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9 Steps to Appeal a Denied Disability Insurance Claim

When it comes to a disability insurance claim, denial is not final! There are always grounds for appeal. In fact, many disability insurance claims are awarded after the initial denial.

As long as you have a competent disability insurance claims attorney, don’t consider giving up on compensation just because your initial attempt has failed. Whatever your situation, the following steps are crucial when appealing a denied disability insurance claim.

1. Establish the Nature of the Appeal Deadline

You need to establish what the appeal deadlines are. While some are ‘soft’ (meaning a late application could be accepted), others are ‘hard’ (fail to meet them and your goose is cooked). The appeal deadline should be indicated on the denial letter. However, if it is not, it is your responsibility to call the claims officer to confirm the date in writing. The deadlines are even stricter when seeking a non-profit disability compensation.

2. Maintain Your Sick Leave Status with Your Employer

Don’t buckle under pressure from your employer to return to work on the argument that your disability claim has failed. He or she may demand that you return to work or view you as being on unapproved leave, which could attract disciplinary action that could also jeopardize your appeal. One way of making sure this does not happen is by having your doctor send a letter to your employer reiterating the fact that you are still on disability leave. After your doctor confirms that your disability status is still valid, your employer will have no option than to continue viewing you as being on sick or disability leave, even after your claim is denied.

3. Compile Information about the Initial Denial

To have a better chance of succeeding with your appeal, you need to understand why your first attempt was denied. Compile as much information and paperwork about the denial. Some of the documents you should get your hands on are the denial letter stating why your claim was denied, a copy of the regulations and rules governing the appeal process, a copy of the insurance policy, and a copy of your “claim file” from the insurance company.

4. Establish Other Disability Benefits You May Qualify For

If your disability claim is denied, the subsequent appeal could take months. You need an alternative plan to survive the wait. Among possible alternatives include the workers’ compensation or the employment insurance sickness benefits.

5. Have a Personal Financial Plan

If your worst case scenario shows up and you only have yourself to depend on until the appeal is heard and successfully concluded, you need a personal financial plan to survive the wait. Audit your expenses, savings and other sources of income to determine if you can wait out the appeal. Where resources are insufficient, consider getting soft loans from friends and family members.

6. Establish Gaps in the Denial Letter and Claims Document

You stand a better chance of a successful appeal if you can identify gaps in the claims document and the denial letter and then start filling them.

7. Come up with an Appeal Game Plan

Prepare a game plan for your appeal that specifically addresses your unique situation. Come up with a strategy and a range of tactics that will aid your appeal. Remember your cases is unique and does not have to compare with another.

8. Implement Your Game Plan

After compiling medical documents and gathering information for your appeal, prepare written submissions to demonstrate how you have gone about filling gaps and explain why the earlier denial no longer holds.

9. Wait for the Decision

You have done all there is to do. You should get a response within 30 days. All you can hope for is that your appeal has been successful. If not, do not give up; appeal to the next level. It is not over until you win!

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