disability claim denied?
Here's How to Fight Back.

Why Disability Claims Are Denied (And How to Fix It)

Disability insurance (both Short-Term and Long-Term) is unique because it relies heavily on subjective "proof of loss." Unlike a car crash where damage is visible, disability often turns on doctors' opinions and job descriptions.

1. "Lack of Medical Evidence" (The #1 Reason)

The insurer isn't saying you aren't sick. They are saying your medical records don't *prove* you can't do your specific job duties.

The Fix: Don't just send more notes. Get a Residual Functional Capacity (RFC) form filled out by your doctor. This document translates your symptoms into physical limitations (e.g., "cannot sit for more than 4 hours," "cannot lift over 10lbs").

2. Surveillance and Social Media

Insurers often hire investigators to film you or scour your Facebook. If you claim you can't walk but post a photo hiking, your claim will be denied.

The Fix: Be honest with your doctors about your "good days" and "bad days." If they catch you doing something you said you couldn't do, explain the context—e.g., "I went to the store, but I paid for it with 2 days of bedrest."

3. "You Can Still Work" (The Vocational Denial)

They might agree you can't be a construction worker anymore, but say you can be a "ticket taker" or "sedentary worker."

The Fix: This often requires a Vocational Expert's opinion to rebut. You must prove your condition prevents you from doing *any* gainful occupation your policy covers (review your "Own Occupation" vs "Any Occupation" clause).

Your Rights Under ERISA

Most employer-provided disability plans are governed by the Employee Retirement Income Security Act (ERISA). This federal law has strict rules:

• Appeal Deadline: You typically have 180 days to file an appeal. DO NOT MISS THIS.
• The "Administrative Record": You generally cannot add new evidence after the final internal appeal. You must stack the deck *now* before it goes to court.

Step-by-Step Appeal Guide

1. Request Your Claim File: Write a letter demanding your full administrative file under ERISA. It's free and mandatory.
2. Analyize the Denial Letter: Identify exactly *why* they denied you. Was it a specific missing test? A particular doctor's note?
3. Gather New Evidence: Get RFC forms, additional testing, and "buddies statements" from coworkers witnessing your struggle.
4. Write the Appeal Letter: Use our Letter Generator to create a professional appeal that addresses their specific denial points legally.
5. Send via Certified Mail: Never trust "upload portals" alone.

Common Mistakes to Avoid

• Appealing over the phone: Always do it in writing.
• Relying only on your doctor's "notes": Notes are illegible. dedicated questionnaires (RFCs) win cases.
• Quitting your job: If you quit before being approved, you may lose coverage.

When to Hire a Lawyer

Disability appeals are complex. You almost certainly need an attorney if:

• You have a chemically-based illness (depression, fibromyalgia) which insurers hate covering.
• Your claim value is high (LTD benefits for 20+ years).
• You've received a "Final Denial" and need to file a federal lawsuit.