Q: My client was seriously injured in a mass tort case. Could they also have an ERISA disability claim?
A: Yes — and for many injured workers, that claim may represent a significant source of income replacement that goes entirely unpursued.
If you represent plaintiffs in mass tort litigation — pharmaceutical injury cases, medical device failures, toxic exposure claims, or similar actions in Pennsylvania, New Jersey, or Maryland — there is a good chance some of your clients had long-term disability (LTD) coverage through their employers when they were injured. If that coverage is governed by the Employee Retirement Income Security Act of 1974 (ERISA), they may have a parallel federal disability claim that is entirely separate from your tort case. This ERISA disability claim requires its own legal strategy, its own deadlines, and its own body of law.
This is not a gap in your representation. It is a specialized area of federal law that operates on a completely different legal track. The Garner Firm attorneys have extensive experience in this area and may be able to help your clients recover the full benefits they are entitled to receive.
Does Your Mass Tort Client Have an ERISA Disability Claim?
Many mass tort plaintiffs are — or were — working adults who had employer-sponsored group disability insurance through their jobs. Under ERISA, these plans provide long-term disability benefits to employees who become unable to work due to illness or injury. The injury that grounds your tort case — the defective device, the dangerous drug, the toxic exposure — may be the very same condition that has prevented your client from working and that entitles them to monthly disability benefits under their employer’s plan.
The question is not whether these two claims conflict. They do not. A mass tort claim and an ERISA disability claim arise under completely different legal frameworks. The tort case is pursued against a manufacturer or third party; the ERISA disability claim is brought against the client’s employer’s benefit plan or the insurer that administers it. Both can proceed simultaneously, and resolving the tort case does not extinguish the disability claim. For an injured worker who has been unable to return to their occupation, monthly LTD benefits — which can replace a percentage of pre-disability income — may be one of the most important forms of ongoing financial relief available. That said, it is important to note that LTD benefits could be offset by a tort recovery, and there are subrogation-related issues that need to be carefully considered and addressed.
How Do ERISA LTD Plans Define Disability for Mass Tort Plaintiffs?
One of the most important — and most misunderstood — aspects of ERISA disability claims is how the plan defines “disability.” Most group LTD plans use one of two definitions, and the difference matters for your client’s recovery.
Under an “own occupation” standard, a claimant is considered disabled if they cannot perform the material and substantial duties of the specific occupation they held at the time of disability — even if they could theoretically work in some other capacity. Under an “any occupation” standard, benefits are available only if the claimant cannot perform any occupation for which they are reasonably suited by education, training, or experience. Many plans transition from own occupation to any occupation after 24 months of benefits, which creates a critical window during which the standard of proof shifts and insurers frequently attempt to terminate benefits.
For a mass tort plaintiff who worked as a nurse, a carpenter, a truck driver, or any other occupationally specific role, the distinction between these two definitions is not academic. It is the difference between receiving ongoing monthly income replacement and having benefits denied or cut off entirely. Understanding and fighting for the correct application of that definition requires specific knowledge of ERISA law and the claims administration process.
Why ERISA Disability Claims Require Separate Counsel
ERISA is notoriously complex. Unlike personal injury litigation — where the standard of proof is preponderance of the evidence and discovery is governed by the Federal Rules of Civil Procedure or state court rules — ERISA disability litigation operates in a fundamentally different environment.
Under ERISA, a claimant typically must exhaust the plan’s internal administrative appeal process before filing a lawsuit in federal court. That administrative record — the documents submitted during the claims and appeals process — often becomes the entire evidentiary record in subsequent federal litigation. Courts reviewing most disability denials apply a deferential “arbitrary and capricious” standard, which means that the quality of the evidence submitted at the administrative level, and the strength of the appeal brief, can determine the outcome of any later lawsuit.
There are generally no depositions, no additional fact discovery, and no jury — just the record that was built during the administrative process. This is why the administrative appeal is not a procedural box to check. It is the single most consequential step in an ERISA disability claim.
Critical Deadlines for ERISA Disability Claims in Mass Tort Cases
For attorneys handling mass tort and personal injury matters in Pennsylvania, New Jersey, and Maryland, timing is one of the most urgent reasons to identify potential ERISA disability claims early.
ERISA plans are required to set procedures for filing benefit claims and for appealing adverse determinations, and those deadlines are typically strict. Under ERISA regulations, claimants generally have 180 days from the date of an adverse benefit determination to file an administrative appeal. If a client’s benefits were denied, those deadlines may already be running.
There is also a significant intersection between your tort case and your client’s ERISA plan that requires careful management. Many ERISA plans contain “other income” offset provisions, meaning the plan may seek to reduce monthly disability benefits by the amount of workers’ compensation, Social Security disability benefits, or, in some cases, tort settlements the claimant receives. In some jurisdictions, insurers may also assert subrogation or reimbursement rights against personal injury recoveries, though the scope of those rights depends heavily on the specific plan language and controlling circuit authority. These interactions are areas where coordinated legal strategy — between tort counsel and ERISA counsel — can directly affect the client’s net recovery.
The Garner Firm: Focused ERISA Disability Representation
The attorneys at The Garner Firm have concentrated their practice on representing claimants in ERISA disability matters, including long-term disability denials, benefit terminations, and administrative appeals in federal courts across the Mid-Atlantic region. The firm brings focused knowledge of the Third Circuit’s evolving ERISA jurisprudence — which directly governs disability claims in Pennsylvania and New Jersey — as well as the Fourth Circuit’s approach applicable to Maryland claimants.
The firm’s attorneys understand how LTD insurers analyze claims, how administrative records are built and used in litigation, and how to navigate the intersection between ERISA disability claims and parallel tort recoveries. For mass tort and personal injury attorneys, partnering with The Garner Firm on the ERISA side of a case is not about adding complexity — it is about making sure your client’s full picture of potential recovery is addressed and that deadlines and strategy in the disability matter are handled by someone who has devoted their practice to this area of law.
For answers to common questions about how ERISA disability claims work, visit our ERISA FAQs.
Refer ERISA Disability Claims: Better Outcomes for Your Clients
If you are a mass tort or personal injury attorney in Pennsylvania, New Jersey, or Maryland, consider making it a standard step in your intake process to ask clients whether they had employer-sponsored disability coverage when they became unable to work. If they did, and if benefits have been denied, delayed, or never claimed, that coverage may represent a meaningful and overlooked source of recovery.
The Garner Firm accepts referrals from other attorneys and is committed to working collaboratively to protect your client relationship while ensuring the disability claim is handled with the precision and thoroughness that ERISA demands.
Contact The Garner Firm today to discuss whether your client may have an ERISA disability claim worth pursuing.