Appealing a Long Term Disability Claim

When a long term disability claim is denied the individual then has the right to file an appeal. A long term disability appeal allows the claimant to present additional information that may not have been available at the time of the original claim. Through this additional medical information the denial of the original claim can be overturned and long term disability benefits provided.

There are four different components or stages in a long term disability appeal. Not all cases will progress through all four options for settlement, especially if the claimant has legal representation. A qualified attorney can provide legal advice in preparing for the appeals process as well as in providing additional supporting documentation for the claim throughout the process.

Step One: Reconsideration

Reconsideration is the least formal stage of the process and occurs when an appeal is filed within 60 days of the claim denial. This is a documentation review with the option for the claimant to provide additional medical or other relevant information. The examiner, who is previously uninvolved in the case, reviews the records and either upholds or overturns the denial.

Step Two: Administrative Hearing

If the reconsideration found in favor of the denial, you then have 60 days to file a request for an administrative hearing. At reconsideration the claimant is not required to meet with the examiner, however in the administrative hearing you will testify directly to an Administrative Law Judge. He or she will be familiar with your case and will assess your injury or disability based on the information that you provide. There may be the option to have expert witnesses and outside testimony at this point in the appeals process.

Step Three: Appeals Council Review

The judge may not find in your favor but you do have the option to then request a complete review of your case by the Social Security Appeal Council. An attorney is highly recommended at this stage to prepare the necessary documentation and to assist in preparing for the review.

Step Four: Federal Court

If an attorney has not been involved in the case you will need to retain legal services at this point. A lawsuit will be filed in your Federal District Court and a trial date set. This is a formal court process with the option to call witnesses and provide additional medical experts on the injury or long term disability sustained. An attorney is essential in helping navigate the legal system as well as preparing for your hearing in court.