Common mistakes that hurt an LTD appeal
Six mistakes, each one a direct consequence of a rule explained elsewhere on this site rather than a guess about what tends to happen.
None of these are guesses about outcomes. Each one is a direct consequence of a rule covered elsewhere on this site.
1. Waiting to see if the deadline is really 180 days
180 days is a floor, and it runs from your receipt of the letter, not its date. See the 180-day appeal deadline explained and use the deadline calculator early, not close to when you think the deadline might be.
2. Not requesting the complete claim file
Responding only to what the denial letter quotes, instead of everything the plan actually considered, misses evidence you are entitled to see for free. See how to request your complete claim file.
3. Saving new evidence for a lawsuit
A later court case is often limited to the record from the internal appeal. See the administrative record explained.
4. Restating the claim instead of rebutting the denial's specific reasons
An appeal that responds point by point to the plan's stated basis is stronger than one that repeats the original application. See what evidence to add to your appeal and why now.
5. Assuming ERISA applies without checking
Government employer plans, church plans, and individually purchased policies generally are not ERISA plans and follow different rules and deadlines entirely. See the is my plan ERISA self-assessment.
6. Not finding out whether a discretionary clause applies
Whether a future court decides your case fresh or only checks reasonableness depends on one clause in your plan document. See what is a discretionary clause.