Steps to Take after a Denial of Benefits

November 26, 2019 | J. Price McNamara
Steps to Take after a Denial of Benefits It is not unusual for individuals to be denied long-term disability benefits the first time around. In some instances, these denials happen because of missed deadlines. However, at other times, a benefits claim is denied because the applicant did not include the necessary documentation. In many instances, employer-sponsored long-term disability plans are covered by the ERISA statute that sets the deadlines for filing an appeal, along with other requirements.  Whatever the reason for your denial, if you are still interested in receiving benefits, there are certain steps that you should always take. By following these steps, you increase your chances of ultimately recovering the benefits that you need. At J. Price McNamara ERISA Insurance Claim Attorney, our experienced Texas disability lawyers can review your denial letter with you and assist you with the process of appealing your benefits denial. Please contact us online today for more information about how we could assist you throughout this process.

Carefully Read over the Benefits Denial Letter

If your insurance company decides to deny you benefits, it must send you a letter specifically stating the reasons for the denial. The letter will also set forth the specific steps which you must take to appeal the denial. You should also make sure that you fully understand the reason(s) why the insurance company denied your claim and that you address those concerns when you file your appeal. Finally, you should make sure to carefully note any deadlines mentioned in the denial letter and make sure that you comply with those deadlines. If you fail to do so, it is almost certain that your claim for benefits will be denied a second time. 

Request a Copy of the File

After you have reviewed your denial letter, your next step should be to contact your insurance company in writing and ask to be sent a complete copy of your file. The insurance company is required, by law, to forward you a copy of the entire file without charging you a fee. You should also make sure to send your letter via certified mail, and when you receive the green card receipt, hold onto it. Once you have received a copy of your plan, you should make sure that you read and understand how a long-term disability is defined under your plan. 

Speak with a Lawyer

One of the most important steps you should take following your benefits denial is to speak with an experienced Texas disability lawyer about what happened. You should have your claim denial letter ready. A lawyer can help you to assemble the necessary documentation, in hopes of obtaining the disability benefits you deserve. A lawyer can assist you with all of the following:
  • Obtaining copies of all of your medical records, including imaging studies, doctor notes, emergency room records, and surgery records
  • Obtaining an expert medical opinion from a health care provider who his willing to state an opinion that you are disabled and that as a result, your mental and physical abilities have been affected
  • Obtaining an opinion from a vocational expert 
  • Filing a proper appeal in accordance with your plan’s specific requirements and assist you with any further appeals

Contact a Texas Disability Lawyer Today

At J. Price McNamara ERISA Insurance Claim Attorney, we can assist you with gathering the necessary medical documentation and other evidence necessary to appeal a disability benefits denial. To schedule a free legal consultation and case evaluation with a Texas disability lawyer, please contact us online today for more information. 
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J. Price McNamara


Losing my own brother, then my father and sister after long, disabling illnesses just a few months apart drove a career change for me. Before that experience, I never truly understood the place you’re in. I never understood the dramatic impact that receiving (or not receiving) the disability and life insurance benefits you paid for and counted on can have on your life especially when you need to focus on family and healing. What I experienced with my own family now drives the way I view my clients and my work, and I will never forget it!

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