By Eric A. Shore, Esq., Founding Attorney, Law Offices of Eric A. Shore
If your long-term disability benefits were denied or terminated, you may have 180 days to file an administrative appeal. In many ERISA disability cases, that appeal is the most important part of the entire claim.
That surprises people. Most people think the appeal is just a letter asking the insurance company to take another look. It is not.
In an ERISA long-term disability case, the appeal may be your best chance to put medical records, doctor opinions, job evidence, vocational proof, and statements about your daily limits into the file. If that evidence is missing, a federal court may have little or no chance to consider it later.
I’m Eric Shore, founder of the Law Offices of Eric A. Shore. Since 1994, I have helped disabled people across the United States with long-term disability claims, disability benefit problems, and related legal issues. In over 30 years of doing this work, I have seen good disability claims damaged because the appeal was treated like simple paperwork.
It is not simple paperwork. It is the record you may have to live with.
The Law Offices of Eric A. Shore helps disabled people across the United States with long-term disability appeals, and much of this process can often be handled by phone, mail, email, and secure document exchange.
Key Takeaways
Many ERISA long-term disability policies give you at least 180 days to appeal after a denial or termination of benefits.
The appeal is not just a letter. It may be your final real chance to add medical, vocational, and factual evidence before the case goes to federal court.
Insurance companies often rely on paper reviews by doctors who never examined you.
You should request your full claim file, policy, plan documents, medical reviews, vocational reviews, and any evidence the insurance company used to deny or terminate benefits.
The biggest mistake is sending a short appeal that says, “My doctor says I’m disabled,” without explaining your restrictions, limitations, job duties, medication side effects, and real-world work problems.
What Usually Goes Wrong After a Long-Term Disability Denial?
Here is a situation we see often.
Someone gets a letter saying their long-term disability benefits are denied or cut off. They are shocked, scared, and angry. They may already be dealing with pain, fatigue, medication side effects, depression, anxiety, a serious illness, or a condition that makes daily life unpredictable.
Then the insurance company gives them a deadline.
The person thinks, “I just need to explain that I’m still disabled.” So they write a short letter. They attach a doctor’s note. Maybe they send a few medical records. They believe they have appealed.
Technically, they may have. Strategically, they may have given the insurance company a weak record.
That is the mistake.
In many ERISA long-term disability cases, the appeal is not just about asking the insurer to reconsider. It is about building the evidence file before the insurance company makes its final decision. If the appeal does not answer the insurer’s reasons for denial, the case may become much harder later.
What Is the 180-Day LTD Appeal Deadline?
The 180-day deadline is the time many long-term disability claimants have to appeal after receiving a denial or termination letter. Under ERISA claim regulations, disability benefit plans must generally provide at least 180 days after an adverse benefit determination for a claimant to appeal.
Do not count this deadline casually.
Read the denial letter. Save the envelope. Save the email, if the denial came electronically. Confirm when the deadline starts and when the appeal must be received. Some people assume the deadline is based on when they opened the letter. Others assume mailing the appeal on the deadline is enough. Those assumptions can create serious problems.
If you are unsure, get help immediately.
In my experience, people lose valuable time because they spend the first few weeks in shock. That reaction is human. A denial letter can feel like the floor dropped out from under you.
But the deadline keeps running.
Why Is the LTD Appeal So Important?
The LTD appeal is important because it often becomes the evidence record that controls what happens next. If the evidence is not included during the appeal, you may not be able to add it later in federal court.
This is the part most people never get told clearly.
A long-term disability appeal is not just about arguing with the insurance company. It is about proving the claim in the way the policy and ERISA process require.
That proof may include updated medical records, detailed doctor opinions, test results, job descriptions, vocational evidence, medication side effects, functional capacity issues, and statements from people who see how your condition affects your daily life.
One mistake I see over and over is relying only on a diagnosis.
A diagnosis matters, but diagnosis alone does not prove disability. The insurance company wants to know what you can and cannot do. Can you sit long enough to work? Can you stand? Can you walk? Can you focus? Can you use your hands? Can you show up reliably? Can you get through a workday without needing to lie down? Can you perform the duties of your own occupation or any occupation, depending on the policy definition?
Those are restriction and limitation questions. That is where many appeals are won or lost.
The better question is not, “Can I write my own appeal?”
The better question is, “What evidence needs to be in the claim file before the insurer makes the final appeal decision?”
What Should I Request From the Insurance Company?
You should request your full claim file, the long-term disability policy, the plan document, the summary plan description, internal medical reviews, vocational reviews, surveillance materials, and any documents the insurance company relied on to deny or terminate benefits.
Ask in writing. Do not rely on a phone call.
The claim file may show you what the insurance company actually used against you. It may include medical reviews, nurse reviews, doctor reviews, vocational reports, internal notes, job information, surveillance, social media references, and communications between the insurer and the employer or plan administrator.
You should request:
- The full claim file.
- The long-term disability policy.
- The plan document.
- The summary plan description.
- All medical reviews.
- All vocational reviews.
- Any surveillance materials.
- Any internal notes or documents used to deny the claim.
- Any documents explaining appeal rights and deadlines.
- Any medical or vocational expert information the plan is required to disclose.
You need those materials before building the appeal. Otherwise, you may be answering the wrong problem.
What Is the Difference Between Own Occupation and Any Occupation?
Own occupation usually asks whether you can perform the material duties of your regular job. Any occupation usually asks whether you can perform another job based on your age, education, training, experience, and medical restrictions.
Many long-term disability policies change definitions after a certain period. A person may qualify during the own occupation period, then get cut off when the policy changes to any occupation.
That shift often happens around the 24-month mark in some policies, but you must read the actual policy. Do not assume the timing. Do not assume the insurance company applied the correct definition. Do not assume the job description in the file matches what you actually did every day.
This matters because job titles can be misleading.
A person may be called a “manager” but spend half the day lifting, walking, climbing stairs, driving, or handling physical tasks. Another person may have a desk job on paper but need intense focus, speed, memory, or frequent interaction with customers. If the appeal does not explain the real job, the insurance company may use a cleaner, easier version of the job against you.
The policy definition controls the legal test. The facts explain why you meet it.
Can My SSDI Claim Affect My Long-Term Disability Claim?
Yes. Many long-term disability policies reduce benefits by the amount you receive from Social Security Disability Insurance. If SSDI pays back benefits, the LTD insurer may claim there was an overpayment and demand repayment.
This surprises people.
They apply for SSDI because the LTD insurer tells them to. Then they win SSDI. Then the LTD insurer sends a letter demanding money back from the past-due benefits.
That does not mean SSDI is bad for your long-term disability claim. In many cases, an SSDI approval can help support the disability argument. But the financial interaction has to be understood before the SSDI back pay is spent.
This is another DISINJURY™ issue.
DISINJURY™ means one accident, illness, or medical condition can trigger multiple overlapping legal claims that must be managed together, because mishandling one claim can hurt another. Long-term disability, SSDI, workers’ compensation, personal injury, and employment issues can all affect each other.
The goal is to make sure one benefit does not accidentally create a problem in another part of the case.
What Evidence Should Go Into an LTD Appeal?
A strong long-term disability appeal should answer the insurance company’s denial reasons with evidence. It should not simply say, “I disagree.”
Depending on the case, the appeal may include updated treatment records, physician statements, test results, imaging, medication lists, side effect documentation, job duty evidence, functional capacity evidence, vocational opinions, affidavits from family members or coworkers, and a detailed explanation of why the insurer’s medical or vocational review is wrong.
The exact evidence depends on the denial.
If the insurer says there is not enough objective proof, the appeal should address objective findings where they exist and explain how the condition affects function. If the insurer says you can do sedentary work, the appeal should address sitting tolerance, standing tolerance, concentration, attendance, pain flares, medication side effects, and whether you can perform work on a reliable full-time basis.
If the insurer relied on a doctor who never examined you, the appeal should point out the limits of that paper review and answer it with strong treating source evidence.
A one-page appeal rarely does that.
What If the Insurance Company Used a Doctor Who Never Examined Me?
That happens often. Insurance companies may rely on paper-only medical reviews from doctors who review records but never meet you, examine you, or see what your daily life looks like.
A paper review can still hurt your claim.
The reviewing doctor may say the records do not support your restrictions. The doctor may say your exam findings are mild. The doctor may say you can sit, stand, walk, lift, focus, or work at a certain level. If the appeal does not respond directly, those opinions may become part of the record against you.
This is why treating doctor support matters, but it has to be specific.
A note that says “patient is disabled” may not be enough. A stronger opinion explains what the condition prevents you from doing, how often symptoms interfere with work, what restrictions apply, whether the limitations are expected to last, and why the person cannot perform the job duties required under the policy.
The insurance company is usually not looking for sympathy. It is looking for gaps in proof.
What Should I Do After an LTD Denial?
If your denial letter just arrived, mark the appeal deadline today. Then request the claim file and plan documents in writing.
If the insurer says you can work but your doctors disagree, do not send a one-page appeal. The appeal should explain why the insurer is wrong and should support that explanation with medical, functional, and vocational evidence.
If the denial mentions surveillance, paper reviews, job duties, transferable skills, lack of objective evidence, or the change from own occupation to any occupation, those points need to be answered directly.
If you also have SSDI, workers’ compensation, personal injury, or employment issues, those claims should be coordinated. A statement made in one claim can create problems in another if it is incomplete, careless, or inconsistent.
The main point is this: do not give the insurance company a weak record and then expect a court to fix it later.
Can I Appeal a Long-Term Disability Denial Myself?
Yes, you can appeal a long-term disability denial yourself. The risk is that you may not know what evidence needs to be added before the administrative appeal closes.
That is the catch.
A person can be completely honest and still file a weak appeal. They may send medical records without explaining what the records prove. They may rely on a diagnosis instead of restrictions and limitations. They may fail to address the job duties. They may ignore the insurer’s vocational report. They may not know that surveillance or social media was part of the file.
By the time they learn what was missing, the appeal may already be denied.
If the case involves ERISA, long-term disability benefits, SSDI offsets, serious medical conditions, or a possible federal lawsuit, get advice before filing the appeal.
What If I Already Sent In My Appeal?
If you already sent in your appeal, do not assume nothing can be done. The next step depends on timing and whether the insurance company has issued a final decision.
If the insurer has not decided the appeal yet, there may still be time to submit additional evidence. If the final denial has already been issued, the options may be more limited, but the file still needs to be reviewed carefully.
Do not wait just because you already mailed something.
The worst answer is silence. Find out where the appeal stands, what was submitted, what was missing, and whether anything can still be added before the insurer closes the record.
What If I Missed the 180-Day Deadline?
Missing the 180-day deadline can be serious. In some cases, it may damage or end the claim.
There may be limited arguments depending on the denial notice, the policy language, the plan documents, communications from the insurer, and the facts of what happened. But you should not assume an exception applies.
If you missed the deadline, get advice immediately. Do not send a rushed explanation without understanding the consequences. The first question is not only why the deadline was missed. It is also whether the insurance company gave proper notice, whether the documents were clear, and whether any facts affect the appeal rights.
This is a legal problem that should be looked at quickly.
Should You Call Before Filing an LTD Appeal?
Yes. If your long-term disability benefits were denied or terminated, you should get advice before filing the appeal, especially if ERISA applies.
The biggest mistake is treating the appeal like a simple form. It may be the most important record-building stage of the case.
The Law Offices of Eric A. Shore helps disabled people across the United States with long-term disability appeals and ERISA-related disability claims. Since 1994, Eric and his team have helped tens of thousands of injured and disabled people who cannot work because of injury, illness, disability, or workplace issues.
Call 1-800-CANT-WORK for a free consultation before the 180-day deadline gets away from you. You do not have to figure this out alone, and you should not have to guess your way through an appeal that may decide your benefits.
FAQ
What is the 180-day deadline for a long-term disability appeal?
The 180-day deadline is the time many long-term disability claimants have to appeal after receiving a denial or termination letter. Under ERISA claim regulations, disability plans generally must give claimants at least 180 days to appeal an adverse benefit determination.
Is a long-term disability appeal just a letter?
No. In an ERISA long-term disability case, the appeal is usually the key opportunity to build the claim record with medical evidence, doctor opinions, vocational proof, job duty evidence, and statements about your limitations.
Can I appeal a long-term disability denial myself?
Yes, but it can be risky. If ERISA applies, the appeal may create the final evidence record. If important proof is missing, you may not be able to add it later.
What if my insurer used a doctor who never examined me?
That happens often. A paper-only review can still hurt your claim, so the appeal should respond with specific medical, functional, and vocational evidence.
Can my SSDI claim affect my LTD claim?
Yes. Many LTD policies offset SSDI benefits. If you receive SSDI back pay, the LTD insurer may demand repayment for an alleged overpayment.
What if I already sent in my appeal?
There may still be steps to take if the insurance company has not issued a final decision. If the final decision has already been issued, the options may be more limited, but the file should still be reviewed.
What if I missed the 180-day deadline?
That can be serious. There may be limited arguments depending on the denial notice, policy language, plan documents, and facts, but you should get advice immediately.
Author Bio
Eric A. Shore is the founding attorney of the Law Offices of Eric A. Shore, with offices in Pennsylvania, New Jersey, and Florida. Since 1994, Eric and his team have helped tens of thousands of people who cannot work because of injury, illness, disability, or workplace issues. Clients of the firm have received or are expected to receive more than $250 million in judgments, settlements, and estimated lifetime benefits. Eric is licensed in Pennsylvania, New Jersey, and Florida, and he administers one of the largest Social Security Disability groups on Facebook, with over 40,000 members. Through the firm’s DISINJURY™ approach, Eric looks at every case for overlapping claims, including personal injury, workers’ compensation, disability benefits, and employment law, so nothing a client may be entitled to gets left behind. Have questions about your situation? Call 1-800-CANT-WORK or visit www.1800CantWork.com for a free consultation
Eric A. Shore
Law Offices of Eric A. Shore
1-800-CANT-WORK | 1800cantwork.com
Philadelphia, PA | Drexel Hill, PA | Cherry Hill, NJ | Atlantic City, NJ | Fort Lauderdale, FL
Free consultation. No fee unless we win.
Eric A. Shore has been licensed to practice law since 1994. He founded the Law Offices of Eric A. Shore in 1999. The firm handles personal injury, SSDI and SSI, and long-term disability under ERISA. It also handles workers’ compensation and employment law. Offices are located in Philadelphia, Drexel Hill, Cherry Hill, Atlantic City, and Fort Lauderdale. Call 1-800-CANT-WORK or visit 1800cantwork.com.
