What Happens When Your Long-Term Disability Claim Is Denied

When an insurance company denies your long-term disability claim, 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 the insurance company, and you can submit new medical evidence, new statements from your doctor, or documentation the company missed the first time.

The timeline matters. Most long-term disability policies require you to file an appeal within 180 days of the denial letter, though some allow up to one year. The denial letter itself will state the important date and the address where appeals go. If you miss the important date, you lose the right to appeal through the insurance company and must pursue other legal options, which are slower and more expensive.

The appeal does not go back to the person who denied you. It goes to a separate reviewer — often called a claims examiner or appeals specialist — who reads your original file and anything new you submit. This person has no stake in the original decision and is required to consider all materials you provide before making a new information.

Key Takeaways

  • You must file your appeal within the important date stated in your denial letter, which is usually 180 days but can vary by policy.
  • Send your appeal in writing to the address listed in the denial letter, and keep a copy for your records along with proof of delivery.
  • New medical evidence — recent test results, a detailed letter from your treating doctor, or records from a specialist — is the strongest material you can submit with your appeal.
  • If the insurance company denies your appeal, you can file a complaint with your state's insurance commissioner or pursue legal action through an attorney.

Gathering Medical Evidence Before You File

The reason most long-term disability claims are denied is insufficient medical documentation. The insurance company needs objective evidence that your condition prevents you from working — not just your statement that you cannot work, but records that show why. Before you write your appeal letter, contact your treating doctor and ask for a detailed statement addressing the specific reasons the company gave for the denial.

Request that your doctor address these points in writing: what your diagnosis is, what tests or imaging confirm it, what your functional limitations are (can you sit for eight hours, lift objects, concentrate on tasks), whether those limitations are expected to last at least 12 months, and whether you can perform the duties of your own job or any job. If the denial letter said your condition is not severe enough, ask your doctor to explain why the company's assessment is wrong. If it said you did not provide enough evidence, ask your doctor to provide the specific tests or records that were missing.

If you have seen a specialist since your original claim — a rheumatologist, cardiologist, neurologist, or psychiatrist — request records from that visit. Specialist opinions carry more weight than general practitioner notes. If you have had recent imaging, lab work, or psychological testing, include those records. The insurance company will not search for evidence on your behalf; you must provide it.

Writing and Submitting Your Appeal Letter

Your appeal letter should be brief, specific, and organized. Start by stating your policy number, the date of the original denial, and the date you are filing the appeal. Then address each reason the company gave for the denial, one at a time, with a response based on the new or overlooked evidence you are submitting.

If the denial said your condition does not meet the policy definition of disability, explain how it does — cite the policy language and show how your medical records prove you meet that definition. If the denial said you did not provide sufficient medical evidence, point to the new records you are enclosing and explain what they show. If the denial said you can perform other work, explain why the company's assessment of your functional capacity is incorrect, using your doctor's statement as support.

Keep the letter to one or two pages. Do not repeat yourself or include irrelevant details. The appeals reviewer will read your letter alongside your medical records, so your job is to direct them to the key evidence and explain why it changes the outcome. End by requesting a written decision and the date you expect to receive it.

What Documents to Include With Your Appeal

Send your appeal letter along with copies of the following materials. Do not send originals — keep originals for yourself and send photocopies or scans.

  • A new or updated statement from your treating doctor addressing the specific reasons for denial.
  • Recent medical records — test results, imaging reports, specialist evaluations, hospital discharge summaries, or mental health treatment notes.
  • A copy of your original denial letter.
  • A copy of your policy or the relevant section that defines disability.
  • Any records showing you have sought treatment or rehabilitation since the denial.
  • A written summary of your job duties if the denial said you can perform other work — include this only if your doctor's statement does not already address your functional capacity.

Organize these materials in the order listed above. Use a cover sheet that lists what you are enclosing. Number the pages. This makes it easier for the reviewer to follow your argument and less likely that pages will be lost or overlooked.

Sending Your Appeal and Tracking It

Send your appeal package by certified mail with return receipt requested. This creates proof that the insurance company received it and on what date. Write the certified mail tracking number on your cover sheet before you mail it. Keep the return receipt in a safe place — you may need it later if the company claims they never received your appeal.

Do not email your appeal unless the denial letter specifically says email is acceptable. Most insurance companies require paper appeals so they can file them in your official claim record. If you must use email, send it to the address listed in the denial letter and request a read receipt.

After you mail your appeal, wait one week, then call the insurance company's appeals department to confirm they received it. Have your policy number and certified mail tracking number ready. Ask for the name of the person reviewing your appeal and when you should expect a decision. Write down the date and time of the call and the name of the person you spoke with.

What to Expect During the Appeals Review

The insurance company must issue a written decision on your appeal within a set timeframe — usually 30 to 60 days, depending on your policy and state law. The decision letter will either overturn the denial and approve your claim, or uphold the denial with an explanation of why your new evidence did not change the outcome.

If your appeal is approved, the company will tell you when benefits will begin and how much your monthly payment will be. If your appeal is denied again, the letter will explain which policy requirements you did not meet and why the company believes the medical evidence does not support your claim. Read this letter carefully — it will tell you what your next options are.

Some policies allow a second appeal, called a reconsideration or final appeal. The denial letter will state whether this option is available and what the important date is. A second appeal follows the same process as the first but is rarely successful unless you have significant new medical evidence — such as a recent hospitalization or a new diagnosis that occurred after the first appeal.

What to Do if Your Appeal Is Denied Again

If the insurance company denies your appeal, you have two main options: file a complaint with your state's insurance commissioner, or consult an attorney about filing a lawsuit.

Filing a complaint with your state insurance commissioner is free and does not require a lawyer. You submit a written complaint describing the denial and why you believe it was wrong. The commissioner's office investigates and can pressure the insurance company to reconsider. This process takes several months and does not always result in approval, but it creates an official record and may uncover errors in how the company handled your claim.

Consulting an attorney is the more direct route if you believe the insurance company made a clear error or acted in bad faith. Many disability attorneys work on contingency, meaning they take a percentage of your award if you win and charge nothing if you lose. An attorney can file a lawsuit in state or federal court, depending on your policy and circumstances. This process is longer and more expensive than an insurance appeal, but it gives you access to discovery — the ability to demand the insurance company produce all documents related to your claim — and a judge or jury to decide the case.

Frequently Asked Questions

Can I appeal if I missed the important date in my denial letter?

No. Once the important date passes, you cannot appeal through the insurance company. Your only option is to consult an attorney about filing a lawsuit, which must happen within the timeframe set by your state's statute of limitations — usually two to four years from the denial, but this varies. An attorney can advise whether you have a case.

Should I hire a lawyer before I appeal?

Most people do not need a lawyer for the first appeal. If you have strong medical evidence and can write a clear letter, you can appeal on your own. Hire a lawyer if your appeal is denied and you are considering a lawsuit, or if the denial letter is confusing and you cannot tell what evidence the company wants.

What if the insurance company says my condition is not permanent enough?

Ask your doctor to provide a written statement that your condition is expected to last at least 12 months — or for the length of time your policy requires. Include this statement with your appeal. If your condition has improved since the original claim, be honest about that, but explain why you still cannot work and why the improvement does not change your functional limitations.

Can I submit new medical evidence even if I did not have it for the original claim?

Yes. The appeal is specifically the time to submit evidence you did not have before — new test results, a specialist evaluation, or a detailed statement from your doctor. This is one of the main reasons to appeal rather than accept the denial.

How long does the appeal process take?

The insurance company must issue a decision within 30 to 60 days of receiving your appeal, depending on your policy and state law. In practice, many companies take the full timeframe. Add one to two weeks for mailing time on both ends, so expect a decision within six to ten weeks of sending your appeal.