Important information to know before appealing a denial of your long-term or short-term disability insurance claim

Before you can sue your insurance company for denying your claim to long-term disability benefits or short-term disability benefits, the Sixth Circuit federal Court of Appeals requires that you first exhaust the plan’s internal appeal procedure, even if the insurance company’s document suggests that internal appeal is optional or permissive. Failure to exhaust can be a basis for a later dismissal of your lawsuit.  Further, if a lawsuit must be filed, you will often be limited to the evidence presented in your internal administrative appeal to the insurance company. Therefore, it is essential to gather and present as much supporting evidence as possible in the appeal process, delaying a decision if necessary to allow more time for investigation.  You have 180 days to appeal a denial.  Once your appeal is filed, the insurance company must decide your appeal within 45 days, with extensions permitted.  The appeal review process must be structured so that it does not accord deference to the initial decision, meaning that the appeal must be decided by a person or committee of persons other than the one which decided the original claim. If medical necessity for treatment is an issue, a health care professional must be consulted.