File a disability insurance claim and appeal a denial

  1. Locate the Summary Plan Description and insurance policy certificate
    45 min

    This step produces the complete set of plan documents: the Summary Plan Description (SPD), the insurance policy certificate, any endorsements, and amendments. Without these, you cannot know what your policy covers, what it excludes, or what deadlines apply. The SPD is the plain-language summary; the certificate is the actual insurance contract with the full legal language that controls in any dispute.

    1. Check your employer’s HR department or benefits portal. Most employers post the SPD as a PDF on their intranet or benefits platform (ADP, Workday, BambooHR, Rippling).
    2. Log into the insurance carrier’s member portal. Carriers such as MetLife, Cigna, The Hartford, Lincoln, Prudential, and Unum post plan documents under “Documents” or “Forms.”
    3. If neither route produces the certificate, send a written request to the plan administrator citing ERISA § 104(b)(4). The plan administrator must respond within 30 days. Send by email and by USPS Certified Mail with Return Receipt Requested.
    4. In your request, include: your full name, the plan name (if known), your employee ID or SSN (last four digits), and the request: “I request copies of the Summary Plan Description, insurance policy certificate, all endorsements, and any amendments for the group disability plan under which I am covered.”