Your Long-Term Disability Claim Was Denied. Here's What to Do Next
Your insurer sent a denial letter. Maybe it cited insufficient medical evidence. Maybe it said you don't meet the policy's definition of disability. Maybe the language was so vague you're not even sure what they're objecting to.
Whatever it says, a denial is not a final answer.
You have the right to appeal — and in most cases, you're required to appeal before you can take your insurer to court. The clock starts the moment you receive that letter. Missing the deadline doesn't just slow things down; it can permanently end your ability to recover the benefits you're owed.
Long-term disability insurance claim denials happen for reasons that often have nothing to do with whether your disability is real, and in most cases, a denied claim can be appealed.
The most important thing you can do right now is understand what type of policy you have. That determines your deadlines, your rights, and what legal remedies are available to you.
Start Here! Your Long-Term Disability Denial Steps Depend on the Type of Policy You Have
Not all long-term disability policies work the same way — and the differences aren't minor. They affect your appeal deadline, what evidence you can use, whether you'll face a judge or a jury, and whether you can pursue damages beyond the benefits themselves.
Employer-Sponsored Group LTD (ERISA)
If your long-term disability coverage came through your job — as part of your employee benefits package — it's almost certainly governed by a federal law called ERISA (the Employee Retirement Income Security Act). This applies whether your employer paid the premiums or you did through payroll deductions.
ERISA sets strict procedural rules and limits what you can recover — your appeal is the foundation of any federal court case that follows. That appeal is not just a formality — it's the only opportunity you'll have to build the record that a federal court will later review if you need to sue. Whatever evidence you don't submit during the appeal typically cannot be introduced later. One incomplete appeal can cost you the case before it ever reaches a judge.
ERISA also limits what you can recover. Even if your insurer acted in bad faith, you generally cannot pursue punitive damages under federal law. Your remedies are largely limited to the benefits owed, plus potential attorney's fees.
Individual Private Disability Policy (Private or Own-Occupation)
If you purchased your policy directly from an insurance company — not through an employer — state law governs your claim, not ERISA. These are sometimes called individual disability insurance (IDI) policies or own-occupation policies, and they're common among physicians, dentists, attorneys, executives, and other professionals who chose to protect their specific occupation.
The rules here are meaningfully different. State courts handle these cases, not federal courts. Discovery rights are broader. And critically, in states with punitive damages, you may be able to pursue bad faith claims against your insurer — which can include damages well beyond the policy benefits themselves.
If you're not sure which type of policy you have, check your denial letter. ERISA plans are required to identify themselves as such. If you still can't tell, an attorney can review your policy documents and tell you within minutes.
Common Reasons Long-Term Disability Insurance Claims Are Denied
Most long-term disability denials don't happen because someone isn't disabled. They happen because the insurer found a gap — in the paperwork, in the medical records, or in how the claim was presented.
Insufficient medical evidence is the most common reason cited. What this usually means in practice: your treating physician documented your diagnosis, but didn't specifically address your functional limitations — how long you can sit, stand, concentrate, or perform the duties of your specific job. Insurers don't approve claims based on diagnoses alone. They look for documented functional impairment, and if your file doesn't spell it out clearly, they'll use that silence against you.
The definition of disability shifted. Most group LTD policies start with an "own occupation" standard — meaning you only need to show you can't perform your specific job. After 24 months, many policies switch to an "any occupation" standard, requiring you to prove you can't perform any job for which you're reasonably suited by education, training, or experience. Insurers time termination letters around this transition. If your benefits were cut off around the two-year mark, this is likely why.
A doctor who never examined you said you could work. Insurance companies routinely hire physicians to conduct "paper reviews" — reading your medical file and rendering an opinion without ever meeting you, examining you, or speaking to your treating doctors. These reviews consistently minimize limitations and contradict the assessments of the people who actually know your condition.
Surveillance undermined your claim. Investigators may have photographed or filmed you on a good day — walking to your car, carrying groceries, attending a family event — and presented that footage as evidence that your limitations aren't as severe as claimed. A single photo taken out of context can be used to contradict months of medical documentation. [ERIN REVIEW: confirm this characterization of surveillance use is appropriate for a service page]
A pre-existing condition exclusion was invoked. Insurers look back at your medical history — often 3 to 12 months before your coverage began — searching for any treatment, diagnosis, or complaint related to your current condition. If they find one, they may deny the claim as excluded under the policy's pre-existing condition clause, even when the connection is tenuous.
The pattern across all of these: insurers build a case file designed to justify denial. Your job — or your attorney's job — is to build a stronger one.
How to Appeal a Long-Term Disability Denial: Step by Step
An appeal isn't just a letter saying you disagree. A well-built appeal is a legal record — and for ERISA claims especially, it may be the most consequential document in your entire case.
Before You Start: Know Your Appeal Deadlines!
- ERISA (employer-sponsored) plans: 180 days from your denial letter
- Individual private policies: Varies — some as few as 60 days
- Insurer's decision on your appeal: 45 days, with a possible 45-day extension
Missing your deadline typically ends your right to benefits permanently — regardless of how strong your medical evidence is.
Step 1: Immediately Request Your Complete Long-Term Disability Claim File
You have the right to request the full claim file from your insurer — every medical record they reviewed, every internal note, every outside physician opinion, and any surveillance footage used in making their decision. Request it in writing immediately. You can't effectively challenge a denial if you don't know exactly what it's based on.
Step 2: Find Your Long-Term Disability Appeal Deadline
Check your denial letter for the specific deadline. Write the date down. Set a reminder. Missing this deadline is one of the few mistakes that truly cannot be fixed.
Step 3: Identify the Exact Reason(s) for Denial — Then Plan to Address Each One Specifically
A generic appeal that restates your medical history won't move the needle. The insurer denied your claim for stated reasons. Your appeal needs to directly refute each one, with evidence. If they said your medical evidence was insufficient, get it. If they relied on a paper review, obtain a detailed letter from your treating physician that directly contradicts it.
Step 4: Build the Medical Evidence Your Appeal Requires
This means more than sending records. You need narrative letters from your treating physicians that specifically address your functional limitations — how your condition affects your ability to perform the material duties of your occupation, not just a summary of your diagnosis. If a functional capacity evaluation hasn't been done, one may strengthen your case. The stronger your medical record, the weaker the insurer's footing.
Step 5: Address the Policy's Definition of Disability Directly
Your physicians need to write to the standard your policy actually uses. If your doctors aren't writing to the right standard, their letters may be accurate but legally ineffective. Rather than accept a letter that doesn’t write to the correct standard, it’s best to work with the physician to get what is needed – even though that might take some time. An experienced LTD attorney will know exactly what language is needed.
Step 6: Submit Everything in Writing, With Tracking
Never call the insurer and rely on verbal communication. Every piece of evidence, every letter, every submission goes in writing — certified mail, email with confirmation, or fax with a confirmation sheet. If you can't prove you sent it, it didn't happen. Make sure to retain your own copies.
What Should a Long-Term Disability Denial Appeal Letter Include?
Your appeal letter is the cover document for everything you're submitting — it isn't where you make your medical case, but it needs to do three things clearly: state that you are appealing the denial, identify each reason the insurer gave and why it's wrong, and direct the reviewer to the specific evidence in your packet that refutes their position.
Keep it factual and specific. Reference the denial letter by date. Name the policy provisions the insurer cited and explain why their interpretation is incorrect or incomplete. If your treating physician submitted a letter, reference it by author and date. The goal is a document that forces the reviewer to engage with your evidence rather than repeat the original denial language.
If you're handling an ERISA appeal, remember: this letter and everything attached to it becomes the legal record.
Why You Should Contact an Attorney Before You File Your Appeal
Most people assume the appeal is just more paperwork. It isn't. For ERISA claims especially, the administrative appeal is the only opportunity you'll have to submit evidence — a federal court reviewing your case later will look only at what's in that record. Nothing new can be added if you aren’t successful and later file a lawsuit.
That makes what goes into your appeal, and how it's framed, a legal decision as much as a procedural one. An experienced long-term disability attorney reviewing your denial letter before you respond can identify which of the insurer's stated reasons are most vulnerable, spot procedural errors the insurer may have made, and tell you exactly what medical evidence is missing. Most LTD attorneys, including Sandstone Law Group, offer free consultations. Spending 30 minutes on a call before you file can prevent mistakes in the appeal record that no court can fix later.
What Happens If Your Long-Term Disability Appeal Is Denied
A denial of your appeal isn't the end of the road either.
For ERISA claims, a denied appeal typically opens the door to federal court litigation. The judge will review the administrative record you built during the appeal — which is exactly why how that appeal was constructed matters so much from the start.
For individual private policies, a denied appeal may allow you to file suit in state court with full discovery rights. In some states, bad faith law gives policyholders additional legal tools. If your insurer unreasonably denied or delayed a valid claim, you may be entitled to damages beyond the policy benefits — including attorney's fees and, in some circumstances, punitive damages.
Litigation isn't a threat most insurers take lightly when the firm across the table has federal court experience and a track record of going the distance.
Why Using a Long-Term Disability Attorney Changes Your Odds
Long-term disability law is a legal specialty area. Other types of attorneys who might occasionally take these cases often don't know the procedural traps that lose them before they begin.
Understanding how to win a long-term disability claim comes down to one thing: building a record the insurer can't dismiss and a court can't ignore.
Sandstone Law Group focuses exclusively on long-term disability and long-term care insurance denials. Every case the firm handles involves an insurer trying to avoid paying benefits someone legitimately earned. The attorneys know the tactics — paper reviews timed to denial letters, IMEs from physicians who specialize in finding claimants able to work, surveillance programs designed to manufacture contradictions — because they've seen them used systematically across hundreds of cases.
Erin Ronstadt, who founded the firm, has represented clients against most of the major disability insurers and has handled every stage of the process — from proof of loss through federal court litigation. Kyle Shelton has secured large verdicts for disabled clients and their families. The firm works on a contingency fee basis, meaning there are no upfront costs and no fees unless they win your case.
One more thing most firms don't do: Sandstone continues to support clients after a case is resolved. Insurers sometimes resume pressure after a settlement or reinstatement. The firm stays involved.
Why Choose Sandstone Law Group to Fight for Your Long-Term Disability Insurance Benefits?
We understand that our clients would give anything to feel well again, return to work, and regain normalcy. But when insurers refuse to honor their promises, we step in with conviction, clarity, and relentless legal resolve.
Because of Sandstone, I get to Focus on My Wellness and Live in Peace
The only thing harder than becoming disabled is finding out you're (unfairly) being denied your disability benefits you paid for and rely on. This is the situation I found myself in after being on Long-Term Disability for over 6 years. Despite our panic, my husband and I took our time to find a good law firm. After doing a lot of research and interviewing over 7 firms, it was clear that Sandstone Law Group was the best choice for us. Erin and Kyle are exceptional lawyers, but just as importantly — they're good people that truly care about disability rights. From the jump, the entire Sandstone Team understood how we were feeling and the levels of stress we were up against. They were diligent to order all necessary doctors' records, got us scheduled for additional medical evaluations, and filed an appeal in a timely manner. Their work was exceptional, and I was put back on claim. I am grateful to have them in my corner moving forward!
- Morgan T.
We Know Insurers’ Tactics
Insurance companies have well-documented patterns of minimizing valid claims through tactics like:
- Discrediting treating physicians: Undermining the opinions of doctors who know your condition best.
- Downplaying symptoms using biased reviewers: Relying on medical professionals who rarely approve claims.
- Exploiting surveillance footage out of context: Misrepresenting isolated moments to deny ongoing disability.
- Misapplying policy language: Twisting terms to limit or terminate benefits.
We Win Because We Care
We do not treat cases like files or numbers. We treat them like the deeply personal battles they are. Our clients are people whose lives have been upended by disability and corporate denial—and we treat their stories with the respect and legal firepower they deserve.
Our legal team brings a rare combination of legal aggression and personal compassion. We have seen the damage done by disability denials, and we fight like it is personal, because in many ways, it is.
We Serve Clients Nationwide
Sandstone Law Group has offices in Arizona and California, and represents long-term disability claimants nationwide. Wherever you are, a consultation costs nothing and carries no obligation. The firm will tell you honestly what your options are.
Are you in Arizona or California? We have some useful guides specifically about long-term disability denials in those states.
→ Arizona Long-Term Disability Denial Assistance
→ California Long-Term Disability Denial Assistance
Long-Term Disability Insurance Denials FAQs
What is the deadline to appeal a long-term disability denial?
For employer-sponsored plans governed by ERISA, you generally have 180 days from the date of your denial letter to file an internal appeal. Some plans may allow less — check your denial letter for the exact timeframe. For individual private disability policies, deadlines vary by policy and state, and some are as short as 60 days. Missing either deadline can permanently forfeit your right to benefits, so treat it as the most important date in your case.
Do I need a lawyer to appeal a long-term disability denial?
You're not legally required to have one, but the stakes of appealing without legal help are significant — especially for ERISA claims, where the administrative appeal is the only opportunity to submit evidence before a potential federal court case. Attorneys who specialize in LTD denials know what medical evidence is needed, how to counter insurer tactics like paper reviews and surveillance, and how to write to the specific legal standard your policy uses. Most LTD attorneys, including Sandstone Law Group, work on contingency — no fee unless they win.
What should I include in a long-term disability appeal letter?
Your appeal letter should identify the denial by date, address each stated reason for denial directly, and reference the supporting evidence you're submitting — physician narrative letters, updated medical records, functional capacity evaluations, or employer statements. For ERISA claims, the letter and all attachments form the administrative record a court will later review, so completeness matters more than brevity.
What's the difference between ERISA and a private disability policy?
ERISA governs employer-sponsored group disability plans and is a federal law. Private disability policies — purchased individually, outside of employment — are governed by state law. The differences are significant: ERISA restricts the evidence record to what's submitted during the appeal, limits damages, and routes cases to federal court without a jury. Private policies allow broader discovery, state court litigation, and in some states, the ability to pursue bad faith claims with additional damages.
Can I sue my insurance company for denying my LTD claim?
Yes, in most cases — but you generally must complete the internal appeal process first. For ERISA claims, you sue in federal court and the judge reviews only the administrative record. For private policies in some states, you can sue in state court and may be able to pursue bad faith claims if the insurer's denial was unreasonable. An attorney can assess which path applies to your situation after reviewing your policy and denial letter.
Take Action Against Your Long-Term Disability Denial With Sandstone Law Group
At Sandstone Law Group, we've built our practice around holding disability insurers accountable when they fail to honor their obligations to policyholders.
We understand the tactics insurance companies use to avoid paying claims, and we know how to use consumer protection laws to position your denied claim for approval.
Don't let an insurance company's denial force you into financial hardship. The longer you wait, the more difficult it becomes to build a strong appeal and preserve your legal rights.
Contact Sandstone Law Group online or at (602) 615-0050 for a free consultation about your long-term disability denial.
We'll review your case, discuss your rights, and develop a comprehensive strategy to pursue the benefits you are entitled to. Our team is ready to fight for you and hold your insurance company accountable for its decision to deny.