ERISA & Long-Term Disability: How to Appeal a Denied Claim
When your long-term disability (LTD) benefits are denied, it can feel like your financial security has been pulled out from under you. Many employees rely on these benefits when illness or injury prevents them from working. Unfortunately, insurance companies frequently deny claims—even valid ones. If your disability claim falls under the Employee Retirement Income Security Act (ERISA), your rights and options are governed by a complex set of federal laws that can be challenging to navigate without professional legal guidance.
Hiring an ERISA disability attorney can significantly improve your chances of overturning a denial and securing the benefits you are legally entitled to.
Understanding ERISA and Long-Term Disability Claims
The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets the standards for most employer-sponsored benefit plans in the United States, including long-term disability insurance. While ERISA was designed to protect workers, it often gives insurance companies powerful tools to delay or deny claims.
Unlike private disability insurance policies, ERISA-governed plans limit your ability to sue directly and restrict the type of evidence you can use during an appeal. This makes it essential to act quickly and strategically after a denial. A law firm specializing in ERISA claims can help you understand the plan’s terms, filing deadlines, and documentation requirements.
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Common Reasons Long-Term Disability Claims Are Denied
Insurance carriers deny long-term disability claims for a variety of reasons, many of which are preventable with the right legal support. Some of the most common include:
- Insufficient medical evidence – The insurer claims your documentation doesn’t prove total disability.
- Administrative errors – Missing forms, incorrect dates, or procedural missteps.
- Definition disputes – Disagreements over whether your condition meets the plan’s definition of “disability.”
- Surveillance or social media evidence – Insurers may use limited video footage or online activity out of context to challenge your credibility.
- Missed filing deadlines – Strict ERISA timelines mean even minor delays can forfeit your right to appeal.
If your claim has been denied, it’s critical not to panic—but also not to delay. Contacting an experienced ERISA attorney immediately can help you build a strong administrative record and protect your right to future litigation if necessary.
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The ERISA Appeal Process: Step-by-Step
The ERISA appeal process is not like a typical lawsuit. Before you can take your claim to court, you must complete the insurer’s internal appeal process. This is known as “exhausting administrative remedies.” Every step you take during this phase matters, because the appeal record will form the entire basis of your case if you later file a lawsuit.
1. Request the Denial Letter and Plan Documents
Your first step is to carefully review the denial letter. ERISA requires insurance companies to provide a written explanation for any denied claim, including the reasons and the specific plan provisions cited. Request a full copy of your plan documents and the insurer’s claim file immediately.
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2. Collect Strong Medical and Vocational Evidence
Since new evidence cannot typically be added after the internal appeal, this is your one opportunity to submit all relevant documentation—doctor’s opinions, test results, statements from employers, and vocational assessments. A disability insurance law firm can coordinate directly with your healthcare providers to ensure the evidence aligns with ERISA’s legal standards.
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3. File the Appeal Within the Deadline
Most ERISA plans require you to file an appeal within 180 days of the denial notice. Missing this deadline almost always results in losing your right to benefits. An ERISA attorney ensures that all forms, statements, and records are submitted correctly and on time.
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4. Wait for the Insurer’s Decision
Once your appeal is submitted, the insurance company generally has 45 days to issue a response, with one possible 45-day extension. If the insurer upholds its denial, you may proceed to federal court. A law firm with ERISA litigation experience can prepare your case for judicial review, challenging the insurer’s reasoning based on administrative records.
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Why You Need an ERISA Attorney
ERISA is notoriously complex. It restricts discovery, limits jury trials, and often favors insurers unless the claimant can demonstrate that the company acted arbitrarily or capriciously. Handling an appeal alone can jeopardize your claim, especially if you’re unfamiliar with procedural deadlines and evidentiary rules.
A qualified ERISA lawyer will:
- Evaluate the insurer’s reasoning and identify procedural violations
- Gather expert medical and vocational testimony
- Draft persuasive appeal letters and legal arguments
- Ensure compliance with ERISA’s strict timeframes
- Represent you in federal court if necessary
Insurance companies have teams of lawyers protecting their interests—you deserve the same level of representation. Many disability insurance attorneys offer free consultations and work on a contingency basis, meaning you pay nothing unless your claim succeeds.
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Mistakes to Avoid During Your ERISA Appeal
Many claimants unknowingly weaken their appeals by making simple mistakes:
- Relying solely on the insurer’s forms without supplemental documentation
- Failing to obtain detailed medical opinions from treating physicians
- Submitting incomplete or inconsistent information
- Missing the 180-day appeal window
- Attempting to represent themselves without legal counsel
These missteps can cost you your benefits. Working with a disability insurance law firm ensures that your appeal is meticulously prepared and legally sound from the start.
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Final Thoughts: Protect Your Financial Future After a Denied ERISA Claim
A denied long-term disability claim is not the end of the road—it’s the beginning of a legal process designed to test your persistence and preparation. With the help of an ERISA and long-term disability insurance lawyer, you can navigate complex regulations, challenge the insurer’s reasoning, and fight for the benefits you deserve.
Insurance companies often bank on claimants giving up. Don’t let that happen to you.
Call to Action
If your long-term disability benefits have been denied, don’t face the insurance company alone. Contact a law firm specializing in ERISA disability appeals today. An experienced attorney can review your denial, prepare your appeal, and fight aggressively for your rightful benefits.
Take control of your claim—schedule a free consultation with a disability insurance lawyer today.
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