Compelling evidence and thorough documentation are critical to the success of a long-term disability (LTD) claim, especially during an appeal. Insurers and plan administrators evaluate claims primarily through the medical and supporting records submitted. Objective evidence—including diagnostic imaging, lab results, specialist reports, and functional capacity evaluations—carries substantial weight in this process.
Beyond clinical data, detailed statements from treating physicians are essential. These statements must clearly explain how your condition limits specific work-related activities. A consistent record of ongoing treatment and documentation of any failed attempts to return to work will further strengthen your case. Additionally, vocational evidence such as job descriptions and functional assessments can demonstrate that you can no longer perform the material duties of your occupation.
Submitting a comprehensive, well-organized file from the outset reduces the risk of denial for insufficient proof. Whether you are filing an initial claim or responding to a denial, partnering with an experienced long-term disability attorney can significantly improve your chances of a favorable outcome.
Yes, when the carrier has not reserved discretion.
The Supreme Court established in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), that judicial review of an ERISA plan administrator’s decision to deny benefits is de novo, unless the plan vests the administrator with discretion. Id. at 115. If the plan did not vest the administrator with discretion, de novo review is appropriate. Under de novo review, the court is not bound by the administrative record, but instead takes a fresh look at both the administrator’s interpretation of the plan and the administrator’s factual determinations. Pedersen v. Union Labor Life Ins. Co., Case No. 06-C-75., 2006 BL 123097, at *4 (E.D. Wis. Nov. 29, 2006) citing, Perlman v. Swiss Bank Corp. Comprehensive Disability Prot. Plan, 195 F.3d 975, 982 (7th Cir. 1999); Ramsey v. Hercules, Inc., 77 F.3d 199, 204 (7th Cir. 1996); Casey v. Uddeholm Corp., 32 F.3d 1094, 1098-99 & n. 4 (7th Cir. 1994). And where the record before the administrator is inconclusive as to either, the parties are free to present additional evidence. Forste v. Paul Revere Life & Acc. Ins. Co., 2004 WL 3315386, at *10 (S.D. Ind. 2004).
If your plan document does not grant the administrator discretionary authority to interpret the plan or determine eligibility, the court may conduct a de novo review—examining the evidence independently and deciding the claim without deference to the insurer’s earlier decision.
Whether you are a healthcare professional, lawyer, executive, or skilled laborer, you will receive the same dedicated attention we provide to every client. Each case receives the diligent research, meticulous attention to detail, and persuasive advocacy necessary to achieve the results you deserve. Call 262-785-9606 or contact us here for more information.
