Long Term Disability Appeal Letter Sample

[Date]

[Insurance Company Name]
[Claims Department Address]
[City, State, ZIP Code]

Dear [Insurance Company Name] Claims Department,

Re: Appeal for Long Term Disability Claim Denial
Claim Number: [Your Claim Number]
Insured Name: [Your Name]

I am writing to formally appeal the denial of my long-term disability claim, dated [Date of Denial Letter], which was rejected on the grounds of [specific reason for denial]. After thoroughly reviewing the denial letter and the accompanying documentation, I believe that the denial was made in error. I request a reconsideration of my claim based on the additional information and clarifications provided below.

Summary of Initial Claim

My initial claim was submitted on [Date of Initial Claim Submission], including comprehensive medical documentation from my treating physician, Dr. [Doctor's Name], which confirmed my diagnosis of [specific condition or illness]. The documentation outlined my ongoing treatment, the severity of my condition, and how it impairs my ability to perform the essential functions of my job as [Your Occupation]. Despite providing extensive evidence, my claim was denied based on [specific reason for denial, e.g., "insufficient evidence of functional impairment"].

New Evidence and Clarifications

1. Updated Medical Records: Since the original submission, I have received further medical evaluations and updated records from Dr. [Doctor's Name]. These records include detailed descriptions of my current condition and ongoing limitations, which were not fully captured in the initial documentation. I have attached copies of these updated records for your review.

2. Detailed Functional Limitations: Attached is a comprehensive report from my occupational therapist, [Therapist's Name], outlining the specific functional limitations I face daily. This report provides a clearer picture of how my disability affects my ability to perform my job functions and supports the necessity of long-term disability benefits.

3. Additional Testimonies: I have also included a statement from my employer, [Employer's Name], describing the impact of my condition on my work performance and my inability to meet the essential job functions. This testimony supports my claim and demonstrates the practical difficulties I face in returning to work.

4. Comparison to Policy Terms: Upon reviewing the policy terms, it appears that the denial did not fully consider the criteria for eligibility. I have provided a detailed comparison of my condition against the policy requirements, showing that my case meets the criteria for long-term disability benefits as outlined in the policy.

Request for Reconsideration

Given the new evidence and clarifications provided, I respectfully request a reevaluation of my claim. I believe that the updated medical records, functional limitations report, and employer testimony address the concerns raised in the denial letter and substantiate the validity of my claim. I am confident that this additional information will demonstrate that my condition qualifies for long-term disability benefits according to the terms of the policy.

Please review the enclosed documents and reconsider my claim at your earliest convenience. I am hopeful for a prompt resolution and am available to provide any further information or documentation if needed. You may reach me at [Your Phone Number] or [Your Email Address] should you require additional details or wish to discuss this matter further.

Thank you for your attention to this important matter. I look forward to your favorable response.

Sincerely,
[Your Name]

Enclosures:

1. Updated Medical Records
2. Functional Limitations Report
3. Employer's Testimony
4. Policy Terms Comparison