How to read your LTD denial letter
What a compliant denial letter must tell you, the one extra date the appeal denial has to carry, and the questions to ask if either is missing.
An ERISA denial letter is not just a form rejection. Federal regulation requires the plan to disclose specific things inside it, and reading the letter with that checklist in hand tells you where to focus your appeal.
For a disability denial the letter must set out "either the specific internal rules, guidelines, protocols, standards or other similar criteria of the plan relied upon in making the adverse determination or, alternatively, a statement that such rules, guidelines, protocols, standards or other similar criteria of the plan do not exist." Those are the only two options. There is no third option of promising to send the rule later if you ask for it: that option exists in the regulation, but it is written for a determination "by a group health plan" and does not apply to a disability claim. If your disability denial only offers to provide the rule on request, it has not given you what this paragraph requires.
Where the denial rests on a medical judgment, such as a finding that a treatment was not medically necessary, the plan must either explain the scientific or clinical basis for the decision or state that the explanation will be provided free of charge on request. Separately, the letter must tell you that you are entitled to receive, on request and free of charge, reasonable access to and copies of all documents, records and other information relevant to your claim: see how to request your complete claim file.
The letter must also discuss the decision, including the plan's basis for disagreeing with or not following the views of the treating and vocational professionals you put in front of it, the views of any medical or vocational expert whose advice the plan obtained, whether or not the plan relied on that advice, and any Social Security Administration disability determination you gave the plan. That last one is easy to miss. If the SSA found you disabled and the plan did not, the plan has to say why, and a denial that simply ignores an SSA decision you submitted has skipped a required step.
On the notice that denies your appeal, look for one more date
The rules above are about the letter denying your claim. The notice denying your appeal has to carry something extra, and it is the single easiest thing on this page to overlook. For a disability claim, the statement of your right to sue "shall also describe any applicable contractual limitations period that applies to the claimant's right to bring such an action, including the calendar date on which the contractual limitations period expires for the claim."
In other words, if your plan sets its own deadline for starting a lawsuit, the notice has to tell you the calendar date it runs out. Find that date and write it down. If the notice does not give one, ask the plan administrator in writing. See can you sue after an ERISA appeal denial.
What to do if the letter is vague
If the letter does not clearly identify the rules it relied on or say that none exist, does not name the medical or vocational experts involved, or ignores an SSA determination you submitted, request that information in writing, alongside your complete claim file request. A vague denial letter is itself something to raise inside your appeal, since the regulation requires these disclosures in the notice itself.
Sources
29 CFR 2560.503-1(g)(1)(vii), which sets what a disability denial notice must contain. The provide-it-on-request option for internal rules sits at (g)(1)(v)(A) and is scoped to group health plans. The contractual-limitations-period date required in an appeal denial is at (j)(4)(ii). Checked 2026-09-16.