How to Appeal a Long Term Disability Denial

Key Takeaways

• A denied long-term disability (LTD) claim does not have to be the end of your disability case — you have the right to appeal.
• Under federal law, the Employee Retirement Income Security Act (ERISA) governs most group disability insurance appeals and sets strict deadlines. However, ERISA does not apply to most government, church, or individually purchased disability plans, which are typically governed by state law and may provide broader rights.
• Strong evidence, such as updated medical records, physician statements, and vocational evaluations, is critical to recovering long-term disability benefits.
• A long-term disability lawyer can provide legal advice, guide you through ERISA law, and represent you in court if necessary.
• Many people confuse appeals with “bad faith” insurance claims, but disability law provides different remedies for challenging a denial.
• The Law Office of Justin C. Frankel, PC, has recovered more than $300 million for clients nationwide and provides focused advocacy for claimants in New York and across the country.

Facing a denial of your long-term disability claim can feel frustrating and overwhelming, especially when you depend on these benefits for financial stability during a difficult time.

The stress of complex paperwork, confusing insurance language, and the fear of losing your financial support often leave claimants feeling powerless and unsure of what to do next.

A denial, however, does not necessarily mean the end of your claim. Understanding the appeal process is an important step toward improving your chances of success. Hiring the Law Office of Justin C. Frankel, PC, gives you experienced guidance in navigating appeals, building strong medical evidence, and challenging the insurer’s decision. This guide explains the essential steps of appealing a long-term disability denial and provides the knowledge you need to protect your right to benefits.

What Happens If Long-Term Disability Is Denied?

If your long-term disability claim is denied, you will not receive the benefits you applied for, which can cause significant financial strain. A denial means the insurance company decided that you do not meet the policy’s definition of disability.

Common reasons for denial include:

• Insufficient medical evidence supporting your disability
• A determination that your condition does not meet the policy’s definition of disability
• Missed deadlines or application errors
• Opinions from insurer-paid medical or vocational consultants who claim you are still able to work

At this stage, carefully reviewing the denial letter is critical. Knowing the exact reason for denial will guide your next steps, which typically include filing an appeal.

Can You Appeal Long-Term Disability Insurance Denial?

Yes, in most cases you can appeal a denied long-term disability claim. Disability insurance companies must provide an appeals process, particularly for policies governed by the Employee Retirement Income Security Act (ERISA).

Appealing gives you the opportunity to:

• Submit new or updated medical records
• Provide additional physician statements
• Correct errors or inconsistencies in the insurer’s evaluation
• Present vocational evidence explaining why you cannot work

If successful, the appeal may overturn the denial and restore benefits.

Long-Term Disability Appeal Under ERISA

For group disability insurance policies governed by the Employee Retirement Income Security Act (ERISA), the appeal process follows strict rules.

Key points about ERISA appeals:

• Claimants generally have 180 days from the date on the denial letter to file an appeal. Once the appeal is submitted, the insurer typically has 45 days to make a decision, with a possible 45-day extension under special circumstances. Keeping track of both your filing deadline and the insurer’s review timeline is essential.
• All supporting medical and vocational evidence must be included during the administrative appeal stage.
• Courts usually review only what is in the administrative record — no new evidence can be added later. However, in limited circumstances, courts may allow extra-record evidence, particularly if the case is reviewed de novo or there are procedural irregularities. The standard of review and your circuit can impact what the court will consider.
• The same insurance company that denied your claim often conducts the appeal review. However, ERISA regulations require that the appeal be reviewed by someone new who is independent and not influenced by the original decision, and who has no financial incentive tied to denying benefits.

Because of these limitations, ERISA appeals require careful preparation. Missing a deadline or failing to submit strong evidence can severely restrict your ability to pursue benefits.

Individual Long-Term Disability Appeal

For individual long-term disability policies, often purchased directly from insurers such as Northwestern Mutual or Berkshire Life Insurance, the appeal process can differ from ERISA-governed claims.

These appeals may include:

• More than one level of internal appeal or reconsideration
• Greater flexibility to submit new medical and vocational evidence at later stages
• The option to pursue litigation in state court if internal appeals are unsuccessful

Because individual policies often provide broader rights than group policies under ERISA, claimants may have more avenues to challenge a denial.

ERISA vs. Non-ERISA Disability Appeals: Key Differences

There are important differences between ERISA and non-ERISA disability appeals:

• Timelines: ERISA generally requires an appeal within 180 days, while individual policies may have different deadlines.
• Evidence: ERISA restricts evidence to what is submitted during the administrative appeal, while non-ERISA claims may allow new evidence in court.
• Legal rights: ERISA cases are reviewed by a federal judge without a jury, while non-ERISA claims can be litigated in state courts with broader discovery rights.
• Procedures: ERISA appeals are reviewed by the same insurance company that denied the claim, while individual policies may permit independent or external reviews.

Because these differences can significantly affect your appeal strategy, having guidance from the Law Office of Justin C. Frankel, PC, can help you understand your options and build a stronger case for benefits.

What Steps Should I Take After My Long-Term Disability Claim Is Denied?

If your long-term disability claim was denied, it’s important to act quickly and strategically. A long-term disability attorney, such as the Law Office of Justin C. Frankel, PC, can help you protect your rights and build a strong appeal. The following steps outline what to do after receiving a denial:

• Obtain and review your complete disability claim file. Request your full claim file from the insurer. Review the denial letter carefully to understand the reasons and confirm the appeal deadline.
• Create a detailed appeal strategy and collect supporting evidence. Develop a plan to address the insurer’s stated reasons for denial. Collect updated medical records, physician statements, and vocational evidence.
• Submit a timely and properly documented appeal. File your appeal before the deadline listed in your denial letter (generally 180 days under ERISA). Missing this deadline may mean losing your right to LTD benefits.
• Schedule an evaluation with an independent medical professional. An independent medical opinion can provide objective support for your disability status.
• Define your job duties and work requirements. Document the physical and cognitive demands of your role. Show how your condition prevents you from performing essential duties.
• Compile a thorough and organized record. Collect medical evidence, personal statements, and work history in one file to strengthen your appeal.
• Plan for the outcome of your appeal. After filing, the insurer will issue a decision. If denied again, discuss next steps with an attorney, including the possibility of litigation.
• Watch for suit deadlines in your policy. In addition to appeal deadlines, most policies contain a time limit (often three years) from the date proof of loss is due to file a lawsuit.

Working with the Law Office of Justin C. Frankel, PC, at this stage can help you prepare a comprehensive strategy, gather compelling evidence, and protect your rights throughout the appeal process.

Responding to New Evidence Provided by the Insurer During the Appeal

Insurers sometimes introduce new evidence during the appeal, such as medical reviews or vocational assessments. Under ERISA regulations, if the insurer plans to rely on any new evidence or reasoning, they must provide it to you in advance and allow a fair opportunity to respond before making a final decision. It is important to review and rebut this evidence promptly and thoroughly.

Steps to take include:

• Review the new evidence carefully with your attorney.
• Submit a rebuttal letter supported by medical or vocational opinions.
• Identify and address inaccuracies or bias in the insurer’s reports.
• Provide updated records or professional statements to counter their findings.

Failing to respond may weaken your appeal and give the insurer more reason to uphold the denial. Working with the Law Office of Justin C. Frankel, PC, can help you analyze new evidence, prepare a strong rebuttal, and protect your rights during the appeal.

How Can I Strengthen My Long-Term Disability Appeal?

The most effective way to build a successful appeal is to build a complete, well-documented record and comply with every deadline. This includes:

• Gathering updated medical and vocational evidence
• Reviewing the entire claim file for errors or gaps
• Developing a detailed strategy to address the insurer’s denial reasons
• Filing on time

Working with the Law Office of Justin C. Frankel, PC, can make a meaningful difference. Our team understands ERISA rules, LTD insurance company tactics, and how to prepare appeals that give you the strongest chance of success.

What Evidence Helps Win a Long-Term Disability Appeal?

A strong long-term disability appeal depends on comprehensive evidence, including:

• Updated medical records from all treating physicians
• Detailed physician statements explaining your work limitations
• Functional capacity evaluations (FCEs)
• Vocational expert assessments
• Diagnostic tests such as MRIs, CPET testing, neurocognitive testing, X-rays, or lab reports
• Personal statements describing daily challenges
• Documentation of symptoms and treatment history
• Statements from family, friends, or coworkers

Working with the Law Office of Justin C. Frankel, PC, can help you identify, organize, and present the strongest evidence to support your claim.

Why Reviewing Your Claim File Matters

Your claim file contains the full record of how the insurance company evaluated your disability claim. Careful review can help you:

• Identify errors or omissions in medical or vocational reviews
• Spot inconsistencies in insurer notes or reports
• Understand which evidence the insurer relied on or overlooked
• Identify opportunities to submit new, targeted evidence

Without this step, appeals risk being incomplete or unfocused, increasing the likelihood of another denial. The Law Office of Justin C. Frankel, PC, reviews claim files in detail to uncover weaknesses in the insurer’s reasoning and strengthen your appeal.

Mistakes to Avoid in a Long-Term Disability Appeal

Common mistakes can weaken an appeal, including:

• Filing an appeal too quickly without preparing strong evidence
• Ignoring internal insurer notes that may contain negative opinions
• Overlooking the vocational aspects of your disability claim
• Burdening your doctor with excessive requests, which may reduce cooperation
• Attending insurer-requested medical exams without a witness

The Law Office of Justin C. Frankel, PC, helps clients avoid these pitfalls and focus on strategies that strengthen their appeal.

Common Reasons Long-Term Disability Claims Are Denied

Insurance companies often deny long-term disability claims for reasons such as:

• Insufficient medical evidence
• Not meeting the policy’s definition of disability
• Missed filing or appeal deadlines
• Paperwork errors or incomplete submissions
• Pre-existing condition exclusions
• Conflicting medical or occupational reports
• Assertions that you can perform other work despite limitations

The Law Office of Justin C. Frankel, PC, helps clients address these issues directly by gathering stronger evidence and challenging flawed insurer reasoning.

How to Write a Strong Long-Term Disability Appeal Letter

An effective long-term disability appeal letter should:

• Clearly state your intent to appeal and include policy details
• Summarize your medical condition and explain how it impacts your ability to work
• Address each reason for denial with supporting evidence
• Reference medical reports, diagnostic tests, and vocational statements
• Maintain a professional, factual tone
• Include all relevant supporting documents

This letter is your opportunity to demonstrate why the denial was incorrect and why your benefits should be restored. The Law Office of Justin C. Frankel, PC, can draft detailed appeal letters that respond directly to insurer objections and build a persuasive case for benefits.

How a Long-Term Disability Attorney Can Help

A long-term disability attorney provides guidance through every stage of the appeals process. They can explain complex policy language and ERISA requirements, review your claim file for errors or missing evidence, and identify ways to strengthen your case.

Attorneys also gather medical records, physician statements, and vocational documentation to create a strong evidentiary record. They prepare detailed, evidence-based appeal letters that directly respond to the insurer’s reasons for denial while managing all communications on your behalf.

If litigation becomes necessary, an attorney can represent you in court and protect your rights under the policy. Working with the Law Office of Justin C. Frankel, PC, gives you the support needed to navigate the process with confidence and a focused strategy.

Why Our Clients Trust The Law Office of Justin C. Frankel, PC

At the Law Office of Justin C. Frankel, PC, we have decades of experience standing up to disability insurance companies and advocating for clients whose benefits have been denied. Our firm has recovered more than $300 million in benefits nationwide and understands the tactics insurers often use to delay or deny claims.

We are consistently recognized for our legal work, including Super Lawyers® designations, and we remain dedicated to protecting the rights of claimants. Just as importantly, we recognize the emotional and financial stress that comes with a disability denial, and we provide compassionate, focused representation throughout the process.

Testimonials

“Highly Recommend for Disability I am incredibly grateful to Justin Frankel and his paralegal Christina Panzarella for the outstanding support and expertise they provided throughout my disability insurance process. From the moment I reached out, Justin was attentive, professional, and genuinely invested in helping me. They walked me through every step, explained the complex legal details in a way that was easy to understand, and kept me informed at every stage. Justin understands dentistry and how a disability can effect your ability to practice. He also understands and has worked with all of the different insurance companies, and each companies nuances. Thanks to their thorough preparation, strategic approach, and understanding of the system, they were able to successfully win my appeal. I truly felt like I had a strong advocate in my corner, and I can’t imagine going through this process without their guidance. If you’re looking for a reliable and knowledgeable attorney to handle your disability claim, I highly recommend Justin Frankel.” — Heidi W.

“I would recommend the Law Office of Justin Frankel without hesitation. Atty Frankel and his senior paralegal, Christina, were amazing from beginning to end. They were consistently in touch with me and made sure I was updated and part of the disability appeal process. If you want a professional, top notch law firm fighting for your rights, I would unequivocally recommend that you call this law firm.” — Susan A.

“I have been a client of Justin Frankel for 8 years. From my very first, tearful phone call to him, Justin offered compassion and kindness. He expressed interest in my case. I was reassured by his confidence in his expertise. Justin won my disability appeal and has continued to represent me, acting as a buffer for me against the insurance company. If you are struggling with your disability claim, I strongly recommend giving Justin Frankel a call.” — Mary K.

Frequently Asked Questions About Long-Term Disability Denial Appeals

What Are the Chances of Winning a Disability Appeal?

The outcome of a long-term disability appeal depends on the strength of the medical evidence and the way the case is presented. Working with the Law Office of Justin C. Frankel, PC, can improve your chances by building a complete and well-supported appeal.

What Is Vocational Evidence in a Long-Term Disability Appeal?

Vocational evidence includes assessments that evaluate your ability to work based on your education, skills, work history, and medical limitations. This type of evidence can show whether you can perform your past work or adapt to other work in the economy.

How Many Times Can I Appeal a Long-Term Disability Claim Denial?

Most ERISA plans allow one administrative appeal. ERISA regulations prohibit insurers from requiring more than two internal appeals before a claimant can proceed to court. In practice, many LTD policies require just one appeal. If denied again, the next step is typically litigation in federal court, where new evidence is generally not permitted. Reviewing your policy is essential to understand your options.

What Should I Avoid Saying When Applying for Long-Term Disability?

Do not exaggerate symptoms, make inconsistent statements, or describe activities that contradict your disability claim. Use clear, accurate, and consistent language focused on the specific limitations caused by your condition.

Start Your Appeal Now. Schedule a Free Consultation With Our Long-Term Disability Attorney Today.

A denied long-term disability (LTD) claim does not have to be the end of your case. Reviewing the denial letter, gathering medical records, and following the appeals process under ERISA or your individual disability policy can make a meaningful difference. With strong evidence, physician support, and a clear strategy, claimants can challenge an insurance company’s decision and pursue the long-term disability benefits they are entitled to seek.

If your LTD claim has been denied, the Law Office of Justin C. Frankel, PC, is here to help. Our firm practices exclusively in disability law, providing legal advice to clients nationwide with a focus on ERISA cases and individual disability policies. We review your claim file, insurance policy, and appeal letter to identify weaknesses in the insurer’s reasoning and strengthen your case with additional evidence.

Call 888-583-4959 or fill out our online contact form to schedule a free consultation and learn how we can help with your long-term disability appeal under your insurance plan.