To successfully appeal an adverse disability decision, you must first abide by the administrative procedures outlined in the disability plan. Failure to follow deadlines for submitting evidence to the plan administrator may convince a court that you have waived your right to appeal, thus forcing the court to side with the plan administrator. To avoid this unfavorable outcome, follow the guidelines below.
Guidelines for Appealing an Adverse Disability Decision
When you receive notification of an adverse decision, ensure you submit relevant medical documentation along with any other refuting evidence in your appeal to the plan administrator.
You will typically receive a notification back from the plan administrator acknowledging your appeal; however, if you do not receive this notification in a timely manner, follow up with the plan administrator to ensure they received your documentation. Certified mail may be the best option to preserve evidence that you submitted your appeal on time. Again, failing to meet deadlines provides a near-certain path to losing your disability benefits permanently.
In a subsequent post, we will discuss some types of evidence that can help an appeal. If the plan administrator rejects your appeal after reviewing the evidence you provided, which can possibly trigger a plan administrator’s non-appealable final decision or could initiate a new period in which the plan administrator requests more evidence, it may be best to speak with an attorney to secure particularized advice on your case and how best to proceed with future appeals.
Even if the plan administrator renders a final decision that is adverse to you, there may still be a path for you to secure your benefits in, or out of, court. If you need assistance with private disability insurance plan claims and appeals, please contact Patricia Bellac at or by submitting a contact form here.