Opening a letter from an insurance company only to find a denial of your long-term disability (LTD) benefits is a jarring experience. For many people in Denver and across the Front Range, these benefits are the only thing keeping their households afloat during a health crisis. If you are facing this situation, you are likely wondering what your next step should be and how you will manage your bills without that expected income.
The good news is that a denial is rarely the final word on your case. But the path forward depends heavily on whether your policy is governed by federal law or Colorado state law. Most employer-sponsored plans fall under a complex federal statute called the Employee Retirement Income Security Act of 1974 (ERISA). Understanding how this law interacts with Colorado-specific insurance protections is the first step toward reclaiming your benefits.
Understanding why your Colorado LTD claim was denied
Before you can build a strong appeal, you must identify the specific reason the insurance company rejected your claim. Under ERISA regulations, your insurer is legally required to provide a written notice explaining the exact reasons for the denial (29 C.F.R. § 2560.503-1).
Common reasons for a denial in Colorado include:
- Insufficient medical evidence: The insurer may claim your medical records do not objectively prove you are unable to work.
- The “Own Occupation” vs. “Any Occupation” shift: Many policies cover you if you cannot perform your specific job for the first 24 months, but then shift to a stricter standard where you must prove you cannot perform any job for which you are suited.
- Video surveillance: Insurance companies often hire private investigators to follow claimants in areas like Cherry Creek or LoDo, hoping to catch them performing physical activities that contradict their disability claims.
- Missed deadlines: Failing to submit paperwork or medical updates within the strict timelines set by the policy.
Once you have the letter, look for the section that outlines your right to appeal. This letter serves as the roadmap for your entire legal strategy.
The critical 180-day appeal window
If your policy is an ERISA-governed plan, you typically have 180 days from the date you receive the denial letter to file a formal administrative appeal. While six months might seem like plenty of time, it moves quickly when you are dealing with doctors, medical tests, and legal requirements.
In an ERISA case, the administrative appeal is the most important stage of the process. This is because you generally cannot add new evidence to your file once the appeal is over. If you eventually have to sue the insurance company in the U.S. District Court for the District of Colorado, the judge will only look at the “administrative record” that was created during the appeal.
If you do not include a specific medical report or vocational expert’s opinion now, you may never be able to use it later. We focus on “stacking the record” during this phase to ensure every piece of favorable evidence is documented and ready for court if necessary.
Colorado state law and “Bad Faith” protections
While ERISA is a federal law that often limits a claimant’s options, Colorado has unique statutes that offer additional protections for policyholders. One of the most significant is Colorado Revised Statute § 10-3-1115, which prohibits an insurer from “unreasonably” delaying or denying payment of a claim for benefits.
Under C.R.S. § 10-3-1116, if a court finds that an insurer unreasonably delayed or denied your disability benefits, you may be entitled to recover:
- Two times the covered benefit;
- Reasonable attorney fees;
- Court costs.
The Colorado General Assembly specifically declared these statutes as laws “regulating insurance,” which helps them survive some of the broad preemption rules that usually give ERISA-governed insurers more leeway (C.R.S. § 10-3-1115(4)). This means that in certain Colorado cases, the insurance company faces much higher stakes for acting unfairly than it might in other states.
De Novo review and the end of “Discretionary Clauses”
For years, insurance companies included “discretionary clauses” in their policies. These clauses essentially told the courts, “Our interpretation of the policy stands unless we are being completely arbitrary.” This made it very difficult for Denver residents to win their cases in court.
However, Colorado took a stand against this. Under C.R.S. § 10-3-1116(2), any insurance policy or plan issued in Colorado that offers disability benefits cannot contain a provision that reserves “discretion” to the insurer to interpret the terms of the plan.
This is a massive win for you. It means that if your case goes to court, you are entitled to a de novo review. In a de novo review, the judge does not give the insurance company’s decision any special weight. Instead, the judge looks at the evidence with fresh eyes and decides for themselves whether you are disabled under the terms of the policy.
Steps to take after a denial in Denver
If you are standing in your kitchen in Aurora or Lakewood holding a denial letter, follow these steps immediately:
1. Request your complete claim file
You have a legal right to receive a copy of your entire claim file from the insurance company at no cost. This file contains the internal notes, emails, and medical reviews the insurer used to deny you. You cannot know what you are fighting until you see what is in that file.
2. Speak with your doctors
Your physicians are your strongest allies. Show them the denial letter and ask if they can provide a more detailed statement that specifically addresses the insurer’s concerns. For example, if the insurer says you can “sit for six hours,” but your doctor knows your spinal condition makes that impossible, a specific letter from your doctor explaining why can be a game-changer.
3. Avoid speaking to the insurance adjuster alone
Once a claim is denied, the insurance adjuster is no longer just “checking in.” They are looking for reasons to uphold the denial. Any casual comment you make about your day or your activities could be misinterpreted and used against you in the appeal.
4. Gather vocational evidence
Sometimes medical records aren’t enough. You may need a vocational expert to explain how your physical or mental limitations prevent you from performing the tasks of your specific job in the Denver labor market.
How we fight for Colorado’s disabled workers
At Roeschke Law, LLC, we do not just file paperwork; we build cases designed to win. Our team understands that when you are fighting an insurance giant, it can feel like the deck is stacked against you. That is why we take a caring but aggressive approach. We see you as a person, not just a case number, but we are all in when it comes to holding insurers accountable.
We know the tactics these companies use to save money at the expense of Colorado families. Whether your employer is a small business in Boulder or a major corporation in the Denver Tech Center, we have the experience to challenge their insurers. We take pride in being the team you want on your side when your financial future is on the line.
If your long-term disability claim was denied, do not wait for the deadline to pass. Let us put our expertise to work for you and fight for the benefits you earned.
Call Roeschke Law, LLC today at 720-796-9971 for a consultation on your Colorado LTD appeal.
