An appeal letter for long-term disability is a formal request. It asks your insurance company to reconsider their denial of your benefits. It’s your chance to present new information or clarify why you believe you qualify.
Writing an appeal letter can feel daunting. You might not know where to start. That’s why we’re here to help.
We’ve gathered templates, examples, and samples of appeal letters. Use these resources to craft a strong and persuasive letter. Make the process easier and increase your chances of approval.
Appeal Letter For Long Term Disability
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Appeal for Long-Term Disability Benefits – [Your Policy Number] – [Your Claim Number]
Dear [Claims Department/Specific Contact Person],
I am writing to appeal the denial of my long-term disability (LTD) benefits claim. My claim number is [Your Claim Number] and my policy number is [Your Policy Number]. I received your denial letter on [Date of Denial Letter]. I was very disappointed to learn of this decision.
As you know, I previously worked as a [Your Job Title] at [Your Company Name]. My job duties required [Briefly describe job duties, e.g., “extensive computer work, lifting up to 25 pounds, and frequent client meetings”]. Due to my medical condition, [State your medical condition], I am no longer able to perform these duties. This condition has significantly impacted my life.
My doctors, including [Doctor’s Name], a [Doctor’s Specialty], and [Another Doctor’s Name], a [Another Doctor’s Specialty], have all confirmed the severity of my condition. They have stated that I am unable to return to my previous occupation. I have attached additional medical documentation to this letter. This documentation includes updated reports and test results.
The denial letter stated [Summarize the reason for denial, e.g., “that there was insufficient medical evidence to support my claim”]. However, I believe the attached documentation clearly demonstrates the extent of my disability. It is comprehensive. It shows how my condition prevents me from working.
I am also including a personal statement that further explains the challenges I face daily. It details how my condition affects my ability to perform even basic tasks. I hope this provides a clearer picture of my situation.
I understand the importance of providing sufficient evidence to support my claim. I have made every effort to do so. I am confident that a thorough review of the enclosed information will lead to a different conclusion. I am committed to regaining my health. I want to return to work when possible.
I respectfully request that you reconsider your decision and approve my claim for long-term disability benefits. I look forward to your positive response.
Thank you for your time and consideration.
Sincerely,
[Your Signature]
Long Term Disability Appeal Letter
Subject: Appeal of Long-Term Disability Claim Denial – [Your Claim Number]
Dear [Insurance Company/Claims Adjuster Name],
I am writing to formally appeal the denial of my long-term disability benefits dated [Denial Date]. I respectfully request a full reconsideration of my case based on updated medical records and continued inability to work due to [Condition Name].
Enclosed are medical documents from [Doctor/Hospital Name], along with statements supporting the severity of my condition and its ongoing impact on my daily function and employment.
Please review the appeal and respond at your earliest convenience.
Sincerely,
[Your Full Name]
[Your Policy/Claim Number]
[Your Contact Information]
Disability Appeal Letter Sample
Subject: Disability Appeal – [Claim Number]
Dear [Claims Department],
I am appealing the denial of my disability benefits received on [Date]. I believe the decision was made without full consideration of my medical condition and current limitations.
Attached are new documents, including physician evaluations and test results, which support my ongoing disability. I kindly request that you review these documents and reconsider your decision.
Thank you for your time and attention.
Sincerely,
[Your Name]
Appeal For Long Term Disability Denial
Subject: Appeal for Denied Long-Term Disability Claim – [Policy #]
Dear [Insurance Provider Name],
I am submitting this letter to appeal the denial of my long-term disability claim. My condition, [Condition Name], prevents me from performing my job responsibilities as detailed by my physician, [Doctor’s Name].
Please find attached updated medical records and a letter from my employer confirming my inability to work.
I respectfully request a prompt and fair reconsideration of my claim.
Kind regards,
[Your Full Name]
[Your Contact Information]
Long Term Disability Claim Appeal Letter
Subject: Formal Appeal – Long-Term Disability Claim #[Claim Number]
Dear [Claims Administrator Name],
This letter is to formally appeal your decision dated [Date] denying my long-term disability claim. I disagree with your assessment and request a second review based on new medical findings.
Enclosed you will find updated clinical evaluations, supporting documents from my treating specialists, and a functional capacity assessment.
Please confirm receipt and the next steps in the appeal process.
Sincerely,
[Your Name]
Sample Disability Appeal Letter
Subject: Appeal for Disability Claim Reconsideration
Dear [Insurance Company Name],
I am appealing your recent decision to deny my disability claim. I have included additional medical records and statements from my physician that were not previously considered.
Given the seriousness of my condition, I am unable to fulfill my work duties and believe the original denial was premature.
Please let me know if further documentation is needed.
Sincerely,
[Your Full Name]
Appeal Letter For Denied Disability Claim
Subject: Disability Claim Denial Appeal – [Policy/Claim Number]
Dear [Claims Manager],
I respectfully appeal your denial of my disability claim dated [Date]. My condition has significantly impacted my ability to work, and my healthcare providers have confirmed its disabling nature.
I am enclosing new test results and detailed physician reports supporting my case.
I request a prompt review and reconsideration of my claim.
Sincerely,
[Your Full Name]
[Your Contact Info]
Disability Benefits Appeal Letter
Subject: Appeal for Disability Benefits – [Claim Number]
Dear [SSA or Insurance Provider],
I am writing to appeal the decision to deny my disability benefits claim. My condition, [Condition Name], has worsened, and I am unable to maintain employment as verified by my doctors.
I am attaching updated medical records, specialist evaluations, and a personal statement outlining my daily challenges.
Thank you for your reconsideration.
Best regards,
[Your Full Name]
Appeal For Social Security Disability
Subject: Request for Reconsideration – Social Security Disability Claim #[SSN/Claim Number]
To Whom It May Concern,
I am appealing the denial of my Social Security Disability Insurance (SSDI) claim received on [Date]. I believe a reevaluation is warranted due to the nature of my disability and supporting medical evidence.
Included with this letter are updated clinical notes and medical test results from [Doctor/Hospital].
I request a fair and complete review of my case.
Sincerely,
[Your Name]
[Your SSN (last 4 digits)]
Appeal Letter For Disability Benefits
Subject: Appeal Letter – Disability Benefits Denial
Dear [Appeals Officer Name],
I am writing to appeal the denial of my disability benefits. My disability, [Condition], prevents me from earning a sustainable income. Enclosed are detailed medical reports and doctor’s notes that confirm the chronic and disabling nature of my condition.
Please reconsider the denial in light of this new evidence.
Sincerely,
[Your Full Name]
[Policy or Claim Number]
Letter Requesting Review of Disability Denial
Subject: Request for Review – Denial of Disability Claim
Dear [Claims Officer or Appeals Department],
I respectfully request a formal review of the decision to deny my disability benefits claim. Since the initial evaluation, I have obtained further documentation and assessments confirming that my condition prevents me from working.
Attached are updated medical records and supporting evidence. I would appreciate a timely review of my appeal.
Thank you,
[Your Name]
[Contact Information]
How to Write an Appeal Letter for Long Term Disability
Understanding the Denial
Receiving a denial for your long-term disability claim can be disheartening, a veritable slap in the face when you’re already grappling with debilitating health issues. The first crucial step is not to succumb to despair, but to meticulously examine the denial letter. Decipher the rationale behind the insurer’s decision. Pinpoint the specific lacunae in your initial application. Did they question the severity of your impairment? Did they find your medical documentation inadequate? Understanding their objections is paramount to crafting a compelling appeal.
Gathering Additional Pertinent Documentation
Bolstering your appeal requires amassing a robust arsenal of evidence that unequivocally supports your disability claim. This might entail procuring additional medical records, perhaps a more detailed functional capacity evaluation elucidating the extent of your limitations. It may also involve soliciting statements from treating physicians, therapists, or even vocational rehabilitation specialists who can corroborate your inability to perform the essential functions of your previous occupation, or any reasonable occupation given your education and experience. Don’t underestimate the power of testimonial letters from family members, friends, or former colleagues who can attest to the impact of your disability on your daily life and work performance.
Addressing the Insurer’s Concerns Directly
Your appeal letter should not be a mere reiteration of your initial application. Instead, it should directly address the insurer’s specific concerns as articulated in the denial letter. If they questioned the credibility of your symptoms, provide further substantiation, perhaps through more frequent medical consultations or specialized diagnostic testing. If they deemed your medical documentation insufficient, supplement it with comprehensive records from all relevant healthcare providers. Be precise and unambiguous in your explanations, avoiding ambiguous language or generalizations.
Crafting a Clear and Concise Argument
Clarity is key. Avoid jargon; write in a straightforward and easily understandable manner. Structure your argument logically, presenting your strongest evidence first. Every assertion should be supported by concrete evidence. Maintain a professional and respectful tone throughout the letter, even if you feel frustrated or aggrieved. Remember, you are attempting to persuade the insurer to reconsider their decision, not antagonize them.
Highlighting the Impact of the Disability
Don’t just describe your medical condition; vividly illustrate how it impairs your ability to perform daily activities and occupational tasks. Elaborate on the pain, fatigue, cognitive dysfunction, or any other symptoms that hinder your functionality. Describe specific instances where your disability has prevented you from engaging in activities you once enjoyed or fulfilling your work responsibilities. The more compelling your narrative, the more likely the insurer is to empathize with your situation.
Adhering to Deadlines and Procedural Requirements
Pay meticulous attention to the deadlines stipulated in the denial letter. Missing a deadline could irrevocably jeopardize your right to appeal. Furthermore, ensure that you comply with all procedural requirements outlined by the insurer. This might include submitting your appeal via certified mail with return receipt requested, or providing specific information in a particular format. Diligence in adhering to these requirements demonstrates your seriousness and professionalism.
Seeking Legal Counsel (If Necessary)
Navigating the complexities of long-term disability claims can be daunting, particularly when faced with a denial. If you find yourself overwhelmed or unsure how to proceed, consider consulting with an experienced disability attorney. An attorney can provide invaluable guidance, assess the merits of your claim, and advocate on your behalf. While legal representation entails costs, it can significantly increase your chances of a successful appeal, especially if your claim is complex or involves substantial financial stakes. Sometimes, a sternly worded letter from a legal professional is enough to change the insurer’s perspective.
FAQs about appeal letter for long term disability
What information should I include in my long-term disability appeal letter?
Your appeal letter should clearly state your full name, policy number, and the date of the denial letter. It should also include a detailed explanation of why you believe the denial was incorrect, supported by medical evidence, doctor’s opinions, and any other relevant documentation that strengthens your claim. Highlight any errors or inconsistencies in the insurance company’s assessment.
What medical evidence is most helpful in supporting my long-term disability appeal?
Strong medical evidence is crucial. Include detailed reports from your treating physicians that clearly outline your diagnosis, symptoms, limitations, and how your condition prevents you from performing the essential duties of your occupation. Objective medical findings, such as MRI results, lab tests, and functional capacity evaluations, are also very helpful. Ensure all medical records are complete and up-to-date.
How long do I have to file an appeal for long-term disability benefits?
The timeframe for filing an appeal is typically outlined in your denial letter and policy documents. It’s crucial to adhere to this deadline, as missing it could result in the loss of your right to appeal. Generally, you have 180 days from the date of the denial letter to file your appeal. Review your policy carefully to confirm the exact deadline.
What if my doctor is not supportive of my long-term disability claim?
If your primary doctor is not supportive, consider seeking a second opinion from a specialist who is more familiar with your condition and its impact on your ability to work. A supportive doctor who can provide detailed medical documentation and advocate on your behalf can significantly strengthen your appeal. You can also ask your current doctor to specify the reasons for their lack of support in writing.
Should I seek legal assistance when appealing a long-term disability denial?
While not always necessary, consulting with an experienced disability attorney can be beneficial, especially if your claim is complex or the insurance company is being difficult. An attorney can help you understand your rights, gather necessary evidence, craft a compelling appeal letter, and represent you in negotiations or litigation if needed. They can significantly increase your chances of a successful appeal.
Related: