The appeal does not go to a government agency. It stays within your insurance company's internal system. Your goal is to show that the denial was wrong — either because your condition meets the definition of disability in your policy, because the company missed or misread medical records, or because new information has emerged since the original decision.
You do not need a lawyer to appeal, but many people hire one because the process involves reading your policy carefully, understanding how insurance companies interpret medical evidence, and building a written case. If you do hire a lawyer, they typically work on contingency — meaning they take a percentage of any money you recover, not an upfront fee.
Key Takeaways
- Your appeal important date is set by your policy document, usually 180 to 365 days from the denial letter, so check that letter when ready for the exact date.
- You must submit your appeal in writing to the address listed in your denial letter, and you should send it by certified mail so you have proof of delivery.
- New medical evidence — test results, specialist reports, or updated treatment records — is the strongest reason to appeal, because it shows the original decision was based on incomplete information.
- The appeal reviewer is often a different person than the original reviewer, and they must consider all evidence you submit, including documents that contradict the denial.
- If your appeal is also denied, you can file a second appeal (called a reconsideration) if your policy allows it, or pursue an external review through your state's insurance department.
Finding Your Appeal important date and Requirements
Your denial letter contains the appeal important date and the address where you must send your appeal. Read that letter carefully — the important date is a hard stop, and missing it usually closes your right to appeal through the insurance company. Write down the date now, and count backward to give yourself time to gather documents and write your appeal letter.
The letter should also tell you what form to use (if any) and what documents to include. Some companies require a specific appeal form; others accept a letter. If the letter does not say, call the claims department and ask: "What is the correct address and form for a disability appeal?" Write down the name of the person who answers and the date you called.
Check your policy document for any additional rules about appeals. Some policies limit you to one appeal; others allow two or more. Some require you to submit new medical evidence; others let you argue that the original decision was wrong based on the same records. Knowing these rules before you start prevents wasted effort.
Gathering Medical Evidence and Records
The strongest appeal includes medical records that either were not in the original file or show your condition has worsened since the denial. Request your complete medical file from every doctor, hospital, and mental health provider who has treated you for the condition that led to your disability claim. Ask for records from the date you stopped working backward for at least two years, and forward to the present.
Prioritize recent records — test results, imaging, specialist evaluations, and treatment notes from the past three to six months. If you have seen a new doctor since the denial, that provider's records are especially valuable because they represent a fresh medical opinion. Ask that doctor to write a letter addressing your specific condition and whether it prevents you from working in your usual job or any job, depending on what your policy requires.
If your condition is mental health–related, ask your therapist or psychiatrist to document how your symptoms affect your ability to concentrate, remember instructions, interact with others, or manage a work schedule. Insurance companies often deny mental health claims because they underestimate the functional impact, so specific detail about daily limitations matters more than a diagnosis alone.
Writing Your Appeal Letter
Your appeal letter should be clear, organized, and specific. Start by stating that you are appealing the denial dated [date], for claim number [number]. Then explain why you believe the denial was wrong. Do not repeat your original claim process — instead, focus on what the insurance company got wrong or what new information contradicts their decision.
Structure your letter in short paragraphs, each addressing one point. For example: "The denial states that my condition does not prevent me from working. However, my neurologist's report from [date] documents that I cannot stand for more than 20 minutes without severe pain, which makes my job as a [job title] impossible." Then attach the neurologist's report. Repeat this pattern for each piece of evidence.
If the denial cited a specific reason — such as "your condition is not severe enough" or "you did not follow recommended treatment" — address that reason directly. If the reason was vague, ask the insurance company in your letter to explain what evidence would support a reversal. Keep a copy of everything you send, and mail it by certified mail with return receipt requested so you have proof the company received it.
What Happens During the Appeal Review
After you submit your appeal, the insurance company has a important date to respond — usually 30 to 60 days, though some policies allow longer. During that time, a different reviewer (or sometimes a team) reads your appeal letter, your new medical evidence, and the original claim file. They are required to consider all evidence you submit, even if it contradicts the denial.
The reviewer may contact your doctors to ask questions about your condition or your ability to work. They may also order an independent medical examination (IME) — a review of your records by a doctor hired by the insurance company. If an IME is ordered, you have the right to know who the doctor is and what they found. You can submit a rebuttal if you disagree with their conclusions.
The insurance company must send you a written decision explaining why they upheld or reversed the denial. If they reverse it, they will tell you when benefits begin and how much you will receive. If they uphold it, they must explain their reasoning and tell you what your next options are.
Second Appeals and External Review
If your first appeal is denied, check your policy to see if you are allowed a second appeal (called a reconsideration or second-level appeal). If you are, the process is similar: you submit new evidence or a new argument, and a different reviewer considers it. Second appeals succeed less often than first appeals, so they are worth pursuing only if you have genuinely new information.
If you have exhausted the insurance company's internal appeals or if your policy does not allow further appeals, you can request an external review through your state's insurance department or through an independent review organization. This is a free process that puts your case in front of a neutral medical reviewer who is not employed by the insurance company. External reviews have different standards and timelines depending on your state, so contact your state insurance commissioner's office for details.
Some people also pursue legal action if the insurance company's denial appears to violate the terms of the policy or federal law (such as ERISA, the law that governs employer-sponsored disability plans). A disability lawyer can tell you whether your case has legal merit and what it might cost to pursue.
Timeline and What to Expect
| Step | Typical Timeline | What You Do |
|---|---|---|
| Receive denial letter | Day 1 | Read the letter, note the appeal important date and address, request your medical records. |
| Gather medical evidence | Days 1–30 | Collect records from all providers, ask for new letters from doctors, organize documents. |
| Write and submit appeal | Days 30–60 | Draft your appeal letter, attach evidence, mail by certified mail before the important date. |
| Insurance company reviews | Days 60–120 | Wait for the company to respond; they may contact your doctors or order an IME. |
| Receive appeal decision | Day 120 (or later) | Read the decision letter; if denied again, decide whether to file a second appeal or external review. |
Frequently Asked Questions
Do I have to use the insurance company's appeal form, or can I just write a letter?
Check your denial letter and policy. Some companies require their form; others accept a letter. If the letter does not specify, call and ask. A letter is usually acceptable, but using the company's form (if one exists) shows you followed their process exactly, which can matter if you later pursue legal action.
Can I appeal if I missed the important date?
Probably not through the insurance company. Once the important date passes, most policies close the appeal window. However, some states allow late appeals if you can show good cause (such as serious illness or the company's error in notifying you). Contact your state insurance commissioner's office to ask whether an exception is possible in your situation.
Should I hire a lawyer before I appeal?
You do not need one to file a first appeal. Many people succeed without a lawyer by submitting strong medical evidence. However, if your claim is complex, the denial seems unfair, or you plan to pursue legal action, a consultation with a disability lawyer is worth the cost. Many offer free initial consultations.
What if the insurance company orders an independent medical exam?
You have the right to attend the exam and to request a copy of the report afterward. You can also submit a written rebuttal if you disagree with the examiner's findings. The rebuttal becomes part of your appeal file and must be considered by the reviewer.
How long does it take to get a decision on my appeal?
Most policies require a decision within 30 to 60 days of receiving your appeal. Some allow up to 90 days. The timeline depends on how complex your case is and whether the company needs to contact your doctors or order an exam. Ask the company for an estimated decision date when you submit your appeal.