LTD Claims Got Denied? Here's What to Do Next

Getting a denial letter feels awful, but it's not the end of the road. Insurance companies deny first claims more often than you'd think, and many of those denials get reversed on appeal. If you're in the US (employer-sponsored plan under ERISA): 1. Read the denial letter carefully — it has to state the specific reason for denial and reference the policy language they're relying on 2. You have 180 days to file an appeal — this deadline is strict, don't miss it 3. Get your full claim file from the insurer — you're entitled to it, and it shows exactly what they reviewed (and what they might have missed) 4. Get additional medical evidence — ask your doctor to write a detailed letter addressing the specific reason for denial, not just a generic 'this patient is disabled' 5. Submit your appeal in writing with all new evidence — keep copies of everything 6. The insurer has 45 days to respond to your appeal (can extend 30 days) 7. If your appeal is denied, you can file a lawsuit in federal court — the judge reviews the claim file, so make sure it's complete during the appeal stage 8. This is where an ERISA attorney is genuinely worth it — they work on contingency (no upfront cost) and know exactly what evidence wins If you're in Canada (private LTD insurance): 1. Request a written explanation of the denial 2. File an internal appeal with the insurance company 3. If still denied, file a complaint with your provincial insurance regulator 4. You can also sue in court for breach of contract — limitation periods vary by province (typically 1-2 years), so check your deadline 5. A personal injury or disability lawyer can help — many offer free consultations If you're in Canada (CPP-D denied): 1. You have 90 days to request a reconsideration — this is a mandatory first step 2. If still denied, you can appeal to the Social Security Tribunal 3. At each stage, you can submit new medical evidence The most important thing: DO NOT give up after the first denial. The system is designed to weed out people who won't fight back. If your condition genuinely prevents you from working, keep pushing.