My Disability Claim Was Denied. What Do I Do Now?

You paid your premiums. Your doctors agree you can't work. And the insurance company still said no.

If that is where you are right now, here is the most important thing to know: a denial is not the end. You have a legal right to appeal, and the insurance company is counting on the fact that most people never do.

According to a former Cigna executive, fewer than 1% of denied disability claims are ever appealed. But when Unum, one of the largest disability insurers in the country, was forced by state regulators to reopen 215,000 denied claims, 45% of those denials were reversed. Nearly half. The claims were valid. The insurer just said no and waited for people to go away.

This guide walks you through exactly what to do after a denial, step by step, in plain language. If you are new to how disability insurance works, start there first. Otherwise, read on for the process, the deadlines, and the traps that catch most people off guard.

Your deadline starts now: the 180-day appeal window

If your disability insurance comes through your employer, it is almost certainly governed by a federal law called ERISA (the Employee Retirement Income Security Act). Under ERISA, you have 180 days from the date of your denial letter to file an appeal. That deadline is set by federal regulation 29 CFR 2560.503-1.

Some plans use a shorter window. Your denial letter might give you 60 or 45 days instead of 180. Check the letter. The clock printed on that page is the one that matters.

If you bought a private, individual disability policy (not through an employer), your deadline varies by policy and by state. It could be 60 to 180 days. Read your policy or call the insurer to confirm.

Missing this deadline is one of the most common mistakes. Once it passes, your right to appeal is gone. In most cases, you cannot go back and reopen the claim. This is not a soft deadline that can be extended with a phone call. It is a hard legal cutoff.

If your denial arrived recently and you are reading this, the best thing you can do today is write down the date on the letter and count 180 days forward. That is your wall. Everything else in this guide fits inside that window.

Step 1: Request your complete claim file

Before you do anything else, call your insurance company and request a full copy of your claim file. You have a legal right to it under ERISA, and the insurer is required to provide it.

This file contains everything the insurer used to make their decision. That includes:

• All medical records they reviewed
• Internal notes from the claims adjuster
• Any surveillance footage or investigation reports
• Vocational assessments
• Reports from any doctors the insurer hired to review your case

The claim file is where you find out what actually happened behind the scenes. Sometimes the file reveals that the insurer never received records your doctor sent. Sometimes it shows that the insurer's hired doctor spent 15 minutes on a case that your own physician documented over years. Sometimes it contains notes that directly contradict the reasons listed in the denial letter.

Request the file in writing. It may take a few weeks to arrive. That is normal. But do not wait to request it, because those weeks eat into your 180-day window.

Once you have the file, read every page. Look for these specific things:

• Missing documents. Are your treating physician's records all there? ERISA requires the insurer to consider all relevant evidence. If records are missing, that is a procedural failure you can challenge.
• Inaccurate job descriptions. The insurer may have used a generic description of your job rather than what you actually do. If you are a surgeon and they described your role as "physician," that changes whether you meet the definition of disabled.
• The reviewing doctor's specialty. If the insurer hired a psychiatrist to evaluate your orthopedic claim, that is worth challenging. The reviewer should have relevant expertise in your condition.
• Financial patterns. Some reviewing doctors do hundreds of evaluations for the same insurer every year. That pattern matters.

The claim file is not just paperwork. It is the foundation of your appeal. Skipping this step is like going to court without reading the evidence against you.

Step 2: Read your denial letter like it's a contract

The denial letter tells you exactly why the insurer said no. That matters because your appeal has to address every reason listed. If the letter gives three reasons and your appeal only responds to two, the insurer can deny you again on the third.

Common denial reasons and what they actually mean:

Write down every reason listed. Then, for each one, start collecting evidence that directly contradicts it. This is the core of your appeal.

Step 3: Build your appeal package

An appeal is not a phone call. It is not a letter saying "please reconsider." It is a written package of evidence that addresses every denial reason and proves your case is stronger than the insurer's.

A strong appeal typically includes:

Updated medical records. Get the most recent treatment notes, test results, and imaging from every doctor treating your condition. If your denial came months ago, there should be new records since then that further document your limitations.

A detailed physician statement. Ask your treating doctor to write a letter that specifically addresses your functional limitations. Not just your diagnosis, but what you cannot do. Can you sit for more than 30 minutes? Can you lift more than 10 pounds? Can you concentrate for a full workday? The insurer does not care about labels. They care about whether you can perform specific job duties.

A Functional Capacity Evaluation (FCE). This is a formal, multi-hour physical assessment conducted by a licensed evaluator. It tests your actual abilities: lifting, carrying, sitting, standing, bending, gripping. The results are documented in a standardized report that is difficult for the insurer to dismiss. An FCE is an out-of-pocket expense, but it produces some of the strongest evidence you can submit.

A vocational expert opinion. If the insurer denied you because they say you can do "any occupation," a vocational expert can evaluate whether that is actually true given your specific limitations, education, work history, and age. This is especially valuable when your policy has switched from own-occupation to any-occupation coverage.

Your actual job description. Not the generic title the insurer pulled from a database. The real, detailed description of what your job requires day to day. If your employer will write one, get it on letterhead.

Witness statements. Letters from family members, coworkers, or friends who can describe how your condition affects your daily life and ability to function. These are not medical evidence, but they add context that medical records sometimes miss.

Put all of this into a written submission with a cover letter that walks through the denial reasons one by one and explains why each one is wrong. Reference specific pages from the claim file and specific evidence in your appeal package.

This is important: under ERISA, the appeal is often your only shot. If your appeal is denied and you go to federal court, the judge will usually review only the evidence that was in the administrative record. You generally cannot introduce new medical records, new witnesses, or new arguments at that stage. A 2018 rule change requires the insurer to share any new evidence they gather with you during the appeal, but it does not change the fact that what you submit now is what the court will see later.

One disability attorney put it this way: "This is your one shot. After you submit your appeal, you will not be able to add evidence."

The traps that catch most people off guard

The appeal process has rules, and the insurance companies know them better than you do. Here are the traps that forum after forum says people wish they had known about before they fell into them.

The return-to-work trap

You feel a little better. You try going back to work part-time. Two weeks later, your condition flares and you have to stop again.

The insurer now has evidence that you attempted to work. In their view, that attempt proves you were not fully disabled. Your claim for the period after the relapse becomes harder to win because you demonstrated an ability to perform job functions, even briefly.

This does not mean you should never try to return to work. But if you do, document everything. Get your doctor to write detailed notes about why the attempt failed and why your condition prevents sustained work. The attempt itself is not the trap. The lack of documentation around it is.

The 24-month definition switch

Most long-term disability policies have a clause that changes the definition of "disabled" after 24 months. For the first two years, "disabled" means you cannot do your own job. After 24 months, it means you cannot do any job for which you are reasonably qualified by education, training, or experience.

This switch blindsides thousands of people every year. A surgeon who cannot operate but could theoretically work a desk job. A construction worker with a back injury who could, on paper, answer phones. The insurer terminates benefits at the 24-month mark and says you are capable of "sedentary work."

If your policy is approaching this transition, start preparing months in advance. Get your doctor to document limitations that go beyond your specific occupation. A vocational expert opinion at this stage can be the difference between continued benefits and termination.

Read more about how own-occupation definitions work and why they change.

The "Independent" Medical Exam is not independent

If the insurer asks you to attend an Independent Medical Examination (IME), understand what that actually is. The insurance company picks the doctor. The insurance company pays the doctor. Some of these doctors do hundreds of evaluations per year for the same insurer.

The exam itself is typically about an hour: a brief interview and a basic physical examination. For chronic conditions like pain, fatigue, or cognitive impairment, an hour is nowhere near enough to evaluate the full picture. Your treating physician has seen you dozens of times over months or years. The IME doctor has seen you once.

You generally cannot refuse an IME without risking an automatic denial. But you can prepare:

• Bring copies of your own medical records to the exam. The insurer may not have provided the doctor with your complete file.
• Ask for the doctor's CV beforehand. Check whether they specialize in your condition.
• Bring a witness if your plan allows it. A friend or family member who can observe the exam and note what was actually tested.
• Ask for a copy of the report after the exam.
• Be honest about your symptoms. Do not exaggerate. Do not minimize. Describe your bad days and your good days. If you exaggerate, the report will say so. If you minimize because you are having a better day, the report will say you are functional.

If the IME contradicts your treating physician's findings, your appeal should explain why your doctor's years of observation carry more weight than a single exam.

Your social media is being watched

Disability insurers routinely monitor claimants' social media accounts. Facebook, Instagram, TikTok. They are looking for anything that contradicts your claim of disability.

A photo of you at a family barbecue does not prove you can work an 8-hour day. But the insurer will use it to argue exactly that. One documented case involved nine different doctors confirming a man was totally disabled. The insurer hired a private investigator who followed him from a doctor's appointment, filmed him running an errand, and used that footage to challenge his claim.

This is standard practice, not paranoia. Insurers also conduct physical surveillance: investigators parked outside homes, following claimants to appointments, filming for multiple consecutive days to eliminate the "good days and bad days" defense.

Practical steps: Set all social media accounts to private. Stop posting about physical activities. Do not accept friend requests from people you do not know. Better yet, take a break from posting altogether until your claim is resolved. Anything you post can and will be taken out of context.

ERISA vs. private policy: why it matters for your appeal

The type of policy you have determines what happens if your appeal fails and you end up in court. One path leads to a federal judge reviewing paperwork. The other leads to a jury trial where you can present new evidence.

The practical effect of ERISA is that the appeal stage is far more important than the court stage. Under ERISA, the court reviews only the same file the insurer already denied. No jury hears your story. No new evidence gets considered. The judge evaluates whether the insurer acted "reasonably," and the bar for overturning an insurer's decision is high.

This is why the appeal package matters so much. If your policy is through your employer, the administrative appeal is very likely the last point where you can add evidence to your case. Everything you submit now is everything the court will ever see.

If you bought your policy individually (not through an employer), you have more options. State courts, jury trials, the ability to present new evidence, and the possibility of punitive damages if the insurer acted in bad faith. The stakes of the administrative appeal are still high, but the consequences of an imperfect appeal are less severe.

When to hire a disability insurance attorney

The short answer: as early as you can afford to.

The pattern across every forum, every case study, and every law firm's data is the same. People who have an attorney from the beginning of the appeal process tend to have better outcomes than people who try to handle it alone and hire a lawyer after things go wrong.

The reason is the administrative record. Every piece of evidence you submit during the appeal, and every piece you fail to submit, becomes a permanent part of the file. An attorney who specializes in disability insurance knows what evidence the insurer will challenge, what types of documentation carry the most weight, and how to structure the appeal to close loopholes the insurer will try to exploit.

Most disability insurance attorneys work on contingency, meaning they take a percentage of your recovered benefits rather than charging upfront fees. If you cannot afford to pay out of pocket, this is worth asking about. Not all attorneys offer contingency, but many who specialize in this area do.

When looking for an attorney, prioritize experience with disability insurance specifically, not general personal injury or insurance law. Ask how many disability appeals they have handled, what percentage of their practice is disability claims, and whether they have experience with your specific insurer.

If hiring an attorney is not an option, the steps in this guide still apply. You can file your own appeal. But understand that the insurer has a legal team, and they do this every day. The more complex your case, the more an experienced attorney changes your odds.

What happens after you file the appeal

Once your appeal is submitted, the insurer has 45 days to make a decision. They can extend that by another 45 days if they notify you before the first period ends and explain the reason for the delay. In complex cases, a second 45-day extension is possible. So the total wait could be up to 135 days.

During the review, the insurer may contact your doctors, request additional records, or send you for another medical examination. Under the 2018 ERISA rule change, if the insurer obtains new evidence or relies on a new rationale during the appeal, they must share it with you and give you a reasonable opportunity to respond before making a final decision.

From here, one of three things happens:

The appeal is approved. Benefits are reinstated, usually with back pay to the date they were terminated. This is the outcome in a meaningful percentage of cases, especially when the appeal introduces evidence that was not in the original claim file.

The appeal is denied. If your policy is governed by ERISA, your next step is a federal lawsuit. If you have a private policy, you can go to state court. In either case, this is the point where most people need an attorney if they do not already have one.

The insurer offers a settlement. Some insurers offer a lump-sum settlement instead of continuing monthly benefits. Be careful here. A settlement that sounds large upfront may be worth far less than the total benefits you would receive over the remaining benefit period. Do not accept a settlement without understanding the full math, and ideally without legal advice.

The insurers with the most complaints

Not all insurers handle claims the same way. Several of the largest disability insurers have documented histories of claims practices that regulators and courts have called unfair.

Unum: In the early 2000s, a multi-state regulatory investigation found that Unum engaged in "unfair claims practices and wrongfully denied legitimate claims." California fined the company $8 million and forced them to reopen up to 26,000 cases. The CEO resigned over internal policies designed to reduce claim costs. As noted above, 45% of the reassessed claims were reversed.

Cigna: In a 2023 investigation, Cigna was accused of using an algorithm called nH Predict to deny approximately 300,000 claims in a two-month period. Only 0.2% of affected policyholders filed an appeal. Investigators alleged a 90% error rate in the algorithmically processed denials.

UnitedHealthcare: Denial rates for post-acute care claims increased from 10.9% in 2020 to 22.7% in 2022, more than doubling in two years.

Aetna: In March 2026, Aetna settled for $117.7 million over diagnostic coding issues that affected claim processing.

If your insurer is one of them, the pattern is worth knowing. Hartford, MetLife, Lincoln Financial, and Liberty Mutual also appear frequently in disability denial lawsuits.

What to do today

If you have a denial letter in front of you, do these five things before the end of this week:

1. Write down the date on the denial letter. Count 180 days forward (or whatever deadline your letter specifies). Put that date everywhere you will see it.

2. Call the insurer and request your complete claim file in writing. You need this before you can build an effective appeal.

3. Read the denial letter and list every reason for the denial. Your appeal must respond to each one specifically.

4. Contact a disability insurance attorney for a consultation. Many offer free initial consultations. Even if you decide to handle the appeal yourself, an attorney can tell you whether your case has issues you might miss.

5. Lock down your social media. Set everything to private. Stop posting. Assume anything public is being monitored.

The insurance company has a legal department, a claims department, and a process designed to make this hard. You have a deadline, a legal right to appeal, and better odds than you think. Nearly half of Unum's reassessed denials were valid claims. The system works for people who fight back. It counts on the 99% who do not.