How to Appeal a Long-Term Disability Denial

Long-term disability insurance (LTD) offers wage replacement payments at a certain percentage of your usual income if you have a medical condition that keeps you from working for an extended period of time. If you need to file for LTD benefits and your claim has been denied at first, don’t give up—all LTD policies provide at least one, and often two, levels of administrative appeals (meaning through the insurance company rather than in court).

It’s through this appeals process that many workers eventually receive their benefits. If your LTD claim isn’t approved internally, you’ll likely have to “exhaust your administrative appeals” before you can sue the insurance provider in federal court, so it’s important to know what steps you should take in order to preserve your administrative records before you file a lawsuit, if necessary.

How Does a Long-Term Disability Appeal Work?

Employer-provided LTD insurance policies are governed by a federal law known as the Employee Retirement Income Security Act (ERISA). (29 U.S.C. §1001 (2026).) Under ERISA, the LTD appeal process begins when you receive a denial letter from your insurance provider. The letter will tell you the specific reason why your claim was denied, your right to appeal the denial, and the deadlines for submitting the appeal. (Individually-purchased LTD plans are covered under state insurance law rather than ERISA, but the provisions are usually similar.)

Once you receive the denial letter, you should request your claim file from the LTD provider to see what evidence wasn’t included for the examiner to review. Then, gather any evidence you need to show that the decision to deny your claim was incorrect. Submit this new evidence along with the LTD provider paperwork before the appeal deadline. Make sure to file the appropriate paperwork on time to avoid another denial.

Should I File an Optional Long-Term Disability Appeal?

It might seem odd that the same insurance company that denied your disability claim could reverse that decision on appeal. But LTD appeals are often successful because they’re evaluated by different claim units within the company. And the examiners in those units sometimes disagree with the initial decision.

If you have employer-provided LTD insurance, ERISA requires you to appeal at every possible opportunity before you’re allowed to file a lawsuit against the insurance company in federal court, so the “optional” appeal isn’t really optional in this instance. But even if you have an individual plan not governed by federal law, you should still exhaust all your administrative appeals. There’s no sense in filing a lawsuit before you have to.

How to Write a Long-Term Disability Appeal Letter

After you’ve received the denial letter, read it closely to see the reason for your denial. In your appeal letter, you’ll want to address the specific reasons why your LTD claim was denied. These reasons usually fall into two categories: you were denied because you aren’t technically eligible to receive LTD, or you were denied because the insurer doesn’t believe you’re disabled.

Denied Because You Aren’t Eligible for LTD

LTD plans have certain preliminary eligibility requirements that you must meet before the insurer can make payments. If you don’t meet these requirements, your initial application may be denied. Examples include:

• You haven’t worked for your employer long enough (or you haven't had the policy long enough) to qualify for coverage.
• Your impairment isn’t covered (sometimes because it’s a pre-existing condition).
• You missed a deadline or skipped a form when you filed your initial LTD claim.
• You failed to file a claim for Social Security Disability Insurance, which many LTD insurers require.
• You haven’t been disabled long enough to qualify for LTD benefits under the terms of your policy.

If your denial is due to one of these “procedural” problems, address them in your appeal letter and include evidence showing that you are eligible for LTD. You may want to provide payroll records establishing that you worked long enough for your employer to warrant LTD coverage, for example.

Denied Because the Insurer Doesn’t Think You’re Disabled

Even if you meet the preliminary eligibility requirements, if the insurance company isn’t convinced you’re disabled, your LTD claim will be denied. Any of the following could lead to a denial:

• You failed to submit enough medical evidence.
• You’re not getting regular medical treatment for your impairment.
• You didn’t prove your impairment keeps you from doing any kind of work (under the common “any occupation” standard for LTD policies).
• Your insurance company has pictures or videos of you doing activities you claim you can’t do. Perhaps an insurance investigator took pictures of you working in your yard, or someone posted a video online that shows you dancing at a wedding.

For example, if you were denied because your condition “lacked objective documentation,” it likely means the insurance company wanted to see more test results (like X-rays, MRIs, or blood panels). If that’s the case, you’ll want to include additional test results as part of your appeal.

Long-Term Disability Appeal Dos and Don’ts

When appealing a long-term disability denial, there are some things you can do that will help you win your claim and other things you should avoid doing. The following chart contains some basic dos and don’ts for your LTD appeal.

Remember that your medical records need to be as strong as possible in order to succeed in your LTD appeal. This is particularly important if you need to file a lawsuit against the insurance company in federal court, since under ERISA the judge can’t review any evidence that wasn’t in your claim file for the administrative appeals. That means you’ll want to get as much favorable evidence as you can while the record is open.

The exact evidence you’ll need will depend on your specific medical condition, but generally includes the following:

• progress notes from your physician, psychologist, or psychiatrist
• radiology and diagnostic imaging reports
• lab test results
• surgical reports, and
• emergency room intake and discharge summaries.

If you notice anything is missing when you review your claim file, you'll need to request it and send it to your insurance company for consideration.

How Long Can an LTD Appeal Take?

ERISA claims have a 180-day window where you can appeal a denial. (29 C.F.R. §2560.503-1(h)(3)(i) (2026).) The insurance company then has 45 days to make a decision on the appeal, with one 45-day extension possible if circumstances require. (29 C.F.R. §2560.503-1(i)(3)(i) (2026).)

When to Get an Attorney in an LTD Case

The earlier you hire a lawyer for your LTD claim, the better. Insurance companies won’t hesitate to use your unfamiliarity with the process against you. For example, not all LTD insurers define “disability” the same way—some will find you disabled if you can’t perform your previous work (your “own occupation”), while others need to see that you can’t do any kind of job before your claim can be approved.

An experienced long-term disability attorney can go over your policy terms with you as well as highlight the strengths and weakness of your claim in order to address them on appeal. Your lawyer will know what kind of medical evidence you’ll need to submit (and might also be more familiar with doctors in your area who can potentially help with your case), and can craft a persuasive appeal letter to improve your chances of successfully appealing a denial or termination of LTD benefits.