Reviewed by Laurence P. Banville, Esq.Read the denial letter first
Everything starts with your denial letter. By law it must tell you the specific reason your claim was denied, the plan provisions relied on, what additional information would help, and the deadline to appeal. Common denial reasons include “insufficient objective medical evidence,” a definition-of-disability dispute, missed deadlines, or a pre-existing condition exclusion. Knowing the exact reason tells you what your appeal has to overcome.
Know your deadline and which law applies
Most LTD policies come through an employer, which usually means they fall under ERISA, the federal law governing employee benefit plans. Under ERISA you generally have 180 days from the date of the denial to file your internal appeal, and you must complete that appeal before you can sue. Miss the window and you can lose the right to challenge the denial at all.
If you bought the policy yourself (a private, non-employer plan), New York insurance law and your contract control instead, and the deadlines and procedures can differ. Either way, calendar the deadline the moment you read the denial letter.
Build the administrative record
The appeal stage is the most important part of an ERISA case because, if you later end up in court, a judge usually reviews only the evidence already in your claim file, no new testimony. That makes the appeal your one real chance to get the proof in.
- Request your complete claim file in writing. You are entitled to it, including the insurer’s internal notes and the reports of any doctors who reviewed your file.
- Add strong medical evidence: updated treatment records, objective testing, and a detailed letter from your treating physician tying your condition to specific work restrictions.
- Address the exact denial reason: if they said “no objective evidence,” supply imaging, test results, or functional capacity evaluations that fill that gap.
- Consider supporting proof: vocational assessments, statements from people who see your limitations, and your own description of how the condition affects daily function.
Submit the written appeal and track it
File your appeal in writing before the deadline and keep proof of delivery. The insurer must give you a full and fair review and respond within the timeframes the law allows. If the internal appeal is denied, your remaining option under ERISA is typically a lawsuit in federal court, where that administrative record you built becomes the case.
LTD appeals are technical and the rules are unforgiving, so many people consult a disability attorney before the deadline rather than after a second denial. To understand the bigger picture, see what comes next when a long-term disability claim is denied, which conditions qualify, and how long benefits can last in our long-term disability hub.
Frequently asked questions
How long do I have to appeal a denied LTD claim?
If your plan is governed by ERISA, you generally have 180 days from the date on the denial letter to file your internal appeal. Private, individually purchased policies may set different deadlines under your contract and New York insurance law. Check your denial letter and calendar the date immediately, because missing it can end your claim.
Do I have to complete an internal appeal before suing?
Under ERISA, yes. You generally must exhaust the insurer's internal appeal process before you can file a lawsuit. Filing the appeal correctly and on time also preserves the evidence a court will later review, so skipping or rushing it can permanently weaken your case.
Why does new medical evidence matter so much at the appeal stage?
In most ERISA cases, if your appeal is denied and you go to court, the judge reviews only the evidence already in your administrative record. New testimony usually is not allowed later. That makes the appeal your one real opportunity to add updated records, objective testing, and detailed physician statements.
What are the most common reasons LTD claims get denied?
Frequent reasons include a finding of insufficient objective medical evidence, a dispute over whether you meet the policy's definition of disability, missed deadlines or paperwork errors, and pre-existing condition exclusions. Your denial letter must state the specific reason, which tells you what your appeal needs to overcome.
Should I hire a lawyer for an LTD appeal?
It is not required, but LTD appeals are technical and the rules are unforgiving, especially under ERISA. Many people consult a disability attorney before the appeal deadline so the record is built correctly the first time. Outcomes vary and depend on your policy, medical proof, and the facts of your situation.
Should I just file a new claim instead of appealing?
Usually no. Filing a fresh claim does not reset the appeal deadline on your denial, and missing that deadline can end your case for good. The appeal is the correct path to challenge a denial and build the record.