Your claim was denied. That is not the end of your case — but the clock is now running, and the most important stage of your fight has just begun.

 

A long term disability denial is designed to feel final. It is not. Under most policies you have the right to appeal, and a well-built appeal is often where claims are won. But you usually get only one appeal, and what you submit during it can decide your case for good — including in court. This is the moment to get it right.

 

The Maddox Firm represents professionals with their long term disability appeals in New York, New Jersey, and nationwide. We know how insurers build their denials, because we have seen it from the inside. Let us use that to take yours apart.

 

Why the appeal is the most important stage of your claim

 

If your long term disability coverage came through your employer, your claim is almost certainly governed by ERISA — and ERISA changes everything about how an appeal works.

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Here is the part most claimants never hear until it is too late: in an ERISA case, the evidence you submit during your administrative appeal is, in most cases, the only evidence a court will ever be allowed to consider. When the appeal closes, the record closes with it. If you later have to sue your insurer, the judge generally will not let you add new medical records, new test results, or new expert opinions. The court reviews what was already in the file.

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That means your appeal is not a formality before the "real" fight in court. Your appeal is the fight. Everything that could ever prove you are disabled has to go in now. A denial letter that looks like a setback is really your last clear opportunity to build a complete evidentiary record — and the insurer is counting on you not knowing that.

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This is why filing a strong appeal yourself, without help, is so risky. You may only discover what was missing after the deadline to add it has passed.

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How long do you have to appeal a long term disability denial?

 

Under ERISA, you generally have 180 days — about six months — from the date you receive your denial to file your appeal. That can feel like plenty of time. It is not. Gathering complete medical records, arranging the right testing, obtaining expert reports, and rebutting the insurer's own doctors all take time, and every piece has to be in place before the deadline.

 

If your policy is an individual or private policy that is not governed by ERISA, your deadline and your options may be different. Either way, the safest assumption is that time is short. The sooner you involve us, the more we can do.

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What goes into a winning long term disability appeal

 

A persuasive appeal does not simply tell the insurer it was wrong. It rebuilds the claim from the ground up and forecloses the reasons the insurer used to deny you. When you engage us, we work to:

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• Obtain and review your complete claim file, including the reports the insurer's reviewing doctors relied on, so we can see exactly why you were denied.

• Gather the medical records and treating-physician opinions that establish your limitations and restrictions.

• Arrange the right objective testing for your condition — for example, a functional capacity evaluation or specialized testing that documents what you can no longer do.

• Develop vocational evidence showing how your limitations prevent you from performing the duties of your occupation.

• Help you, your treating providers, and the people who know you prepare statements that show how your condition has changed your daily life and your ability to work.

• Directly answer the insurer's medical reviewers and independent medical examiners, point by point, so their conclusions do not stand unchallenged in the record.

 

If you want to understand the document at the center of this process, our guide on how to write a long term disability appeal letter walks through what an effective appeal actually contains.

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ERISA appeals vs. individual policy appeals

 

Not every disability policy works the same way.

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ERISA (employer-provided) policies. Most group plans offered through an employer fall under ERISA. You typically must complete the plan's internal appeal — exhaust your administrative remedies — before you are allowed to file a lawsuit. And, as above, the administrative record generally closes at the end of that appeal.

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Individual and private policies. If you bought your policy yourself, it may not be governed by ERISA. These claims can follow different rules, with different deadlines and, often, a broader ability to present evidence later. The strategy for an individual-policy appeal can look very different from an ERISA appeal.

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Knowing which set of rules applies to your claim is the first thing that has to happen — because it determines everything that follows. We will tell you exactly where you stand.

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Why a former insurer's perspective matters

 

The reports that denied your claim were written by people who do this for a living. So is the response.

 

Our team includes experience from inside the disability insurance industry — we have seen how claims are reviewed, how denials are constructed, and where they are vulnerable. We know what an insurer's file looks like, what its reviewing doctors are asked to find, and which arguments actually move a claims decision. When we answer a denial, we are not guessing at the insurer's playbook. We have read it.

 

The insurers know us. We use that to your advantage.

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What happens if the appeal is denied?

 

If your insurer upholds its denial after a proper appeal, you have generally exhausted what ERISA requires, and you may be able to take your insurer to court. Because we build your appeal with that possibility already in mind, the record is ready if litigation becomes necessary. Learn more about long term disability litigation and how we hold insurers accountable when they refuse to pay benefits you and your employer paid for.

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Frequently asked questions about long term disability appeals

 

• Can I appeal a long term disability denial myself? You can — but in an ERISA case, the evidence you submit during your appeal is usually the only evidence a court will ever see. Mistakes or gaps at this stage are often permanent. This is the moment where experienced help matters most.

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• How long do I have to file my appeal? Under ERISA, generally 180 days (about six months) from when you receive your denial. Individual policies may have different deadlines. Do not wait to find out which applies to you.

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• Do I have to appeal before I can sue my insurer? For most employer-provided (ERISA) policies, yes. You generally must exhaust the plan's internal appeal process before filing a lawsuit. Even when it is not required by the language of an individual policy, it is generally the better course of action.

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• What if I have new medical evidence after my appeal? In most ERISA cases, a court will not consider evidence that was not part of the administrative record. That is why everything needs to go in during the appeal — not after.  

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• How much does it cost to have you handle my appeal? Schedule a free consultation and we will explain how we work and what to expect. We take on most appeals on a contingency basis. There is no cost to find out where you stand.

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Talk to a long term disability appeals attorney

 

You likely get one appeal. Let us make it count. Contact The Maddox Firm today for a free, no-obligation consultation, and let a long term disability appeal attorney review your denial and your options.

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