Generated by All in One SEO Pro v5.0.0.1, this is an llms-full.txt file, used by LLMs to index the site. # The Garner Firm Law firm specializing in ERISA, long-term disability and employment law ## Posts ### [How to Fight Common Reasons ERISA Insurers Deny Disability Claims](https://www.garnerltd.com/erisa-disability-claim-denial-reasons-and-how-to-fight-back/) **Published:** February 12, 2026 **Author:** Adam Garner **Excerpt:** Learn the most common reasons for an ERISA disability claim denial and proven strategies to fight back. Our ERISA attorneys explain how to challenge denied LTD and STD benefits, from insufficient medical evidence to insurer cherry-picking tactics. Contact The Garner Firm for a free consultation. **Content:** ![](https://www.garnerltd.com/wp-content/uploads/2026/02/Gemini_Generated_Image_e4cy7we4cy7we4cy-1024x559.png "Gemini_Generated_Image_e4cy7we4cy7we4cy - The Garner Firm")An **ERISA disability claim denial** can be devastating. If your **long-term disability (LTD)** or **short-term disability (STD)** claim was denied, you are not alone. Insurance companies deny thousands of disability claims every year. However, many of these denials can be challenged with the right evidence and legal strategy. As a result, understanding why insurers deny [ERISA ](https://www.dol.gov/general/topic/health-plans/erisa)disability claims is the first step toward fighting back and recovering the benefits you deserve. This guide examines the most common reasons insurance companies use to deny [disability benefits](https://www.garnerltd.com/practice-areas/erisa-litigation/) and provides strategies for overcoming each type of ERISA disability claim denial. ## Insufficient Medical Evidence One of the most frequently cited reasons for an ERISA disability claim denial is that the claimant failed to provide sufficient medical evidence. Insurers may argue that: - Your medical records do not document objective findings consistent with disability - Your treating physicians’ opinions are not supported by clinical evidence - You have not undergone sufficient diagnostic testing **How to fight back**: First, obtain detailed narrative reports from your treating physicians explaining your diagnosis, clinical findings, functional limitations, and why you cannot work. Additionally, consider obtaining a functional capacity evaluation (FCE) that objectively measures your physical or mental capabilities. Finally, include all relevant diagnostic tests, imaging studies, and laboratory results. ## Reliance on Paper Reviews Over Treating Physicians Insurance companies frequently hire non-examining physicians to conduct “paper reviews” of your medical records. These reviewers never examine you but nonetheless render opinions that your condition is not disabling. As a result, courts have criticized this practice. This is especially true when the paper reviewer contradicts the opinions of treating physicians who have actually examined the claimant. **How to fight back**: Document the credentials and treatment history of your treating physicians. Then, obtain detailed statements addressing the specific reasons the insurer cited for denial. In addition, point out in your appeal that the reviewing physician never examined you and may have “cherry-picked” evidence from your records while ignoring findings that support your claim. Furthermore, research the reviewing clinician’s credentials and their qualification to evaluate your disability. ## Surveillance and Social Media Evidence Insurers frequently use surveillance investigators to observe claimants and scour social media for evidence that contradicts disability claims. For example, a photograph of you at a family gathering or a video of you carrying groceries may be used to argue that you are not as limited as you claim. **How to fight back**: Remember that brief activities captured on video rarely reflect your overall functional capacity. In fact, courts have recognized that performing isolated activities does not necessarily mean you can sustain full-time employment. Therefore, provide context for any surveillance evidence and obtain physician statements explaining how your condition affects your ability to work on a sustained basis. ## ERISA Disability Claim Denial at the “Own Occupation” to “Any Occupation” Transition Many **LTD** policies pay benefits for 24 months if you cannot perform your own occupation. After that, they require you to prove you cannot perform any occupation for which you are qualified. This transition point is a common time for insurers to terminate benefits. **How to fight back**: Obtain a vocational analysis from a qualified expert addressing what jobs, if any, you could perform given your age, education, work experience, and functional limitations. In addition, address not only your physical or mental capabilities but also whether you could sustain full-time employment and earn a comparable income. ## Mental Health and Self-Reported Symptom Limitations Many [disability insurance](https://www.garnerltd.com/5-things-to-know-about-disability-insurance-claims/) policies limit benefits for conditions based on self-reported symptoms or mental illness to 24 months. Insurers frequently argue that conditions like chronic fatigue syndrome, fibromyalgia, or chronic pain fall under these limitations. **How to fight back**: Obtain documentation showing that your condition has an organic basis and is not solely dependent on subjective symptom reports. Importantly, courts have held that insurers cannot impose objective evidence requirements for conditions that cannot be objectively measured, such as fibromyalgia. ## Pre-Existing Condition Exclusions Some disability policies exclude coverage for conditions that existed before you enrolled in the plan. As a result, insurers may deny claims by arguing that your current disability is related to a pre-existing condition. **How to fight back**: Review the policy’s specific definition of “pre-existing condition” and the applicable look-back period. Then, obtain medical evidence distinguishing your current condition from any prior health issues. In many cases, the connection between a pre-existing condition and current disability is tenuous at best. ## Failure to Follow Treatment Insurers may deny benefits if they determine that you have failed to follow prescribed treatment. Similarly, they may argue that your condition could improve with additional care. **How to fight back**: Document your compliance with all recommended treatments. Also, explain any reasons why certain treatments were not pursued, such as side effects, cost, or physician recommendations against treatment. ## Cherry-Picking and Selective Review Courts have repeatedly criticized insurers for “cherry-picking” evidence that supports denial while ignoring evidence favorable to claimants. This selective review violates the insurer’s fiduciary duty to conduct a full and fair review of your claim. **How to fight back**: In your [appeal](https://www.garnerltd.com/why-your-erisa-disability-appeal-is-the-most-important-step-in-your-benefits-claim/), specifically identify evidence in your claim file that the insurer failed to address. Additionally, point out inconsistencies between the denial rationale and the actual contents of your medical records. ## Contact The Garner Firm for Help With Your ERISA Disability Claim Denial If you are dealing with an **ERISA disability claim denial**, you need an experienced attorney on your side. At The Garner Firm, our [ERISA disability attorneys](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/) have helped hundreds of clients overturn wrongful denials and recover the **long-term disability** benefits they deserve. We understand the complex rules governing ERISA claims, appeals, and litigation. [Contact us today](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") at **(267) 805-6557** for a free consultation about your case. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Long Term Disability **Tags:** disability, Disability Benefits, disability claim denial, ERISA, ERISA lawyer, erisa litigation, long term disability, LTD --- ### [Administrative Exhaustion in ERISA: Why Your Appeal Is Critical to Your Case](https://www.garnerltd.com/administrative-exhaustion-in-erisa-why-your-appeal-is-critical-to-your-case/) **Published:** August 6, 2026 **Author:** Adam Garner **Content:** A denied disability, life, or pension claim rarely ends in a courtroom on the merits. It ends—or survives—based on what a claimant does in the months right after the denial letter arrives. Federal courts require a participant to complete the plan’s internal appeal process before filing an ERISA lawsuit. A claimant who cannot prove that the plan received a timely ERISA appeal often loses the right to any judicial review of the denial. In short, the ERISA appeal is where most benefit claims are won or lost. A recent decision involving a former Kirkland & Ellis attorney, *Stempel v. Unum Life Insurance Company of America* (N.D. Ill.), shows how quickly that risk becomes real. The plaintiff never litigated whether he was disabled. He litigated whether he mailed an appeal—and he lost. ![ERISA life insurance lawyer reviewing a denied claim and preparing the administrative appeal record](https://www.garnerltd.com/wp-content/uploads/2026/08/erisa-administrative-exhaustion-build-the-record-branded-v2-1024x576.png "erisa-administrative-exhaustion-build-the-record-branded-v2 - The Garner Firm")erisa administrative exhaustion build the record branded v2## What Administrative Exhaustion Means Under ERISA ERISA Section 502(a)(1)(B), codified at 29 U.S.C. § 1132(a)(1)(B), gives a participant the right to sue “to recover benefits due to him under the terms of his plan.” The statute says nothing express about exhaustion. Courts have read an exhaustion requirement into the statutory scheme. Plan documents almost always impose one directly (29 U.S.C. § 1132(a)(1)(B); *Harrow v. Prudential Ins. Co. of Am.*, 279 F.3d 244 (3d Cir. 2002)). Two independent sources create the obligation: - **The plan’s own terms.** Most summary plan descriptions state that a claimant must complete the appeal process before starting any legal action, and courts enforce that language as a contractual condition (*Stempel v. Unum Life Ins. Co. of Am.* (N.D. Ill.)). - **Federal policy.** Courts require exhaustion to build a factual record, encourage consistent claim handling, and reduce litigation costs (*Harrow*, 279 F.3d at 249). The Department of [Labor’s](https://www.ecfr.gov/current/title-29/subtitle-B/chapter-XXV/subchapter-L/part-2560/section-2560.503-1 "Labor's") claims regulation supplies the deadlines that make an ERISA appeal workable. A disability claimant receives at least 180 days to appeal an adverse benefit determination. The plan must then decide the appeal within fixed periods (29 C.F.R. § 2560.503-1). Courts have enforced the 180-day appeal window strictly. ## The *Stempel* Decision: An ERISA Appeal Lost on Proof of Mailing The plaintiff in *Stempel* filed a long-term disability claim under a group plan that Unum issued to his former law firm. Unum denied the claim and sent a letter that explained how to appeal and told him that Unum’s appeals team would confirm receipt of any appeal he submitted. He testified that he drafted an appeal, mailed it in January 2022, and mailed a follow-up letter that July. Unum never acknowledged either letter. More than a year later, he sent copies by priority mail. Unum responded in January 2024 that it had never received the earlier letters and that his appeal deadline had passed. Suit followed in July 2024, and the parties took limited discovery on exhaustion alone, then submitted that single issue to the court for decision on the record. ### How the Court Ruled in Stempel The court entered judgment for Unum. The reasoning matters more than the result: - **No confirmation of receipt.** The plaintiff produced no witness who saw him mail either letter and no electronic copy of either document, and he gave inconsistent testimony about the computers he used to draft them. - **The envelope undercut the story.** The envelope he offered as proof carried the wrong address, no postage, and no postmark. - **The insurer’s records held up.** Unum’s mailroom supervisor described a strict intake, sorting, and quality-control protocol, digital retention of received mail for at least seven years, and a search of both the digital archive and the vendor’s physical facility that turned up nothing. - **The mailbox rule did not rescue the claim**. The common-law presumption that a properly addressed and stamped letter reaches its destination never attached. The mailing evidence failed on credibility and on the basics of address and postage. The insurer’s nonreceipt evidence also rebutted any presumption that might have applied. The court also confirmed that exhaustion language in a summary plan description binds the claimant when that document forms part of the plan. ## ERISA Appeal Lessons for Claimants and Referring Attorneys *Stempel* is a proof case, not a medical case. The following practices keep a claim on the merits track: - **Track the appeal deadline from the denial letter’s date.** For disability claims, expect 180 days, and calendar an internal deadline well before it (29 C.F.R. § 2560.503-1(h)). - **Send appeals through a traceable channel.** Certified mail with return receipt, overnight courier with delivery confirmation, or the insurer’s electronic portal each generate independent proof of delivery. - **Keep the full record.** Retain the appeal letter in native electronic form, the transmittal, the tracking data, and the postage receipt. - **Demand written confirmation.** When an insurer promises acknowledgment of an appeal and none arrives within two weeks, call, document the call, and resend. - **Submit the complete evidentiary package.** Courts in most circuits limit review to the administrative record, so treat the appeal as the trial. - **Watch for deemed exhaustion.** When a plan fails to adhere strictly to the disability claims regulation, the claimant may be deemed to have exhausted and may proceed directly to court (29 C.F.R. § 2560.503-1(l)(2)(i)). - **Do not rely on futility.** The Third Circuit demands “a clear and positive showing of futility,” weighing factors such as diligence and the administrator’s own compliance failures (*Harrow*, 279 F.3d at 250). ## How The Garner Firm Protects the Administrative Record The Garner Firm concentrates its practice on plaintiff-side ERISA litigation[.](https://www.garnerltd.com/practice-areas/erisa-litigation/ "Employee Benefits (ERISA) Litigation") [That](https://www.garnerltd.com/category/erisa-litigation/ "(ERISA) Litigation") work covers long-term disability, life insurance, health benefits, pension and retirement plan disputes, and Section 510 retaliation claims. Our [attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") have handled individual and class matters and briefed and argued appeals from denied benefit claims. [We have also taught continuing legal education ](https://www.garnerltd.com/attorney-profiles/adam-garner/ "Adam H. Garner")programs on the ERISA appeal, the standard of review, remedies, and attorney’s fees. That experience shapes how we work a case before litigation ever begins. We prepare appeals that develop the medical, vocational, and occupational evidence a court will later read; we insist on written confirmation of every submission; and we document each step so that no insurer can argue, as Unum successfully argued in *Stempel*, that the appeal never arrived. We also review files that other attorneys refer to us after a denial, including matters where the appeal deadline is close. Early involvement gives a claimant the widest range of options; late involvement narrows them quickly. ## Talk to an ERISA Attorney Before Your Appeal Deadline Passes If an insurer or plan administrator denied your claim for benefits, act now rather than after the deadline. [Contact The Garner Firm ](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today")for a case evaluation, and bring your denial letter, your plan documents, and any correspondence you have already sent. We will assess your deadlines, your exhaustion posture, and the evidence your appeal still needs. *This article provides general information and does not constitute legal advice. Deadlines and requirements vary by plan and by circuit.* **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment, Disability Benefits, Employee Benefits --- ### [When ERISA Reaches Overseas: What Ajeti v. Life Insurance Company of North America Means for Disability Benefits Claims](https://www.garnerltd.com/erisa-disability-attorney-ajeti-v-lina/) **Published:** July 31, 2026 **Author:** Adam Garner **Content:** ![ERISA appeal process for a denied disability, life, or pension benefit claim](https://www.garnerltd.com/wp-content/uploads/2026/07/ajeti-erisa-cross-border-hero-with-logo-erisa-1024x576.png "ajeti-erisa-cross-border-hero-with-logo-erisa - The Garner Firm")In *Ajeti v. Life Insurance Company of North America,* No. 2:26-cv-03249 (E.D. Pa. Jul. 27, 2026), the United States District Court for the Eastern District of Pennsylvania issued a ruling with broad implications for workers who rely on employer-sponsored disability plans. Notably, the decision reaches even those workers who live and work abroad. The court held that ERISA’s complete preemption doctrine barred seventeen Kosovar employees from pursuing their disability benefits claims in state court. Moreover, the court found that ERISA governs benefit claims arising from U.S.-maintained plans even when the plan participants are foreign nationals who worked overseas. In short, the case is a pointed reminder that where, and under what law, a disability benefits case gets decided can be just as consequential as the merits of the claim itself. If you have a question about your employer-provided disability benefits, consulting with an ERISA disability attorney can help. ## The Facts: Seventeen Workers, One U.S. Plan, and a Denied Disability Claim The seventeen plaintiffs in *Ajeti* are all citizens of the Republic of Kosovo who worked for AECOM, a U.S.-based global infrastructure firm. Through their employment with AECOM, the plaintiffs participated in an employer-sponsored long-term disability (LTD) plan that AECOM maintained in the United States. When the plaintiffs became disabled and sought LTD benefits, the plan’s insurer — **Life Insurance Company of North America (LINA)**, a subsidiary of **New York Life** — denied their claims. The plaintiffs filed suit in state court, asserting claims under state law. LINA and New York Life removed the case to federal court, arguing that ERISA — the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 *et seq.* — completely preempted the plaintiffs’ state law claims. The plaintiffs moved to remand the case back to state court. The Court denied the motion to remand and, finding that the plaintiffs’ complaint did not state an ERISA cause of action, dismissed the complaint. [AJETI v. LIFE INSURANCE COMPANY OF NORTH AMERICA, No. 2:26-cv-03249 (E.D. Pa. Jul 27, 2026)](https://app.midpage.ai/document/ajeti-v-life-insurance-company--5c757588-8fef-4c8b-8de3-cfcd8ced2dbd?utm_source=mcp) ## ERISA Preemption and the Well-Pleaded Complaint Rule: A Primer To understand why *Ajeti* matters, you need to understand two intersecting legal concepts: the **well-pleaded complaint rule** and **complete preemption**. Under the well-pleaded complaint rule, federal jurisdiction ordinarily exists only when a federal question appears on the face of a plaintiff’s complaint. A plaintiff can often choose to plead state law claims and stay in state court — even if a federal defense like preemption exists — because a federal defense alone does not justify removal. **Complete preemption** is a powerful exception carved out by the Supreme Court. ERISA’s civil enforcement provision, Section 502(a), 29 U.S.C. § 1132(a), has such extraordinary preemptive force that it converts state law claims within its scope into federal claims — regardless of how a plaintiff labels them. When a plaintiff’s state law claim is, at its core, a claim to recover benefits under an ERISA plan, Section 502(a) applies, the well-pleaded complaint rule does not block removal, and federal courts have jurisdiction. The Supreme Court established this framework in *Metropolitan Life Insurance Co. v. Taylor*, 481 U.S. 58 (1987), and courts have applied it consistently in disability benefits litigation ever since. In *Ajeti*, the court found that the plaintiffs’ claims — however styled under state law — were fundamentally claims for disability benefits under an ERISA-governed plan. That determination triggered complete preemption, defeated the motion to remand, and led to dismissal of a complaint that failed to state an ERISA cause of action. ## A Significant Holding: ERISA Applies to Foreign Nationals Under U.S.-Maintained Plans Perhaps the most noteworthy aspect of *Ajeti* is the court’s analysis of ERISA’s reach beyond U.S. borders. The plaintiffs argued that ERISA should not apply to them because they are foreign nationals living and working in Kosovo. The court rejected that argument. The Court held that ERISA applies to the benefit claims of foreign nationals when the relevant plan is **maintained in the United States** and the **economic injury** — the denial of disability benefits — occurs **domestically**. The geographic location of plan administration and the financial harm controls the analysis, not the nationality or residence of the plan participant. This ruling has direct practical consequences. Any multinational employer that administers a single, U.S.-based benefit plan covering workers stationed overseas should understand that those workers are plan participants may be subject to ERISA. And any overseas employee of a U.S. company fighting a disability benefits denial should know that their battle could play out in federal court — under federal law. ## The Role of LINA and New York Life LINA has long operated as one of the most active — and most litigated — disability insurers in the United States. In 2022, New York Life acquired Cigna’s group insurance business, which included LINA, making New York Life one of the dominant carriers in the employer-sponsored group disability market. Millions of American workers — and, as *Ajeti* confirms, workers employed abroad by U.S. companies — now receive their long-term disability coverage through LINA policies underwritten under the New York Life umbrella. When LINA denies a disability claim under an ERISA plan, *Ajeti* confirms that the claimant’s remedy lies exclusively in federal court under ERISA Section 502(a). State law remedies — including state insurance bad faith claims that could yield punitive damages — are off the table. This matters enormously because ERISA’s remedial framework is more restrictive than state law: under ERISA, a claimant’s recovery is typically limited to the wrongfully denied benefits themselves, along with potential attorneys’ fees. The complete preemption doctrine that *Ajeti* illustrates is one of the primary reasons why experienced, specialized ERISA disability attorney is essential in any disability benefits dispute involving an employer-sponsored plan. ## What an ERISA Disability Attorney Wants Claimants to Know *Ajeti* carries several practical takeaways for anyone fighting a disability benefits denial under an employer-sponsored plan: - **Your claim will be governed by ERISA, not state law.** If your disability coverage comes through your private-sector employer, ERISA almost certainly applies — and complete preemption means you cannot use state court as an end-run around the federal statute. - **The “administrative record” is built before you file suit.** ERISA courts typically review benefit denials on the record developed during the insurer’s internal claims and appeals process. The work you do *before* filing suit — gathering medical evidence, submitting detailed appeals, and creating a complete record — often determines the outcome of your case. - **Deadlines are strict and unforgiving.** ERISA imposes rigorous deadlines for administrative appeals and lawsuits. Missing them can permanently bar your claim. - **Foreign nationals employed by U.S. companies are not exempt.** *Ajeti* confirms that the location of the plan, not the nationality of the participant, controls whether ERISA applies. - **Who you hire matters.** ERISA practice is a distinct, highly technical area of law. An attorney without specific ERISA experience may miss critical procedural requirements that can sink an otherwise meritorious claim. --- ## The Garner Firm: Your Experienced ERISA Disability Attorney The [attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") at **The Garner Firm, Ltd.** have devoted their practice to representing individuals — and in appropriate cases, classes of individuals — whose ERISA disability benefits claims have been wrongfully denied by insurers like [**LINA** and **New York Life**](https://www.garnerltd.com/homepage/insurers-we-litigate-against-in-erisa-benefit-claims/ "ERISA LTD Disability Insurers We Fight for You"). We understand how the complete preemption doctrine shapes the litigation landscape, how to build the administrative record that ERISA courts will rely on, and how to develop the legal and factual arguments that give our clients the best chance of recovering the benefits they earned. Our attorneys handle ERISA disability benefits cases at every stage — from the initial administrative appeal through trial and, where necessary, appeal. We represent clients in individual cases and in complex, multi-plaintiff and [class-wide ERISA litigation](https://www.garnerltd.com/practice-areas/erisa-litigation/) involving large group insurers and multinational employers. If you or a loved one has been denied [long-term disability](https://www.garnerltd.com/practice-areas/ "Practice Areas") benefits under an employer-sponsored plan, do not wait. The deadlines in ERISA cases are strict, and early intervention by an experienced ERISA disability attorney makes a real difference. [Contact](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") The Garner Firm, Ltd. today to [schedule a consultation](https://www.garnerltd.com/contact/) with an experienced ERISA disability attorney. Our Philadelphia office is ready to hear your story. --- *This blog post is for general informational purposes only and does not constitute legal advice. Reading this post does not create an attorney-client relationship. You should consult a qualified ERISA attorney about your specific situation.* **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Employment Law, Long Term Disability **Tags:** complete preemption, Disability Benefits, disability benefits attorney, disability benefits denial, ERISA, erisa attorney, ERISA lawyer, erisa litigation, LINA, long term disability, long term disability attorney --- ### [What to Do First After an ERISA Long-Term Disability Denial](https://www.garnerltd.com/what-to-do-first-after-an-erisa-long-term-disability-denial/) **Published:** February 1, 2026 **Author:** Adam Garner **Content:** --- ## What to Do First After an ERISA Long-Term Disability Denial Receiving a denial letter for your [long-term disability (LTD) claim](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/) can be devastating. After months of medical treatment, lost income, and uncertainty about your future, the last thing you expect is for your disability insurance company to tell you that you do not qualify for benefits. If you’ve received an ERISA LTD denial, what you do next matters enormously—perhaps more than you realize. This guide explains the critical first steps you should take immediately after receiving a denial of your **LTD claim** and why acting quickly and strategically can make the difference between winning and losing your benefits. ## After an ERISA LTD Denial: Do Not Panic—But Do Act Quickly The first thing to understand is that a denial of your **long-term disability** claim is not the end of the road. Under the Employee Retirement Income Security Act (**ERISA**), you have the right to appeal an adverse benefit determination. Federal regulations require that your plan provide you with a “full and fair review” of your claim, and the administrative appeal is your opportunity to challenge the denial and submit additional evidence supporting your disability.[](https://ppl-ai-file-upload.s3.amazonaws.com/web/direct-files/collection_a71c08b7-a30b-4861-bccb-4c3dcb9cabe7/e5dd557a-ead6-4257-b3e7-51b17bef2fe3/Final-Draft-ERISA-Basics-Benefit-Claims-Part-1-2022-mk-1.pptx) However, time is critical. Under ERISA regulations, you have **no less than 180 days** from the date you *receive* your denial letter to file your appeal. While 180 days may seem like ample time, building a comprehensive appeal requires gathering medical records, obtaining detailed opinions from your treating physicians, and potentially engaging vocational and medical experts. Starting immediately gives you the best chance of success.[](https://ppl-ai-file-upload.s3.amazonaws.com/web/direct-files/collection_a71c08b7-a30b-4861-bccb-4c3dcb9cabe7/6eb8823b-898b-42be-9924-49689bd50998/CFR-2024-title29-vol9-subtitleB-chapXXV.pdf) ## Understanding Your ERISA LTD Denial Letter Your denial letter is a roadmap that tells you exactly why the insurance company denied your claim. Under [29 C.F.R. § 2560.503-1(g)](https://www.law.cornell.edu/cfr/text/29/2560.503-1), the denial must include specific information:​ - The specific reason or reasons for the denial - Reference to the specific plan provisions on which the determination is based - A description of any additional material or information necessary to perfect the claim - An explanation of the plan’s review procedures and applicable time limits - Your right to bring a civil action under ERISA Section **502(a)(1)(B)** if your appeal is denied Understanding why your claim was denied is essential to crafting a successful appeal. Common reasons for denial include insufficient medical evidence, failure to meet the plan’s definition of disability, reliance on surveillance or activity reports, or determinations that you can perform sedentary work.​ ## Request Your Complete Claim File and Plan Documents One of your first actions should be to request all documents relevant to your claim. Under ERISA, you are entitled to receive, upon request and free of charge, copies of all documents, records, and other information relevant to your claim. This includes:[](https://ppl-ai-file-upload.s3.amazonaws.com/web/direct-files/collection_a71c08b7-a30b-4861-bccb-4c3dcb9cabe7/e5dd557a-ead6-4257-b3e7-51b17bef2fe3/Final-Draft-ERISA-Basics-Benefit-Claims-Part-1-2022-mk-1.pptx) - Your complete claim file, including all medical records reviewed - Any surveillance videos or investigation reports - Reports from physicians and vocational consultants retained by the insurer - Internal emails, activity logs, and claims notes - The plan document, summary plan description (SPD), and any applicable insurance policy This documentation is critical because it shows you exactly what information the insurance company considered when denying your claim—and what it may have ignored or mischaracterized. Courts have criticized insurers for “cherry-picking” evidence and disregarding information favorable to claimants.​ ## Review the Plan’s Definition of Disability **Disability insurance** policies define “disability” in specific ways, and the definition that applies to your claim determines what you must prove to receive benefits. Most **LTD** policies use one of two standards:​ **Own Occupation**: Benefits are payable if you cannot perform the material and substantial duties of *your* regular occupation—the job you were doing when you became disabled. **Any Occupation**: Benefits are payable only if you cannot perform the duties of *any* occupation for which you are reasonably qualified by education, training, or experience. Many policies begin with an “own occupation” standard for the first 24 months and then transition to the more restrictive “any occupation” standard. Understanding which definition applies at the time of your denial is essential because the evidence you need to submit may differ significantly depending on the standard.​ ## Identify What Additional Evidence You Need Based on your review of the denial letter and claim file, identify gaps in the evidence that you can fill during the appeal. A comprehensive appeal may include:[](https://ppl-ai-file-upload.s3.amazonaws.com/web/direct-files/collection_a71c08b7-a30b-4861-bccb-4c3dcb9cabe7/9bc17292-408a-4fe1-a73b-e1c7171130b8/2023-PBI-Employment-Law-Institute-Slides.pdf) - **Updated medical records**: All treatment notes, diagnostic tests, imaging studies, and laboratory findings documenting your condition - **Detailed physician statements**: Letters or questionnaires from your treating doctors explaining your diagnosis, functional limitations, and why you cannot work - **Functional capacity evaluation (FCE)**: A professional assessment of your physical abilities conducted by a qualified evaluator - **Vocational analysis**: An expert opinion regarding whether jobs exist that you could perform given your limitations, education, and experience - **Social Security disability determination**: If you have been awarded SSDI benefits, include the decision and supporting documentation - **Personal and lay witness statements**: Declarations from you, family members, friends, and former coworkers describing how your condition affects your daily life The administrative appeal is your best—and often only—opportunity to build the evidentiary record that will follow your case into court. In most ERISA cases, courts limit their review to the evidence contained in the administrative record.[](https://ppl-ai-file-upload.s3.amazonaws.com/web/direct-files/collection_a71c08b7-a30b-4861-bccb-4c3dcb9cabe7/58f72d94-2bc4-4b7a-8552-020ad3b88fca/ERISA-Survey-of-Federal-Circuits-2024-Edition-PDF.pdf) ## Understand the Appeal Deadlines and Procedures [The regulations governing disability claim appeals](https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/publications/group-health-and-disability-plans-benefit-claims-procedure-regulation) are strict, and failure to comply with deadlines can result in losing your right to benefits. Key timelines include:​ - **180 days** to file your appeal from receipt of the denial; - **45 days** for the plan to issue an appeal decision, with a possible 45-day extension for special circumstances; and - If the plan fails to issue a timely decision, your claim may be deemed denied, allowing you to proceed directly to federal court. If you can, send your appeal well before the deadline and always use a trackable delivery method so you can prove when the plan received your submission.​ ## Consider Consulting an Experienced ERISA Attorney The ERISA appeal process is complex, and the stakes are high. Insurance companies have teams of claims adjusters, medical reviewers, and lawyers working to deny claims. Having an experienced **ERISA disability** attorney on your side can level the playing field. At The Garner Firm, we represent individuals whose **[disability insurance](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/)** claims have been wrongfully denied. [Our attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") have deep experience handling claims under ERISA Section **[502(a)(1)(B)](https://www.law.cornell.edu/uscode/text/29/1132)** and understand how to build comprehensive appeals that maximize your chances of success. Firm founder [Adam H. Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/) has two decades of experience as an ERISA attorney and serves as Senior Editor of the treatise *Employee Benefits Law*.[](https://www.garnerltd.com/attorney-profiles/adam-garner/)​​ ## Received an ERISA LTD Denial? Do Not Wait to Get Help If you’ve received an ERISA LTD denial, every day counts. [Contact The Garner Firm today](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") at (267) 805-6557 or visit www.garnerltd.com to schedule a consultation with an experienced ERISA attorney. We will review your denial letter, analyze your claim file, and explain your options for pursuing the benefits you deserve. ![](https://www.garnerltd.com/wp-content/uploads/2026/02/Gemini_Generated_Image_mintuimintuimint.png "Gemini_Generated_Image_mintuimintuimint - The Garner Firm") **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits **Tags:** disability, disability benefits attorney, ERISA, erisa attorney, ERISA lawyer, long term disability, long term disability attorney, LTD --- ### [What You Need to Know About How SSD Interacts With LTD](https://www.garnerltd.com/ltd-offset-for-ssd/) **Published:** July 22, 2026 **Author:** Zachary Lipschutz **Content:** ![Man reviews disability benefits documents at a table with a laptop showing a Benefits.gov page.](https://www.garnerltd.com/wp-content/uploads/2026/07/generated-image-4-1-1024x576.png "generated-image 4 - The Garner Firm")Social Security Disability (“SSD”) and Long-Term Disability (“LTD”) often operate at the same time, but they do not treat each other the same way. Most group LTD policies reduce what they pay when you receive SSD. Understanding the LTD offset for SSD is essential, because the LTD offset for SSD determines how much of your long-term disability benefit the insurer can reduce once Social Security Disability begins. Below, the ERISA disability attorneys at The Garner Firm explain how SSD and LTD interact and how the LTD offset for SSD affects your monthly benefits. ## SSD and LTD: The Basic Framework SSD (more precisely SSDI) is a federal benefit run by the [Social Security Administration](http://www.ssa.gov). It pays a monthly benefit if you meet both insured-status requirements and strict federal disability standards. SSD can also include “back pay” for past months, annual cost-of-living increases, Medicare eligibility after a waiting period, and sometimes auxiliary benefits for eligible family members. LTD is a private insurance benefit, usually sponsored by an employer and often governed by [ERISA](https://www.garnerltd.com/erisa-faqs/ "ERISA Frequently Asked Questions"). It typically pays a percentage of your pre-disability earnings, often around 60–70 percent, subject to a maximum and detailed plan language on definitions of disability, offsets, and benefit duration. The Garner Firm’s ERISA disability [attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") handle both [LTD](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/ "LTD") and SSD-related issues daily, including ERISA-governed group policies and individual disability contracts. ## Can You Receive SSD and LTD at the Same Time? You can usually receive SSD and LTD at the same time. Many group LTD policies require you to apply for SSD as a condition of continuing LTD benefits, and some insurers even hire “advocacy” vendors to help you apply. Once you receive SSD, however, most group LTD plans treat SSD as “other income” and reduce your LTD payment dollar for dollar by the SSD benefit. Your SSD check does not change, but the insurer uses the offset clause in the policy to lower its share of your total disability income. As a result, your combined monthly income often stays close to the same level; only the mix between SSD and LTD changes. Essentially, the disability insurer is subsidizing its obligation to provide benefits through SSD. Attorneys at The Garner Firm routinely advise clients who receive LTD first, then secure SSD awards—sometimes years later—and need help evaluating how the two benefits interact and what the insurer can legally recoup. ## How the LTD Offset for SSD Usually Works Most ERISA-governed group LTD plans include an offset or “other income benefits” provision. This clause allows the insurer to reduce your LTD benefit by certain other income sources, which almost always include SSD paid to you and often SSD paid to your dependents. In broad terms, the LTD offset for SSD works like this: - The LTD plan promises a percentage of your pre-disability earnings, such as 60 percent. - The insurer calculates your “gross” LTD benefit based on that percentage and your earnings definition. - The insurer subtracts SSD and other listed income sources to arrive at your “net” monthly LTD payment. Many policies also treat dependent or auxiliary SSD benefits—for eligible spouses or children—as additional offsets. The plan then reduces your LTD benefit by those dependent amounts as well. Lawyers at The Garner Firm review offset language line by line. They examine whether the insurer has applied the offset correctly and whether it has taken credit for amounts the plan does not actually permit. ## How LTD and SSD Influence Each Other Substantively The relationship between SSD and LTD is not just financial. It also has important substantive and strategic dimensions that can affect the strength and timing of both claims. First, SSD and LTD use different legal standards. SSD often requires that you cannot engage in substantial gainful activity in any job in the national economy, although the standard can change based on your age, education, and work history. LTD plans often use an “own occupation” standard for a period, then change to an “any occupation” standard after a set number of months or years. Second, evidence flows in both directions. Medical records, treating physician opinions, functional capacity evaluations, and vocational evidence used for LTD claims and appeals also matter for SSD claims and hearings. Inconsistent descriptions of your limitations, work history, or activities can undermine both claims. A strong, consistent record can support both. Third, an SSD approval does not guarantee LTD approval, but it often serves as powerful evidence. Many insurers and courts recognize a favorable SSD decision as highly persuasive, even though it does not bind the LTD insurer. In ERISA litigation, The Garner Firm often challenges insurers that discount or ignore favorable SSD awards without a reasonable explanation. Attorneys at The Garner Firm prepare LTD appeals with an eye toward the SSD file and vice versa. They coordinate the documentation, address inconsistencies, and explain to insurers why the SSD decision supports ongoing LTD eligibility rather than undermining it. ## Common Pitfalls When SSD and LTD Interact Several recurring problems arise when SSD and LTD claims run together: - Failing to apply for SSD when the LTD policy requires it, which can lead to LTD terminations or reductions. - Accepting the insurer’s offset or overpayment calculations at face value without a careful review of the plan language, payment history, and attorney-fee credits. - Allowing inconsistent work history, job description, or functional statements to develop across SSD, LTD, workers’ compensation, and other benefits, which insurers then use to justify a denial or termination. The Garner Firm’s lawyers focus on these coordination issues from the outset. They help clients and referring attorneys build a consistent record, anticipate offsets, and avoid unexpected demands that can destabilize a family’s finances. ## Why Experienced LTD and SSD Counsel Matters The interaction between SSD and LTD, including the LTD offset for SSD, often controls how much money you receive each month and for how long, and whether the insurer has the legal right to reduce or terminate future LTD payments. These questions depend on a mix of federal statutes, case law, ERISA regulations, plan documents, insurance company practices, and Social Security rules. They can be easy to misread if you do not work with these issues on a regular basis. The attorneys at The Garner Firm focus their practice on disability and ERISA benefits, including LTD–SSD coordination, complex offset and overpayment disputes, and federal court litigation over LTD denials and reimbursement claims. They represent individuals nationwide in ERISA-governed LTD disputes and consult with other lawyers who need subject-matter support in disability and benefits cases. Their work includes reviewing policy language, building the LTD administrative record, advising on SSD timing and strategy, and litigating LTD terminations that disregard favorable SSD decisions. ## Speak With an ERISA Disability Attorney About Your LTD and SSD Benefits If you receive LTD benefits, are applying for SSD, or have just received an SSD award and a reimbursement letter from your LTD insurer, you should speak with counsel who understands how these systems intersect and what the policy actually permits. You can [contact The Garner Firm](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") to schedule a consultation about your LTD and SSD benefits, review your plan documents and Social Security award letters, and develop a coordinated strategy that protects your income and your legal rights. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Long Term Disability **Tags:** disability, Disability Benefits, disability benefits attorney, ERISA, erisa attorney, ERISA lawyer, erisa litigation, long term disability, long term disability attorney, LTD --- ### [AD&D Benefits Denied to Executive's Widow in ERISA Life Insurance Case](https://www.garnerltd.com/add-benefits-denied-to-executives-widow-in-erisa-life-insurance-case/) **Published:** January 30, 2024 **Author:** Adam Garner **Excerpt:** Case serves as an important reminder of the complexities inherent in ERISA litigation, and the need to aggressively push for discovery to unearth all relevant facts and evidence. **Content:** In the recent case of *Mueller v. Lincoln National Life Insurance Company*, No. 2:23-cv-00919 WBS JDP, 2024 U.S. Dist. Lexis 14384 (E.D. Cal. Jan. 25, 2024), the United States District Court for the Eastern District of California dissected a complex claim for accidental death and dismemberment insurance benefits under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001, et seq. This case demonstrates the interplay of ERISA regulations, insurance policy interpretations, and the critical role of evidence and discovery in ERISA benefits litigation. ## Factual Background The case originated from the accident that led to the death of Kenneth Mueller. As an employee of Raley’s, a supermarket chain, Mueller was a participant in an employee life insurance policy issued and administered by Lincoln National Life Insurance Company. The policy, governed by ERISA, included provisions for accidental death and dismemberment benefits, which became the crux of the dispute following Mueller’s death in a plane crash. At the heart of the case was the interpretation of the insurance policy’s specific clauses. The policy contained an “aircraft exclusion” clause that generally excluded coverage for deaths resulting from aircraft incidents. However, an exception to this exclusion could potentially apply if the aircraft was owned or leased by the policyholder’s employer and the deceased was a “passenger” in the plane. Mueller, the decedent’s wife and the plaintiff in this case, argued that this exception should apply to her husband’s case. ## The Case was Decided Under *De Novo* Review The case was decided under a *de novo* standard of review, a method that requires the court to evaluate the matter anew, independent of previous administrative decisions. This approach is crucial in ERISA cases, as it allows for a thorough and impartial re-examination of the facts and policies in question and affords no deference to the decision of fiduciary who previously decided the claim (in this case, Lincoln). The court conducted a bench trial solely based on the papers submitted, scrutinizing the details of the case. Unlike ERISA cases decided using the more deferential “abuse of discretion” or “arbitrary and capricious standard of review” post-claims process discovery is often more widely available in many jurisdictions on *de novo* review, which is often more favorable to the plaintiff and helps to level the playing field in ERISA benefits litigation. ## The Court Decided the Deceased was a Passenger, but Rules for the Insurer The court ultimately determined that although Kenneth Mueller could be classified as a “passenger” under the policy terms, the plaintiff failed to provide sufficient evidence that the aircraft was owned or leased by Raley’s. This lack of evidence underscored a significant aspect of *de novo* ERISA litigation: the necessity of discovery. It is often not sufficient to rely only on the record created during the benefit claims process as the plaintiff has the burden of proving his or her claim by a preponderance of the evidence. > The Mueller case serves as an important reminder of the complexities inherent in ERISA litigation, and the need to aggressively push for discovery to unearth all relevant facts and evidence that could influence the outcome of the case. Discovery, the process of gathering evidence, remains vital in *de novo* review cases under ERISA. It provides an opportunity to supplement the record with crucial information that might not be present in or available during the administrative claim process. In Mueller’s case, this could have involved presenting evidence about the ownership or leasing status of the aircraft, a detail that proved to be a deciding factor in the court’s ruling. The Mueller case serves as an important reminder of the complexities inherent in ERISA litigation, especially in matters concerning life insurance and accidental death claims. It highlights the importance of not solely relying on the record created during the administrative claims process. Instead, it emphasizes the need to aggressively push for discovery to unearth all relevant facts and evidence that could influence the outcome of the case. ## The Garner Firm’s Experienced ERISA Attorneys For individuals and families navigating the complexities of ERISA benefits claims and life insurance claims, the expertise of experienced attorneys is invaluable. The Garner Firm and its [employment law attorneys](/attorney-profiles/) focus their practice on ERISA benefits claims. They offer significant experience and a deep understanding of the nuances in ERISA litigation. The firm’s team of skilled ERISA attorneys is adept at dissecting policy language, understanding the intricacies of the law, and ensuring that all necessary evidence is brought to light, significantly improving the chances of a favorable decision. If you have an ERISA life insurance or accidental death claim, [contact](https://www.garnerltd.com/contact/) our Philadelphia ERISA life insurance attorneys today. **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment, Life Insurance **Tags:** accidental death, accidental death and dismemberment, ad&d, aircraft exclusion, ERISA, ERISA lawyer, erisa litigation, life insurance, Lincoln National Life, Mueller v. Lincoln --- ### [Lawyer's ERISA Long Term Disability Claim Denied by his Firm's Client](https://www.garnerltd.com/lawyers-erisa-long-term-disability-claim-denied-by-his-firms-client/) **Published:** February 13, 2024 **Author:** Adam Garner **Content:** In an ironic and unfortunate turn of events, an attorney at one of the law firms that represents Reliance Standard Life Insurance Company and its related entities in ERISA disability benefits litigation all over the country had his claim for long-term disability (“LTD”) benefits denied by First Reliance Standard Life Insurance Company under his law firm’s ERISA-regulated employee welfare benefit plan. *See John Scott Burris, Plaintiff v. First Reliance Standard Life Ins. Co*., Defendant, No. 220CV00999CDSBNW, 2024 WL 551937 (D. Nev. Feb. 9, 2024). (Opinion also available [here](https://casetext.com/case/burris-v-first-reliance-standard-life-ins-co-7).) ## Factual Background The Plaintiff, Burris, was a defense attorney who does not appear to have represented First Reliance in ERISA litigation. He submitted a claim for LTD benefits under his law firm’s disability benefit plan, which was insured by one of the firm’s significant clients—First Reliance. Burris, suffering from chronic fatigue syndrome, argued that his condition rendered him unable to continue his profession, thus entitling him to disability benefits. Despite presenting medical evidence to support his claim, First Reliance contested the sufficiency of this evidence and denied the claim, asserting that Burris did not meet the policy’s definition of disabled. The court reviewed First Reliance’s adverse claim determination under the arbitrary and capricious standard of review, which is highly deferential to the insurer. The Court examined the medical documentation, expert opinions, and the criteria set forth by the disability plan to determine whether Burris’ condition met the threshold for total disability as defined within the policy. Ultimately, the court ruled in favor of First Reliance, granting their motion for judgment. ## Proving Claims Based on Self-Reported or Subjective Symptoms Can be Challenging When Reviewed Under Deferential Review The court’s decision was predicated on the conclusion that Burris failed to conclusively prove his total disability in accordance with the policy’s requirements because his condition was principally based on his self-reported and subjective symptoms. This ruling underscores the challenges faced by claimants in proving disability under ERISA LTD plans, highlighting the strict and often unfair standards applied by courts in evaluating such claims. Given the fact that the defendant was one of his firm’s own clients, the case serves as a poignant example of the complexities inherent in ERISA litigation and the stringent scrutiny applied to disability claims under such federally governed plans. For those encountering obstacles in their pursuit of ERISA disability benefits, *Burris* exemplifies the critical need for advocacy, perseverance, and the right legal expertise. It brings to light the invaluable role of dedicated ERISA disability lawyers who possess the knowledge and experience necessary to guide claimants through the arduous process of securing their rightful benefits. ## The Garner Firm’s Attorneys May be Able to Help Similar Claimants The Garner Firm’s attorneys are leaders in the ERISA disability benefits field, offering significant knowledge, experience, and commitment to support to those facing denied ERISA disability claims. With a profound understanding of ERISA litigation and a steadfast commitment to their clients’ success, The Garner Firm’s [attorneys](https://www.garnerltd.com/attorney-profiles/) are equipped to tackle the most challenging ERISA disability cases, ensuring that claimants receive the justice and benefits they are entitled to. If you or someone you know is struggling with an ERISA disability claim, consider [contacting The Garner Firm](https://www.garnerltd.com/contact/) for guidance and support in fighting for your rights and securing the benefits you rightfully deserve. **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** arbitrary and capricious, Burris v. First Reliance, Disability Benefits, ERISA, First Reliance Standard, long term disability, LTD --- ### [Unum Liable for ERISA Disability Benefits Due to Risk of COVID-19](https://www.garnerltd.com/unum-liable-for-erisa-disability-benefits-due-to-risk-of-covid-1/) **Published:** August 21, 2024 **Author:** Adam Garner **Content:** ## How a Recent ERISA Case Against Unum Could Impact Your Long-Term Disability Claim If you’ve been denied long-term disability (LTD) benefits by your insurance company, you’re not alone. Navigating the complex world of disability insurance can be overwhelming, especially when you’re dealing with serious health conditions that prevent you from working. This is where understanding your rights under the Employee Retirement Income Security Act (ERISA) and having an experienced ERISA lawyer on your side can make all the difference. A recent case against Unum Life Insurance Company provides a great example. ## A Recent Victory for ERISA Participants: Maureen Downes vs. Unum [A recent court decision](https://law.justia.com/cases/federal/district-courts/california/candce/3:2023cv01643/410746/37/) demonstrates that there is hope for individuals struggling to obtain the long-term disability benefits they deserve. In the case of *Maureen Downes v. Unum Life Insurance Company of America*, the court ruled in favor of a plaintiff who was denied LTD benefits by Unum, one of the largest disability insurance providers in the country. This case sheds light on the importance of understanding your rights under ERISA and the need for expert legal representation when dealing with a denial of benefits. ## Background of the Case Maureen Downes, a 70-year-old pediatric physician, had been in practice for over forty years when she was forced to stop working in early 2020 due to a combination of serious health issues. Her medical problems were so severe that her doctors advised her not to return to work, especially as the COVID-19 pandemic was rapidly escalating. Downes applied for long-term disability benefits under her employer’s ERISA-regulated insurance plan, which was administered by Unum. Despite her significant health risks and the advice of her doctors, Unum denied her claim. They argued that while she was at high risk for severe COVID-19 complications, her condition didn’t prevent her from performing her job, especially if she used personal protective equipment (PPE) and followed other preventive measures. ## The Court’s Decision: What It Means for You The court disagreed with Unum’s assessment. After reviewing the case, the judge ruled that Downes was indeed disabled under the terms of her insurance policy. The court recognized that her underlying health conditions, combined with the risks posed by the COVID-19 pandemic, constituted a legitimate disability. The judge also highlighted that, as a pediatric physician, Downes was regularly exposed to patients who might have been infected with COVID-19, further increasing her risk of severe illness or death. This ruling is significant because it is persuasive authority for other long-term disability claims, particularly for those who face heightened health risks due to their occupation or who face a serious “risk of relapse” of a previously-disabling condition if they were to return to work. It shows that courts are willing to consider the unique circumstances of each case, including the specific dangers posed by working during a global pandemic. ## Why This Case Matters to You If you’re dealing with a long-term disability and your claim has been denied by your insurance company, this case demonstrates that you have options. Insurance companies like Unum often deny claims, arguing that policyholders are not sufficiently disabled to qualify for benefits. However, the *Downes* case illustrates that courts can and do overrule these decisions when the evidence shows that a disability exists under the policy’s terms. This decision also underscores the importance of having a knowledgeable ERISA lawyer on your side. ERISA is a complex area of law, and insurance companies often rely on this complexity to justify denying valid claims. An experienced ERISA attorney can help you understand your rights, gather the necessary medical evidence, and present a compelling case that maximizes your chances of receiving the benefits you deserve. ## The Importance of Seeking Legal Help If you’ve been denied long-term disability benefits, it’s crucial to act quickly. Under ERISA, there are strict deadlines for filing an appeal, and missing these deadlines can mean losing your right to challenge the denial. For LTD claims, you typically have 180 days from the date you receive your adverse claim determination to submit your ERISA appeal. Under ERISA, you generally must appeal an adverse claim determination before you are able to pursue it under Section 502(a) of ERISA in court. At The Garner Firm, Ltd., we devote the majority of our practice to representing individuals in ERISA claims, generally, and ERISA long-term disability claims, specifically. Our [attorneys](https://www.garnerltd.com/attorney-profiles/) have decades of experience litigating ERISA claims. We understand the tactics insurance companies use to deny claims, and we know how to fight back. ## Contact The Garner Firm, Ltd. Today Don’t let an insurance company like Unum deny you the benefits you deserve. If you’ve been denied long-term disability benefits or are struggling with an ongoing LTD claim, [contact](https://www.garnerltd.com/contact/) The Garner Firm, Ltd. today at (215) 645-5955. Our experienced ERISA [lawyers](https://www.garnerltd.com/attorney-profiles/) are here to help you navigate the claims process, fight denials, and secure the benefits you’re entitled to. Your health and your future are too important to leave to chance. Reach out to us for a free consultation, and let us help you get the financial support you need to move forward with your life. **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** COVID-19, Disability Benefits, Downes v. Unum, ERISA, long term disability, LTD, unum --- ### [Strong Medical Evidence Is Critical to Long-Term Disability Claim](https://www.garnerltd.com/strong-medical-evidence-is-critical-to-long-term-disability-claim/) **Published:** February 1, 2025 **Author:** Adam Garner **Content:** If you are facing a **long-term disability (LTD)** denial from your insurance company, you’re not alone. Insurers frequently deny valid claims, forcing claimants into a long and frustrating appeals process. Fortunately, federal courts sometimes step in to hold them accountable. A recent case, [***Dime v. Metropolitan Life Insurance Company***, No. C24-0827-JCC (W.D. Wash. Jan. 29, 2025)](https://casetext.com/case/dime-v-metro-life-ins-co-2/?q=Dime%20v.%20Metropolitan%20Life%20Insurance%20Company%2C%20No.%20C24-0827-JCC%20(W.D.%20Wash.%20Jan.%2029%2C%202025)&sort=relevance&p=1&type=case&resultsNav=false), is a perfect example of how can courts apply **ERISA** protections to ensure claimants receive the benefits they deserve. If you’re struggling with a denied LTD claim, this case could provide insight into how an **ERISA disability lawyer** can help you fight back. ## **Case Summary** The plaintiff worked as a **Director of Administration** for a wealth management firm. In 2023, she developed **severe chronic pain** that made it impossible to work. Her condition required frequent rest periods, and she was unable to sit for prolonged periods—an essential part of her job. She applied for **long-term disability benefits** through her employer’s insurance provider, **Metropolitan Life Insurance Company (MetLife)**, which administers the benefits under an **ERISA-governed plan**. Despite strong medical evidence supporting her disability, **MetLife denied her claim**. The insurer argued that she could still perform her job with a sit/stand desk, despite clear evidence that her pain prevented her from sitting or standing for the required duration. After exhausting MetLife’s internal appeals process, **Dime took her case to federal court**. ## **The Court’s Holding: MetLife Wrongfully Denied LTD Benefits** After reviewing the case *de novo*, the **United States District Court for the Western District of Washington** ruled in favor of Dime, finding that **MetLife wrongfully denied her LTD benefits**. The court made several **critical findings**: ### 1. **The Court Gave Signficant Weight to Dime’s Treating Physician’s Opinion** One of the key issues in the case was the weight given to **Dime’s treating physician, Dr. Penny Li**, who had been managing her condition for several years. Dr. Li repeatedly documented that: - Dime could not sit for more than **30 minutes at a time** without needing to lie down for **at least an hour** to recover. - She could not stand for more than **20 minutes at a time** before experiencing severe pain. - Even with an **adjustable sit/stand desk**, she **could not work a full-time schedule** due to her pain. MetLife **disregarded** Dr. Li’s findings and relied instead on **independent physician consultants (IPCs)** who never examined Dime in person. These IPCs concluded that she was capable of working, despite overwhelming evidence to the contrary. The court **rejected MetLife’s selective reliance** on its hired experts and instead gave **significant weight to Dr. Li’s findings**, noting that she had been treating Dime since **2020** and had firsthand knowledge of her condition. ### **2. The Ninth Circuit’s Bright-Line Rule on Sedentary Work Applied** Another **key legal issue** in the case was whether Dime could perform her job, which MetLife classified as “**sedentary work**.” Under **Ninth Circuit law**, an employee who **cannot sit for more than four hours in an eight-hour workday** **cannot perform sedentary work**. This Ninth Circuit established this **bright-line rule** in **Armani v. Northwestern Mutual Life Insurance Co.**, where the court ruled that an individual who cannot sit for at least **half the workday** cannot meet the definition of sedentary work. In Dime’s case: - **MetLife’s own reviewing physician** admitted that she could only sit for up to **four hours per day**—which is the **absolute minimum** for sedentary work. - However, **Dr. Li’s evaluation** indicated that **Dime could not even sit for four hours total** in a workday, as she required long breaks to lie down. - The court ruled that **Dime was disabled under the Ninth Circuit’s standard** and that MetLife’s decision **violated established ERISA case law**. ### **3. MetLife Ignored Critical Evidence Supporting Disability** MetLife’s denial was based largely on purported **independent medical reviewers** who never examined Dime in person and who are not independent in that they are paid (directly or indirectly) by the insurer. The court found that MetLife: - **Cherry-picked evidence** that supported denial while ignoring **strong medical documentation** confirming Dime’s disability. - **Dismissed Dr. Li’s opinion** despite her long treatment history with Dime. - **Overlooked statements from Dime’s employer**, which confirmed that her job **required extensive sitting**—more than she was capable of. Ultimately, the court ruled that **Dime was disabled under the terms of the LTD policy** and ordered MetLife to **pay her benefits**. ## **Why This Case Matters for LTD Claimants** If you’re dealing with an **ERISA disability claim denial**, this case provides several important takeaways: ### **1. Your Treating Physician’s Opinion Matters** - Insurance companies frequently rely on **hired medical consultants** to justify denials. However, the courts sometimes **give more weight to the doctor who has been treating you over time**—especially if their records are consistent and well-documented. - At a minimum, your physician must support your disability claim through your medical records and, sometimes, a clear and detailed narrative explanation as to why you are disabled. - If your healthcare provider does not support your disability claim, you can assume that the insurer’s consultants will not support it either. ### **2. The Ability to Sit for At Least Four Hours Per Day Is Crucial** **Sedentary Occupations** - If your insurance company claims you can do sedentary work, **challenge them on this point**. - If you **cannot sit for at least four hours per workday**, **Ninth Circuit law says you are disabled** and **entitled to LTD benefits**. - If you cannot sit for at least six hours out an eight-hour day, many courts have determined that you cannot perform sedentary work. ### **3. Insurance Companies Will Look for Any Reason to Deny Your Claim** - Even if you have strong medical evidence, insurers may **cherry-pick records, downplay symptoms, or ignore key reports**. - Often your medical records and the opinions of your healthcare providers may be taken out of context or misrepresented to justify an ERISA disability claim denial. - If your claim is denied, **an experienced ERISA lawyer can help you fight back**. - Your ERISA disability appeal is a critical time to engage an attorney and build a detailed record to support your long-term disability claim. ## **What to Do If Your LTD Claim Is Denied** If your **long-term disability claim** has been denied, don’t give up. **Insurance companies frequently deny valid claims** in hopes that claimants will walk away. But as this case shows, **you have the right to challenge an unfair denial—and win**. At **The Garner Firm**, **Ltd.** we devote a significant portion of our practice to handling[ **ERISA disability cases**](https://www.garnerltd.com/practice-areas/long-term-disability/) and know how to take on big insurance companies like MetLife. If you’re struggling with a disability claim denial, we can help you fight for the benefits you deserve. ### **📞 Call us today for a free consultation!** **📞 (215) 645-5955 | 🌐 www.garnerltd.com** **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** Dime v. MetLife, Disability Benefits, ERISA, long term disability, LTD, medical evidence, MetLife --- ### [Court Awards Nearly $200,000 in Fees After Settlement of ERISA Life Insurance Dispute](https://www.garnerltd.com/court-awards-nearly-200000-in-fees-after-settlement-of-erisa-life-insurance-dispute/) **Published:** March 13, 2025 **Author:** Adam Garner **Content:** Navigating the complexities of life insurance claims under the Employee Retirement Income Security Act (ERISA) can be daunting. The recent case of *[Thomas R. v. Hartford Life & Accident Insurance](http://chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://cases.justia.com/federal/district-courts/new-york/nysdce/1:2021cv01388/554435/117/0.pdf?ts=1741697782)* sheds light on the challenges beneficiaries face when seeking the benefits they are entitled to under ERISA-governed plans. This case underscores the importance of having experienced legal representation to advocate for your rights. # The Case Overview In *Thomas R. v. Hartford Life & Accident Insurance*, the plaintiffs, Thomas R. and his guardian, Gino F., sought to recover benefits under life insurance plans provided by Hartford Life & Accident Insurance Company. These plans were part of an employee welfare benefit plan governed by ERISA. The case revolved around whether the coverage for Tara R., the insured and Thomas R.’s mother, had commenced before her untimely passing. The court found that the terms of the insurance plans were ambiguous, leading to disputes over key definitions such as “Full-time Active Employee” and the “Date of Hire.” Despite the challenges, the plaintiffs achieved a settlement with Hartford, though the issue of attorney’s fees remained contested. Ultimately, the court awarded the plaintiffs $194,756.58 in attorney’s fees and $518.44 in costs, recognizing their success in the case. # Key Takeaways for Beneficiaries This case highlights several critical aspects of ERISA life insurance claims: 1\. Ambiguity in Plan Terms: Insurance policies often contain complex and ambiguous language. In this case, the court noted that both parties’ interpretations of the terms were reasonable, which prolonged the litigation. 2\. Importance of Documentation: The plaintiffs relied on detailed records, including benefits enrollment forms and employment documents, to support their claim. Proper documentation is crucial in ERISA cases. 3\. Legal Expertise Matters: The plaintiffs were represented by experienced ERISA attorneys who navigated the intricate legal and procedural hurdles, ultimately securing a favorable outcome. # How The Garner Firm Can Help At The Garner Firm, Ltd., we specialize in representing clients in ERISA life insurance claims. We understand the emotional and financial toll these disputes can take on families. Our team is dedicated to providing compassionate and effective legal representation to ensure you receive the benefits you deserve. ## Why Choose Us? - Expertise in ERISA Law: With years of experience handling ERISA cases, we have the knowledge and skills to tackle even the most complex disputes. - Client-Centered Approach: We prioritize your needs and work tirelessly to achieve the best possible outcome for your case. - Proven Track Record: Our firm has successfully represented numerous clients in life insurance and other ERISA-related claims. ## Take Action Today If you or a loved one are facing challenges with an ERISA life insurance claim, don’t navigate this journey alone. Contact The Garner Firm, Ltd. today for a consultation. Let us help you secure the benefits you are entitled to and provide the support you need during this difficult time. Call us at (215) 645-5955 today to get started. Your case matters, and we are here to fight for you. **Categories:** (ERISA) Litigation, Employee Benefits, Life Insurance **Tags:** attorney's fees, denial of benefits, employee welfare benefit plan, ERISA, erisa litigation, life insurance, Thomas v. Hartford --- ### [Magistrate's Recommendation Criticizes Lincoln's Denial of ERISA AD&D Benefits](https://www.garnerltd.com/magistrates-recommendation-criticizes-lincolns-denial-of-erisa-add-benefits/) **Published:** May 6, 2025 **Author:** Adam Garner **Content:** In a recent ERISA decision, Magistrate Judge Jason B. Libby recommended that a District Court overturn Lincoln National Life Insurance Company’s denial of Accidental Death & Dismemberment (AD&D) benefits. The recommendation, issued in Sewell v. The Lincoln National Life Insurance Company, sheds important light on common ERISA litigation issues, particularly focusing on the abuse of discretion standard, evidence evaluation, and policy exclusions related to alcohol use. ## The Background of Sewell v. Lincoln The case stems from a tragic accident on August 28, 2021, when Timothy Sewell, an insurance professional and Navy veteran, suffered a devastating spinal injury resulting in quadriplegia. Sewell was injured during a fishing trip in Port Aransas, Texas, when he dove into unexpectedly shallow water and fractured his cervical spine. Sewell filed a claim under his employer’s AD&D insurance plan administered by Lincoln, an ERISA-governed plan. Lincoln denied his claim, citing a policy exclusion related to alcohol intoxication. The exclusion invoked a presumption of intoxication due to Sewell’s hospital blood test result indicating a blood alcohol concentration (BAC) of 0.222%, nearly triple the legal limit for driving in Texas. ## Disputed Evidence and Expert Opinions At the heart of the litigation was the reliability of the BAC test result. Sewell and eyewitnesses testified consistently that he exhibited no signs of intoxication throughout the day. The affidavits highlighted that Sewell consumed only six beers over several hours, supplemented with food and non-alcoholic beverages, contradicting the BAC results indicating severe intoxication. Lincoln supported its denial primarily through expert reports that solely relied upon the hospital’s blood test results. Lincoln’s experts argued that the high BAC indicated significant impairment that contributed directly to Sewell’s accident. Conversely, Sewell presented substantial rebuttal evidence, including expert toxicologist Dr. Thomas Arnold’s testimony asserting the hospital test was fundamentally flawed and inaccurate. ## Magistrate’s Critique: Abuse of Discretion Judge Libby conducted a detailed analysis under the abuse of discretion standard, customary in ERISA cases when policy administrators have discretionary authority. Despite the deferential standard favoring plan administrators, Libby found Lincoln’s decision arbitrary, capricious, and unsupported by substantial evidence. ### Key Issues Identified by Judge Libby: 1. **Misapplication of Policy Exclusion**: Libby emphasized that Lincoln improperly treated the presumption of intoxication as conclusive rather than rebuttable. The recommendation stressed that a presumption under ERISA does not end the inquiry—claimants can present evidence to rebut such presumptions, which Sewell effectively provided. 2. **Ignoring Witness Testimony**: Lincoln summarily dismissed multiple eyewitness accounts supporting Sewell’s clear-headedness and physical coordination at the time of the accident. This dismissal, according to Libby, amounted to ignoring critical factual evidence, a serious error under ERISA. 3. **Conflict of Interest**: Lincoln’s dual role as plan administrator and payer created an inherent conflict of interest. While Lincoln argued its internal processes mitigated this conflict, Judge Libby found the conflict palpable in the record, evidenced by Lincoln’s selective consideration of evidence and reliance on long-term consultants whose impartiality appeared compromised. 4. **Flawed Expert Opinions**: The Magistrate criticized Lincoln’s reliance on expert reports that lacked critical engagement with contradictory facts. The defense experts dismissed substantial eyewitness evidence without valid justification, undermining the credibility and thoroughness of Lincoln’s evidentiary basis. ## Lessons for ERISA Practitioners and Claimants This case underscores vital considerations for both claimants and attorneys navigating ERISA AD&D claims: - **Policy exclusions** involving presumptions (like intoxication) are not absolute. Claimants must proactively offer substantial rebuttal evidence, as Sewell effectively demonstrated through credible eyewitnesses and expert testimony. - **Administrators’ evidentiary duties** are significant. ERISA plan administrators must actively and meaningfully engage with all credible evidence provided. Ignoring or summarily dismissing claimant evidence can constitute an abuse of discretion. - **Conflict of interest concerns** remain central. Practitioners must scrutinize plan administrators’ decisions for evidence of bias, particularly when decisions heavily favor the financial interests of insurers. ## Conclusion and Next Steps Judge Libby’s recommendation, if adopted, sends a powerful message about the evidentiary standards ERISA administrators must meet. The Magistrate’s findings reinforce that ERISA’s protective purpose requires genuine impartiality and a full, fair review of all evidence. For attorneys and individuals involved in AD&D or other ERISA-related claims, this recommendation illustrates the importance of vigorously contesting unsupported denials based on questionable policy exclusions. It also serves as a cautionary tale for insurers like Lincoln, highlighting the potential consequences of inadequately supported benefit denials. As Sewell v. Lincoln progresses, attorneys and claimants should closely monitor final district court decisions and potential appeals, which may further clarify the responsibilities and limits of ERISA administrators. **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment **Tags:** abuse of discretion, accidental death and dismemberment, ad&d benefits, ERISA, erisa litigation, Lincoln National Life, Sewell v. Lincoln --- ### [Standing Up for Workers in ERISA Disability and Retirement Claims: Insights from Adam Garner](https://www.garnerltd.com/standing-up-for-workers-in-erisa-disability-and-retirement-claims-insights-from-adam-garner/) **Published:** June 9, 2025 **Author:** Adam Garner **Content:** When your **[long-term disability (LTD)](https://www.garnerltd.com/practice-areas/long-term-disability/)** claim is denied or your retirement benefits are in dispute, it’s more than just a paperwork issue—it’s your future at stake. At [The Garner Firm](https://www.garnerltd.com), we help workers across the country enforce their rights under the **Employee Retirement Income Security Act (ERISA)**. Our experienced attorneys focus on **ERISA disability claims**, **LTD appeals**, and **retirement plan disputes**. In a recent video, firm founder **[Adam Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/)** explains our client-centered approach to handling complex benefit litigation. ## Our ERISA Practice: Disability and Retirement Benefits We represent clients in a full spectrum of **[ERISA litigation](http://garnerltd.com/practice-areas/erisa-litigation/)**, with special focus on: ### Long-Term Disability (LTD) Denials and Appeals - Denied or terminated LTD benefits - “Own occupation” vs. “any occupation” disputes - **LTD appeals** and administrative reviews - Federal lawsuits under ERISA § 502(a) - Offset and overpayment issues Insurers and other plan fiduciaries often deny valid claims—sometimes without properly considering medical records or plan language. We help clients navigate tight deadlines and present a strong case at every stage. ### Retirement and Pension Benefit Disputes - Errors in benefit calculations or eligibility - Early retirement and lump sum payment disputes - Claims under defined benefit and defined contribution plans - Breach of fiduciary duty under ERISA Whether it’s a denied **pension claim** or a severance dispute, we bring clarity to complex benefit issues—and results to our clients. ## Why Clients and Referring Attorneys Trust The Garner Firm Adam Garner is a nationally respected **ERISA disability attorney**. We routinely accept **referrals in ERISA LTD appeals**, retirement benefit cases, and fiduciary breach litigation. Attorneys and clients trust us for our: - Deep understanding of **ERISA procedures and regulations** - Litigation experience in federal courts across the country - Proven results in disability and pension litigation - Clear, honest, and responsive communication ## If Your ERISA Disability Claim Was Denied, We Can Help The **ERISA appeals process** is time-sensitive. If your long-term disability benefits were denied or your retirement benefits are at risk, don’t delay. [Contact The Garner Firm today](https://www.garnerltd.com/contact/) to schedule a consultation or discuss a referral. **📞 Phone:** [(215) 645-5955](tel:2156455955) **🌐 Website:** [www.garnerltd.com](https://www.garnerltd.com) **📩 Contact:** [Request a Free Consultation](https://www.garnerltd.com/contact/) ERISA attorney, ERISA disability, LTD appeal, ERISA lawyer Philadelphia, long-term disability denial, pension plan dispute, ERISA LTD benefits, disability insurance appeal, ERISA litigation lawyer **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Long Term Disability **Tags:** Adam Garner, Disability Benefits, disability benefits attorney, ERISA, erisa attorney, ERISA disability claims, ERISA lawyer, erisa litigation, long term disability, long term disability attorney, LTD, retirement plan disputes --- ### [ERISA & LTD: How Severance Agreements Risk Your Benefits](https://www.garnerltd.com/erisa-ltd-how-severance-agreements-risk-your-benefits/) **Published:** August 15, 2025 **Author:** Adam Garner **Content:** When you are leaving a job, severance agreements can feel like a welcome financial cushion. But what if signing that severance agreement could unintentionally forfeit your right to ERISA long-term disability (LTD) benefits worth hundreds of thousands of dollars? This hidden risk is more common than you think. Most people focus on the dollar amount in severance agreements, give the legal language a quick scan, and sign—without realizing they may be signing away critical disability benefit rights. ### Real-World Consequences: Two Critical ERISA Cases This isn’t just a hypothetical risk. A recent federal court decision, *[Schuyler v. Sun Life Assurance Company](https://ww3.ca2.uscourts.gov/decisions/isysquery/894d077a-df01-4ded-85be-cda63e63e756/16/doc/23-498_complete_opn.pdf)*, No.23-498 (2d Cir. Aug. 14, 2025) shines a bright light on this very issue, offering a crucial lesson for anyone signing severance agreements while dealing with a serious medical condition. This case, when contrasted with *Thomas v. Prudential*, highlights how a few simple questions can make all the difference in protecting your ERISA rights. If you are navigating a job exit and have a long-term disability (LTD) claim, understanding these cases is essential. ### The Hidden Trap: General Releases in Severance Agreements At the heart of nearly every severance agreement is a “General Release” clause. This is the section where you agree not to sue your employer for any reason related to your employment. On its face, this seems straightforward. However, these releases are often written in incredibly broad terms. They typically state that you release the company and its “parents, subsidiaries, related or affiliated entities, agents, insurers, and plan administrators” from “any and all claims.” That broad language is the trap. Your company’s long-term disability insurer, like Sun Life or Prudential, is often considered an “insurer” or an “affiliated entity” under the terms of these agreements. Without careful review, you could sign away your right to pursue a legitimate ERISA disability claim against the insurance company—even if that claim is your financial lifeline. ### The Case That Changed the Conversation: *Schuyler v. Sun Life* Kristen Schuyler was an employee at Benco Dental Supply Company when she suffered a traumatic brain injury. She eventually went on medical leave and filed a claim for long-term disability benefits with Sun Life, the insurer for Benco’s ERISA-governed LTD plan. While her claim was pending, she negotiated her exit from the company. Benco presented her with a severance agreement containing a standard, broad general release. But Ms. Schuyler did something smart: she asked questions. Concerned about how the agreement would affect her disability claim, she specifically asked Benco’s attorney about it. In writing, Benco’s counsel gave her two critical assurances: 1. “Sun Life is a separate and independent third-party entity in charge of LTD.” 2. “…this agreement should have **absolutely no effect** on your ability to appeal your LTD…” Relying on these statements, Ms. Schuyler signed the agreement. When Sun Life later denied her appeal, she filed a lawsuit under ERISA. One of Sun Life’s defenses was simple: it argued Ms. Schuyler had already signed away her right to sue them. The insurer claimed it was an “related or affiliated entity” covered by Benco’s severance agreement. The trial court agreed and entered summary judgment for Sun Life. The U.S. Court of Appeals for the Second Circuit disagreed. The court didn’t just look at the words on the page; it conducted a “totality of the circumstances” analysis to determine if Ms. Schuyler had *knowingly and voluntarily* waived her rights, a key element to a valid release. The court found that Benco’s explicit, written assurances were the most important factor. Because her employer told her the release would not impact her disability claim, she could not have “knowingly” signed away her rights to that claim. The court ruled in her favor, reversed the entry of judgment in favor of Sun Life and remanded her ERISA LTD claim to the District Court. ### A Different Story: When the Release Is a Problem The outcome in *Schuyler* is a huge victory for employees, but it’s not always how these disputes end. Consider the contrasting case of *Thomas v. The Prudential Insurance Company of America*, No. 17-4522 (E.D. Pa. May 8, 2018). Thomas signed a severance agreement with his employer that released claims against the company and its “insurers” and “plan fiduciaries.” Prudential was the insurer for the company’s long-term disability plan. Unlike Ms. Schuyler, there was no evidence before the court that Mr. Thomas asked his employer whether the release would apply to his disability benefits. Making matters worse, his severance agreement contained a specific exception, or “carve-out,” for his “vested benefits under a retirement plan governed by ERISA.” However, it included no such carve-out for long-term disability benefits. When Mr. Thomas later sued Prudential for denying his LTD claim, Prudential filed a counterclaim, accusing him of breaching the severance agreement by filing the lawsuit. Thomas moved to dismiss Prudential’s counterclaim, arguing that the release didn’t apply to the insurance company. The court denied the motion to dismiss. It found that Prudential’s argument was plausible and survived the motion to dismiss. The court focused on the plain language of the contract: since Prudential was clearly an “insurer,” the release appeared to apply to them. The court also noted that because the agreement specifically carved out an exception for retirement benefits but not for disability benefits, it was reasonable to infer the parties intended to release the disability claim. While this was not a final ruling on the merits, it allowed Prudential’s breach of contract counterclaim to proceed. ### Key Lessons from *Schuyler* and *Thomas* The difference between these two cases provides a clear roadmap for anyone facing a similar situation: 1. **Never Assume.** Do not assume that a general release in a severance agreement excludes your ERISA long-term disability claim. The default assumption should be that it *does* include it unless stated otherwise. 2. **Ask Questions and Get It in Writing.** As Schuyler’s case proves, asking direct questions about the impact of the release on your LTD benefits can save your claim. A simple email to your employer’s representative asking for clarification can become a powerful piece of evidence, but it should not be your only evidence. 3. **Negotiate a Specific “Carve-Out.”** The safest and most effective strategy is to negotiate a specific provision in the severance agreement that explicitly excludes your disability benefits from the release. 4. **Consult an Experienced ERISA Attorney.** Severance agreements are legally binding contracts with serious financial implications. Before you sign anything, especially if you have a potential or pending long-term disability claim, it is crucial to have the document reviewed by an attorney who has significant experience in ERISA and employment law. An experienced attorney can spot these hidden traps and help you negotiate the protections you need. ### Protect Your Future Your health and financial security are too important to leave to chance. The *Schuyler* decision provides a powerful shield for employees, but only for those who are proactive. By understanding the risks hidden in severance agreements and taking the right steps, you can ensure that the dotted line you sign leads to a secure future, not a forfeited one. **If you are leaving your job and have questions about a severance agreement or a long-term disability claim, [contact](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") The Garner Firm, Ltd. today online or at (215) 645-5955. [Our experienced ERISA attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") regularly negotiate [severance agreements](https://www.garnerltd.com/practice-areas/severance-benefits/ "Severance Benefits Attorneys") under similar circumstances and are here to help you navigate these complex issues and protect your rights.** ## Follow us on TikTok > [@garnerfirmltd](https://www.tiktok.com/@garnerfirmltd?refer=embed "@garnerfirmltd") It’s been a bit since I posted. If you have a severance agreement and an ERISA disability claim, get the advice of an experience ERISA attorney before signing the agreement. #[\#erisa](https://www.tiktok.com/tag/erisa?refer=embed "erisa")\#[\#ltdlawyers](https://www.tiktok.com/tag/ltdlawyers?refer=embed "ltdlawyers")\#[\#erisalawyers](https://www.tiktok.com/tag/erisalawyers?refer=embed "erisalawyers")\#[\#severance](https://www.tiktok.com/tag/severance?refer=embed "severance") [♬ original sound – The Garner Firm, Ltd.](https://www.tiktok.com/music/original-sound-7538900549899406093?refer=embed "♬ original sound - The Garner Firm, Ltd.") **Categories:** (ERISA) Litigation, Disability Benefits --- ### [ERISA ESOP Litigation Dismissed: Key Retirement Takeaways](https://www.garnerltd.com/erisa-esop-litigation-dismissed-key-retirement-takeaways/) **Published:** August 25, 2025 **Author:** Adam Garner **Content:** A recent federal court decision has highlighted a key principle in retirement litigation. All participants in Employee Stock Ownership Plans (ESOPs) and their legal counsel must understand this: alleging a company overpaid for its stock is not enough to sustain a lawsuit. Moreover, the ruling in [Taylor v. BDO USA, P.C.](https://cases.justia.com/federal/district-courts/massachusetts/madce/1:2025cv10128/279869/44/0.pdf) demonstrates an important requirement. Plaintiffs in an ERISA class action must show a concrete, personal financial injury to have their day in court. Furthermore, this decision serves as a crucial reminder of the pleading standards that ESOP litigation requires. Additionally, it highlights the need for experienced ERISA lawyers who can navigate these complex cases. ## Background of the *Taylor v. BDO* ERISA Litigation The case took place in the U.S. District Court for the District of Massachusetts. It involved Tristin Taylor, a participant in the BDO USA Employee Stock Ownership Plan (BDO ESOP). To clarify, an ESOP is a type of employee benefit plan that gives workers ownership interest in the company through shares of stock. Subsequently, Taylor filed a putative ERISA class action on behalf of himself and other ESOP participants. He targeted BDO, its Board of Directors, its CEO, and the ESOP Trustees. The lawsuit stemmed from a 2023 transaction where the newly created BDO ESOP purchased approximately 42% of BDO’s outstanding stock from the company’s principals for around $1.3 billion. This transaction created a ‘leveraged ESOP,’ meaning the retirement plan itself took on the $1.3 billion in debt to acquire the shares. The loan, provided by Apollo Global Management affiliates at a substantial 11.36% interest rate, placed a massive liability directly on the ESOP. Taylor’s central claim was that the defendants, who are fiduciaries under the [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/employee-retirement-income-security-act), breached their duties by causing the ESOP to overpay for the BDO stock. ## Allegations of an Inflated Stock Value The plaintiff’s complaint alleged that the defendants orchestrated the transaction to benefit the company’s principals at the expense of the employees’ retirement plan. According to the lawsuit, the valuation of BDO stock, conducted by independent trustee State Street, was artificially inflated due to several key factors: - **Misleading Financial Information:** The complaint alleged that BDO employees were pressured to mischaracterize client prepayments as immediate revenue, which provided a misleadingly rosy picture of the company’s financial health to the valuator. - **Concealment of Business Problems:** The lawsuit contended that the valuation failed to account for a known deterioration in the quality of BDO’s audit work, an issue documented by the Public Company Accounting Oversight Board (PCAOB). - **Unreasonable Financing Terms:** The plaintiff argued that the 11.36% interest rate on the loan used to finance the stock purchase was “unreasonably high,” further damaging the ESOP. - **Lack of Control Discount:** The complaint asserted that the $1.3 billion price tag did not properly apply a discount for the fact that the ESOP was acquiring a non-controlling, minority interest in the company. Based on these allegations, Taylor brought claims for engaging in prohibited transactions and breaching fiduciary duties under **ERISA**, seeking monetary relief and the removal of the current ESOP Trustees. ## The Court’s Decision: The Critical Importance of “Injury in Fact” Despite the detailed allegations, the court dismissed the entire lawsuit. The decision did not hinge on the merits of whether the fiduciaries had acted improperly. Instead, it was dismissed on a crucial threshold issue: **standing**. Under Article III of the U.S. Constitution, a plaintiff must show they have suffered an “injury in fact”—a harm that is both “concrete and particularized.” In the context of **retirement litigation**, this means a plaintiff must plausibly show that the alleged misconduct led to a tangible financial loss in their own retirement account. Merely alleging that a plan asset lost value is not enough; the plaintiff must connect that loss to their own bottom line. The court in *Taylor* found that the complaint fell short of this standard. Judge Richard G. Stearns noted that the complaint “points to no instance in which a tangible loss of value was actually incurred by Taylor.” The court concluded that without a clear allegation of financial harm that affected the plaintiff “in a personal and individual way,” the claim of injury was merely “speculation.” The court also found the complaint lacked plausible allegations that the independent trustee, State Street, had performed deficiently or that the named BDO defendants had personally and improperly influenced State Street’s valuation. ## Key Takeaways for ESOP Participants and Fiduciaries The dismissal of the *Taylor v. BDO* **ESOP litigation** provides critical lessons for employees, plan fiduciaries, and legal practitioners in the **ERISA** space. 1. **Allegations Require Specificity and Concrete Harm:** It is not enough to simply claim that a plan overpaid for stock. A successful **ESOP class action** complaint must contain sufficient factual matter to show that the overpayment resulted in a concrete financial loss to the individual participants bringing the suit. This often requires pleading specific facts about the decline in value of a participant’s account. 2. **The Role of Independent Trustees is Key:** The court noted the absence of any plausible allegations that the independent trustee failed to perform its due diligence. This highlights the importance of fiduciaries retaining qualified, independent experts for ESOP transactions and properly documenting their evaluation process. 3. **Standing Can be a High Hurdle in ERISA Litigation:** This case is a powerful example of how **ERISA litigation** can be stopped before it even begins if plaintiffs cannot meet the constitutional requirements for standing. A skilled **ERISA lawyer** understands the necessity of pleading a direct and measurable injury from the outset. Navigating the complexities of **ERISA** requires deep expertise and a thorough understanding of both the substantive law and procedural requirements. Cases like this are why having the right legal team is paramount. ## The Garner Firm: Leaders in ERISA and Retirement Litigation Successfully prosecuting an ERISA class action requires a legal team with a proven track record. [Adam Garner](https://www.garnerltd.com/attorneys/adam-garner/), of The Garner Firm, has been appointed lead counsel in several major ERISA class actions, securing significant recoveries for employees and retirees whose retirement savings were compromised. If you have questions about your ESOP or believe your retirement benefits have been mismanaged, it is vital to seek experienced legal counsel. [Contact The Garner Firm](https://www.garnerltd.com/contact/) today for a confidential consultation. Our team of dedicated ERISA lawyers is here to help you understand your rights and protect your financial future. **Categories:** (ERISA) Litigation, Employee Benefits **Tags:** class action, employee benefits, ERISA, erisa litigation, ESOP, retirement, retirement benefit plan, standing, Taylor v. BDO --- ### [Second Circuit Opinion Offers Guidance on ERISA Standing](https://www.garnerltd.com/second-circuit-opinion-offers-guidance-on-erisa-standing/) **Published:** August 27, 2025 **Author:** Adam Garner **Content:** The Second Circuit’s recent decision in *[Collins v. Northeast Grocery, LLC](https://law.justia.com/cases/federal/appellate-courts/ca2/24-2339/24-2339-2025-08-18.html)* has significant implications for employees, retirees, and plan sponsors involved in ERISA litigation. The case underscores the critical importance of Article III standing in class action lawsuits brought under Section 502(a) of the Employee Retirement Income Security Act of 1974 (ERISA). For individuals seeking to protect their retirement savings, understanding the legal hurdles of standing is more crucial than ever. This blog post will delve into the *Collins* decision, its impact on ERISA litigation, and how The Garner Firm is uniquely positioned to navigate these complex legal challenges. ## The Collins Decision: A Closer Look In *Collins*, former grocery store employees filed a putative class action lawsuit against the fiduciaries of their employer-sponsored 401(k) plan. The plaintiffs alleged that the plan’s fiduciaries breached their duties of prudence and loyalty under ERISA by mismanaging the plan’s investment options. Specifically, they claimed that the fiduciaries failed to investigate the availability of lower-cost and better-performing share classes and alternative funds, and that they allowed the plan’s recordkeeper to receive excessive compensation through revenue-sharing arrangements. The central issue in the decision was whether the plaintiffs had Article III standing to bring their claims. To establish standing, a plaintiff must demonstrate that they have suffered a concrete and particularized injury that is fairly traceable to the defendant’s conduct and that is likely to be redressed by a favorable judicial decision. In the context of a defined contribution plan, such as a 401(k), this typically means showing a financial loss to the plaintiff’s individual account. The district court dismissed several of the plaintiffs’ claims for lack of standing, finding that they had not alleged any personal financial injury related to the specific investment options they were challenging. The plaintiffs had not invested in the funds that they claimed were imprudently managed, and therefore, they could not show that their own retirement accounts had been harmed. The Second Circuit affirmed the district court’s decision, holding that participants in a defined contribution plan must plausibly plead a constitutionally-cognizable individual injury to establish Article III standing. The court rejected the plaintiffs’ argument that they had standing to sue on behalf of the plan as a whole. The court also found that the plaintiffs lacked class standing because they had not suffered any individual injury and therefore could not represent the interests of absent class members who may have been harmed. ## The Implications for ERISA Litigation The *Collins* decision has significant implications for future ERISA class action lawsuits. It reinforces the principle that plaintiffs must demonstrate a direct, personal financial injury to have standing to sue. This may make it more difficult for plaintiffs to bring claims challenging the management of investment options in which they have not personally invested. For plan sponsors and fiduciaries, the *Collins* decision provides a potential defense against ERISA claims. Defendants may be able to challenge the standing of plaintiffs who have not suffered any individual financial loss, which could lead to the early dismissal of some lawsuits. However, it is important to note that the *Collins* decision does not give fiduciaries a free pass to mismanage retirement plans. Fiduciaries still have a duty to act prudently and in the best interests of all plan participants, and they can be held liable for breaches of that duty that cause financial harm to the plan. ## How The Garner Firm Can Help Navigating the complexities of ERISA litigation requires a deep understanding of the law and a strategic approach to every case. At The Garner Firm, our experienced ERISA lawyers have a proven track record of success in representing clients in a wide range of retirement plan disputes, including class action lawsuits. We have the knowledge and expertise to handle even the most complex ERISA cases, and we are committed to protecting the rights and interests of our clients. [Our attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") have extensive experience in all aspects of ERISA litigation, from benefit claim appeals, investigating and pleading claims to discovery, motion practice, and trial. We have a thorough understanding of the legal issues involved in ERISA cases, including the complex requirements of Article III standing. We work closely with our clients to develop a customized legal strategy that is tailored to their specific needs and goals. If you are a plan participant who is concerned about the management of your retirement savings, The Garner Firm may be able to help. We offer a free consultation to discuss your situation and determine whether we may be of service. ## Contact Us Today The legal landscape of ERISA litigation is constantly evolving. The *Collins* decision is just the latest example of how the courts are shaping the rights and obligations of plan participants and fiduciaries. If you have questions or concerns about your retirement plan, it is important to seek the advice of an experienced ERISA lawyer. [The attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") at The Garner Firm are here to help. We have the knowledge, experience, and dedication to guide you through the complexities of ERISA and to protect your financial future. [Contact us](/contact) today to schedule a consultation. Let us put our experience to work for you. **Categories:** (ERISA) Litigation, Employee Benefits **Tags:** 401(k) litigation, Article III standing, class action, Collins v. Northeast Grocery, erisa attorney, ERISA standing, fiduciary breach, Philadelphia, retirement plan claims --- ### [How a Settlement Agreement Can Forfeit Your ERISA Claims](https://www.garnerltd.com/how-a-settlement-agreement-can-forfeit-your-erisa-claims/) **Published:** August 28, 2025 **Author:** Adam Garner **Content:** When an employment relationship ends, it is common for an employer to offer a **severance agreement** or **settlement agreement** if certain claims have been alleged against the employer. This document, which typically provides a departing employee with a sum of money, can offer a welcome financial cushion during a period of transition. However, these agreements are not gifts; they are legally binding contracts. In exchange for payment, an employee is typically required to give up something of significant value: the right to bring legal claims against their former employer. While many employees are aware they are releasing claims for things like wrongful termination or discrimination, they are often unaware of the full, sweeping scope of the rights they are surrendering. A recent federal court decision, [Gonzalez v. JPMorgan Chase Bank, N.A.](https://law.justia.com/cases/federal/district-courts/new-jersey/njdce/2:2025cv01889/564193/41/), provides a cautionary illustration of how signing a release can inadvertently lead an individual to forfeit valuable, and potentially substantial, claims related to the mismanagement of their retirement funds under the Employee Retirement Income Security Act of 1974 (ERISA). This case underscores a critical piece of advice we give every client: never sign a severance agreement without first consulting an [experienced employment attorney](https://www.garnerltd.com/employment-law/). While many employees are aware they are releasing claims for things like wrongful termination or discrimination, they are often unaware of the full, sweeping scope of the rights they are surrendering. A recent federal court decision, *[Gonzalez v. JPMorgan Chase Bank, N.A.](https://law.justia.com/cases/federal/district-courts/new-jersey/njdce/2:2025cv01889/564193/41/)*, provides a cautionary illustration of how signing a **release** can inadvertently lead an individual to forfeit valuable, and potentially substantial, claims related to the mismanagement of their retirement funds under the Employee Retirement Income Security Act of 1974 (**[ERISA](https://www.garnerltd.com/erisa-faqs/ "ERISA Frequently Asked Questions")**). This case underscores a critical piece of advice we give every client: never sign a severance agreement without first consulting an experienced **employment attorney**. ### A Cautionary Tale: The *Gonzalez v. JPMorgan* Case The facts of the *Gonzalez* case are straightforward and, for many employees, unsettlingly familiar. Alexandro Gonzalez was a former employee of JPMorgan and a participant in the company’s 401(k) Savings Plan. In January 2025, upon the conclusion of his employment, he entered into a “Confidential Negotiated Settlement Agreement & General Release.” In exchange for a monetary payment, he agreed to settle various employment-based claims against the company. A few months later, Mr. Gonzalez filed a putative class-action lawsuit against JPMorgan under **ERISA**. He alleged that the fiduciaries of the company’s 401(k) plan had breached their duties of prudence and monitoring by investing plan assets in an underperforming stable value fund. The lawsuit, brought on behalf of all plan participants, sought to recover the investment losses the plan suffered due to this alleged mismanagement. JPMorgan responded with a motion to dismiss the lawsuit, arguing that Mr. Gonzalez had already given up his right to bring the lawsuit when he signed his **settlement agreement**. The court agreed, and the case was dismissed before it could even begin. ### The Court’s Decision: A Promise Is a Promise The U.S. District Court for the District of New Jersey focused its analysis on several key provisions within Mr. Gonzalez’s severance agreement. The document contained not only a broad “General Release” of claims but also two other critical clauses: a “Class and Collective Action Waiver” and, most importantly, a separate paragraph titled “Promise Not to Sue.” Unfortunately, the agreement’s specific terms are confidential and not publicly available. According to the court’s opinion, the plaintiff’s “Promise Not to Sue” was a specific, affirmative covenant in which Mr. Gonzalez promised not to initiate any legal action, including any claims under **ERISA**. The court found this language to be “clear and unambiguous.” In effect, Mr. Gonzalez had contractually barred himself from filing the very lawsuit he initiated. The court determined that this promise mooted his case, meaning he no longer had a live controversy for the court to resolve. By signing the agreement, he had relinquished his legal right—his “standing”—to bring these claims on behalf of the plan. His case was dismissed not because his **ERISA** allegations were weak, but because he had already contracted that right away. ### “Release” vs. “Covenant Not to Sue”: A Distinction with a Major Difference One of the takeaways from the *Gonzalez* opinion is the court’s treatment of the “Promise Not to Sue” as distinct from the general **release** provision. While these concepts are similar, their presentation in a legal document can have profound consequences. - A **Release** is typically understood as the relinquishment or extinguishment of a known or knowable claim that exists at the time the agreement is signed. - A **Covenant Not to Sue** is an affirmative promise that one party will not pursue a specific type of legal claim against another in the future. In Mr. Gonzalez’s **[severance agreement](https://www.garnerltd.com/practice-areas/severance-benefits/ "Severance Benefits Attorneys")**, the “Promise Not to Sue” was located in a separate paragraph from the general **release**. The court interpreted this structural separation as evidence of a clear intent to create a distinct and independently enforceable obligation. This seemingly minor detail in document drafting was pivotal. It allowed the court to enforce the covenant as a standalone promise, effectively blocking the courthouse doors to Mr. Gonzalez and the entire class of employees he sought to represent. An untrained eye would likely see these clauses as redundant legal boilerplate. An experienced **attorney**, however, could immediately recognize the danger the provision could have to future, unreleased claims. ### The Hidden Dangers in Your Severance Agreement The *Gonzalez* case is a reminder that a **severance agreement** is a document drafted by your employer’s lawyers for the sole purpose of protecting your employer. The language used is intentionally broad to eliminate as much future legal risk for the company as possible. When you sign a standard severance agreement, you may be waiving rights you didn’t even know you had. This includes the right to sue for breaches of fiduciary duty under **ERISA**. A fiduciary breach can have a devastating impact on your retirement savings. For example, if your 401(k) plan fiduciaries imprudently invest in excessively expensive or poorly performing funds, your account balance could be thousands, or even hundreds of thousands, of dollars lower than it should be. By signing a general **release**, you could be trading the right to recover those substantial, life-altering retirement losses for a comparatively modest severance payment. This is a trade that very few employees would knowingly make, yet it happens every day. ### Why You Must Consult an Experienced Attorney Before Signing The time to protect your rights is *before* you sign on the dotted line. Once signed, a **severance agreement** is extremely difficult to undo. The lesson from *Gonzalez* is that proactive legal counsel is not a luxury—it is a necessity. An experienced Employment attorney, and in particular one with deep knowledge of **ERISA** is incredibly important when reviewing a severance agreement. At The Garner Firm, our attorneys can provide the critical guidance you need. When reviewing a proposed severance agreement, our attorneys will: 1. **Scrutinize the Language:** We meticulously analyze every clause, identifying overly broad language, hidden waivers, and dangerous provisions like the “Promise Not to Sue” that proved fatal to the *Gonzalez* lawsuit. 2. **Negotiate Carve-Outs:** We can negotiate with your former employer to insert specific “carve-out” language into the agreement. This language explicitly preserves your right to bring certain claims, such as claims for vested retirement benefits or for breaches of fiduciary duty under **ERISA** if such a carve out may be necessary. 3. **Explain the Full Scope of Your Rights:** We ensure you understand exactly what you are giving up and what you are getting in return. We advise you on the potential value of any **ERISA** claims you may have, so you can make a fully informed decision about whether the severance payment offered is fair compensation for the rights you are being asked to surrender. 4. **Protect Your Financial Future:** Our ultimate goal is to protect your long-term financial security. We work to ensure that a short-term severance payment does not come at the cost of your hard-earned retirement savings. ### Contact The Garner Firm Today The *Gonzalez v. JPMorgan* decision is a warning to all employees. A **severance agreement** is a high-stakes legal document with lasting consequences. Signing one without a full understanding of its terms can lead to the unintentional forfeiture of your most important financial protections. [The attorneys at The Garner Firm](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") have decades of experience litigating complex employment and **ERISA** cases and counseling individuals on employee benefits and severance agreements. We have seen firsthand how carefully worded documents can strip employees of their rights. We are dedicated to ensuring that does not happen to you. If you have been offered a **severance agreement** or suspect that your 401(k) or pension plan has been mismanaged, do not sign away your rights. **[Contact](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") the experienced [ERISA attorneys](https://www.garnerltd.com/practice-areas/erisa-litigation/ "Employee Benefits (ERISA) Litigation") at The Garner Firm today for a consultation to protect your financial future.** **Categories:** (ERISA) Litigation, Employee Benefits, Severance Agreements **Tags:** ERISA, erisa attorney, erisa litigation, JPMorgan Chase, release of claims, retirement benefits, settlement agreement, severance agreement --- ### [The Epilogue: Recovering Attorneys' Fees in an ERISA Long-Term Disability Case](https://www.garnerltd.com/the-epilogue-recovering-attorneys-fees-in-an-erisa-long-term-disability-case/) **Published:** August 29, 2025 **Author:** Adam Garner **Content:** For individuals unable to work due to a serious illness or injury, a [long-term disability (LTD) insurance](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/ "ERISA Short-Term & Long-Term Disability Attorneys") policy is more than a convenience—it’s a financial lifeline. When that policy is provided by a private sector employer, it is governed by a complex federal law known as the Employee Retirement Income Security Act of 1974, or [ERISA](https://www.dol.gov/agencies/ebsa/key-topics/health-and-other-employee-benefits/disability-benefits). Unfortunately, obtaining these vital benefits can be an arduous process. Insurance companies often deny valid claims, forcing disabled individuals into a legal battle they are ill-equipped to fight alone. The threat of having to pay your attorneys’ fees is often the economic risk an insurer has when it comes to a denied ERISA LTD claim. While winning a court judgment that awards you the long-term disability benefits you are owed is a monumental victory, many claimants are surprised to learn that the fight isn’t over. A critical, and often contentious, second phase of the litigation begins: the [recovery of attorneys’ fees](https://www.law.cornell.edu/uscode/text/29/1132), costs, and interest. A recent federal court decision, *[Macalou v. First Unum Life Insurance Company](https://law.justia.com/cases/federal/district-courts/new-york/nysdce/1:2022cv10439/590837/119/)*, provides a compelling look into this process and underscores why experienced legal representation is indispensable not only for winning your case but for ensuring you are made financially whole. ### The Initial Victory: Securing Your Long-Term Disability Benefits The central issue in any ERISA LTD case is proving that you meet your policy’s specific definition of “disability.” In the *Macalou* case, the claimant, Anticia Macalou, suffered from several debilitating conditions. Her insurer, First Unum, denied her claim. After a lengthy administrative appeal process, she was forced to file a federal lawsuit. Following a bench trial, the court ruled in Ms. Macalou’s favor, finding that she had successfully proven she was disabled under the terms of her policy. The court ordered First Unum to pay her over $928,000 in past-due benefits. However, this judgment for back benefits did not account for the substantial legal fees she incurred to win her case or the interest she lost on the money that was wrongfully withheld from her. ### The Second Battle: The Fight for ERISA Attorneys’ Fees This is where the second battle began. ERISA contains a “fee-shifting” provision, which gives federal courts the discretion to award “a reasonable attorney’s fee and costs of action to either party.” The purpose of this provision is to provide access to the courts for individuals like Ms. Macalou. Without it, the staggering cost of litigating against a multi-billion dollar insurance company would prevent most people from ever challenging a wrongful denial. In *Macalou*, the court had already determined that an award of fees was appropriate, but the parties disagreed on the *amount*. Ms. Macalou’s legal team requested over $250,000 in attorneys’ fees. First Unum, as is typical for insurance carriers, objected and argued for a much lower amount. This triggered a detailed, line-by-line analysis by the court to determine what constitutes a “reasonable” fee. ### What Makes Attorneys’ Fee “Reasonable”? Courts do not simply rubber-stamp a fee request. They conduct a thorough investigation to ensure the fees are justified, a process that highlights the importance of partnering with a law firm that operates with efficiency and integrity. The analysis generally breaks down into two key components: #### 1. The Reasonable Hourly Rate A court first determines if the hourly rates charged by the attorneys and paralegals are reasonable. This is not based on what the law firm alone says it is worth, but on the prevailing market rates in the community for attorneys of comparable skill, experience, and reputation. In *Macalou*, the plaintiff’s attorneys submitted declarations from other prominent ERISA lawyers in New York City to support their requested rates. The court largely agreed with the rates for most of the legal team. However, it decided to reduce the lead partner’s rate from a requested $895 per hour to $810 per hour. While acknowledging the attorney’s extensive experience and reputation, the court adjusted the rate to align it more closely with what had been awarded in other recent, similar ERISA cases in the district. #### 2. The Reasonable Hours Expended Next, the court scrutinizes the amount of time the legal team spent on the case. Every task is reviewed to ensure the time spent was not excessive, redundant, or unnecessary. In *Macalou*, the court found some inefficiencies. It noted that an excessive number of hours were spent drafting a reply brief, especially given the attorneys’ expertise and prior work on the case. More significantly, the court pointed out that the firm failed to properly delegate tasks. Highly experienced—and expensive—senior attorneys were performing work like legal research and initial drafting that, in the court’s view, should have been handled by more junior, and less expensive, associates. Because of these issues, the court imposed a 15% across-the-board reduction on the total number of hours claimed. This decision underscores a critical point: an effective legal team is not just skilled, but also structured efficiently to maximize value and withstand judicial scrutiny. ### Making You Whole: The Importance of Prejudgment Interest Beyond attorneys’ fees, there is the crucial issue of prejudgment interest. This is the compensation a claimant is owed for the time they were deprived of their benefits. Essentially, the insurance company had use of the claimant’s money for years, and the claimant should be compensated for that loss. In *Macalou*, the debate over the interest rate was significant. The plaintiff argued for a rate of 21.8%, tying it to First Unum’s own “Adjusted Operating Return on Equity” during the period her benefits were withheld. Her argument was a powerful one: an insurer should not be able to wrongfully deny a claim and then profit by investing that money for its own gain. She also detailed the severe financial hardship she endured, including taking on high-interest credit card debt and making early withdrawals from her retirement account. The court, however, opted for a more traditional approach, applying New York’s statutory interest rate of 9% in simple interest. It reasoned that this rate was sufficient to compensate Ms. Macalou fairly without being improperly punitive to the insurer. While lower than her request, the 9% rate still resulted in an additional award of nearly $140,000—money that was essential to making her financially whole. ### How The Garner Firm’s Experience Maximizes Your Attorneys’ Fee Recovery The *Macalou* case provides a clear road map of the complexities of **ERISA** litigation. It demonstrates that winning your **long-term disability** benefits is just the first step. Successfully navigating the second battle over **attorneys’ fees** and interest requires a legal team with not only deep subject-matter expertise but also a commitment to efficient and ethical case management. At The Garner Firm, [our attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") have decades of experience focused specifically on ERISA and **LTD** claims. We have a proven track record of not only securing our clients’ benefits but[ also successfully fighting for and recovering the maximum possible award for fees, costs, and interest](https://law.justia.com/cases/federal/district-courts/pennsylvania/paedce/2:2019cv00798/553582/68/). Our staffing model is designed to be both effective and efficient, ensuring that the right tasks are handled by the right professionals at the right cost. We build our cases and document our work with the full expectation that it will be scrutinized by a federal judge, and our meticulous approach ensures our fee petitions are strong, defensible, and successful. If you are facing a denial of your **ERISA** **long-term disability** benefits, you do not have to fight the insurance company alone. [Contact](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") The Garner Firm today for a confidential consultation to learn how we can put our experience to work for you. **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** attorneys fees, Disability Benefits, ERISA, erisa litigation, fee recovery, First Unum, long term disability --- ### [Long Term Disability Application Error Costs Musician Her Benefits](https://www.garnerltd.com/long-term-disability-application-error-costs-musician-her-benefits/) **Published:** September 3, 2025 **Author:** Adam Garner **Content:** Filing for **[Long Term Disability (LTD)](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/ "long-term-disability-insurance")** benefits can be a difficult process, especially when you are grappling with a health condition. The forms are complex, the deadlines are strict, and insurance companies are known for scrutinizing every detail. A recent decision from the U.S. Court of Appeals for the Seventh Circuit, *[Moratz v. Reliance Standard Life Insurance Company](https://media.ca7.uscourts.gov/cgi-bin/OpinionsWeb/processWebInputExternal.pl?Submit=Display&Path=Y2025/D09-02/C:24-2825:J:Kolar:aut:T:fnOp:N:3418321:S:0)*, provides a critical lesson for anyone applying for disability benefits under an **[ERISA-governed plan](https://www.garnerltd.com/erisa-faqs/ "ERISA Frequently Asked Questions")**: accuracy and consistency are not just important—they are paramount. A fundamental inconsistency in an application can be the difference between receiving the benefits you deserve and having your claim thrown out on a procedural technicality. This case serves as an example of the pitfalls of the **ERISA claims process** and highlights how an [**experienced ERISA attorney** ](https://www.garnerltd.com/attorney-profiles/adam-garner/ "experienced ERISA attorney ")can help claimants navigate the system. At **The Garner Firm**, our Philadelphia-based ERISA and [long-term disability attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") have seen firsthand how insurance giants like [Reliance Standard](https://www.garnerltd.com/homepage/insurers-we-litigate-against-in-erisa-benefit-claims/ "Insurers We Litigate Against in ERISA Benefit Claims") leverage minor errors to deny legitimate claims. Understanding the court’s reasoning in *Moratz* can empower you to avoid similar mistakes and build a stronger case from the beginning. **Why is this case important for ERISA claimants?** It demonstrates the critical importance of getting expert legal guidance from the very start of your disability claim process. At The Garner Firm, we have seen firsthand how insurance giants like Reliance Standard leverage minor errors to deny legitimate claims. Understanding the court’s reasoning in *Moratz* can empower you to avoid similar mistakes and build a stronger case from the beginning. ### A Musician’s Career Derailed by COVID-19 The case centered on Karen Moratz, a world-class musician who served as the principal flutist for the Indianapolis Symphony Orchestra (“ISO”) for decades. Like many, her career was disrupted by the COVID-19 pandemic. In March 2020, the ISO furloughed its musicians, including Ms. Moratz. In December of that year, while still on furlough, she contracted COVID-19 and developed long-haul symptoms, including dizziness and tinnitus that made it impossible for her to perform her duties as a professional musician. In February 2022, Ms. Moratz applied for long-term disability benefits through the policy her employer had with Reliance Standard Life Insurance Company. On her application, she stated that her last day of work was March 13, 2020, and the date she first became unable to work due to her disability was December 11, 2020. Reliance Standard denied her claim in less than a week. The reasoning was straightforward: according to the policy, a person was only eligible for coverage if they were an “active, Full-time employee”. Because Ms. Moratz was on furlough and not actively working in December 2020 when she claimed her disability began, Reliance determined she was not eligible for benefits under the terms of the LTD plan. ### The Appeal That Became a “New Claim” This initial denial is a tactic used by LTD insurers. However, the critical part of this story happened during the appeal. In August 2022, Ms. Moratz, now with legal counsel, appealed Reliance’s decision. In her appeal, she presented a new piece of information: the ISO had actually re-hired her and other musicians in September 2021. She had attempted to return to work, but her symptoms of dizziness and tinnitus made it impossible to practice and perform with the full symphony. Consequently, the ISO placed her on sick leave on September 15, 2021. With this new information, her argument changed. She was no longer claiming her disability began in December 2020 while she was on furlough. Instead, she was now asserting that she was an active, full-time employee as of September 1, 2021, and that her disability began on September 15, 2021, when she was forced to take sick leave. Reliance Standard’s response to this appeal was simple. In January 2023, it affirmed its denial. The company stated that because her initial claim was for a disability beginning in December 2020, it was correctly denied. As for the new information about her September 2021 employment and disability onset, Reliance advised her that this constituted a “new LTD claim” and that she was free to “file a new” application based on that later date. Instead of doing so, Ms. Moratz filed a lawsuit under ERISA. ### The Seventh Circuit’s Ruling: Why a “Complete 180” Sinks an ERISA Appeal The legal battle hinged on one question: Was the information Ms. Moratz submitted on appeal a simple correction to her initial claim, or was it a fundamentally new claim for benefits? The Seventh Circuit Court of Appeals sided with Reliance Standard, and its reasoning is a lesson for all LTD applicants. The court explained that under the policy, a “claim” is a request for payment for a particular “loss”—in this case, the inability to work. Ms. Moratz’s initial application was for a loss that began in December 2020. The information she provided on appeal, however, was for a separate loss that began in September 2021. Her employment status and the facts surrounding her inability to work were entirely different on these two dates. While ERISA regulations require an insurer to consider all information submitted by a claimant during an appeal, the court drew a line between adding new, supportive facts and presenting *contrary* facts. The court stated that Ms. Moratz was not merely correcting a scrivener’s error; she was trying to “do a complete 180 and change the date she claimed she was last able to work”. The court found that her first application was “inconsistent” with the facts presented in her appeal. It concluded: “No claims processing system can work if an applicant can submit information that is not just new or complementary but completely inconsistent with previous facts”. Because the appeal effectively presented a new claim for a disability beginning in September 2021, Ms. Moratz was required to follow the proper procedure: file that new claim with Reliance and exhaust the administrative process before going to court. Her failure to do so was fatal to her lawsuit. ### Key Takeaways for Your Long-Term Disability Claim The *Moratz* decision offers several takeaways for anyone preparing to file an LTD claim, particularly with an insurer like Reliance Standard. 1. **Precision is Everything:** Dates, job descriptions, and medical information must be accurate. As this case shows, the “last day worked” and “date of disability” are not formalities; they are the part of basis for your claim. An error on these key dates can give the insurer a reason to deny your claim. 2. **An Appeal is Not a “Do-Over”:** The purpose of an administrative appeal is to argue that the insurer’s initial decision was wrong based on the evidence. You can and should submit additional medical records or statements that support your original claim. However, you may not be able fundamentally change the nature of the claim itself by alleging a different set of core facts, such as a different disability onset date that falls under different employment circumstances. 3. **Recognize When to File a New Claim:** If your circumstances change after your initial application—for example, if you attempt to return to work and are unsuccessful—the correct path may not be to appeal a previously denied claim. As Reliance Standard itself pointed out, the proper course of action may be to file a brand-new claim based on the new disability onset date. This resets the process but ensures you are exhausting your administrative remedies for the correct “loss.” An experienced ERISA attorney can help you navigate this process and determine which is the best approach for your situation. ### How The Garner Firm Can Protect Your Rights The procedural aspects of ERISA can be difficult to navigate alone. The *Moratz* case is an example of how an unrepresented claimant can make an error at the application stage, which even subsequent legal counsel cannot fully undo. Insurance companies like Reliance Standard have teams of experts looking for any inconsistency to justify a denial. At The Garner Firm, our experienced ERISA and long-term disability attorneys understand these tactics. We help our clients from the beginning, ensuring their applications are accurate, complete, and strategically sound. We can help you: - **Review Your Policy:** We analyze your LTD policy to understand its specific definitions, requirements, and exclusions *before* you file. - **Frame Your Claim Correctly:** We work with you and your doctors to establish an accurate and supported disability onset date that aligns with your medical evidence and employment history. - **Manage the Process:** We handle all communications with the insurance company, manage deadlines, and build a comprehensive administrative record designed to win at the appeal stage or, if necessary, in court. If you are preparing to file for long-term disability benefits or if your claim has been denied by Reliance Standard or another insurer, do not risk making a procedural error. The stakes are too high. [Contact The Garner Firm today](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") for a comprehensive consultation. Let our experience be your advantage in securing the benefits you need and deserve. **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** application error, ERISA, erisa litigation, long term disability, LTD denial, Reliance Standard, Seventh Circuit --- ### [Court Gives Unum a Second Bite at the Apple and It Still Acts Unreasonably](https://www.garnerltd.com/court-gives-unum-a-second-bite-at-the-apple-and-it-still-acts-unreasonably/) **Published:** September 16, 2025 **Author:** Adam Garner **Content:** You received short-term disability (STD) benefits, a clear acknowledgment from the insurance company that your medical condition prevents you from working. But when the time came to transition to long-term disability (LTD), you received a denial letter stating you were not disabled during the LTD elimination period. This frustrating and seemingly contradictory scenario is a common tactic used by insurers, but a recent federal court decision confirms it can be an abuse of discretion. Unfortunately, as a recent federal court decision against [Unum Life Insurance Company of America](https://www.garnerltd.com/homepage/insurers-we-litigate-against-in-erisa-benefit-claims/ "Insurers We Litigate Against in ERISA Benefit Claims") highlights, securing these benefits can be a complex and frustrating process, especially when transitioning from short-term disability (STD) to long-term disability (LTD). At The Garner Firm, our attorneys regularly represent individuals in claims governed by the Employee Retirement Income Security Act of 1974 (ERISA), the federal law that oversees most employer-sponsored disability plans. We have seen firsthand how insurance companies can create seemingly illogical roadblocks for deserving claimants. A key area of contention often involves the “elimination period,” a concept that can be confusing and is frequently used by insurers to deny otherwise valid LTD claims. A recent case, *[Rogers v. Unum Life Insurance Company of America](https://www.govinfo.gov/content/pkg/USCOURTS-mad-1_22-cv-11399/pdf/USCOURTS-mad-1_22-cv-11399-1.pdf)*, \_\_ F. Supp. 3d \_\_, No. 22-cv-11399-AK (D. Mass. Sept. 11, 2025), provides a powerful example of this very issue and offers important lessons for anyone navigating the disability claims process. ## Understanding the “Elimination Period” in Unum Long-Term Disability Claims Before diving into the specifics of the *Rogers* case, it’s crucial to understand what an LTD elimination period is. The elimination period, also known as a waiting or qualifying period, is a specific length of time that you must be continuously disabled before your long-term disability benefits can begin. Typically, the elimination period for an LTD plan is designed to align with the maximum benefit period of an accompanying short-term disability plan. For example, if your STD plan provides benefits for 26 weeks, your LTD plan might have a 180-day (approximately 26-week) elimination period. The intent is to create a seamless transition: your STD benefits cover the initial months of your disability, and once they are exhausted, your LTD benefits kick in, assuming you remain disabled. To satisfy the elimination period, you must prove to the insurance company that you were disabled, as defined by the policy, for the entire duration of that waiting period. This is where many claimants run into trouble. ## The *Rogers v. Unum* Decision: An Abuse of Discretion Dr. Rogers, a Senior Scientist, was forced to stop working due to a combination of debilitating conditions. He applied for and was granted short-term disability benefits from Unum. In fact, Unum approved his STD benefits on three separate occasions, awarding him the maximum 26 weeks of benefits available under the policy. During this same period, the Social Security Administration and Unum’s own FMLA division also determined that Dr. Rogers was disabled. However, when Dr. Rogers applied for long-term disability benefits, Unum denied his claim. The insurer’s rationale was that despite having paid STD benefits for the entire 26-week period, it did not believe the medical evidence was sufficient to prove he was disabled during that same timeframe—the LTD elimination period. Dr. Rogers challenged this denial in federal court. Initially, the court found Unum’s review so arbitrary and flawed that it remanded the case, giving the insurer a second chance to correct its denial letter. Even after this second opportunity, Unum issued another denial that suffered from the same core deficiencies. On this final review, the court, applying a deferential “arbitrary and capricious” standard of review, found Unum’s decision to be unreasonable and unsupported by the evidence. The judge pointed to a glaring inconsistency: Unum had approved and paid Dr. Rogers’s STD benefits based on the opinions of his treating physicians, yet it chose to disregard those same medical opinions when evaluating his LTD claim. The court found this to be a critical flaw. It was an abuse of discretion for Unum to approve Dr. Rogers for short-term disability benefits and then contend that he had not satisfied the LTD elimination period that ran concurrently with the STD benefit period. Unum could not provide a persuasive explanation for how Dr. Rogers could be deemed unable to work for STD purposes but simultaneously capable of working for LTD purposes during the exact same period. ## Key Takeaways from the Ruling for ERISA Claimants The *Rogers* decision underscores several critical points that are vital for individuals pursuing ERISA long-term disability claims: 1. **Consistency is Key:** An insurer cannot arbitrarily treat the same period of time differently. If you have been approved for STD benefits, this serves as strong evidence that you have satisfied the elimination period for your LTD benefits, provided the definition of disability is similar under both plans. 2. **The Importance of Treating Physician Opinions:** ERISA plans, particularly those administered by large insurers like Unum that are subject to the [Unum Regulatory Settlement Agreement](https://www.maine.gov/pfr/insurance/publications/financial-market-conduct-exam-reports/unum-provident-multistate-exam-settlement-agreement), are often required to give significant weight to the opinions of a claimant’s treating physicians. In *Rogers*, the court criticized Unum for summarily dismissing the consistent, cross-specialty opinions of four of Dr. Rogers’s treating doctors without a detailed, evidence-based reason for doing so. 3. **Subjective Symptoms Matter:** Many disabling conditions, such as chronic pain, fatigue, and cognitive dysfunction, do not always show up on “objective” tests like MRIs or X-rays. The court noted that an insurer’s reliance on the absence of objective findings, while ignoring clinically significant subjective symptoms, can be a basis for overturning a denial. Your real-world functional limitations are what matter, and these must be properly documented. 4. **Don’t Give Up After a Denial:** The initial denial of an LTD claim is not the end of the road. ERISA provides a process for appealing the insurer’s decision and, if necessary, filing a lawsuit in federal court. As the *Rogers* case demonstrates, courts will hold insurance companies accountable for unreasonable and poorly reasoned denials. ## How The Garner Firm Can Help Navigating the complexities of an ERISA disability claim can be overwhelming, especially when you are focused on your health. The legal and procedural hurdles are significant, and insurance companies have teams of lawyers and claims analysts dedicated to protecting their financial interests. [The attorneys at The Garner Firm](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") have extensive experience handling [ERISA disability claims](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/ "ERISA Short-Term & Long-Term Disability Attorneys") at all stages of the process, from the initial application and administrative appeal to federal court litigation. We understand the tactics that insurers use to deny valid claims, and we know how to build a strong record to counter them. If, like Dr. Rogers, you have been approved for short-term disability benefits only to be denied long-term disability benefits, you may have been subjected to an arbitrary and capricious decision. If your insurer is dismissing the opinions of your trusted medical providers or is unfairly demanding “objective evidence” for your disabling symptoms, we may be able to help. We are committed to ensuring our clients receive the benefits they are entitled to. We will thoroughly review your policy and your medical records, work with your doctors to obtain the evidence needed to support your claim, and advocate tirelessly on your behalf. **If you are struggling to secure your long-term disability benefits, [contact The Garner Firm](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") today for a confidential consultation. Let our experience guide you through this challenging process and fight for the financial security you deserve.** **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** abuse of discretion, elimination period, ERISA, long term disability, LTD denial, short term disability, unum --- ### [What's in a Name? How Clear Intent Saved Survivor Benefits in a Federal ERISA Case](https://www.garnerltd.com/whats-in-a-name-how-clear-intent-saved-survivor-benefits-in-a-federal-erisa-case/) **Published:** October 29, 2025 **Author:** Adam Garner **Content:** ![](https://www.garnerltd.com/wp-content/uploads/2025/10/Blog-Post-Image.png "Blog Post Image - The Garner Firm")When a 401(k) beneficiary designation form contains a technical error—such as an incorrect last name—but also includes a perfectly matching Social Security number that would allow an ERISA fiduciary to determine who the rightful beneficiary is if it exercised a bit of dilligence, who is the legal beneficiary? Can a simple error invalidate a participant’s clear intent and divert life-changing assets to their estate? These are important questions. A recent federal court case, *[Kostomite v. Kimberly-Clark Corp](https://www.govinfo.gov/content/pkg/USCOURTS-paed-2_24-cv-04473/pdf/USCOURTS-paed-2_24-cv-04473-0.pdf).*, from the [U.S. District Court for the Eastern District of Pennsylvania](http://www.paed.uscourts.gov), addressed this exact question with a resounding “no.” The court’s ruling, which strongly affirmed the decedent’s clear intent over a minor error, provides a critical lesson in how disputes over **survivor benefits** are resolved under the [Employee Retirement Income Security Act of 1974 (**ERISA**)](https://www.dol.gov/general/topic/retirement/erisa). This case highlights a frequent and costly battleground. When plan administrators face potential competing claims, they often file a legal action called an **[interpleader](https://www.law.cornell.edu/wex/interpleader)**. This procedure forces the rival claimants (in this case, the decedent’s long-time partner and his estate) into a federal lawsuit to prove their right to the funds. It is a tool that ERISA fiduciaries use to avoid their fiduciary obligation to fully and fairly adjudicate claims. While the judge in *Kostomite* found the decedent’s intent “inescapably obvious,” the case still required litigation. This demonstrates the critical importance of hiring an experienced **[ERISA attorney](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles")**. A knowledgeable attorney can navigate the complexities of federal benefits law, dismantle “fanciful” legal arguments from opposing parties, and build the strongest possible case to affirm a participant’s clear wishes and secure the benefits you are rightfully owed. ## The Case of the Contested 401(k): *Kostomite v. Kimberly-Clark Corp.* The facts of the *Kostomite* case are straightforward. The decedent, Mr. Bill Teetsel, worked for Kimberly-Clark and participated in the company’s 401(k) & Profit Sharing Plan. For over twenty years, Mr. Teetsel was in a committed, long-term romantic relationship with Ms. Kostomite. They lived together for many years, but they never legally married. The Kimberly-Clark plan had a crucial rule regarding beneficiaries: 1. If a participant was **married**, their spouse was the *automatic* beneficiary of the plan’s **survivor benefits**, regardless of who was named on the form. 2. If a participant was **unmarried**, they were free to designate any beneficiary they chose. Mr. Teetsel, being unmarried, properly exercised his right to name a beneficiary. On the form, he designated “Sophie Teetsel.” Critically, alongside this name, he also provided the beneficiary’s Social Security number and date of birth. These identifiers were a perfect match for his long-time partner, Ms. Kostomite. Evidence even showed that Ms. Kostomite occasionally used the last name “Teetsel” in social settings, such as at a local swim club. Upon Mr. Teetsel’s passing, Ms. Kostomite sought to claim the 401(k) benefits. However, the decedent’s estate also filed a claim for the funds, arguing that Ms. Kostomite was not the person named on the form. Faced with two competing claims, the plan administrator, Kimberly-Clark, did what many plan administrators do in this situation: it filed an **interpleader** without adjudicating which of the claimant’s was entitled to the benefits. ## What is an Interpleader? (And Why It Matters) For prospective clients and referring attorneys, understanding the mechanism of an **interpleader** is key. An interpleader is a legal action filed by a “stakeholder”—in this case, the Kimberly-Clark 401(k) Plan—that holds funds or property for which it faces multiple, conflicting claims. Instead of trying to decide who is right (and risking being sued by the party it *doesn’t* pay), the stakeholder essentially turns to the court and says, “We hold this money, but we don’t know who to pay. We are depositing the money with the court. Please have the rival claimants argue their case, and you, the Court, tell us who legally deserves it.” There are many instances where this is a reasonable approach; however, the interpleader mechanism does not absolve an ERISA fiduciary of its obligation to fully and fairly adjudicate claims for benefits when it can do so. Thus, ERISA fiduciaries have to be careful not to simply abdicate their fiduciary duty. Part of being a fiduciary is sometimes making challenging decisions. Nonetheless, the interpleader procedure protects the plan administrator from double liability. For the claimants, however, it means the beginning of a federal lawsuit. The plan administrator deposits the contested funds into the Court’s registry and is typically dismissed from the case, leaving the two claimants (here, Ms. Kostomite and the Estate) to litigate against each other for the benefits. This is precisely what happened in *Kostomite*. ## The Estate’s “Absurd” Argument and the Court’s Clear Ruling In *Kostomite,* the Court was plainly disappointed with the fiduciary’s obvious and cowardly failure to adjudicate Ms. Kostomite’s straightforward claim. The Estate’s entire argument hinged on the name discrepancy. It argued that because Ms. Kostomite’s legal name was not “Sophie Teetsel,” she could not be the beneficiary. The Estate then offered what the Court described as a “fanciful” and “absurd” alternative theory: that by naming “Sophie Teetsel,” the decedent was creating “a qualifier, a requirement” that Ms. Kostomite would only receive the funds if they were married. The federal judge, Hon. Gail Weilheimer, swiftly dismantled this argument. First, the judge pointed out the glaring logical flaw: the plan *automatically* voided non-spousal beneficiary designations if the participant was married. If Mr. Teetsel and Ms. Kostomite *had* been married (as the Estate’s “qualifier” theory required), the designation form would have been irrelevant, and the benefits would have gone to her automatically as the spouse. The Estate’s argument was, therefore, self-defeating and “nonsensical.” Second, and most importantly, the court looked to the decedent’s clear intent. **ERISA** requires plan fiduciaries to act “in accordance with the documents and instruments governing the plan.” Here, the plan documents included the beneficiary designation form. The court found it “inescapably obvious” that Mr. Teetsel intended to name Ms. Kostomite. The use of her correct Social Security number and date of birth made his intent “entirely unambiguous.” The minor name error, the court reasoned, was virtually irrelevant in the face of such specific, corroborating data. The judge concluded that “the only logical conclusion… is that the Decedent, in his own mind, thought of Plaintiff as his spouse and referred to her as having his name.” The court granted summary judgment to Ms. Kostomite, finding that no reasonable jury could ever conclude otherwise and that the Estate’s theory was “rank speculation” in an attempt to gain a windfall. ## Key Lessons from an ERISA Attorney The *Kostomite* case was, in the judge’s own words, “so obvious from the outset.” However, this clarity came only *after* a federal lawsuit was filed. Ms. Kostomite still had to endure the stress, time, and expense of litigation to secure the benefits that were clearly intended for her. As **ERISA attorneys**, we see several critical lessons for plan participants and their loved ones: 1. **Precision is Your Best Defense:** While Ms. Kostomite ultimately prevailed, this entire lawsuit could have been avoided. Always use the full, current legal name of your beneficiary on all designation forms. 2. **Identifying Information is Powerful:** The decedent’s decision to include Ms. Kostomite’s Social Security number and date of birth was the saving grace. This unique data made his intent undeniable. Never leave these fields blank. 3. **Review Your Designations Regularly:** Life changes. People get married, divorced, or have children. A beneficiary designation from 20 years ago may not reflect your current wishes. Review your 401(k), life insurance, and pension beneficiaries every few years or after any major life event. 4. **Understand Your Plan’s Rules:** Mr. Teetsel understood that as an *unmarried* participant, he had the right to name his partner. Many people mistakenly believe a will can override a plan’s beneficiary designation. It cannot. **ERISA** plan documents almost always supersede a will. ## How The Garner Firm Handles Complex ERISA Disputes While the *Kostomite* case was straightforward, the vast majority of **ERISA** disputes are not. These cases are governed by a complex web of federal laws and regulations. They often involve ambiguous plan language, competing medical opinions (in disability cases), or allegations that a plan fiduciary breached its duties. At The Garner Firm, our attorneys have extensive experience navigating the complexities of **ERISA** litigation. We represent participants, beneficiaries, and spouses in a wide range of benefit disputes, including: - Contested [**survivor benefits** and life insurance claims](https://www.garnerltd.com/practice-areas/life-insurance/ "Life Insurance Claims"). - Denials of [long-term disability benefits](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/ "Long-Term Disability Attorneys"). - [Pension](https://www.garnerltd.com/practice-areas/retirement-plan-benefit-claims/ "Retirement Plan Benefit Claims Attorneys") miscalculations and eligibility disputes. - Breaches of fiduciary duty by plan administrators. We understand the tactics plan administrators use to deny or delay claims, and we are prepared to fight for our clients’ rights at every stage, from administrative appeals to federal court litigation. We also frequently partner with referring attorneys from trust and estate, family law, or personal injury practices who encounter complex **ERISA** issues that fall outside their typical scope. ### Contact The Garner Firm Today If you or a client are facing a dispute over **ERISA** benefits, you do not have to face the insurance company or plan administrator alone. The law is on your side, but it is complex. [Contact The Garner Firm today](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") for a consultation. Our experienced **ERISA attorney** team is ready to analyze your case, explain your rights, and develop a strategy to secure the benefits you are rightfully owed. **Categories:** (ERISA) Litigation, Employee Benefits **Tags:** 401(k), beneficiary designation, ERISA, erisa litigation, interpleader, survivor benefits --- ### [MetLife's Denial of Attorney's LTD Claim is Affirmed](https://www.garnerltd.com/metlifes-denial-of-attorneys-ltd-claim-is-affirmed/) **Published:** November 21, 2025 **Author:** Adam Garner **Content:** # **Diagnosis is Not Disability: Lessons from the Eleventh Circuit’s Ruling in *Hovan v. MetLife*** For high-functioning professionals, the onset of a debilitating mental health condition is a profound crisis. It threatens not only one’s well-being but also one’s career and financial stability. When that safety net—**long-term disability** (LTD) insurance—is pulled away, the consequences are often catastrophic. A recent decision from the United States Court of Appeals for the Eleventh Circuit, *[Stacy Hovan v. Metropolitan Life Insurance Company](https://law.justia.com/cases/federal/appellate-courts/ca11/24-11167/24-11167-2025-11-20.html)*, serves as a stark reminder of the rigorous hurdles claimants face under **ERISA**. This case illustrates a critical, often misunderstood reality of **disability insurance** law: a diagnosis, no matter how severe, does not automatically equal a disability. As an experienced **[ERISA lawyer](https://www.garnerltd.com/attorney-profiles/adam-garner/ "Adam Garner")**, I frequently encounter clients who are baffled when their benefits are terminated despite ongoing medical treatment. The *Hovan* decision provides a textbook example of how insurance giants like **[MetLife](https://www.garnerltd.com/homepage/insurers-we-litigate-against-in-erisa-benefit-claims/ "ERISA LTD Disability Insurers We Fight for You")** leverage clinical documentation gaps to deny claims and why having seasoned legal counsel is essential to protecting your rights under **Section 502(a)**. ## **The Case: *Hovan v. Metropolitan Life Insurance Company*** Stacy Hovan was a commercial litigator at a prominent law firm, a role that demanded high-level cognitive functioning, critical thinking, and the ability to manage intense stress. Her career was interrupted by a resurgence of bipolar disorder, a condition she had managed for years but which eventually precipitated a mental health crisis requiring hospitalization. Initially, **MetLife** approved her claim for **[long-term disability](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/ "Long-Term Disability Attorneys")** benefits. Her treating psychiatrist had documented “impaired judgment,” “poor decision making,” and an inability to handle stress—limitations that clearly precluded her from working as a litigator. However, the landscape of her claim changed after she was discharged from a partial hospitalization program in late 2020. Her discharge summary noted a “good prognosis,” stating she was “safe to discharge” and that her mood was stable. Based largely on this discharge summary and subsequent therapy notes, **MetLife** terminated her benefits. Hovan appealed administratively and then filed a lawsuit under **ERISA Section 502(a)**. On November 20, 2025, the Eleventh Circuit Court of Appeals affirmed the termination, ruling that Hovan had failed to meet her burden of proving she remained disabled. ## **The “Therapy Note” Trap: Clinical Progress vs. Occupational Disability** The crux of the *Hovan* decision—and a common pitfall in **mental health** disability claims—is the disconnect between therapeutic goals and legal standards. In therapy, a provider’s notes often focus on relative progress. A therapist might note that a patient is “interactive,” “alert,” or “stable” because the patient is no longer in immediate crisis or requiring hospitalization. In *Hovan*, the court seized on these descriptors. It noted that while Hovan continued to experience mood fluctuations and even “fleeting” suicidal ideation, her therapist consistently recorded her “functional status” as “intact”. **MetLife** argued, and the court agreed, that these notes did not prove she was unable to perform the material duties of a commercial litigator. The Court’s rationale highlights a dangerous nuance in **disability insurance** claims. A patient may be “stable” enough to live safely in the community but wholly unable to draft complex motions, argue in court, or manage the intellectual rigors of legal practice. Without a medical opinion connecting the *symptoms* (e.g., anxiety, mania) to specific *occupational limitations* (e.g., inability to concentrate for more than 15 minutes, inability to make reasoned judgments under time pressure), a claim is vulnerable. ## **The Burden of Proof and the So-Called “Administrative Record**“ Under **ERISA**, the burden of proof lies on the claimant to demonstrate entitlement to benefits. This burden must be met during the administrative appeal process—before a lawsuit is ever filed. One of the most damaging aspects of the *Hovan* case was the plaintiff’s failure to supplement the record when given the chance. During the internal appeal, **MetLife** provided Hovan with a report from an independent file reviewer who concluded she was no longer disabled. **MetLife** explicitly invited Hovan to submit additional clinical evidence to refute this finding. Hovan’s counsel at the time declined, instructing **MetLife** to proceed with the decision based on the existing record. This was a critical strategic error. In **ERISA** litigation, the court’s review is often limited to the so-called “administrative record”—the pile of documents that existed when the insurance company made its final decision. This is especially true when the claim is reviewed under the deferential “abuse of discretion” or “arbitrary and capricious” standard of review. If the evidence of disability isn’t in that file, it typically cannot be used in court. By declining to submit new or clarifying evidence linking her condition to her specific job duties, Hovan left the court with only the “intact” therapy notes and the adverse file review. The court noted that Hovan “made no effort to supplement the record… despite knowing MetLife considered \[the\] therapy notes insufficient”. ## **Why “File Reviews” Are Permissible** Many claimants are shocked when an insurance company denies their claim based on the opinion of a doctor who has never met them—a “paper review” or file review. Hovan argued that it was improper for **MetLife** to rely on a file reviewer who hadn’t examined her. The Eleventh Circuit rejected this argument, reaffirming that plan administrators are permitted to rely on independent medical file reviews, provided the review is not arbitrary. The court found that the file reviewer’s report was detailed and addressed Hovan’s symptoms, noting a lack of evidence regarding “impairment in insight and judgment”. Because Hovan did not provide contrary evidence from her own treaters that specifically addressed these vocational capacities, the file reviewer’s opinion apparently stood unrefuted. ## **How an Experienced ERISA Lawyer Makes the Difference** The outcome in *Hovan* underscores why specialized legal representation is non-negotiable in **LTD** claims. An experienced **LTD lawyer** who understands that medical records generated for treatment purposes are rarely sufficient for legal purposes. Treating physicians are focused on clinical care, not disability definitions. They may write “doing better” to encourage a patient, not realizing that an insurance adjuster will read “doing better” as “ready to return to work.” At **The Garner Firm**, we anticipate these tactics. We do not simply forward medical records to the insurance company; we actively curate the administrative record to ensure it contains the precise evidence needed to withstand judicial scrutiny. Having a firm that will fight for you is critically important. ### **The Garner Firm Advantage** The Garner Firm brings a unique depth of perspective to **ERISA** litigation. With experience handling **ERISA** claims since 2007, I have not only represented plaintiffs but have also previously represented employers, plans, and fiduciaries. I have even served as a plan administrator for a large union pension plan. This background provides valuable perspective. As a Senior Editors of the treatise *Employee Benefits Law*, our [attorneys](https://www.garnerltd.com/attorney-profiles/melanie-garner/) are at the forefront of the complex statutory and regulatory landscape that governs these claims. This expertise is critical because **ERISA** is a minefield of technicalities—from strict appeal deadlines to the deferential “arbitrary and capricious” standard of review that makes overturning a denial so difficult. ## **Don’t Fight MetLife Alone** The *Hovan* decision is a sobering reminder that in the world of **ERISA** and **disability insurance**, the truth of your suffering is often secondary to the quality of your evidence. **MetLife** and other insurers are sophisticated entities with vast resources and legal teams dedicated to minimizing their liability. To prevail, you need an advocate who matches their sophistication and aggression. If you are facing a denial of **long-term disability** benefits, or if you are considering filing a claim for a **mental health** condition, do not rely on your medical diagnosis alone to protect you. You need a strategy that bridges the gap between medicine and law. **[Contact The Garner Firm today.](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today")** Let us put our decades of experience and deep understanding of **ERISA** regulations to work for you. We know how to build a record that stands up in court, and we are dedicated to fighting for the benefits you have earned. --- *Disclaimer: This blog post is for informational purposes only and does not constitute legal advice. The outcome of any legal matter depends on the specific facts and applicable law. Contact a qualified attorney for advice regarding your specific situation.* **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** Eleventh Circuit, ERISA, erisa litigation, long term disability, LTD denial, mental health disability, MetLife --- ### [Court Rejects LTD Insurer's Pre-Existing Condition Denial](https://www.garnerltd.com/court-rejects-ltd-insurers-pre-existing-condition-denial/) **Published:** November 25, 2025 **Author:** Adam Garner **Content:** In a significant win for ERISA [long-term disability](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/ "Long-Term Disability Attorneys") (LTD) claimants, the Eleventh Circuit Court of Appeals recently reversed [Reliance Standard Life Insurance Company’s](https://www.garnerltd.com/homepage/insurers-we-litigate-against-in-erisa-benefit-claims/ "ERISA LTD Disability Insurers We Fight for You") denial of LTD benefits based on a pre-existing condition exclusion. The November 21, 2025 published decision in *[Johnson v. Reliance Standard Life Insurance Company](https://media.ca11.uscourts.gov/opinions/pub/files/202313443.pdf)*, No. 23-13443, 2025 WL 3251015, \_\_ F. 4th \_\_ (11th Cir. Nov. 21, 2025) provides important protection for individuals with rare or difficult-to-diagnose medical conditions who face benefit denials under their employer-sponsored long-term disability plans. ## Understanding the Johnson LTD Case Cheriese Johnson worked in human resources and obtained long-term disability insurance coverage through her employer in 2016. Within months of her coverage becoming effective, she became totally disabled due to scleroderma—a rare autoimmune disease that causes hardening and thickening of the skin and other tissues. When Johnson filed her disability claim, Reliance Standard denied her benefits, arguing that scleroderma was a “pre-existing condition” under her policy. The insurance company pointed to medical visits Johnson had during the three-month lookback period before her coverage began, during which she was treated for various symptoms including fatigue, nausea, swelling, and joint pain. The critical issue: Johnson’s doctors had diagnosed her with nearly a dozen conditions during that lookback period—including fibromyalgia, borderline lupus, and bronchitis—but no one suspected scleroderma. The disease wasn’t diagnosed until four months after the lookback period ended, following a lung biopsy. ## The Insurance Company’s Overreach Reliance Standard took an extremely broad interpretation of the policy’s pre-existing condition language. The company argued that because Johnson received treatment for symptoms that were “not inconsistent with” scleroderma, her condition was excludable—even though neither Johnson nor any of her doctors knew she had the disease or intended to treat it during the lookback period. The Eleventh Circuit firmly rejected this interpretation as unreasonable. The majority explained that the policy’s language requires that a person receive medical treatment “for” a specific sickness during the lookback period. The word “for” connotes intent and purpose—and quoting then-Judge Alito in a prior opinion noted: “it is hard to see how a doctor can provide treatment ‘for’ a condition without knowing what that condition is or that it even exists.” ## Why This Decision Matters for ERISA LTD Claimants This ruling is particularly important for individuals with rare diseases or conditions that are difficult to diagnose. Under Reliance Standard’s rejected interpretation, virtually any prior medical treatment could be used to deny coverage for a later diagnosis, as the court noted: an insurance company could “deny coverage for a brain tumor if the doctor encouraged a patient with headaches to drink more water.” The decision protects claimants from what the court called an “ex post facto analysis” where “a whole host of symptoms occurring before a ‘correct’ diagnosis is rendered, or even suspected, can presumably be tied to the condition once it has been diagnosed.” This backward-looking reinterpretation would render pre-existing condition exclusions so broad as to be virtually meaningless. ## The Legal Framework: ERISA’s Six-Step Process The Johnson decision also illustrates the often-criticized and complex framework that the Eleventh Circuit uses to review ERISA long-term disability claims. The court applies a six-step analysis when an insurance company denies benefits: 1. Determine whether the denial was wrong under a “de novo” (fresh review) standard 2. If wrong, determine whether the insurance company had discretion to interpret the plan 3. If the company had discretion, determine whether reasonable grounds supported the denial 4. If no reasonable grounds exist, reverse the denial 5. Evaluate whether conflicts of interest exist 6. Consider conflicts as a factor in determining whether the decision was arbitrary and capricious In Johnson’s case, the court found that Reliance Standard’s decision was not only wrong but also unreasonable—meaning it failed at step three of this analysis. Even under the deferential “arbitrary and capricious” standard of review, the insurance company’s interpretation stretched the policy language “beyond what it can reasonably bear.” ## What This Means for Your LTD Claim If your LTD benefits have been denied based on a pre-existing condition exclusion, the *Johnson* decision may provide a strong basis for appeal, particularly if: - You were treated for general symptoms rather than a specific diagnosed condition during the lookback period - Your disabling condition is rare or was difficult to diagnose - Your doctors did not suspect your ultimate diagnosis during the lookback period - The insurance company is using hindsight to connect unrelated symptoms to your current condition The *Johnson* ruling makes clear that ERISA does not permit insurance companies to use creative interpretations of policy language to deny legitimate claims. Treatment for symptoms does not automatically constitute treatment “for” an underlying condition that no one knew existed. ## The Importance of Experienced ERISA LTD Representation ERISA disability cases are highly technical and require specialized knowledge of both federal law and insurance industry practices. The Johnson decision demonstrates how insurance companies may take unreasonable positions when denying claims, hoping that claimants will simply give up or accept the denial without challenge. At The Garner Firm, [our attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") have extensive experience handling ERISA long-term disability claims and appeals. We understand the tactics insurance companies use to avoid paying benefits, and we know how to build compelling cases that hold insurers accountable to the actual terms of their policies. Our team has successfully represented countless clients in disability benefit disputes, helping them secure the benefits they need and deserve. We stay current on developing case law like the *Johnson* decision to ensure our clients benefit from the most recent legal precedents. ## Take Action: Protect Your Rights If you have been denied long-term disability benefits based on a pre-existing condition exclusion—or any other reason—time is critical. [ERISA imposes strict deadlines for filing administrative appeals and lawsuits](https://www.garnerltd.com/how-much-time-do-i-have-to-appeal-a-long-term-disability-claim/). Missing these deadlines can result in the permanent loss of your right to challenge the denial. Don’t let an insurance company’s unreasonable interpretation of policy language prevent you from receiving the benefits you paid for and need. The Johnson decision shows that courts will reject overly broad denials when claimants have skilled legal representation to advocate for their rights. **[Contact The Garner Firm today for a consultation about your ERISA disability claim](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today").** Our experienced ERISA lawyers will review your denial, explain your options, and help you develop a strategy to fight for your benefits. We work on a contingency fee basis for many ERISA cases, which means you pay no attorney’s fees unless we recover benefits for you. Your health and financial security are too important to leave to chance. Let our knowledge and experience work for you in navigating the complex world of [ERISA litigation](https://www.garnerltd.com/practice-areas/erisa-litigation/ "Employee Benefits (ERISA) Litigation"). Reach out to The Garner Firm now to learn how we can help you challenge an unfair benefit denial and secure the long-term disability benefits you deserve. --- *The information provided in this blog post is for general informational purposes only and does not constitute legal advice. Every ERISA case is unique and depends on the specific facts and policy language involved. For advice about your particular situation, please contact an experienced ERISA lawyer.* **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** Eleventh Circuit, ERISA, long term disability, LTD denial, pre-existing condition, Reliance Standard --- ### [5 Warning Signs Your LTD Claim May Be Denied](https://www.garnerltd.com/5-warning-signs-your-ltd-claim-may-be-denied/) **Published:** December 9, 2025 **Author:** Adam Garner **Content:** When you’re unable to work due to a disabling illness or injury, your long-term disability (LTD) insurance should provide the financial protection you’ve been paying for. Unfortunately, insurance companies don’t always act in good faith. In fact, even when claimants have legitimate disabilities and strong medical evidence, insurers frequently use questionable tactics to deny or terminate benefits. Therefore, understanding the warning signs that your LTD claim may be heading toward an unfair denial can help you take proactive steps to protect your rights under [ERISA](https://www.garnerltd.com/erisa-litigation/). ![](https://www.garnerltd.com/wp-content/uploads/2025/12/Blog-Post-Graphic-5-Red-Flags-2.png "Blog Post Graphic - 5 Red Flags - The Garner Firm")## Red Flag #1: The Insurance Company Orders an Independent Medical Examination for Your LTD Claim One of the most common red flags is when your insurance carrier suddenly requests that you attend an Independent Medical Examination (IME) or subjects your claim to a “peer review” by a physician who has never examined you. Despite the term “independent,” these doctors are typically hired and paid by the insurance company—creating an inherent conflict of interest. Some of them derive a substantial percentage of their annual income from performing insurance company reviews. They know where their bread is buttered.​ Moreover, insurance companies often use IME physicians who have a track record of providing opinions that favor claim denials. The examining doctor may spend only 15 to 30 minutes with you. Yet, their brief assessment can be used to override years of treatment records from your own physicians who know your condition intimately. Consequently, when an insurer relies heavily on an IME while dismissing your treating physicians’ opinions, this is a significant warning sign that your long-term disability benefits may be in jeopardy. ## Red Flag #2: Repeated Requests for the Same Medical Records and Documentation Insurance companies have a legitimate right to review your medical records and request documentation supporting your disability claim. However, when your insurer repeatedly asks for the same information you’ve already provided, or makes excessive and burdensome requests for irrelevant documentation, this often signals that they’re building a case to deny your claim rather than fairly evaluating it. (ERISA require insurers to look for reasons to pay your claim, but insurers have a financial conflict of interest that often causes them to look for reasons to deny an LTD claim.) This tactic serves multiple purposes for the insurance company. First, it creates opportunities for you to miss a deadline or fail to provide a requested document—giving them grounds to deny your claim based on lack of cooperation. Second, the constant barrage of requests can be overwhelming, especially when you’re dealing with a serious medical condition. As a result, if your insurance company seems to be on a fishing expedition, consult with an experienced [LTD lawyer](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") who can help you navigate these requests appropriately. ## Red Flag #3: Your LTD Claim Approaches the “Own Occupation” to “Any Occupation” Definition Change Most ERISA long-term disability policies contain a critical provision that changes the definition of disability after a certain period—typically 24 months. During the initial period, you’re considered disabled if you cannot perform your “own occupation.” After this period expires, the definition typically switches to whether you can perform “any occupation” for which you’re reasonably qualified by education, training, or experience.[](https://www.riemerhess.com/wiki/long-term-disability-benefits-termination-red-flags)​ This transition period is when many legitimate LTD claims are wrongfully terminated. Insurance companies often use this change as an opportunity to argue that while you cannot perform your previous job, you could theoretically perform some other type of work—even if no such jobs actually exist in the labor market or would realistically hire someone with your medical limitations.[](https://www.riemerhess.com/wiki/long-term-disability-benefits-termination-red-flags)​ Watch for increased scrutiny of your claim as you approach this transition point. Insurance companies may order vocational assessments, increase their requests for documentation, or suddenly question the severity of your condition. If you’re approaching this threshold in your policy, it’s wise to consult with an attorney who understands ERISA litigation before your benefits are terminated.[](https://www.fieldslaw.com/answer/recognizing-the-red-flags/)​ ## Red Flag #4: Surveillance, Increased Communication, or Invasive Questioning If your insurance company suddenly ramps up communication, attempts to schedule multiple phone interviews, asks leading questions about your daily activities, or you notice signs you may be under surveillance, your claim is likely under heightened scrutiny. Insurance companies routinely hire private investigators to conduct video surveillance of LTD claimants, hoping to capture footage that can be taken out of context to suggest you’re not as disabled as you claim.[](https://www.fieldslaw.com/answer/recognizing-the-red-flags/)​ The problem with surveillance is that it captures isolated moments without context. A claimant with chronic pain might have a “good day” where they’re able to walk to the mailbox or play briefly with their children—but the video won’t show the hours or days of severe pain that follow such activities. Insurance companies will use these cherry-picked moments to argue that you’re capable of full-time work, even when the complete picture tells a very different story.[](https://theatlantasocialsecurityattorney.com/ltd-bad-legitimate-claims-denied/)​ ## Red Flag #5: The Insurer Relies Heavily on Pre-Existing Condition Exclusions to Challenge Your LTD Claim When an insurance company stretches to connect your current disability to an unrelated previous medical condition, this is often a sign they’re grasping at straws to deny your claim. ERISA LTD policies typically contain pre-existing condition exclusions that prevent coverage for disabilities related to conditions you were treated for during a specific period before your coverage began. However, insurers sometimes attempt to apply these exclusions inappropriately, linking your current disabling condition to past health issues that have no genuine connection.[](https://www.kotaklaw.com/five-red-flags-to-look-for-in-your-ltd-denial/)​ Review your denial letter carefully for any reference to pre-existing conditions. If the insurance company is attempting to link unrelated medical history to your current disability, this is a strong indicator of bad faith. An experienced ERISA attorney can help you challenge these improper denials by demonstrating that your current condition is distinct from any previous health issues.[](https://theatlantasocialsecurityattorney.com/ltd-bad-legitimate-claims-denied/)​ ## Understanding Your Rights Under ERISA Section 502(a) The Employee Retirement Income Security Act of 1974 (ERISA) governs most employer-sponsored long-term disability insurance plans. Under Section 502(a) of ERISA, plan participants have the right to file a lawsuit to recover benefits that have been wrongfully denied. Section 502(a) provides the legal framework that allows you to challenge an unfair denial in federal court.[](https://www.riemerhess.com/wiki/second-circuit-clarifies-erisa-waiver-protections-in-schuyler-v.-sun-life)​ However, ERISA claims are complex and subject to strict procedural requirements. Before you can file a lawsuit under Section 502(a), you must typically exhaust the insurance company’s internal appeals process. Many claimants make the mistake of handling their ERISA appeals without legal representation, not realizing that the administrative record built during the appeal becomes the evidence the court will review. Federal courts in ERISA cases often do not allow new evidence at trial, which means your appeal is often your only chance to build a complete record supporting your claim.[](https://www.riemerhess.com/wiki/second-circuit-clarifies-erisa-waiver-protections-in-schuyler-v.-sun-life)​ ## How The Garner Firm Can Help At The Garner Firm, we have built our practice on helping employees and insured individuals fight back against insurance companies that wrongfully deny legitimate long-term disability claims. Our founder, [Adam H. Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/adam-garner-4/ "Adam Garner"), has two decades of experience handling ERISA lawsuits in state and federal courts nationwide, including claims for benefits and equitable relief actions under Section 502(a) of ERISA.[](https://www.garnerltd.com/attorney-profiles/adam-garner/)​ Mr. Garner’s background as a former administrator of multi-million and billion-dollar multiemployer benefit plans provides unique insight into how insurance companies and plan administrators make decisions about LTD claims. This insider knowledge allows us to anticipate the tactics insurers will use and build compelling cases that hold them accountable. We have successfully represented clients throughout Pennsylvania, New Jersey, Maryland, and across the country in complex ERISA benefits claims.[](https://www.garnerltd.com/attorney-profiles/adam-garner/)​ ## Take Action to Protect Your Long-Term Disability Benefits If you’ve noticed any of these red flags in your LTD claim, don’t wait until your benefits are denied or terminated to seek legal help. The time to act is now—whether you’re facing an upcoming IME, approaching the “any occupation” definition change in your policy, or have already received a denial letter. Early intervention by an experienced LTD lawyer can often prevent a denial or significantly strengthen your position if you need to appeal or litigate your claim. The Garner Firm represents employees, executives, and professionals throughout Philadelphia, Southeastern Pennsylvania, the Delaware Valley, and Maryland in ERISA long-term disability claims. We also assist referring attorneys whose clients need specialized representation in ERISA benefits litigation. Our firm handles cases on a contingency fee basis in appropriate cases, which means you don’t pay attorney fees unless we recover benefits for you.[](https://www.garnerltd.com/practice-areas/labor-and-employment/)​ Don’t let an insurance company’s bad faith tactics deprive you of the long-term disability benefits you’ve earned. [Contact The Garner Firm today](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") at (215) 645-5955 or visit [www.garnerltd.com](http://www.garnerltd.com/) to schedule your free, confidential consultation. Let our experience in ERISA litigation work for you. **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** bad faith insurance, disability claim denial, ERISA, independent medical exam, long term disability, LTD denial, surveillance --- ### [How to Leverage This Stunning Unum ERISA Discovery Ruling](https://www.garnerltd.com/erisa-long-term-disability-attorney-unum-discovery-case/) **Published:** February 17, 2026 **Author:** Adam Garner **Excerpt:** A federal court rejected Unum's boilerplate discovery objections in an ERISA long-term disability case, compelling disclosure of internal incentive structures and claims review procedures. Learn what this ruling means for disability claimants and why an experienced ERISA long-term disability attorney is essential to fighting back against insurer stonewalling. **Content:** ![](https://www.garnerltd.com/wp-content/uploads/2026/02/Gemini_Generated_Image_8z602i8z602i8z60.png "Gemini_Generated_Image_8z602i8z602i8z60 - The Garner Firm") If you are fighting [Unum Life Insurance Company of America](https://www.garnerltd.com/homepage/insurers-we-litigate-against-in-erisa-benefit-claims/ "ERISA LTD Disability Insurers We Fight for You") over a denied or terminated long-term disability (LTD) claim, a recent federal court decision offers hope. Specifically, a ruling from the Middle District of Pennsylvania provides a clear roadmap for what claimants can—and cannot—obtain during ERISA discovery. As a result, an experienced ERISA long-term disability attorney can help you use this decision to your advantage. In [Schaefer v. Unum Life Insurance Company of America, No. 4:24-CV-00590 (M.D. Pa. Feb. 12, 2026)](https://docs.justia.com/cases/federal/district-courts/pennsylvania/pamdce/4:2024cv00590/141786/36), Chief United States District Judge Matthew W. Brann granted in part a motion to compel discovery against Unum. In doing so, he delivered a pointed rebuke of the insurer’s blanket, boilerplate objections. As a result, this ruling sets a valuable precedent for any ERISA long-term disability attorney who represents claimants against large insurers. ## The Case: What Happened to Barbara Schaefer? Barbara Schaefer filed suit against Unum after the company terminated her long-term disability benefits. Her amended complaint raised six claims. Specifically, these included breach of contract, bad faith insurance practice, improper denial of benefits, and breach of fiduciary duties under ERISA—the Employee Retirement Income Security Act of 1974. During discovery, Schaefer served interrogatories and document requests on Unum. In particular, she sought information in several key areas: compensation data for the claims adjusters and medical reviewers who handled her file; the approval-and-denial track records of those employees; internal policies governing claims handling; details about Unum’s relationship with Dane Street, LLC, a third-party medical review firm; and communications from agencies that had looked into Unum’s LTD claims handling. In response, Unum listed eight “general objections” and worked them into every single answer. For example, these boilerplate objections claimed the requests were overly broad, unduly burdensome, privileged, and vague. On top of these blanket objections, Unum raised specific objections to particular requests. Moreover, the insurer repeatedly directed Schaefer to the “claim file” as the source for the information she sought. ## The Court Strikes Down Unum’s Boilerplate Objections Judge Brann wasted little time disposing of Unum’s general objections. Citing the Third Circuit’s decision in *Grider v. Keystone Health Plan Central, Inc.*, 580 F.3d 119, 139–40 (3d Cir. 2009), the court deemed all eight general objections waived. In short, the court explained that Unum had “clearly interposed” these objections to shield a large volume of otherwise discoverable material. Furthermore, the court stressed that a defending party cannot push the burden of sorting through generic objections onto the court. Notably, Judge Brann observed that this pattern of boilerplate objections “appears to be a fairly typical practice for Unum.” Indeed, the court cited multiple prior decisions from other courts—including *Dwyer v. Unum Life Ins. Co. of Am.*, 470 F. Supp. 3d 434, 438 (E.D. Pa. 2020). ## What Discovery Did the Court Allow? After clearing the boilerplate hurdle, the court turned to Unum’s specific objections. Overall, the results were nuanced. These rulings show why having a skilled ERISA long-term disability attorney matters during litigation. - **Incentive and Bonus Information:** The court compelled Unum to disclose whether any incentive, bonus, or reward programs existed for employees who reviewed Schaefer’s claim. This included both internal claims adjusters and Dane Street medical staff. Schaefer alleged that Unum “pressures claim personnel to terminate claims” and rewards cost-saving employees. As a result, the court found these claims justified discovery into the incentives behind the review process. However, the court declined to require Unum to produce specific dollar amounts of employee pay. Instead, the court reasoned that raw figures did not justify the burden. Notably, the court still allowed Schaefer to explore pay details during depositions to probe potential bias. - **Review Policies and Procedures:** The court also granted discovery into Unum’s internal claims review procedures and supervisory structure. These documents were directly relevant to Schaefer’s bad faith claims. In particular, they addressed her claims that Unum failed to put safeguards in its claims-handling process. However, the production was limited to procedures at play in Schaefer’s specific claim denial. - **Dane Street Information:** In addition, the court compelled Unum to produce details about Dane Street personnel’s role in Schaefer’s claim denial. This included whether incentive-based pay existed. However, the court denied Schaefer’s request for all communications between Unum and Dane Street over three years. Ultimately, the court found this request too burdensome and lacking relevance to her individual claims. ## What Discovery Did the Court Deny? - **Batting Average Data:** Schaefer sought data showing how often each reviewer found claims to be supported by medical evidence. However, the court denied this request. It followed the Third Circuit’s guidance in *Reichard v. United of Omaha Life Insurance Company*, 805 F. App’x 111, 116–17 (3d Cir. 2020). In that case, the court held that batting average data has “minimal” probative value. Indeed, proving bias would require a mini-trial on every past claim. - **Agency Investigation Records:** Schaefer also sought all communications between Unum and any agency looking into its LTD claims handling over ten years. The court denied this request as vague and overbroad because of the massive burden on a large insurer. Still, the court allowed Schaefer to explore this topic during depositions. - **Additional Interrogatories:** Finally, the court denied Schaefer’s request for leave to serve extra interrogatories beyond the 25 allowed under Federal Rule of Civil Procedure 33(a)(1). The court reasoned that several original interrogatories no longer needed answers because of its other rulings. ## How Your ERISA Long-Term Disability Attorney Navigates New Jersey Discovery Challenges The *Schaefer* case was litigated in the Middle District of Pennsylvania. That court applied the broad discovery standard of Federal Rule of Civil Procedure 26(b)(1), which allows discovery into “any nonprivileged matter that is relevant to any party’s claim or defense and proportional to the needs of the case.” However, claimants fighting Unum and other LTD insurers in the District of New Jersey face a very different reality. In contrast, federal courts in New Jersey take a much more restrictive approach to ERISA LTD discovery. For example, in *Choi v. Unum Life Ins. Co.*, No. 24-06338 (D.N.J. Aug. 6, 2025), the court required the plaintiff to show a “reasonable suspicion of misconduct” before allowing any discovery beyond the administrative record. In that case, the court denied discovery into Unum’s pay structures, performance reviews, claims metrics, and financial targets. The court called the plaintiff’s conflict-of-interest claims “wildly speculative.” Consequently, this standard creates a difficult paradox. Claimants cannot obtain discovery to prove a conflict of interest unless they first show evidence of that conflict. Yet that evidence typically sits solely in the insurer’s files. As a result, the heightened bar in New Jersey effectively blocks extra-record discovery in many ERISA LTD cases. Therefore, an ERISA long-term disability attorney who understands this landscape is essential to overcoming these barriers. ## Third Circuit Precedent Supports Broader Discovery Rights This restrictive approach conflicts with the Third Circuit’s own holdings—consistent with the Supreme Court’s ruling in *Metropolitan Life Insurance Co. v. Glenn*, 554 U.S. 105 (2008). In that case, the Supreme Court held that when an insurer both evaluates claims and pays benefits, that structural conflict should factor into whether the denial was an abuse of discretion. Importantly, Third Circuit courts outside New Jersey allow targeted discovery into how an insurer’s conflict of interest may have affected a specific claim. Unlike New Jersey courts, these courts do not require the preliminary showing demanded by the District of New Jersey. For instance, the *Schaefer* court in the Middle District of Pennsylvania followed this broader approach. This view is more consistent with controlling Third Circuit precedent. See, e.g., *Noga v. Fulton Fin. Corp. Emp. Benefit Plan*, 19 F.4th 264, 273-274 (3d Cir. 2021); *Howley v. Mellon Fin. Corp.*, 625 F.3d 788, 793-794 (3d Cir. 2010). The practical consequence is striking. Claimants with nearly identical claims against Unum may get entirely different levels of discovery based on where their case is filed. Whether the case lands in Newark or Williamsport can change the outcome. Ultimately, this inconsistency undermines the rights of plan participants that ERISA was designed to promote. ## Why You Need an ERISA Long-Term Disability Attorney If Unum or another insurer has denied or terminated your long-term disability benefits, the *Schaefer* decision underscores several important realities. First, insurers like Unum routinely deploy boilerplate objections to stonewall discovery. However, courts are willing to strike them down when attorneys call them out. Second, discovery into an insurer’s internal incentive structures and claims handling procedures is obtainable—but the requests must be tailored to the specific case. Third, where your case is filed matters in the Third Circuit. Therefore, an experienced ERISA long-term disability attorney can help ensure your case is positioned for the best possible procedural outcome. ## Contact an ERISA Long-Term Disability Attorney at The Garner Firm [The attorneys at The Garner Firm](https://www.garnerltd.com/attorney-profiles/) have decades of combined experience helping individuals whose long-term disability and ERISA benefits have been wrongfully denied or terminated. We understand the discovery tactics insurers like Unum use to block claimants from getting the evidence they need. Moreover, we know how to fight back. If you are facing a denial or termination of your LTD benefits, **[contact The Garner Firm today](https://www.garnerltd.com/contact/) for a free consultation. Call us at (215) 645-5955 or visit us at [www.garnerltd.com](https://www.garnerltd.com/)**. As a dedicated ERISA long-term disability attorney, we fight to protect your rights and recover the benefits you deserve. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, General Civil Litigation, Legal Counsel, Long Term Disability **Tags:** bad faith insurance, disability, Disability Benefits, disability benefits attorney, ERISA, erisa attorney, ERISA discovery, ERISA lawyer, erisa litigation, long term disability, long term disability attorney, LTD, unum, Unum discovery --- ### [Philadelphia ERISA Attorney to Present on AI Ethics at ABA Employee Benefits Committee Meeting](https://www.garnerltd.com/philadelphia-erisa-attorney-to-present-on-ai-ethics-at-aba-employee-benefits-committee-meeting/) **Published:** December 9, 2025 **Author:** Adam Garner **Content:** **Philadelphia ERISA Attorney Adam H. Garner to Address Artificial Intelligence and Professional Responsibility at National Conference** PHILADELPHIA, PA – [Adam H. Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/), Esquire, Founder and Managing Member of The Garner Firm, Ltd., will present on the panel “Ethics in an AI World: Responsible Use in Your Practice” at the [American Bar Association Section of Labor and Employment Law Employee Benefits Committee Midwinter Meeting in Austin, Texas, February 4-7, 2026](https://events.americanbar.org/event/669E0FE5-397C-4EC7-AC91-A783342506D2/summary). ![Adam H. Garner ERISA Attorney](https://www.garnerltd.com/wp-content/uploads/2025/12/SNP_Garner_Firm_108_Small_Social_Media-LinkedIN-072523-e1765295210457-1024x1002.jpg "SNP_Garner_Firm_108_Small_Social_Media LinkedIN 072523 - The Garner Firm")Adam H Garner ## AI and ERISA Practice: Navigating New Ethical Frontiers The panel addresses the rapidly evolving intersection of artificial intelligence technology and ERISA legal practice. As generative AI tools become increasingly integrated into legal workflows, ERISA attorneys face unprecedented questions about competence, confidentiality, and professional responsibility under the applicable Rules of Professional Conduct. Garner and his co-panelists—[Ivelisse Berio Lebeau](https://www.acebc.com/profiles/ivelisse-berio-lebeau) of National Employee Benefits Administrators and [Ben Conley](https://www.seyfarth.com/people/benjamin-j-conley.html) of Seyfarth Shaw LLP—will explore practical frameworks for integrating AI into employee benefits practice. Specifically, they will address how to maintain ethical obligations while using AI tools. Moreover, the discussion will cover AI applications in document review automation, legal research acceleration, and drafting. The panel will also examine critical considerations for tool selection and data security. ## ERISA Attorney Thought Leadership in Employee Benefits Law This presentation builds on Garner’s extensive speaking record on ERISA ethics and procedural issues. In April 2025, he presented “ERISA Representation Issues and the Latest ABA Ethics Opinions” for the ABA Joint Committee on Employee Benefits, addressing technology competence requirements under Model Rule 1.1 and confidentiality obligations when using AI tools. Garner’s expertise reflects his comprehensive background representing employee benefit plan participants and beneficiaries in all facets of ERISA litigation. This includes claims for benefits under 29 U.S.C. §1132(a)(1)(B), fiduciary breach litigation, and executive compensation disputes. Furthermore, his unique perspective combines practical litigation experience with deep knowledge of plan administration. He previously served as Administrator of $1.6 billion Taft-Hartley pension plans. ## ABA Model Rules and Artificial Intelligence The panel’s timing is particularly relevant following the ABA’s July 2024 release of [Formal Opinion 512](https://www.americanbar.org/news/abanews/aba-news-archives/2024/07/aba-issues-first-ethics-guidance-ai-tools/). This opinion applies existing Model Rules of Professional Conduct to generative AI use. Importantly, it emphasizes that attorneys using AI tools must satisfy their duties regarding competent representation, client confidentiality protection, and client communication. Additionally, attorneys must ensure proper employee and agent supervision, advancement of meritorious claims, candor toward tribunals, and reasonable fee charging. Recent court decisions have underscored the importance of independent verification of AI-generated content. Consequently, the legal profession increasingly recognizes that while AI can enhance efficiency and service quality, it cannot replace attorney professional judgment and responsibility. ## Practical Guidance for ERISA and Employee Benefits Practitioners The panel will provide actionable strategies for ERISA practitioners incorporating AI into their practices. This includes guidance on selecting appropriate tools, implementing verification protocols, and establishing firm-wide policies. Importantly, attendees will benefit from diverse perspectives representing plaintiffs’ attorneys, plan counsel, and union representatives. ## National Recognition in ERISA Litigation Garner has presented at more than 30 national conferences on employee benefits topics. These include multiple ABA Employee Benefits Committee Midwinter Meetings and Joint Committee on Employee Benefits programs over the last 20 years. His speaking topics have covered benefit claims administration and litigation, fiduciary duties, standard of review in disability litigation, attorneys’ fees, remedies, and civil procedure updates. As Founder of The Garner Firm, Garner represents clients in all aspects of ERISA and employee benefits litigation throughout the United States. He is admitted to practice in Pennsylvania, New Jersey, and Maryland. Additionally, he practices before multiple federal district courts and the United States Courts of Appeals for the Third and Fourth Circuits. ## About The Garner Firm The Garner Firm, Ltd. represents employee benefit plan participants and beneficiaries in ERISA litigation, employment disputes, and insurance bad faith matters. The firm’s attorneys provide sophisticated representation grounded in practical experience and comprehensive knowledge of employee benefits law. The Garner Firm is a proud sponsor of the Employee Benefits Committee Midwinter Meeting. --- **Contact:** [The Garner Firm, Ltd. 1617 John F. Kennedy Blvd., Suite 1111 Philadelphia, PA 19103 (215) 645-5955](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") **Keywords:** ERISA attorney, employee benefits law, AI ethics legal practice, ABA professional conduct, artificial intelligence ERISA litigation, employee benefits litigation Philadelphia, fiduciary duty, benefit claims, professional responsibility, legal technology ethics **Categories:** (ERISA) Litigation, Employee Benefits **Tags:** artificial intelligence, employee benefits, ERISA, erisa litigation, legal ethics, professional responsibility --- ### [The Garner Firm Attorneys Earn 2026 Super Lawyers Recognition](https://www.garnerltd.com/the-garner-firm-attorneys-earn-2026-super-lawyers-recognition/) **Published:** May 26, 2026 **Author:** The Garner Firm **Content:** July 22, 2026 The Garner Firm is pleased to announce that three of our attorneys have again been recognized by Super Lawyers for their work in ERISA and long-term disability insurance benefits claims, based on nominations from other attorneys and legal practitioners across the country. [Adam Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/ "Adam H. Garner") and [Melanie Garner](https://www.garnerltd.com/attorney-profiles/melanie-garner/ "Melanie Garner") have each been selected to the 2026 Super Lawyers list, and [Zachary Lipschutz](https://www.garnerltd.com/attorney-profiles/zachary-lipschutz/ "Zachary Lipschutz"), who recently joined the firm as Counsel, has been selected to the 2026 Super Lawyers Rising Stars list. Adam and Melanie have each been recognized by Super Lawyers for their work every year since 2020, while this is Zach’s second year on the list of Rising Stars. Attorneys are nominated by their peers and chosen following independent research by Super Lawyers. No more than 5% of attorneys in a state are named to the [Super Lawyers](https://www.superlawyers.com/about/selection-process/) list each year; and 2.5% to [Rising Stars](https://www.superlawyers.com/about/selection-process/). This recognition reflects the caliber of work and commitment our attorneys bring to every case. *No aspect of this advertisement has been approved by the Supreme Court of New Jersey.* **Categories:** Legal Counsel, Our Blog **Tags:** Adam Garner, erisa attorney, firm news, Melanie Garner, Super Lawyers, Zachary Lipschutz --- ### [Major Victory for ERISA Plan Participants Involving Forced Arbitration](https://www.garnerltd.com/major-victory-for-erisa-plan-participants-involving-forced-arbitration/) **Published:** December 16, 2025 **Author:** Adam Garner **Content:** ![](https://www.garnerltd.com/wp-content/uploads/2025/12/Forced-Arbitration-Infographic-1024x559.png "Forced Arbitration Infographic - The Garner Firm")An experienced ERISA attorney can help protect your retirement benefits. On December 15, 2025, the U.S. Court of Appeals for the Eleventh Circuit issued a decision in *[Williams v. Shapiro](https://law.justia.com/cases/federal/appellate-courts/ca11/24-11192/24-11192-2025-12-15.html)* that addresses the enforceability of arbitration provisions in ERISA-governed employee benefit plans. The court held that an arbitration clause preventing plan participants from seeking plan-wide relief violated the [effective vindication doctrine](https://sites.psu.edu/arbitrationlawreview/tag/effective-vindication/) and was therefore unenforceable. This decision aligns the Eleventh Circuit with six other federal appellate circuits that have reached similar conclusions in ERISA fiduciary breach cases. ## Case Background A360, Inc., a mortgage services and consulting company, established an employee stock ownership plan (ESOP) in 2016. In January 2017, the ESOP purchased one million shares of A360 stock for $30 million, making the plan the company’s sole owner. In September 2019, A360 and its trustee, Argent Trust Company, sold the ESOP’s shares to A360 Holdings, LLC for approximately $34.6 million. On the same date, A360 amended the plan document to add an arbitration provision titled “ERISA Arbitration and Class Action Waiver”. Five days later, the company terminated the plan. Between October 2019 and December 2021, the plan distributed proceeds to participants, after which the plan held no assets. In September 2022, five plan participants filed a class action lawsuit on behalf of approximately 280 plan participants. The plaintiffs alleged that the defendants caused the plan to sell its shares for $34.6 million when the stock was actually worth approximately $70 million, resulting in a $35.4 million loss to the plan. The complaint asserted multiple ERISA claims, including prohibited transactions under 29 U.S.C. § 1106, breaches of fiduciary duties of prudence and loyalty under § 1104(a)(1), and co-fiduciary liability under § 1105(a). The plaintiffs sought plan-wide relief, including disgorgement of profits and restitution for losses to the plan. ## The Arbitration Provision The arbitration provision added to the plan document contained several key limitations. It required that all covered claims “must be brought solely in the Claimant’s individual capacity and not in a representative capacity or on a class, collective, or group basis”. The provision further specified that claimants could not “seek or receive any remedy which has the purpose or effect of providing additional benefits or monetary or other relief to any individual or entity other than the Claimant”. For claims brought under ERISA Section 502(a)(2) seeking relief under Section 409, the provision limited remedies to: (i) alleged losses to the claimant’s individual account; (ii) a pro-rated portion of profits made through use of plan assets intended to remedy only the claimant’s individual account; and (iii) other equitable relief that did not result in benefits or monetary relief to anyone other than the claimant. ## District Court Proceedings The defendants moved to compel arbitration based on the plan amendments. The district court denied the motion. The arbitration procedure was unenforceable because it prohibited the plan-wide relief that ERISA expressly authorizes. Because the provision was non-severable by its own terms, the district court invalidated it entirely. ## The Eleventh Circuit’s Analysis ### Application of the Effective Vindication Doctrine The Eleventh Circuit reviewed the district court’s decision de novo and began by addressing whether the effective vindication doctrine applies in the ERISA context. The effective vindication doctrine, recognized by the Supreme Court in multiple decisions, invalidates arbitration provisions that prospectively waive a party’s right to pursue statutory remedies. The key inquiry is whether “the prospective litigant effectively may vindicate its statutory cause of action in the arbitral forum”. Although the Supreme Court has not applied the doctrine to invalidate an arbitration provision in an ERISA case, six federal circuit courts have done so in recent years. The Eleventh Circuit noted that the doctrine has substantial support in Supreme Court precedent and federal common law, and that no circuit has rejected its application to ERISA cases. The court therefore adopted and applied the effective vindication doctrine. ### ERISA’s Plan-Wide Relief Framework The court examined ERISA’s statutory framework for fiduciary breach claims. Under Section 409(a), a fiduciary who breaches their duties “shall be personally liable to make good to such plan any losses to the plan resulting from each such breach, and to restore to such plan any profits of such fiduciary which have been made through use of assets of the plan”. Section 502(a)(2) provides that plan participants may bring civil actions for relief under Section 409. The Supreme Court has interpreted these provisions as primarily concerned with “the possible misuse of plan assets, and with remedies that would protect the entire plan, rather than with the rights of an individual beneficiary”. Section 409(a) provides relief “singularly to the plan” rather than to individual plaintiffs, and Section 502(a)(2) claims are “brought in a representative capacity on behalf of the plan as a whole”. The Eleventh Circuit explained that under this statutory framework, plan participants serve as agents litigating on behalf of the plan when they bring Section 502(a)(2) claims. The Supreme Court has recognized that “non-class representative actions in which a single agent litigates on behalf of a single principal are part of the basic architecture of much of substantive law”. ### The Arbitration Provision Eliminated Statutory Rights The court concluded that the arbitration provision plainly prohibited claims brought “in a representative capacity” and claims seeking remedies that would benefit anyone other than the individual claimant. This language prevented plaintiffs from effectively vindicating their statutory rights under ERISA Sections 409(a) and 502(a)(2). The court rejected the defendants’ argument that plaintiffs retained their statutory rights because they could still seek individualized relief in arbitration. The fact that plan participants may obtain some individualized relief under Section 409(a) does not mean they waive the right to bring representative-capacity claims seeking relief on behalf of the plan. The defendants’ reliance on [*Thole v. U.S. Bank, N.A.*, 590 U.S. 538 (2020)](https://www.scotusblog.com/cases/case-files/thole-v-u-s-bank-n-a/), was unpersuasive. *Thole* involved a defined benefit plan and addressed Article III standing requirements, holding that plan participants lacked standing when alleged plan mismanagement did not affect their pension benefits. The decision did not address whether ERISA Section 502(a)(2) claimants can act as agents or proxies of the plan in representative actions. The court also found that the fourth amendment to the plan, which permitted claimants to seek certain injunctive relief, did not cure the provision’s defects. Allowing plan-wide injunctive relief “has no bearing on the fact that it eliminates statutorily created plan-wide monetary relief”. The provision still prohibited representative capacity claims for disgorgement of profits and restitution to the plan—the primary forms of relief sought by the plaintiffs. ### Severability Analysis The Court held that the arbitration provision was not severable. The express language of the provision made clear that the parties intended the arbitration requirements to stand or fall together. Accordingly, the court invalidated the entire arbitration provision. ## Significance of the Decision ### Consensus Among Federal Appellate Courts The *Williams* decision represents the seventh federal circuit to apply the effective vindication doctrine to invalidate ERISA arbitration provisions that prevent plan-wide relief. The Second Circuit reached this conclusion in *Cedeno v. Sasson*, 100 F.4th 386 (2d Cir. 2024). The Third Circuit decided similarly in *Henry v. Wilmington Trust*, 72 F.4th 499 (3d Cir. 2023). The Sixth Circuit has issued multiple decisions on this issue, most recently in *Parker v. Tenneco*, 114 F.4th 786 (6th Cir. 2024). The Seventh Circuit addressed the question in *Smith v. Board of Directors of Triad Manufacturing*, 13 F.4th 613 (7th Cir. 2021). The Ninth Circuit joined these courts in *Platt v. Sodexo*, 148 F.4th 709 (9th Cir. 2025). The Tenth Circuit ruled on the issue in *Harrison v. Envision Management*, 59 F.4th 1090 (10th Cir. 2023). No federal appellate court has reached a contrary conclusion. This emerging consensus provides clear guidance regarding the enforceability of arbitration provisions in ERISA plans. ### Implications for ERISA Plans The decision has several implications for ERISA-governed employee benefit plans. Plan sponsors cannot use arbitration provisions to eliminate participants’ statutory rights to seek plan-wide relief under ERISA Sections 409(a) and 502(a)(2). Arbitration provisions that prohibit representative capacity claims or limit remedies to individual account losses are likely unenforceable in the Second, Third, Sixth, Seventh, Ninth, Tenth, and Eleventh Circuits. An ERISA attorney can help plan participants understand these protections. The decision is particularly relevant for employee stock ownership plans, where fiduciary breaches affecting plan-wide stock valuations can significantly impact all participants’ retirement savings. The ability to bring representative actions seeking full recovery of plan losses serves as an important mechanism for holding ESOP fiduciaries accountable. ## Consult an Experienced ERISA Attorney ERISA litigation involves complex statutory and regulatory requirements. Plan participants considering ERISA claims should consult with an ERISA attorney experienced in employee benefits law to ensure their rights are protected. The Garner Firm has extensive experience representing plan participants in [ERISA litigation](https://www.garnerltd.com/practice-areas/erisa-litigation/), including fiduciary breach claims, benefit denials, and disputes involving retirement plans. The firm’s founding attorney, [Adam H. Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/), previously served as Administrator of two large multiemployer employee benefit plans and as President and CEO of their captive third-party plan administration business. This background provides insight into plan operations and fiduciary obligations. Mr. Garner has handled ERISA cases in state and federal courts nationwide, including claims for benefits and equitable relief under ERISA Section 502(a) and fiduciary breach litigation. He is recognized as a Pennsylvania SuperLawyer and serves as a Senior Editor of the Bloomberg BNA treatise *Employee Benefits Law*. He regularly speaks and writes on ERISA litigation topics. ## Contact Information Plan participants who believe their retirement plan has been mismanaged or who have received benefit denials may benefit from a legal consultation. The Garner Firm offers consultations to discuss ERISA claims and evaluate legal options. The firm can be reached at (267) 805-6557 or through the firm’s website at www.garnerltd.com. [Contact us today](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today"). --- *The information in this blog post is provided for educational purposes only and does not constitute legal advice. Readers should consult with qualified legal counsel regarding specific ERISA claims or disputes.* **Categories:** (ERISA) Litigation, Employee Benefits **Tags:** effective vindication doctrine, ERISA, erisa litigation, ESOP, fiduciary breach, forced arbitration --- ### [Why Your ERISA Disability Appeal Is the Most Important Step in Your Benefits Claim](https://www.garnerltd.com/why-your-erisa-disability-appeal-is-the-most-important-step-in-your-benefits-claim/) **Published:** January 24, 2026 **Author:** Adam Garner **Content:** If your claim for **long-term disability (LTD)** or **short-term disability (STD)** benefits has been denied, the ERISA disability appeal may be your best opportunity to secure the benefits you deserve. Under the Employee Retirement Income Security Act of 1974, commonly known as ERISA, the administrative appeal process is not just a procedural formality; it is the foundation upon which your entire claim will rest if your case proceeds to federal court. ![ERISA attorney disability claim appeal with scales of justice representing insurance litigation](https://www.garnerltd.com/wp-content/uploads/2026/01/Gemini_Generated_Image_cfjd7fcfjd7fcfjd-3-1024x765.png "Gemini_Generated_Image_cfjd7fcfjd7fcfjd - The Garner Firm") This blog post explains why a comprehensive ERISA disability appeal is essential to recovering your disability insurance benefits, the critical deadlines you must follow, and how working with experienced ERISA[ disability attorneys ](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/)can make all the difference in your case. ## What Is ERISA and How Does It Affect Your Disability Claim? ERISA is a federal law that governs most employer-sponsored benefit plans, including **disability insurance** plans that provide LTD and STD benefits. If you receive your disability coverage through your employer, your claim is likely governed by ERISA, which means specific federal rules and procedures apply. One of the most significant aspects of ERISA is its requirement that plans provide participants with a “full and fair review” of their claims. This requirement is codified in Section 503 of ERISA, 29 U.S.C. § 1133, and is implemented through detailed regulations found at[ 29 C.F.R. § 2560.503-1.](https://www.law.cornell.edu/cfr/text/29/2560.503-1) These regulations establish the minimum standards for how claims must be processed, what information must be provided when a claim is denied, and the procedures for appealing an adverse decision. If your disability benefits are wrongfully denied after you have exhausted the administrative appeal process, you may bring a lawsuit under ERISA Section 502(a)(1)(B), [29 U.S.C. § 1132(a)(1)(B)](https://www.law.cornell.edu/uscode/text/29/1132), to recover benefits due to you under the terms of your plan. This provision allows plan participants and beneficiaries to sue in federal court to recover benefits owed, enforce their rights under the plan, or clarify their rights to future benefits. ## Understanding the Deadlines for Your Disability Appeal Time is of the essence when your **ERISA disability** claim has been denied. The regulations provide specific deadlines that you must follow, and missing these deadlines can result in waiving your right to appeal entirely. ### Initial Claim Decision Timelines For disability claims, the [insurance company](https://www.garnerltd.com/homepage/insurers-we-litigate-against-in-erisa-benefit-claims/ "ERISA LTD Disability Insurers We Fight for You") or plan administrator has 45 days to make an initial decision on your claim after it is received. This period may be extended by up to two additional 30-day periods if matters beyond the plan’s control prevent a timely decision, but only if the plan notifies you of the extension before the deadline expires. During any extension, the plan must explain the reasons for the delay, the unresolved issues, and any additional information needed to resolve the claim. ERISA disability insurers often violate this process. ### The Critical 180-Day Appeal Window Once you *receive written notice* that your disability claim has been denied, you have **no less than 180 days** to file your appeal. This deadline is mandatory under the ERISA regulations, and plan administrators cannot shorten this timeframe for disability claims. They can always agree to extend it, but often will be reluctant to do so because they are biased due to their conflict of interest as the adjudicator and payor of claims. It is critically important that you calendar this deadline immediately upon *receiving* your denial letter. The 180-day period begins from the date you *receive* the adverse benefit determination, *not* the date the letter was written. Best practice dictates that you should submit your appeal using a trackable delivery method so you can prove when the plan received your appeal materials. ### Appeal Decision Timeline After you submit your appeal, the plan administrator must issue a decision within 45 days. The plan may extend this period by an additional 45 days if special circumstances require more time, but only if you are notified before the initial 45-day period expires. If the plan fails to issue a timely decision, your claim may be deemed denied, allowing you to proceed directly to federal court. Again, insurers often violate these rules. For example, Reliance Standard Life Insurance Company is a frequent offender in this regard. ## Why Building a Comprehensive Appeal Record Is Essential The administrative appeal is your opportunity to build the evidentiary record that will follow your case into court. This point cannot be overstated: in most ERISA cases, the court’s review is limited to the evidence that was part of the record created during the claims process. Although your attorney may attempt to obtain discovery in litigation, discovery may be significantly limited, and courts generally will not consider new evidence that was not submitted during the appeal. ### Essential Components of a Strong Appeal A comprehensive disability appeal often will include the following elements: 1. **Complete medical records**: All treatment notes, diagnostic test results, imaging studies, and laboratory findings that document your condition; 2. **Treating physician opinions**: Detailed statements from your doctors explaining your functional limitations, restrictions, and inability to perform work duties; 3. **Vocational evidence**: Job descriptions, work demands analyses, and vocational assessments that demonstrate you cannot perform your occupation or any occupation, depending on the plan’s definition of disability; 4. **Social Security disability determination**: If you have applied for and received Social Security disability benefits, that determination should be included; 5. **Personal statements**: Your own detailed account of how your disability affects your daily activities and ability to work; 6. **Third-party statements**: Declarations from family members, friends, and former colleagues who can describe how your condition has changed your capabilities; 7. **Functional capacity evaluations**: Professional assessments of your physical or mental abilities to perform work tasks; and 8. **Medical literature**: Peer-reviewed articles and studies that support your claim. ### Responding to New Evidence and Rationales The ERISA regulations were amended effective April 1, 2018, to provide important additional protections for disability claimants. Under these enhanced regulations, if the plan develops or relies on any new evidence or rationale during the appeal process, it must provide you with that information free of charge and give you a reasonable opportunity to respond before issuing a final decision. This means you have the right to know what the plan is considering and to address any concerns before your appeal is decided. If the plan fails to provide this information, it may have failed to provide you with a full and fair review, which can have significant consequences in subsequent litigation. ## Consequences of an Inadequate Appeal Failing to submit a comprehensive appeal can have devastating consequences for your case. If your appeal lacks sufficient evidence to support your disability claim, the plan administrator will likely uphold the denial. More importantly, if your case proceeds to federal court, you will likely be stuck with an incomplete record. Under the deferential “abuse of discretion” standard of review that applies when plans have discretionary authority, courts generally limit their review to whether the administrator’s decision was reasonable based on the evidence in the administrative record. Without strong medical, vocational, and personal evidence in your appeal, you will have given the court little basis to overturn the denial. Conversely, if the plan fails to follow the claims regulations—such as failing to provide required notices, missing deadlines, or not considering your evidence—courts might apply a less deferential “de novo” standard of review, which can significantly improve your chances of success. ## How The Garner Firm Can Help Navigating the ERISA disability appeal process is complex, and the stakes are high. Insurance companies have teams of adjusters, medical reviewers, and attorneys working to protect their bottom line. You deserve experienced legal advocates on your side who understand the intricate web of ERISA regulations and know how to build a winning appeal. At The Garner Firm, we focus on ERISA and employment law, giving us deep expertise in the complex procedures that govern disability claims. Our [attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") have handled ERISA lawsuits in state and federal courts nationwide, including claims for benefits under Section 502(a)(1)(B) of ERISA. We have successfully helped countless clients navigate the challenging appeals process, recover wrongfully denied benefits, and secure the financial support they need. Firm founder [Adam H. Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/ "Adam H. Garner") has two decades of experience as an ERISA, insurance, and employment attorney and has built a reputation as a dedicated advocate for employee benefit plan participants. As a former administrator of multi-million and billion-dollar multiemployer benefit plans, Mr. Garner has firsthand insight into the policies, procedures, and fiduciary obligations that govern disability programs. He serves as Senior Editor of the treatise *Employee Benefits Law*, published by the American Bar Association in conjunction with Bloomberg. ### What Sets Us Apart - **ERISA focus**: We concentrate on ERISA and employment law cases - **Proven results**: We have a successful track record of overturning benefit denials - **Comprehensive approach**: We handle every aspect of your claim from initial denial through federal court litigation - **No upfront costs**: We work on a contingency basis—you pay nothing unless we recover benefits - **Personalized attention**: You will have direct access to experienced attorneys, not just paralegals or other support personnel ## Take Action Before It Is Too Late If your disability claim has been denied, time is not on your side. The 180-day appeal deadline runs whether or not you are represented by counsel, and every day that passes is one less day to gather evidence and build your case. Do not let the insurance company’s denial be the final word. [Contact The Garner Firm today](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") at **(267) 805-6557** to schedule a consultation. We will review your denial letter, evaluate the strength of your appeal, and explain your options for pursuing the **long-term disability** or **short-term disability** benefits you are owed. Your financial security and peace of mind are too important to leave to chance. Let us fight for your rights. **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** administrative appeal, Disability Benefits, ERISA, ERISA appeal, long term disability, short term disability --- ### [Adam Garner to Speak at the ABA Employee Benefits Committee Midwinter Meeting in Austin, Texas](https://www.garnerltd.com/adam-garner-to-speak-at-the-aba-employee-benefits-committee-midwinter-meeting-in-austin-texas/) **Published:** February 5, 2026 **Author:** Adam Garner **Content:** Philadelphia ERISA attorney [Adam H. Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/adam-garner-4/ "Adam Garner"), founder of The Garner Firm, addresses the intersection of artificial intelligence and ethical practice at the ABA Employee Benefits Committee Midwinter Meeting, one of the nation’s premier conferences for ERISA litigation practitioners. ![](https://www.garnerltd.com/wp-content/uploads/2026/02/IMG_6150-768x1024.jpeg "IMG_6150 - The Garner Firm") The American Bar Association Section of Labor and Employment Law’s Employee Benefits Committee is holding its annual [Midwinter Meeting](https://events.americanbar.org/event/669e0fe5-397c-4ec7-ac91-a783342506d2/summary) in Austin, Texas, from February 4-7, 2026. The Garner Firm, Ltd. is proud to participate in this year’s conference as a Gold sponsor, with Firm founder Adam H. Garner serving as both a featured speaker and a leader of the conference’s Planning Committee. ## A National Conference for ERISA Practitioners The Employee Benefits Committee Midwinter Meeting is one of the nation’s leading conferences for ERISA attorneys and employee benefits professionals. This year’s [agenda](https://custom.cvent.com/F9E449D691AE483080DAC6296EBC2854/files/event/669e0fe5397c4ec7ac91a783342506d2/34eef0adbde4481d9853236dbecccfdf.pdf) features sessions covering the full spectrum of ERISA litigation and compliance, including panels on multiemployer plan issues, long-term disability and life insurance litigation, pharmacy benefit managers, mental health parity enforcement, retirement plan class actions, and regulatory developments under the current administration. The conference draws ERISA attorneys from across the country, representing both plan participants and plan sponsors, as well as government regulators and union counsel. The diversity of perspectives represented at this meeting reflects the complex nature of ERISA practice and makes it an invaluable opportunity for practitioners to sharpen their skills and stay current on developments in the law. ## Adam Garner Presents on AI Ethics for ERISA Attorneys On Friday, February 6, 2026, Adam Garner will speak on a panel titled “Ethics in an AI World: Responsible Use in Your Practice”. The panel provides a practical framework for integrating artificial intelligence into daily law practice while upholding core duties under the Rules of Professional Conduct. As the panel description notes, artificial intelligence is rapidly transforming the practice of law for ERISA attorneys, presenting both unprecedented opportunities for efficiency and new ethical challenges. The session will address the use of AI in automating record review, accelerating legal research, and drafting documents, while offering strategies for selecting the right tools and ensuring data security. The panel brings together perspectives from plaintiffs’ attorneys, plan counsel, and union representatives to help attendees understand how to harness AI to improve their practices without compromising professional obligations. Adam will be joined by fellow panelists Ivelisse Berio LeBeau of National Employee Benefits Administrators and Ben Conley of Seyfarth Shaw LLP. ## Key Ethical Considerations for ERISA Attorneys Using AI The presentation materials address several Model Rules of Professional Conduct implicated by AI use in legal practice, including Rule 1.1 (Duty of Competence), Rule 1.4 (Communications), Rule 1.5 (Fees), Rule 1.6 (Confidentiality of Information), Rule 3.3 (Candor toward the Tribunal), and Rule 5.3 (Responsibilities Regarding Nonlawyer Assistance). As outlined in ABA Formal Opinion 512, lawyers must have a reasonable understanding of the capabilities and limitations of AI tools and must independently verify all AI-generated outputs. The Opinion makes clear that uncritical reliance on these tools violates the duty of competence—a concern that has heightened significance for ERISA attorneys who handle complex benefit claims and fiduciary breach litigation. The presentation also addresses practical considerations such as when client consent is required for AI use, how to select appropriate tools that maintain confidentiality, and how to integrate AI responsibly into litigation workflows. ## Adam Garner’s Role on the Planning Committee In addition to his speaking role, Adam serves as Employee Ombudsman (co-chair) on the 2026 Employee Benefits Committee Midwinter Meeting Planning Committee. He has served on the planning committee for this conference for several years, helping to shape the programming that makes this conference one of the premier ERISA events in the country. Adam has also held leadership roles within the ABA for over a decade. He served as a Plaintiffs’ subcommittee Co-Chair of the ABA Employee Benefits Committee and previously served as Chair of the ABA Torts, Trial, and Insurance Practice Section’s Health and Disability Insurance Committee from August 2020 to August 2021. ## Adam Garner’s ERISA Experience Adam Garner founded The Garner Firm, Ltd. in 2016 as an employee benefits and employment law firm based in Philadelphia, Pennsylvania. The firm represents individuals in claims against and disputes with employee benefit plans, employee benefit plan fiduciaries, and employers. Since founding the firm, Adam has recovered millions of dollars on behalf of ERISA plan participants and their beneficiaries, insureds, and employees in ERISA, insurance, and employment litigation. Adam has been appointed co-lead class counsel in multiple ERISA class action matters, including *Lewis-Abdulhaadi v. Union Security Insurance Company, et al.* (E.D. Pa.) and *McCann v. Hill, et al.* (D. N.J.). He also serves as a Senior Editor of *Employee Benefits Law*, the leading treatise on ERISA published by Bloomberg BNA in conjunction with the ABA Section of Labor and Employment Law. Prior to founding the firm, Adam served as Administrator of two ERISA-regulated multiemployer employee benefit plans with combined assets exceeding $1.6 billion at the time. This experience on the plan administration side provides him with unique insights into how benefit plans operate and where fiduciary breaches may occur. Adam has been named a Pennsylvania Super Lawyer or Rising Star every year since 2018 and is a Fellow of the American Bar Foundation. ## Contact The Garner Firm for Your ERISA Matter If you or someone you know has been denied benefits under an employee benefit plan, has questions about retirement benefits, [disability insurance](https://www.garnerltd.com/why-your-erisa-disability-appeal-is-the-most-important-step-in-your-benefits-claim/), [life insurance](https://www.garnerltd.com/practice-areas/life-insurance/), or other ERISA-regulated benefits, The Garner Firm can help. Whether your matter involves an individual claim for benefits or potential class action litigation involving fiduciary breaches, our attorneys have the knowledge and experience to evaluate your case and pursue the recovery you deserve. The Garner Firm represents ERISA plan participants and beneficiaries throughout Pennsylvania and across the country. [Contact us today](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") to schedule a consultation with an experienced ERISA attorney who understands both the law and the practical realities of plan administration. **Categories:** (ERISA) Litigation, Employee Benefits **Tags:** Adam Garner, artificial intelligence, employee benefits, ERISA, ERISA lawyer, erisa litigation, legal ethics --- ### [Adam Garner to Speak on Urgent Retirement Plan Issues at ABA](https://www.garnerltd.com/erisa-lawyer-adam-garner-urgent-retirement-plan-issues-aba/) **Published:** February 15, 2026 **Author:** Adam Garner **Content:** [Adam Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/) is a noted speaker on ERISA topics. He has multiple speaking engagements set for this winter and spring, including on the topic of [retirement plan litigation](https://www.garnerltd.com/practice-areas/retirement-plan-benefit-claims/). Today, the landscape of retirement plan litigation under the [Employee Retirement Income Security Act of 1974 (ERISA)](https://www.garnerltd.com/what-is-an-erisa-claim/ "What Is an ERISA Claim?") is shifting rapidly. From pension risk transfer challenges to forfeiture lawsuits to ESG investing disputes, retirement plan participants face a growing number of threats to their hard-earned benefits. As an ERISA lawyer who represents plan participants and employees, The Garner Firm’s founder stays at the forefront of these developments—both in the courtroom and at the podium. ![](https://www.garnerltd.com/wp-content/uploads/2026/02/courtroom-sketch.png "courtroom sketch - The Garner Firm")Adam H Garner On February 20–21, 2026, Mr. Garner will speak at the [American Bar Association](https://www.americanbar.org/)‘s [50th Annual TIPS Midwinter Symposium on Employee Benefits, ERISA, Life, Health \\& Disability Insurance, and Insurance Regulation](https://events.americanbar.org/event/df80a919-e95e-48f2-996f-8e92aacb1fca/summary) in La Jolla, California. He will participate on the panel titled “ERISA Hot Topics, Part One: Retirement Plans.” Specifically, the panel will address some of the most consequential issues in retirement plan litigation today. These include pension risk transfers, forfeiture disputes, ESG investing, and fiduciary breach claims. This milestone event—marking the symposium’s 50th and final standalone year—brings together practitioners from both sides of ERISA litigation to examine cutting-edge legal developments. ## What Is ERISA and Why Do You Need an ERISA Lawyer? ERISA is the federal law that governs most employer-sponsored benefit plans. These include 401(k) plans, pension plans, and health and welfare benefit plans. Importantly, ERISA establishes fiduciary duties for those who manage these plans. It also requires transparency and accountability. In addition, it provides participants with the right to sue when those obligations are violated. If you participate in an private sector employer-sponsored retirement plan, ERISA is the law that protects your benefits. An experienced ERISA lawyer can help you understand and enforce those protections. When plan sponsors or fiduciaries fail to act in participants’ best interests, ERISA provides legal remedies. In recent years, retirement plan litigation has expanded significantly. New theories of liability have emerged that challenge long-standing industry practices. As a result, understanding these trends is essential for anyone who depends on an employer-sponsored retirement plan for their financial security. ## Pension Risk Transfers: A Growing Threat to Retirees One of the most significant developments in retirement plan litigation involves pension risk transfers. In a pension risk transfer, an employer shifts its obligation to pay pension benefits to an insurance company by purchasing a group annuity contract. As a result, the employer eliminates its pension liability. However, participants lose the federal protections that ERISA provides. This includes the backing of the [Pension Benefit Guaranty Corporation (PBGC)](https://www.pbgc.gov/). Instead, participants become subject to state insurance regulation, which plaintiffs argue offers weaker protections if the insurer becomes insolvent. A wave of class action lawsuits has challenged these transactions. Plaintiffs allege that plan sponsors and fiduciaries breach their ERISA duties when they select an annuity provider that is not the “safest” available option. So far, courts have reached different conclusions on whether participants have standing to bring these claims. For example, one court allowed the case to proceed to discovery. In contrast, another dismissed the complaint entirely because it found no concrete injury. The outcome of these cases will have major implications for the millions of retirees whose pension benefits have been or may be transferred to insurance companies. If you are affected by a pension risk transfer, consulting an ERISA lawyer is a critical first step. ## The 401(k) Forfeiture Litigation Explosion Since late 2023, more than 80 class action lawsuits have challenged how employers use forfeitures in their 401(k) plans. Forfeitures are the unvested portions of employer contributions that remain in a plan when an employee leaves before fully vesting. The central allegation in these cases is straightforward. Plaintiffs claim that plan sponsors breach their fiduciary duties under ERISA when they use forfeitures to offset future employer contributions. They argue the money should instead reduce plan fees borne by participants or go to other participants’ accounts. More specifically, plaintiffs argue that this practice violates ERISA’s fiduciary duties of loyalty and prudence, its anti-inurement provision, and its prohibited transaction rules. In 2025 alone, 43 forfeiture cases were filed. That represents a more than 40 percent increase over 2024. While most courts have sided with defendants on motions to dismiss so far, several have allowed cases to proceed. Moreover, the legal theories continue to evolve. For plan participants, these cases raise important questions. Is the money left behind by departing employees being used to benefit the people still in the plan—or the employer’s bottom line? ## ESG Investing and ERISA Fiduciary Obligations Environmental, social, and governance (ESG) investing in retirement plans remains a hotly contested issue. ERISA requires fiduciaries to act solely in the financial interest of plan participants. Critics of ESG investing argue that incorporating non-financial factors into investment decisions violates that obligation. Meanwhile, the current administration’s [Department of Labor](https://www.dol.gov/) has signaled its intent to reconsider and potentially rescind a prior rule. That rule allowed ESG factors to serve as a permissible “tiebreaker” between financially equivalent investment options. At the same time, courts have begun weighing in on these disputes. In one notable case, a court found liability where plan fiduciaries failed to adequately monitor an asset manager. The manager allegedly pursued non-financial ESG goals through proxy voting and shareholder activism, ultimately harming plan investment performance. In another case, a Texas federal court upheld the DOL’s ESG regulation. That court held that the rule “never permits fiduciaries to deviate from exclusively achieving financial benefits” for participants. The tension between these rulings creates uncertainty for both plan sponsors and participants. As a result, this is an area where an experienced ERISA lawyer is essential. ## The Supreme Court Raises the Stakes: *Cunningham v. Cornell* The [Supreme Court](https://www.supremecourt.gov/)‘s decision in *[Cunningham v. Cornell University](https://www.supremecourt.gov/opinions/24pdf/23-1007_h3ci.pdf)* resolved a significant circuit split. The case concerned the pleading standard for prohibited transaction claims under ERISA § 406, 29 U.S.C. § 1106. The Court held that a plaintiff can adequately allege a prohibited transaction simply by pleading its existence. In other words, the plaintiff does not need to prove at the pleading stage that no statutory exemption under ERISA § 408(b) applies. This decision makes it easier for participants to get their cases past the motion to dismiss stage and into discovery. For retirement plan participants, *Cunningham* is a meaningful development. It reinforces that ERISA’s fiduciary protections should be broadly construed. Furthermore, it confirms that participants should not be required to plead information that lies solely within the control of plan fiduciaries. A knowledgeable ERISA lawyer can leverage this ruling to build stronger cases on behalf of plan participants. ## Why Choose The Garner Firm’s ERISA Lawyer? The Garner Firm, Ltd. is a Philadelphia-based ERISA employee benefits law firm. The firm represents employees, former employees, and plan participants on an individual, collective, and class basis. Mr. Garner is a nationally recognized ERISA lawyer with extensive experience in federal courts nationwide. He handles claims for benefits, equitable relief actions under Section 502(a) of ERISA, and fiduciary breach litigation. Additionally, as a former administrator of multi-million and billion-dollar multiemployer benefit plans, he brings firsthand knowledge of the policies, procedures, and fiduciary obligations that govern retirement plans. Mr. Garner regularly writes and speaks on ERISA litigation and employee benefits law for legal conferences, bar associations, and professional publications. His selection as a panelist at the ABA’s landmark 50th Annual TIPS Midwinter Symposium reflects his standing in the field. It also demonstrates his commitment to staying on top of the legal developments that affect retirement plan participants. ## An ERISA Lawyer Can Help Protect Your Retirement Benefits If you believe your employer or plan fiduciary has mismanaged your retirement plan, you may have legal options under ERISA. This includes claims involving pension risk transfers, improper use of forfeitures, imprudent ESG investing, or any other fiduciary breach. The Garner Firm has the experience and knowledge to evaluate your situation and fight for the benefits you have earned. **[Contact The Garner Firm, Ltd](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today"). today at (215) 645-5955 or visit [www.garnerltd.com](https://www.garnerltd.com) to schedule a consultation with an experienced ERISA lawyer who will stand up for your rights.** **Categories:** (ERISA) Litigation, Employee Benefits **Tags:** 401(k) forfeiture, ERISA, ESG investing, fiduciary breach, pension risk transfer, retirement plan litigation --- ### [The Garner Firm Welcomes Zachary Lipschutz as Counsel](https://www.garnerltd.com/the-garner-firm-welcomes-zachary-lipschutz-as-counsel/) **Published:** May 11, 2026 **Author:** The Garner Firm **Excerpt:** The Garner Firm welcomes Zachary Lipschutz as Counsel to its ERISA and long-term disability practice. Zach brings extensive experience representing individuals in disability claims and litigation nationwide. **Content:** May 11, 2026 **We are pleased to announce that [Zachary Lipschutz](https://www.garnerltd.com/attorney-profiles/zachary-lipschutz/ "Zachary Lipschutz") has joined the firm as Counsel, focusing on ERISA and long-term disability disputes.** Zach brings a strong background in ERISA, long-term disability, workers’ compensation, and Social Security disability disputes, with experience representing clients in the Philadelphia area and nationwide. He has been recognized in *Best Lawyers: Ones to Watch® in America* and named to the Super Lawyers Rising Stars. > > > “Zach’s arrival reflects our ongoing commitment to providing the highest level of representation to individuals fighting for the disability benefits they are owed,” said Adam Garner, Founding Partner and Managing Member. “We are pleased to welcome him to the firm.” The Garner Firm, led by nationally recognized ERISA attorney Adam Garner, Founding Partner, and Melanie Garner, Partner, has recovered millions of dollars in disability benefits for individuals nationwide. **Categories:** Legal Counsel, Our Blog **Tags:** Adam Garner, erisa attorney, firm news, long term disability, Zachary Lipschutz --- ### [Why Your Last Day of Work May Not Be Your Date of Disability: What ERISA Claimants Need to Know](https://www.garnerltd.com/erisa-disability-attorney-date-of-disability-vs-last-day-of-work/) **Published:** May 18, 2026 **Author:** Adam Garner **Excerpt:** Your last day of work may not be your date of disability under ERISA. Learn why this distinction matters for STD and LTD claims, how insurers exploit it, and when to consult an ERISA disability attorney. **Content:** May 18, 2026 If you are filing a claim for **short-term disability (STD)** or **long-term disability (LTD)** benefits, consulting an experienced **ERISA disability attorney** early can make all the difference. Many claimants assume their last day of work is the same as their date of disability. That assumption is understandable, but it can be wrong. The distinction matters enormously. It can mean the difference between an approved claim and a denial. Under the [Employee Retirement Income Security Act of 1974](https://www.dol.gov/general/topic/retirement/erisa) (**ERISA**), insurers evaluate the “date of disability” as a separate factual and contractual question. This date is distinct from when you last physically reported to work. Understanding why these two dates may differ is essential for protecting your right to benefits. At **[The Garner Firm](https://www.garnerltd.com/)**, our attorneys have spent decades representing employees and professionals whose STD and LTD claims have been denied, terminated, or underpaid. As a dedicated **ERISA disability attorney** team, we routinely handle cases where the date of disability is contested. We know how insurers exploit this issue to defeat otherwise strong claims. ## Defining the “Date of Disability” Under an ERISA-Governed Plan Most group **long-term disability** and **short-term disability** policies define “disability” by a claimant’s inability to perform their key job duties. This definition often includes a minimum loss of earnings, frequently 20% or more. The “date of disability” is simply the date that definition is first met. ERISA-governed plans typically require three elements to coincide: - The claimant must meet the policy’s definition of disability. - Coverage under the plan must be active on that date. - Any applicable elimination period (often 90 or 180 days for LTD) must be satisfied. Because eligibility is tied to the date of disability—not the last day worked—an incorrect date can trigger [pre-existing condition exclusions](https://www.garnerltd.com/erisa-disability-claim-denial-reasons-and-how-to-fight-back/), coverage lapses, or elimination period disputes. ## Why the Last Day of Work and the Date of Disability Often Differ Several common scenarios cause these dates to diverge. An ERISA disability attorney can help you identify which applies to your situation. ### 1. Working Through Symptoms Many high-functioning professionals continue working despite worsening conditions. A physician with multiple sclerosis, an attorney managing severe depression, or a nurse with degenerative disc disease may push through symptoms for months. Sometimes these individuals work, even though they are unable to perform the full range of material duties of their occupation. Medical evidence may show the claimant became “disabled” under the policy well before the last day worked. ### 2. Reduced Hours, Restricted Duties, or Accommodations When an employee shifts to part-time work or lighter duties, the date of disability may predate the last full workday. Many LTD policies include a substantial loss of earnings in their definition. A shift to reduced hours can itself trigger the date of disability, even though the employee still reports to work. ### 3. Use of Paid Time Off, Sick Leave, or FMLA Employees frequently exhaust paid time off (PTO), sick leave, or **Family and Medical Leave Act (FMLA)** leave before applying for disability benefits. Insurers often argue that the last day of “active work” is the last day performing job duties—not the last day on payroll. This matters because many ERISA plans terminate coverage when active employment ends, not when payroll stops. ### 4. Termination, Layoff, or Resignation If an employee is terminated, laid off, or resigns and later claims disability, the insurer will examine whether the disability arose before coverage ended. A claimant fired before filing for LTD faces a steep battle. Success requires medical evidence proving the disability began while coverage was still in force. ### 5. Gradual or Progressive Conditions Conditions like cancer, ALS, Parkinson’s disease, long COVID, and chronic fatigue syndrome progress gradually. Pinpointing the exact date of disability requires careful analysis of medical records and functional assessments. Insurers often pick the date most favorable to denial. That date may fall after coverage lapsed or before a look-back period closed. ## How Insurers Use the Date of Disability to Deny ERISA Claims In our experience litigating [ERISA claims](https://www.garnerltd.com/practice-areas/erisa-litigation/), insurers routinely manipulate the date of disability to create denial grounds. Common tactics include: - **Pre-existing condition exclusions.** Most LTD policies have a look-back period of three to twelve months before coverage began. By pushing the date of disability earlier, insurers argue the condition is excluded. - **Coverage termination defenses.** If the insurer claims disability began after the last day of active work, it may argue coverage had already ended. - **Elimination period disputes.** STD and LTD policies require continuous disability before benefits start. Insurers may claim work activity restarted or invalidated this waiting period. - **Own-occupation versus any-occupation transitions.** Many LTD plans shift definitions after 24 months. The date of disability controls when that transition occurs. ## The Role of Medical Evidence and Documentation Establishing the correct date of disability takes more than your word. Treating physicians’ notes, attending physician statements, and employer records all help build the timeline. Performance reviews, attendance logs, and even emails reflecting your struggles can serve as supporting evidence. Under ERISA’s claims regulations (29 C.F.R. § 2560.503-1), claimants have the right to a full and fair review. This includes the right to submit evidence and receive the administrative record. Building a strong evidentiary record early is critical. Federal courts typically limit their review to the record from the claims and appeals process. ## Why You Need an Experienced ERISA Disability Attorney ERISA disability litigation is a niche field. Strict procedural rules, deferential review standards, and limited discovery in federal court make it vital to position your claim correctly from the start. The [ERISA disability attorneys](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/) at **The Garner Firm** have represented countless claimants against every major carrier. Our experience includes disputes with Unum, The Hartford, Lincoln Financial, Prudential, MetLife, Cigna/New York Life, Reliance Standard, and Sun Life. We understand how carriers exploit ambiguities in the date of disability. We know how to build a record that withstands scrutiny on [administrative appeal](https://www.garnerltd.com/why-your-erisa-disability-appeal-is-the-most-important-step-in-your-benefits-claim/) and in federal court. Our practice includes: - Pre-claim counseling to help plan your transition from work to disability leave. - Administrative appeals of denied STD and LTD claims under ERISA. - Federal court litigation under 29 U.S.C. § 1132(a)(1)(B). - Class and individual actions involving systemic claims-handling abuses. ## Practical Steps for Claimants and Referring Attorneys If you or a client is considering a disability claim, take these steps before stopping work: - Document symptoms, accommodations, and functional limitations in writing. - Obtain detailed treatment records and a clear statement of restrictions from your doctors. - Confirm the effective date of coverage and any pre-existing condition look-back period. - Coordinate the timing of resignation, termination, or leave with medical evidence supporting the date of disability. - Consult an experienced ERISA disability attorney before filing a claim—not after a denial. ## Contact The Garner Firm Today If your **short-term disability** or **long-term disability** claim has been denied, terminated, or is at risk due to a date-of-disability dispute, do not face the **ERISA** claims process alone. The Garner Firm offers free, confidential consultations to claimants and referring attorneys nationwide. [Call us today](https://www.garnerltd.com/contact/) to schedule a consultation with an experienced ERISA disability attorney. Your right to benefits starts with the right legal team—and the right date. **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** date of disability, Disability Benefits, ERISA, ERISA disability attorney, long term disability, short term disability --- ### [The Long-Term Disability Gender Gap: Why Women Lose Claims They Should Win](https://www.garnerltd.com/the-long-term-disability-gender-gap-why-women-lose-claims-they-should-win/) **Published:** May 20, 2026 **Author:** Melanie Garner **Excerpt:** Women with legitimate disabilities are denied long-term disability benefits at higher rates than men — even with comparable medical conditions. Research shows insurers and evaluators often overestimate women’s ability to keep working, creating a gender gap that can leave disabled women without the support they paid for. **Content:** May 20, 2026 Most people with long-term disability coverage assume their policy will pay out if they cannot work. For women, that assumption carries more risk than they realize. Research confirms that women with genuine, work-limiting disabilities are denied benefits more often than men with the same conditions — not randomly, but for specific, structural reasons that appear at predictable points in the claims process. ## Women pay more for coverage and get denied more often Individual disability insurance premiums run significantly higher for women than men. Insurers charge more because women file more claims and are out of work longer. The market acknowledges that women are more likely to become disabled. But what happens after they file tells a different story. [Peer-reviewed research](https://www.nber.org/papers/w26513) by economists Hamish Low of Oxford and Luigi Pistaferri of Stanford found that women with genuine, work-limiting disabilities are 12.8 percentage points more likely to be wrongfully denied than men with comparable health conditions and demographics. Critically, the disparity did not arise at the point of determining whether a disability existed. It arose at the next question: can this person still do some kind of work? When evaluators looked at that question, they consistently concluded that women — even women with the same conditions as men — had more ability to keep working than the evidence supported. That assumption, applied systematically, is what drove the higher denial rate. Although this research examined Social Security Disability Insurance, not LTD benefits, the same reasoning appears throughout private and ERISA-governed claims. The consequences for women are severe: those denied disability insurance despite being unable to work have very few alternatives to support themselves and their dependents long-term. ## Three specific ways the process works against women ### 1. The conditions women most often claim are the hardest to prove Insurers are more comfortable approving claims with objective, measurable findings. A tumor, a fracture, a documented cardiac event — these are straightforward to document. Autoimmune disease is not. 70-80% of autoimmune disease patients are women. Conditions like lupus, rheumatoid arthritis, and multiple sclerosis are serious and often profoundly disabling — but they fluctuate, they can be invisible on standard imaging, and they depend substantially on what a patient reports about her own experience. Women also file at higher rates for **mental health conditions**, which most group LTD policies limit to 24 months under “mental/nervous” provisions, and for **musculoskeletal conditions**, where imaging routinely understates actual loss of function. An executive with lupus, an attorney with a debilitating autoimmune condition, a surgeon whose rheumatoid arthritis prevents her from operating — these are not borderline cases. They are exactly the kind of claims that can get denied because the disability is real, but the proof is complicated. ### 2. Women’s symptoms are more likely to be undertreated — and underrecorded Under ERISA, which governs most employer-sponsored [long-term](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/)[ disability plans](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/), claimants must exhaust the insurer’s full internal appeal process before filing a lawsuit. By the time a case reaches federal court, the administrative record is often fixed. A judge is not evaluating the disability from scratch — she is asking whether the insurer’s decision was reasonable based on what the record already contains. This makes the quality of medical documentation critical from the very first appointment. Women face a well-documented disadvantage here. A [2022 study](https://www.ahajournals.org/doi/full/10.1161/JAHA.121.024199) published in the Journal of the American Heart Association found that women presenting with chest pain waited an average of 11 minutes longer than men before being evaluated, were less likely to be triaged as urgent, and were less likely to receive basic cardiac testing. Research consistently shows that women’s pain is assessed as less severe and treated less aggressively than equivalent symptoms in men. The 2001 analysis [*The Girl Who Cried Pain*](https://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?params=/context/fac_pubs/article/1144/&path_info=The_Girl_who_Cried_Pain.pdf), published in the Journal of Law, Medicine & Ethics, documented that physicians attributed women’s reported pain to emotional factors even when clinical findings pointed elsewhere — a pattern that has been replicated in studies since. When a treating physician minimizes or dismisses what a patient reports, that enters the medical record and, in turn, the claim file. ### 3. Continuing to function at home can be used against you When you file an LTD claim, your insurer will ask detailed questions about your daily activities and may conduct surveillance. A claimant who appears to be functioning — driving, cooking, attending school events — can have those activities used as evidence that her limitations are not as significant as claimed. According to [2024 American Time Use Survey data](https://www.bls.gov/news.release/pdf/atus.pdf), women consistently spend more time than men on housework and caregiving activities. That gap does not fully close when a woman becomes ill. Women who are genuinely disabled are more likely to push through pain and fatigue to manage a household, care for children, or look after aging parents — not because they can return to work, but because those responsibilities do not stop for illness. An executive who can no longer sustain a full workday but still manages her household and gets her kids to school is not demonstrating that she is able to work. She is demonstrating that she is a mother. Insurers do not always draw that distinction, and the consequences can be serious. [Knowing what information insurers collect and how they use it](https://www.garnerltd.com/5-warning-signs-your-ltd-claim-may-be-denied/) before you file — not after — matters. Under ERISA, courts reviewing LTD denials often apply a deferential standard of review. The question is not whether the insurer was wrong — it is whether the insurer was unreasonable. That is a meaningful distinction, and it means that by the time a case is in litigation, your options may be significantly shaped by what is already in the record. ## Why the appeal may be your most important opportunity The internal appeal is the last real opportunity to introduce evidence, correct gaps in medical documentation, and directly challenge the insurer’s reasoning. [What happens — or does not happen — at the appeal stage can be very difficult to undo.](https://www.garnerltd.com/long-term-disability-application-error-costs-musician-her-benefits/) ## If your claim has been denied A denial is not final, but the timeline to respond is short, and the process is unforgiving. If you are a physician, executive, attorney, or other high-earning professional whose LTD claim has been denied or is at risk, call us at (215) 645-5955 or [contact us online](https://www.garnerltd.com/contact/) to discuss your options. Our initial consultation involves no charge and no commitment. If you are an attorney, financial advisor, or CPA with a client in that situation, we would be happy to support you and your client. **Categories:** Disability Benefits, Long Term Disability **Tags:** Disability Benefits, disability claim denial, disability insurance, long term disability, LTD, women --- ### [Mass Tort Cases and Disability Claims: A Recovery Path Your Client May Not Know Exists](https://www.garnerltd.com/erisa-disability-claim-mass-tort-clients/) **Published:** June 16, 2026 **Author:** Melanie Garner **Content:** June 16, 2026 **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)](https://www.dol.gov/general/topic/health-plans/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](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") 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](/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](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today")** to discuss whether your client may have an ERISA disability claim worth pursuing. --- **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** Disability Benefits, ERISA, long term disability, LTD, mass tort, personal injury --- ### [Warning: The ERISA Red Flags Experts Should Watch For](https://www.garnerltd.com/erisa-attorney-disability-claim-red-flags/) **Published:** June 23, 2026 **Author:** Adam Garner **Content:** June 23, 2026 When a client stops working because of a serious illness or injury, their financial advisor or CPA is sometimes the first professional an individual speaks with due to the change in their income and a claim for short-term or long-term disability insurance benefits. A sudden drop in cash flow or an unexplained letter from an insurance company can be the earliest sign that a long-term disability (LTD) claim is in trouble. Because most employer-provided disability policies are governed by the Employee Retirement Income Security Act of 1974 (ERISA), the window to fix a problem is short, and the rules are unforgiving. For trusted advisors in Pennsylvania, New Jersey, and across the country, learning to spot **ERISA disability red flags** early can mean the difference between a client who keeps their benefits and one who loses them permanently. Knowing when to bring in an ERISA attorney is just as important as spotting the warning signs themselves. This guide explains what those red flags look like, why ERISA makes timing so critical, and when a referral to an experienced ERISA attorney is the smartest move you can make for your client. ## Why ERISA Disability Claims Are Different Most people assume that a disability claim works like any other insurance claim: you submit proof, and the insurer pays. ERISA changes that assumption in ways that catch even sophisticated professionals off guard. ERISA preempts most state-law remedies, which means a claimant generally cannot sue for bad faith, punitive damages, or a jury trial the way they could under a private insurance policy (29 U.S.C. § 1144). Instead, the claimant’s case is usually decided by a federal judge reviewing a written record. The most important and most dangerous feature of ERISA is the administrative or internal appeal. Before a claimant can ever file a lawsuit, they generally must exhaust the insurer’s internal appeal process, and the evidence they submit during that appeal typically becomes the entire “administrative record.” In many cases, courts will not consider new evidence that was not submitted before the final denial. That means a doctor’s report, a vocational expert’s opinion, or a witness statement that is left out of the appeal may never be seen by a judge. This is why a denial letter is not just bad news; it is a ticking clock. ## The 180-Day Deadline That Decides Everything The single most important number for any advisor to remember is **180 days**. Under the [Department of Labor’s claims ](https://www.ecfr.gov/current/title-29/section-2560.503-1)regulations, a claimant generally has 180 days from the date the claimant receives a written adverse benefit determination to file an administrative appeal of a disability denial (29 C.F.R. § 2560.503-1). (The deadlines can be *shorter* for retirement and life insurance claims). Missing that deadline can extinguish a client’s right to benefits entirely, no matter how strong their medical evidence is. When a CPA or financial advisor sees a denial or termination letter, the first question should be: *what is the date on this letter, when was it received, and how many days are left?* If the answer is “less than 90,” the situation is urgent. The appeal is the client’s one real chance to build the record, and building a persuasive appeal—complete with updated medical records, functional capacity evaluations, and expert opinions—takes time. Advisors who recognize this deadline and act quickly can connect their clients with a skilled ERISA disability lawyer. That single step often prevents the most common and most devastating ERISA mistake. ## Top ERISA Disability Red Flags Advisors Should Watch For Many disability problems announce themselves before a formal denial ever arrives. The following warning signs are well-documented in disability litigation and should prompt a closer look: - **A denial, termination, or “discontinuation” letter from the insurer.** Any letter stating that benefits are denied, ending, or being reviewed for termination is the clearest red flag of all. As noted above, it requires prompt action to engage experienced ERISA counsel. - **A request to attend an “independent” medical examination (IME).** IMEs are arranged and paid for by the insurer, and the examining doctor often has a financial relationship with the carrier, so these exams frequently favor the insurance company. - **Increased contact and repeated forms.** When an insurer suddenly asks the client to complete claimant statements more than twice a year or contacts the treating physician more often, it may be building a file to support termination. - **Surveillance or a surprise home visit.** Insurers hire investigators to film claimants and conduct in-home interviews to gather evidence that a condition is less severe than reported. - **A shift from the “own occupation” to the “any occupation” standard.** Most LTD policies pay benefits for an initial period (often 24 months) if the claimant cannot perform their own occupation, then apply a stricter “any occupation” test. This transition point is a common moment for terminations. - **Demands for “objective” evidence of subjective conditions.** Conditions such as chronic pain, fibromyalgia, mental illness, and chronic fatigue are frequently denied on the basis that there is no “objective” proof, even when that proof is medically impossible to produce. - **Social media or activity inconsistencies.** Insurers monitor public posts and may use a photo of a client lifting groceries or traveling to argue that the disability is exaggerated. For advisors, the takeaway is simple: when a client mentions any of these events in passing during a financial review or tax meeting, treat it as a signal, not small talk. ## Why CPAs and Financial Advisors Are Uniquely Positioned to Help Financial advisors and CPAs see the financial life of a client in a way that few others do. A CPA preparing a return may notice that a high-earning client suddenly reported disability income, then saw it stop. A financial planner running a retirement projection may discover that a client’s income replacement plan has quietly collapsed. These professionals often learn about a benefits problem months before the client fully understands the legal stakes. This visibility creates both an opportunity and a responsibility. An advisor who understands the 180-day appeal deadline and the importance of the administrative record can steer a client toward help while there is still time to act. A **referral** from a CPA or financial advisor in NJ or Pennsylvania to a qualified **ERISA attorney** can help preserve a client’s entire long-term income stream—often a six- or seven-figure benefit over the life of a claim. Conversely, an advisor who treats a denial letter as a paperwork issue may unknowingly watch the deadline pass. Making a referral does not require the advisor to become an ERISA expert. It simply requires recognizing the warning signs and connecting the client with counsel who handles these disputes every day. ## How an ERISA Attorney Referral Protects Both Client and Advisor A well-timed referral is good for the client and good for the referring professional’s reputation. Clients remember who helped them in a crisis, and a CPA or advisor who guides a client toward the right specialist deepens trust and loyalty. Just as importantly, it reduces the risk that an advisor will be blamed later for a missed deadline or lost benefit. Experienced ERISA counsel can step in at any stage—before the claim is filed, after a denial, or during the appeal—but earlier is almost always better. The goal is to ensure that every necessary piece of evidence makes it into the administrative record before the final decision, because that record may be all a court ever reviews. ## How The Garner Firm Can Help The Garner Firm, Ltd. is a nationally recognized ERISA and long-term disability firm that represents professionals, executives, physicians, and employees in complex disability, life insurance, and employee benefits disputes. Led by founder and managing member [Adam H. Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/ "Adam H. Garner"), the firm routinely faces the [nation’s largest disability and life insurance carriers](https://www.garnerltd.com/homepage/insurers-we-litigate-against-in-erisa-benefit-claims/ "ERISA LTD Disability Insurers We Fight for You") and understands the strategies insurers use to deny, delay, and terminate substantial benefits. The firm focuses specifically on the high-value claims that matter most to the clients, financial advisors, and CPAs it serves. Working with an experienced ERISA disability attorney early gives advisors and their clients the best chance to protect those benefits. ## Contact The Garner Firm Today If you have a client who has received a disability denial or termination letter, is facing an independent medical examination, or has questions about a long-term disability or life insurance claim, do not wait for the 180-day appeal deadline to pass. Early action preserves options. Call The Garner Firm at **(215) 645-5955** or [contact us ](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today")to arrange a confidential consultation. Whether you are a prospective client or a referring professional in Pennsylvania, New Jersey, or anywhere in the country, the firm’s experienced ERISA attorneys are ready to help you protect what your client has earned. *This blog post is provided for informational purposes only and does not constitute legal advice. Reading this article does not create an attorney-client relationship.* **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** claim denial, Disability Benefits, ERISA, ERISA disability attorney, long term disability --- ### [How ERISA Can Fail Professionals Who Can No Longer Practice Their Specialty](https://www.garnerltd.com/how-erisa-can-fail-professionals-who-can-no-longer-practice-their-specialty/) **Published:** July 9, 2026 **Author:** Adam Garner **Content:** A hand injury ends a surgeon’s operating career. A back injury makes chair-side dentistry impossible. A cardiac condition grounds a commercial pilot. In each case, the professional can no longer do the specialized work that defined their career. Yet insurers still deny these long-term disability (LTD) claims. Often, they argue that the professional can perform some other job. As a result, a gap opens between what a policy seems to promise and how an insurer applies it. For surgeons, dentists, pilots, and anesthesiologists in Pennsylvania, New Jersey, and Maryland, that gap can cost millions in lost benefits. Therefore, an experienced ERISA disability attorney can be the difference between a denied claim and recovered benefits. [The ERISA disability attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") at The Garner Firm handle exactly these disputes. This post explains why specialists face unique obstacles under the Employee Retirement Income Security Act ([ERISA](https://www.dol.gov/general/topic/retirement/erisa)). It also covers how Third Circuit courts read key policy language. Finally, it lays out steps you can take to protect your benefits. ## Why Specialty Practice Creates a Disability Trap High-earning professionals depend on narrow, demanding skills. A surgeon needs steady hands, stamina, and the ability to take emergency call. An anesthesiologist must stay alert and keep fine motor control. A pilot must meet strict FAA medical standards. A dentist relies on precise, steady hand skills for chair-side work. When illness or injury takes away those skills, the professional’s career often ends. This is true even if they can still sit at a desk, teach, or handle paperwork. The trouble is how policies define “disability.” Too often, insurers focus on what the professional can still do. As a result, they overlook the specialty the professional actually practiced. ## Own Occupation Versus Any Occupation: A Distinction That May Decide Your Claim The most important feature of any LTD policy is how it defines disability. Two standards dominate. The difference between them often decides whether a specialist recovers benefits. StandardWhat the claimant must proveEffect on specialistsOwn (regular) occupationUnable to perform the material duties of the occupation the claimant actually held More favorable; protects specialty practiceAny occupationUnable to perform any gainful occupation for which the claimant is reasonably suited by education, training, and experience Harder to meet; results in loss of benefits for many claimantsMost group LTD policies pay “own occupation” benefits for a set period. This period is often two years. After that, the plan switches to the stricter “any occupation” standard. This later standard is much harder to meet. As a result, many participants lose their benefits at this stage. For example, a surgeon who can no longer operate may still be found fit for some desk job. Fortunately, *some but not all* group policies issued to hospitals, medical practices, law firms, and other professional service firms will provide own occupation coverage for professionals for the duration of their claim. ## How an ERISA Disability Attorney Proves Your “Regular Occupation” For specialists, one legal battle is often central. The question is simple. Must the insurer look at the actual specialty you practiced? Or may it rely on a generic, national job description instead? On this point, Third Circuit law is favorable. In *Lasser v. Reliance Standard Life Insurance Co*., 344 F.3d 381 (3d Cir. 2003), the court read the phrase “his/her regular occupation” broadly. It means the usual work the insured actually did before the disability, not a general occupation. Under that standard, the court found the insurer’s denial arbitrary and capricious. The case involved an orthopedic surgeon. In short, an insurer may not shrink a specialist’s occupation into a stripped-down national profile that ignores the real demands of the job. *Lasser* and other cases have also held that an individual who cannot perform one of the material or essential duties of his or her occupation is disabled from that occupation, but this rule is not a universal concept. It can depend on your jurisdiction and the specific language in your group insurance policy. The lesson for surgeons, dentists, pilots, and anesthesiologists is clear. Your occupation should reflect what you actually did, and your inability to perform at least one of the truly material duties of that occupation should render you disabled. It should not rest on a generic profile that omits the demands of specialty practice. ## Insurer Tactics an ERISA Disability Attorney Knows How to Counter Understanding common insurer strategies helps you build a stronger claim. In our experience representing professionals, several patterns recur. Recognizing them early is where an experienced ERISA disability attorney adds the most value. - Generic occupation descriptions. Insurers often swap the claimant’s real duties for a national profile. This ignores specialty demands such as emergency call, fine motor precision, or FAA certification. - Paper reviews over exams. Insurers often deny claims based on file reviews by doctors who never examined the claimant. - Demands for objective proof of subjective conditions. In *Mitchell v. Eastman Kodak Co*., the Third Circuit struck down a plan that required objective proof of a condition with no objective test. Even so, insurers still deny many pain, fatigue, and cognitive claims on this basis. - Disregarding Social Security awards. Insurers often push claimants to apply for Social Security Disability Insurance. Then they ignore a favorable award. The Third Circuit has criticized insurers for brushing aside a Social Security decision without explanation. Current rules also require a denial to explain any disagreement with a Social Security finding. - Surveillance and social media. Insurers now use surveillance and social media posts. They argue that a claimant’s activities contradict the reported limits. ## Why the Standard of Review Makes an ERISA Disability Attorney Essential One critical issue is often overlooked: the “standard of review” a court applies to a denial. Some plans grant the administrator discretionary authority to construe the terms of the disability plan and determine eligibility for plan benefits. In those cases, courts review the denial only for “abuse of discretion.” This is a deferential standard. Under it, the insurer often wins even when the evidence conflicts. Competing medical opinions do not make a denial arbitrary. In addition, administrators need not defer to treating physicians. By contrast, a court may review a denial “de novo.” Then the judge weighs the evidence independently and is not limited to the administrative record. Within the Third Circuit, judges have held bench trials on de novo review and entered judgment for claimants. As a result, the standard of review often has a significant impact on the outcome of the case. So we look closely at whether the plan validly conferred discretion. We also check whether certain procedural violations should strip that deference. This is one of the first things our ERISA disability attorneys examine. ## Building a Winning Claim: The So-Called “Administrative Record” Is Everything ERISA litigation is unusual. In most cases, the court decides the claim on the so-called “administrative record.” That record is the evidence gathered during the internal claim and appeal. The appeal is often your one chance to build the record for any later lawsuit. For that reason, the pre-litigation stage is the most important phase of any claim. Effective claim development for specialists includes: - A detailed description of your actual specialty duties, including physical, cognitive, and regulatory demands. - Supportive opinions from treating physicians and, where appropriate, independent medical examinations and functional capacity evaluations. - Vocational evidence tying your specific limitations to your true occupation, not a generic profile. - A response to any new evidence the insurer develops on appeal, which the regulations entitle you to receive and rebut before a final decision. Deadlines are strict. In general, claimants have only 180 days to appeal a denial. For that reason, acting quickly and thoroughly is essential. ## How Our ERISA Disability Attorneys Help Professionals The Garner Firm represents surgeons, dentists, pilots, anesthesiologists, and other professionals. We serve clients across Philadelphia, Pennsylvania, New Jersey, and Maryland. Our ERISA disability attorneys know how insurers define “own occupation” and “any occupation.” We also know how Third Circuit and Fourth Circuit precedent such as *Lasser* protects specialty practice. In addition, we know how to build the administrative record that positions a claim for success. The goal may be to reverse a denial on appeal or to litigate in federal court. In either case, an experienced ERISA disability attorney knows how to hold an insurer accountable. We handle disability matters on both an individualized basis, and we focus on the precise, detail-oriented work these cases demand. Has your long-term disability claim been denied or terminated? Or do you want to review your policy before a problem arises? Either way, [contact The Garner Firm today ](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today")for a consultation. The sooner we get involved, the stronger the record we can build for you. For related guidance, see our resources on [ERISA disability claims for physicians](/erisa-disability-claims-for-physicians), [own versus any occupation coverage](/own-vs-any-occupation-protect-your-ltd-benefits-now), and [the hidden dangers of ERISA disability plans](/the-hidden-dangers-of-erisa-safeguard-your-disability-benefits). --- *This blog post is provided for general informational purposes and does not constitute legal advice. Every disability claim turns on its own facts and the specific terms of the governing plan.* **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** Disability Benefits, ERISA, ERISA disability attorney, long term disability, own occupation --- ### [ERISA Remedies in Action: What the Cigna Residential Treatment Case Teaches About Attorneys' Fees and Prejudgment Interest](https://www.garnerltd.com/erisa-attorney-cigna-fees-interest/) **Published:** July 16, 2026 **Author:** Adam Garner **Content:** When an insurer wrongly denies a health or disability claim governed by ERISA, the law limits what a court can order it to pay. An experienced ERISA attorney can help claimants and referral sources understand those limits. A recent decision from the U.S. District Court for the District of Utah shows how these remedies work in practice. The case is *K.S. v. Cigna Health and Life Insurance Co*., No. 1:22-cv-00004. It matters to families fighting for coverage they already paid for. Plaintiffs’ counsel in *K.S.,* Brian S. King, is a friend of the firm with whom we have co-counseled on prior cases. He secured a judgment that illustrates the full range of relief available under ERISA [Section 502(a)(1)(B)](https://www.law.cornell.edu/uscode/text/29/1132 "Section 502(a)(1)(B)"). This post focuses on the remedies the court awarded rather than the details of the coverage dispute. For claimants and referring attorneys, understanding those remedies is the key to evaluating any ERISA benefits case. ## ERISA Attorney Insight: The Remedies the Court Awarded After finding that Cigna abused its discretion when it denied coverage for residential mental-health treatment, the court entered a judgment that broke down into four distinct categories: - **Benefits owed: $356,718.** The parties agreed on this figure, and the court awarded the full amount as the value of the improperly denied claim. - **Prejudgment interest: $97.73 in prejudgment interest per day for each day after the midpoint of the treatment period, until the full amount of benefits owed has been paid.** This sum compensated the plaintiffs for the years they went without money that should have been paid when the claim was first submitted. - **Attorneys’ fees: $66,265.** The court shifted a substantial portion of the plaintiffs’ litigation costs onto the insurer. - **Costs: $400.00.** This covered the recoverable court costs of bringing the action. ## The Foundation: A Claim for Benefits Under Section 502(a)(1)(B) The plaintiffs’ core claim arose under ERISA Section 502(a)(1)(B). Congress codified it at 29 U.S.C. § 1132(a)(1)(B). The statute lets a plan participant or beneficiary sue to recover benefits due under the plan. It also lets them enforce plan rights or clarify future benefits. Courts compare this remedy to a contract claim under the terms of the plan. That contractual framing defines the primary remedy: the benefits themselves. When a court finds that an administrator wrongly withheld coverage, it can order the plan to pay the amount the participant should have received. In this case, that meant the denied residential treatment benefits. ## Why Prejudgment Interest Matters A claim for benefits paid years late is worth less than the same claim paid on time. Prejudgment interest closes that gap. It compensates claimants for the lost use of their money during the dispute. In the Utah court’s earlier ERISA rulings, judges have awarded interest as high as 10% per year. That rate can enlarge a final judgment by a wide margin. The prejudgment interest award in this case demonstrates the point. Because litigation against an insurer can stretch across several years, the interest component grows steadily and can rival the value of the benefit itself. For claimants, this means that an insurer’s decision to fight rather than pay carries a rising price tag the longer the delay continues. ## Attorneys’ Fees as the Central Deterrent ERISA lets a court award reasonable attorneys’ fees and costs to either party. This power appears in 29 U.S.C. § 1132(g)(1). In the Tenth Circuit, courts apply a five-factor test known as the *Gordon* factors. Every circuit uses these facts, but each circuit calls them by a different name. Those factors weigh the losing party’s culpability and its ability to pay. They also weigh the deterrent effect of an award, whether the party sought to benefit all plan participants, and the relative merits of each side’s position. Fee awards under ERISA carry an important limit. They generally cover only work performed in court. They do not cover the time spent on the internal claim and appeal before litigation begins. Even so, the fee award here sends a message. Courts will shift meaningful sums onto insurers who force claimants to sue for benefits they were owed. This is where the true accountability lies. ERISA sharply limits the remedies available to claimants. A participant suing under Section 502(a)(1)(B), 29 U.S.C. §1132(a)(1)(B), generally recovers the benefits due, plus prejudgment interest and possibly fees. The statute does not allow compensatory or punitive damages for the harm a wrongful denial can cause. Those punishing categories of damages are off the table. As a result, a bad denial exposes an insurer to just three costs. It must pay the benefit it should have paid anyway. It must pay prejudgment interest on that amount. And it must pay the claimant’s attorneys’ fees. ## The Risk of Bad Law and Fees as the Only Real Check Two forces discourage insurers from denying valid claims, and the *K.S.* judgment puts both on display. First is the risk of attorneys’ fees. Specifically, when an insurer knows a court can order it to pay the claimant’s legal bills on top of the benefit, the calculus changes. Otherwise, without fee-shifting, an insurer could deny claims freely, betting that most claimants cannot afford to sue. However, the prospect of a fee award removes much of that incentive. As a result, it helps make competent representation available to claimants on a contingency basis. Second is the risk of creating bad law. For instance, every litigated denial that reaches judgment produces a written opinion. Consequently, when an insurer loses, that decision becomes precedent. As a result, other claimants and courts can cite it against the insurer in future disputes. Moreover, a published finding that a carrier “abused its discretion” is an outcome insurers work hard to avoid, because it can undermine their position in other analogous cases. Therefore, the threat of bad precedent and a fee award together keep insurers honest when they evaluate an ERISA claim. ## How an ERISA Attorney Helps Claimants and Referring Attorneys Ultimately, the *K.S.* judgment offers a clear lesson. ERISA remedies are limited. Nevertheless, they can still add up to a significant recovery when a case is developed and litigated well. Indeed, the combined award of benefits, prejudgment interest, fees, and costs approached $287,000. Notably, the insurer could have avoided most of that by paying the claim when it was first submitted. At The Garner Firm, [our attorneys](/attorney-profiles "our attorneys") handle ERISA benefit denials on an individual and class-wide basis. As an ERISA attorney team, we regularly co-counsel with respected practitioners across the country on complex claims. We know how to build a record that maximizes every category of relief the statute allows. That includes the benefit itself, prejudgment interest, and attorneys’ fees under 29 U.S.C. § 1132(a)(1)(B). If your ERISA disability claim has been denied, or if you are an attorney with a client facing an ERISA denial, [contact](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") The Garner Firm today to discuss your options and how we can help you pursue the full remedies the law provides. --- *This post discusses a specific court decision for informational purposes and does not constitute legal advice. Every case turns on its own facts.* **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Long Term Disability **Tags:** Disability Benefits, disability benefits attorney, ERISA, erisa attorney, ERISA lawyer, long term disability, long term disability attorney, LTD --- ### [How Workers' Comp and ERISA Disability Benefits Work Together](https://www.garnerltd.com/erisa-disability-attorney-workers-comp-ltd-benefits/) **Published:** June 23, 2026 **Author:** Zachary Lipschutz **Content:** If you were hurt at work, an experienced ERISA disability attorney with knowledge of workers’ compensation claims can help you understand how workers’ compensation and disability benefits fit together. When someone is injured at work, one of their first thoughts is workers’ compensation. Will they get paid if they cannot work? Will their medical bills be covered? These questions matter. Yet many people do not realize that they may qualify for other benefits through work. These include short-term and [long-term disability](https://www.garnerltd.com/citystate/philadelphia-long-term-disability-attorney/) benefits (STD/LTD). Many employers offer both. Short-term disability policies often deny a payout when an injury happens at work. Long-term disability policies usually can still pay. However, LTD policies often reduce the benefit by the amount you receive in workers’ compensation. STD covers an initial period of disability. After a one-week waiting period, you can usually collect STD benefits for three to six months. LTD benefits then take over if you have coverage. # Workers’ Compensation vs. ERISA Disability Benefits State law usually governs workers’ compensation. The system has its own paperwork, deadlines, and procedures. It is an administrative law system, and workers’ compensation judges oversee disputes. An injured worker must prove that they are unable to perform their own preinjury job. In comparison, STD and LTD benefits exist outside the scope of the workers’ compensation system. Federal law usually governs them under [ERISA](https://www.dol.gov/general/topic/health-plans/erisa), though exceptions exist. Federal judges oversee most STD and LTD disputes. For STD claims, and often for the first 24 months of an LTD claim, you must prove that you cannot perform your own occupation. After that period, you must prove that you cannot perform any occupation you are reasonably qualified for. An [ERISA disability attorney](https://www.garnerltd.com/practice-areas/erisa-litigation/) can guide you through each step. # How Fault and Eligibility Differ Workers’ compensation is generally a no-fault system. An injured worker only needs to prove that the injury happened in the course and scope of employment. STD and LTD policies usually do not require an injury to happen in a certain way. They do, however, contain exclusions. Common exclusions involve injuries from self-harm and war. # How Benefit Amounts Are Calculated The benefit calculations differ. Both rely on wages, but workers’ compensation caps the maximum amount you can receive. Those benefits usually arrive weekly. While STD benefits may be weekly, LTD benefits usually arrive monthly. The only cap on STD and LTD is the one written into your policy. No state or federal law caps STD or LTD benefits the way it caps workers’ compensation. Workers’ compensation benefits are generally tax-free. They often include health insurance that covers treatment for the work injury. The taxability of LTD benefits depends on whether you paid premiums with pre-tax or post-tax dollars. STD and LTD benefits usually do not include health insurance. An employer may continue your health insurance after an STD or LTD approval, but that arrangement is generally separate from the policy documents. # When Workers’ Compensation and Disability Claims Conflict The interplay between these systems can get complicated. What if an insurer denies your workers’ compensation benefits at first? Can you still collect short-term disability benefits? The answer depends on the language in your short-term disability policy. What if a work injury overlaps with an unrelated condition that also disables you? Sometimes the short-term disability insurer still pays the full amount. The long-term disability insurer may not offset your payments by your workers’ compensation benefits. In that situation, you may receive full payments from the workers’ compensation carrier and the disability providers at the same time. Settlements add another layer. Many policies state that a lump-sum settlement for a related matter gets divided over 60 months. The insurer then offsets your long-term disability benefits each month for 60 months. The right language in your workers’ compensation settlement can reduce that overpayment significantly. A skilled ERISA disability attorney can help you negotiate that language before you sign. # Why an Individual Disability Policy Helps For the strongest protection, consider buying an individual disability insurance policy on top of your group coverage. Individual policies often skip the offset provisions that group plans use. You also get to choose the terms you want. Group coverage rarely offers that flexibility. If health insurance later becomes a problem, an extra stream of income helps. # Talk to an ERISA Disability Attorney These systems are complex, and they overlap in ways that surprise many injured workers. If a work injury affects you, consult a workers’ compensation attorney and an STD and LTD attorney. You deserve the maximum compensation the law allows, and attorneys who know both systems can help you reach it. At The Garner Firm, our team includes an attorney who has worked with both workers’ compensation and Social Security Disability (SSD) claimants, alongside his work on STD and LTD claims. We do not handle workers’ compensation or SSD claims, but [Zachary Lipschutz’s](https://www.garnerltd.com/attorney-profiles/zachary-lipschutz/ "Zachary Lipschutz") background lets us advise our STD and LTD clients with the full picture in mind. [Contact The Garner Firm today](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") with any questions about your ERISA disability claim. **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability --- ### [Insurer Denies Tragic AD&D Claim Due to Blood Thinner](https://www.garnerltd.com/erisa-attorney-add-claim-denial-beard/) **Published:** June 9, 2026 **Author:** Adam Garner **Content:** June 9, 2026 When a loved one dies after a sudden fall, many families would assume an accidental death and dismemberment (AD&D) policy will pay out. After all, what could be more “accidental” than tripping on the way to the bathroom? Unfortunately, as a recent federal appeals court decision shows, the fine print in an ERISA-governed AD&D policy can transform a tragic accident into a denied claim. The Eighth Circuit’s ruling in *Beard v. Lincoln National Life Insurance Co.*, 175 F.4th 943 (8th Cir. 2026), is essential reading for anyone who relies on accidental death insurance — and a cautionary tale about why having an experienced ERISA attorney matters. ## The Facts: A Fall, a Brain Bleed, and a Denied Claim Mr. Beard was battling stage IV pancreatic cancer. The cancer and chemotherapy left him weak, with chronic diarrhea and an elevated risk of blood clots, so his doctors put him on a blood thinner (anticoagulant) to reduce that risk. Mr. Beard fell and hit his head while hurrying to the bathroom. He went to the emergency room, where a CT scan came back normal, and he was sent home. Early the next morning, he became unresponsive. Paramedics rushed him back to the hospital, where a second CT scan revealed a large subdural hematoma — a brain bleed — that was compressing his brain. He died the following day. His wife filed a claim for AD&D benefits under her husband’s employer-sponsored plan, which was insured and administered by Lincoln National Life Insurance Company. Lincoln denied the claim, and a federal lawsuit followed. ## The Policy Language That Decided the Case Because this was an ERISA “accidental death” insurance dispute, the outcome turned on three specific provisions in the plan: - **A discretionary clause.** The plan gave Lincoln “discretionary authority to construe \[its\] terms . . . and to determine benefit eligibility.” - **The coverage trigger.** Benefits are payable only when a covered employee “suffers a loss solely as the result of accidental injury,” with “injury” defined as “bodily impairment resulting directly from an accident and independently of all other causes.” - **The disease exclusion.** The plan excluded any loss “contributed to or caused by . . . disease, bodily or mental illness (or medical or surgical treatment thereof).” Lincoln concluded that Mr. Beard’s death was not covered because it did not result “solely” from the fall and that the disease exclusion applied because his blood thinner — prescribed to treat a cancer-related condition — “contributed to” the fatal brain bleed. Two of the insurer’s reviewing physicians concluded that the anticoagulant contributed to the hematoma that killed him. ## Why the Standard of Review Mattered So Much One of the most important — and frustrating — features of ERISA litigation is the standard of review. Because the plan granted Lincoln discretionary authority, the court reviewed the denial only for “abuse of discretion” rather than deciding the question fresh. The thumb was on the scale for the insurer. Under that deferential standard, a court must uphold the administrator’s decision if it is based on a reasonable interpretation of the plan and is supported by substantial evidence. Substantial evidence is a low bar — it means only that a reasonable person might accept the evidence as adequate to support the conclusion. In plain terms: when an insurer holds discretion, it does not have to be *right* — it only has to be *reasonable*. That deference frequently decides ERISA cases before the facts are even debated. ## The Court’s Reasoning: Two Independent Grounds The Eighth Circuit affirmed the denial on two separate bases. **1. The claimant failed to prove coverage.** Under ERISA, the claimant bears the burden of showing the loss falls within the policy’s coverage. To trigger coverage, Mrs. Beard had to show the fatal injury resulted from the fall “independently of all other causes.” She could not. In fact, she conceded throughout her appellate briefing that “the blood thinner probably did contribute to the hematoma.” That concession was fatal to the coverage argument. **2. The disease exclusion applied.** When an insurer denies a claim based on an exclusion, *it* often carries the burden of proving the exclusion applies. Relying on the two physician reports, the court found substantial evidence that the blood thinner “contributed to” the death — noting that fatal subdural hematomas are more strongly associated with anticoagulant use and that the medication likely made the bleed larger and more lethal. Mrs. Beard argued that contributing to the *hematoma* was not the same as contributing to the *death* and that the exclusion should apply only if her husband would not have died “but for” the blood thinner (*Id.*). The court rejected this, explaining that the parties had agreed “contributed to” meant “to give or furnish along with others towards bringing about a result” — a far broader standard than a strict but-for cause. Because Lincoln’s purportedly “reasonable” interpretation controlled under the deferential standard, the court was “bound to apply that definition.” ## The Takeaways for Policyholders and Beneficiaries *Beard* offers several hard but valuable lessons about AD&D coverage under ERISA: - **“Accidental” is not enough.** A genuine accident can still be denied if a pre-existing disease or its treatment “contributed to” the loss. - **Discretionary clauses tilt the field.** When a plan grants discretion, courts defer to the insurer’s reasonable reading, even if a different reading is equally plausible. - **The administrative record is everything.** Mrs. Beard offered “no contrary evidence” while her claim was before Lincoln, and the court reviewed only the final denial letter. - **Concessions can sink a case.** Statements made during the claim and on appeal narrowed the available arguments. The most important lesson is timing. Once an [ERISA ](https://www.dol.gov/general/topic/retirement/erisa)appeal is decided, the record usually closes. The medical evidence, expert opinions, and legal arguments must be developed *during the administrative appeal*—long before a judge ever sees the file. By the time many families realize what is at stake, the most valuable opportunities have already passed. ## How an Experienced ERISA Attorney Can Help At The Garner Firm, Ltd., our [attorneys ](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles")focus on representing employees and beneficiaries in ERISA disputes, including denied accidental death, life, and disability claims, on both an individual and class-wide basis. We understand how insurers use discretionary clauses, disease exclusions, and the substantial-evidence standard to defeat claims—and we know how to build the administrative record needed to fight back. Decisions like *Beard v. Lincoln National* show why having a knowledgeable accidental death and dismemberment attorney involved early can make the difference between a paid claim and a denied one. If your AD&D, life, or disability claim has been denied, or if you have received a denial letter and are facing a deadline to appeal, do not wait. [Contact](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") The Garner Firm today for a confidential consultation with an experienced ERISA attorney who can evaluate your claim and protect your rights before the record closes. *This blog post is provided for informational purposes only and does not constitute legal advice. Reading this post does not create an attorney-client relationship.* **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment, Employee Benefits, Life Insurance, Our Blog **Tags:** accidental death claim, ad&d benefits, denied insurance claim, erisa attorney, ERISA lawyer, erisa litigation --- ### [ERISA Disability Claims for Physicians: What to Know Before You File](https://www.garnerltd.com/erisa-disability-claims-for-physicians-what-to-know-before-you-file/) **Published:** March 26, 2026 **Author:** Adam Garner **Excerpt:** Filing a disability claim as a physician isn’t as straightforward as it seems. The rules that govern most group policies can limit your rights and shape the outcome long before a decision is made. Here’s what you need to know before you file. **Content:** March 26, 2026 Most physicians who become disabled expect their group disability plan to work the way insurance is supposed to work: you pay premiums, something goes wrong, the insurer pays the claim. That expectation is understandable — and in most cases, it does not reflect how these claims actually work under federal law. If you have long-term disability coverage through an employer-sponsored group plan — which is true for most physicians employed by a hospital system, academic medical center, or large medical group — your claim is governed by **ERISA**, the **Employee Retirement Income Security Act of 1974**. ERISA changes the rules in ways that most physicians don’t discover until something has already gone wrong. Understanding what those rules are before you file is crucial to protecting your rights going forward. ## The Limitations of ERISA-Governed Plans The most important thing to understand about ERISA is what it takes off the table. ERISA preempts state law — and state law is where most insurance protections live. The bad faith statutes and consumer protection remedies that your state provides for insurance disputes do not apply to ERISA-governed plans. If you prevail in an ERISA benefits dispute, your recovery is typically limited by federal law to the benefits owed under the plan, interest, and, at the court’s discretion, attorney’s fees. There is no jury trial, no punitive damages, and no compensation for financial disruption or career damage, even if the insurer’s denial was unreasonable. It is also worth understanding that a court ruling in your favor does not always mean an immediate award of benefits. In some cases, courts remand the claim back to the plan administrator or insurer for further review rather than ordering benefits paid directly. The result is more process, not a check. There is also the question of how courts review denials in the first place. Many ERISA plans grant the insurance company discretionary authority to interpret the plan and decide claims. When that language exists, courts typically apply what is called *abuse of discretion review* — meaning they will uphold the insurer’s decision if it had a reasonable basis, even if the court itself might have reached a different conclusion. Which standard applies to your claim depends on specific language in your plan documents, which is one reason those documents need to be read carefully before you file. ## Why Physician Disability Claims Are Different Physicians face a specific set of vulnerabilities within this framework, and most of them stem from facts that are particular to medical practice. **The definition of disability shifts — and the timing matters.** Most group LTD plans start with an “own occupation” definition of disability: you qualify if you cannot perform the material duties of your specific medical specialty. A surgeon who develops a condition that prevents operating may be disabled under this standard even if they could work in some other capacity. But many group disability plans transition to an “any occupation” standard after 24 months. Under that definition, benefits continue only if you cannot perform the duties of any occupation for which you are reasonably qualified by education, training, or experience. For a physician whose benefits are terminated at the 24-month mark, the financial consequences over the remaining years of a career can be severe. Knowing when and how that transition occurs in your specific plan — and structuring your claim with that shift in mind from the beginning — matters far more than most physicians realize when they first file. Our article on [own occupation vs. any occupation definitions](https://www.garnerltd.com/own-vs-any-occupation-protect-your-ltd-benefits-now/) covers this in more detail. **High-value claims receive a different level of scrutiny.** A 45-year-old physician with a benefit paying 60% of pre-disability income to age 65 can represent a significant potential liability that is usually equal to the maximum benefit amount payable under the policy. Insurers are aware of this. Claims of this magnitude are more likely to trigger close scrutiny, including a so-called Independent Medical Examination, more likely to involve surveillance, and more likely to be subject to intensive ongoing review once benefits begin. The [Supreme Court acknowledged in *MetLife v. Glenn*](https://supreme.justia.com/cases/federal/us/554/105/) the structural conflict of interest that exists when the same company paying benefits also decides who qualifies for them — but recognition of that conflict has not eliminated its practical effect on how claims are handled. **Specialty-specific evidence is frequently overlooked.** For physicians in procedural fields, the record of what they actually did — operative notes, billing data, RVU production, call schedules — is among the most powerful evidence available. It establishes what the occupation concretely required and documents the functional impact of the disabling condition. This evidence is often not gathered at the initial claim stage, and reconstructing it later is difficult. It should be identified and preserved before the claim is filed. ## How the Administrative Record Determines the Outcome of Your Claim This is the part of the ERISA framework that surprises physicians — and their advisors — most consistently. In an ERISA case, a federal court reviewing a denial is often limited to the claim file or “administrative record:” the evidence submitted during the claims and appeal process. New evidence typically cannot be introduced after a legal claim has been filed — the lawsuit is *not* where you build your case. Instead, an ERISA lawsuit is a review of a record that was already built — or wasn’t — during the administrative process. What gets submitted at the initial claim and appeal stage is what the court will ultimately see. Medical records that document only a diagnosis — without translating that diagnosis into specific functional limitations — give an insurer room to argue that the record does not support the claimed disability. Most physicians assume that a well-documented diagnosis makes a strong disability claim. Under ERISA, it does not. What matters is whether the record translates that diagnosis into specific functional limitations — what you cannot do, and how that connects to the demands of your particular practice. It also means the mandatory administrative appeal is not just a formality. When a claim is denied, you have 180 days from receipt of the denial to file an appeal. That window is the last opportunity to strengthen the record before any court review. A claimant who uses the appeal to submit additional physician opinions, independent evaluations, and a thorough analysis of the insurer’s determination goes to court in a materially stronger position than one who does not. For a closer look at how the process works at each stage, see our [Long-Term Disability page](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/). ## Steps Physicians Should Take Before Filing an ERISA Disability Claim Physicians who navigate these claims most effectively share one characteristic: they engage with the process before the initial claim is filed, not after a denial arrives. In practical terms, that means reading the actual plan documents — not just the Summary Plan Description, but the Certificate of Coverage or plan document that controls — before filing. It means understanding precisely how your plan defines disability, when any definitional shift occurs, and what evidence the plan requires. It means ensuring your treating physicians are documenting functional limitations specifically, not just recording diagnoses. And it means identifying and preserving specialty-specific records that establish what your occupation actually demanded. It also means engaging legal counsel before filing. Most physicians contact an ERISA attorney after receiving a denial letter. By that point, the claim has already been submitted, the administrative record has begun to take shape, and some of the most consequential decisions have already been made without legal input. Addressing those gaps at the appeal stage is sometimes possible, but always harder, and sometimes not possible at all. ## How The Garner Firm Approaches These Cases The Garner Firm represents physicians and other high-earning professionals in ERISA disability disputes nationwide, exclusively on the plaintiff side. We work with physicians and their treating providers to understand the specific demands of their practice, identify what the plan actually requires, and build a claim record that reflects the full scope of the disability from the outset. When claims are denied, we handle the administrative appeal with the litigation record in mind, because in ERISA, those two phases are inseparable. If you are a physician or other professional facing a potential disability claim — or an advisor working with one — [](https://www.garnerltd.com/contact/)we welcome the opportunity to discuss your situation with you. [Contact us online ](https://www.garnerltd.com/contact/)or by calling (215) 645-5955 for a free evaluation. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits **Tags:** Disability Benefits, disability benefits attorney, ERISA, ERISA lawyer --- ### [The ERISA Trap Most High-Earning Professionals Never See Coming](https://www.garnerltd.com/the-erisa-trap-most-high-earning-professionals-never-see-coming/) **Published:** May 1, 2026 **Author:** Adam Garner **Excerpt:** If you have an employer-sponsored disability policy, the decisions you make in the earliest stages of your disability claim may determine what evidence a court can ever consider. By the time most professionals realize this, that window has already closed. **Content:** May 1, 2026 Physicians, executives, dentists, airline pilots, attorneys, and other high-earning professionals share a particular professional disposition: they are accustomed to solving complex problems with the resources at hand, so they often don’t consider engaging legal counsel until litigation seems like a real possibility. In the context of an ERISA disability claim, that instinct could cost you the claim. ERISA — the Employee Retirement Income Security Act — is the federal law that governs nearly every group benefit plan offered through a private-sector employer, including the disability, life, and health insurance policies that high-earning professionals often carry. When a claim under one of these policies is denied, ERISA dictates not only how that dispute will proceed, but it can also effectively dictate what a court is permitted to consider when it reviews the insurer’s decision. And that limitation is where most claimants find themselves at a serious disadvantage. ## The Closed Record Rule: What It Means and Why It Matters Before you can sue an insurance company under ERISA, you are required to go through an internal appeals process with the insurer itself. This is called exhausting your administrative appeals. In practical terms, this means that after a denial, you have a defined window — 180 days for disability claims — to submit an appeal. The appeal is often submitted directly to the insurance company that initially denied your claim. That appeal is often your one opportunity to put evidence in front of the insurer before the matter can ever go to court. What most claimants do not appreciate is what happens to the evidentiary record at that point. Once the administrative appeal is decided and that internal process is concluded, the record is effectively closed. In federal court, a judge reviewing your ERISA claim will often only look at the evidence that existed in the administrative record — the documents, medical records, functional assessments, and other materials that were submitted during the claim and appeal process. If you did not get it in before the appeal closed, you cannot introduce it later in litigation. **In plain terms:** if your treating physician’s opinion, a functional capacity evaluation, a vocational assessment, or any other critical piece of evidence was not submitted during the administrative process, a federal court will typically not consider it — no matter how compelling it is. ## What This Looks Like In Practice Consider a **neurosurgeon** whose tremor makes it impossible to operate. She files a disability claim, submits her basic medical records, and the insurer denies the claim. She appeals on her own, adds a few more office visit notes, and the insurer upholds the denial. Now she wants to sue. At this point, her attorney reviews the record and finds that no one ever submitted an independent neurological evaluation documenting the severity of the tremor in functional terms. No one submitted a vocational expert’s opinion explaining that a neurosurgeon’s occupation requires the precise manual dexterity she has lost. Those records do not exist in the administrative file. For purposes of federal court review, they do not exist at all. This pattern repeats across professions with equally high occupational stakes. An **airline pilot** grounded by a cardiac condition faces a particularly unforgiving standard: federal aviation regulations require a medical certificate to fly, and a disqualifying diagnosis ends a career in the cockpit regardless of whether the pilot feels capable of returning to work. Yet the insurer’s file may contain nothing more than a cardiology report and a denial letter citing the pilot’s ability to perform desk work. What is absent is any documentation of the aviation medical certification process, the FAA’s disqualifying criteria, the economic reality of what it means for a commercial pilot to lose flight status, or a vocational assessment explaining that “sedentary work” bears no meaningful relationship to a career built entirely around the right to fly. Those are the materials that make the claim coherent, and they have to be in the record before the appeal closes. The same dynamic plays out with **dentists** whose fine motor deficits are documented in clinical notes but never translated into a functional assessment tied to the demands of their practice and **executives** whose cognitive impairment following illness is real and disabling but was never evaluated in the context of what their specific role requires. By the time an attorney is engaged and the gaps become apparent, the window to address them has closed. ## The Insurer is Building a Record Too Insurance companies that handle ERISA claims are experienced at this process. Their claims teams and medical reviewers approach the file with litigation in mind from the outset. They conduct surveillance, retain their own physicians to review the medical record, and structure their denials to withstand judicial scrutiny under a standard of review that, in many cases, already favors the insurer. When you handle an ERISA claim on your own, or with an attorney who does not regularly practice in this area, you may not realize that you are participating in a legal proceeding in everything but name. **The administrative appeal is not a preliminary step before the real proceeding begins. It *is* the proceeding.** The evidentiary foundation for everything that follows is built there, or it is not built at all. Getting an attorney involved from the outset — before you file, or at a minimum immediately after a denial — changes the dynamic entirely. An experienced ERISA attorney will identify which medical evidence needs to be developed and submitted, recognize which treating physicians should be asked to provide detailed functional assessments, request the complete claim file from the insurer so you know exactly what they have, and structure the administrative appeal as the evidentiary record for whatever comes next, whether that is a negotiated resolution or federal litigation. ## Negotiation And Litigation Both Depend On The Same Record ERISA litigation rarely ends in a courtroom. Most cases resolve through negotiation or settlement. But the strength of your negotiating position depends almost entirely on the strength of the administrative record. A well-constructed record creates leverage. A thin or incomplete one, even in a case with genuine merit, provides little to negotiate from and less to litigate with. ## The Right Time To Act If you hold an employer-sponsored disability policy and are facing a denial, a benefit termination, or even an initial claim that feels contested, the time to consult an ERISA attorney is before that record closes, ideally at the very start of the process. The insurer is already building a record. The only question is whether you are too. We represent professionals, executives, and employees in complex ERISA and long-term disability disputes nationwide. If you have questions about a pending or denied claim, contact us online or by calling (215) 645-5955 for a free consultation. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits **Tags:** Disability Benefits, disability benefits attorney, ERISA --- ### [What Can You Do If Your Long-Term Disability Claim is Denied?](https://www.garnerltd.com/what-can-you-do-if-your-long-term-disability-claim-is-denied/) **Published:** April 24, 2024 **Author:** The Garner Firm **Excerpt:** Many ERISA claims result from a denial of a long-term disability claim. If your disability claim is denied, you can and should appeal the denial of that claim. **Content:** Many ERISA claims result from a denial of a long-term disability claim. It’s where the most areas of dispute often arise. There may be a question as to whether somebody is disabled or how fully impaired they may be. If your disability claim is denied, you can and should appeal the denial of that claim. You have 180 days typically to appeal the denial of a long-term disability claim for an ERISA-sponsored or a risk-regulated employee benefit plan. If you have an individual disability insurance policy that you purchased on your own, not through your employer, you may have different rights as it relates to an appeal. But if you have a risk-regulated employee benefit plan, you have 180 days to appeal that denial. The appeal is typically submitted to the insurance company who first denied your claim, but not always. So it’s important that you understand who you should be submitting the appeal to and what the deadlines for submitting that appeal are. In addition, it’s really important that you provide a comprehensive appeal. Oftentimes, people don’t realize the significance of appealing a denial of claims, and they send in a short letter that says, “Appeal. I’m disabled.” And perhaps they have their doctor send in a note saying, “The client is under my care and is totally disabled from work and can’t work.” That’s not sufficient. It’s really important that if you’re handling your appeal on your own, you provide a very detailed and thorough appeal, but it’s typically a better idea to hire an employee benefits attorney with experience appealing long-term disability claims. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Employment Contracts, Long Term Disability --- ### [Questions to Ask Before Hiring an ERISA Attorney - Video](https://www.garnerltd.com/questions-to-ask-before-hiring-an-erisa-attorney/) **Published:** September 25, 2023 **Author:** The Garner Firm **Excerpt:** Before hiring an attorney to handle your ERISA or long-term disability claim be prepared to ask these questions. **Content:** --- If you’re speaking with an attorney and trying to get a sense of whether or not this is somebody you want to work with on an ERISA case, there are certain things you should be asking, and you should be comfortable with the answers that you’re getting as well before you move forward. The first question you should ask is, “How much experience do you have handling ERISA cases?” As I’ve mentioned before, there are a number of attorneys who dabble in this area of work, but it’s not their primary area of focus. ERISA is a sufficiently niche practice that it’s important that you work with somebody who has a lot of experience handling ERISA cases. A second question you should ask is, do you handle ERISA appeals? Your appeal of the denial of your claim is a critical stage in successfully litigating an ERISA case. In a perfect world, you win the appeal. If you don’t win the appeal, you want to make sure that the appeal has been handled in a comprehensive and thorough way that puts you in the best possible position to litigate the case in federal court, because that appeal is going to provide the record that the court is going to look at in deciding your case. It should concern you if an attorney says that they don’t handle the ERISA benefit appeals and that they only litigate the cases. The next thing you should be asking is what the attorney’s approach is to litigating these cases. Have they ever taken one to judgment? If the law firm simply settles every case and they settle it at a deep discount, that should be a red flag. These cases can be settled for reasonable amounts, and they can be litigated in one, and anybody who tells you that you can’t win an ERISA case in court is mistaken. Now, you can’t win every ERISA case in court, and there are some cases that should settle because they have significant defects, but you should be interviewing attorneys and only working with attorneys who are prepared to take your case to judgment if necessary. You want to ask about the attorney’s win-loss record. What kind of outcomes have they had on behalf of their clients? Are all of those outcomes settlements? Have they lost more cases than they’ve won? What’s happened? You want to ask about their bar-related activities as it relates to ERISA. Are these attorneys speaking at conferences or writing on the topic? How are they keeping abreast of developments in the law? And are they helping to craft the law, not only for their own clients but also for other individuals, and to expand knowledge of the law? Those are just some of the many questions you should be asking. Another important question you should ask is, who will be handling my case on a day-to-day basis? Will it be a legal assistant? Will it be a paralegal? Will it be the attorney? There’s nothing wrong with a legal assistant or a paralegal working on somebody’s case. That’s an important part of delegating work in a law office. That said, you want to be able to speak to your attorney if you have a question about the case, and you want to be confident that your attorney is up to speed on your case and that you have not simply been handed off to a paralegal or a legal assistant who’s managing your case. The attorney should be engaged. There are many strategic decisions that the attorney needs to make at all phases of an ERISA case. And it’s important that your attorney is engaged and involved in that process. At our firm, for example, all of our clients are able to reach the attorneys at the office if we are at our desks and not on the other line or not in a meeting. We are available and accessible and take our clients’ calls when they call, and we’re typically in a position to answer just about any question a client may have about his or her case. ### **Related** [ERISA and Employee Benefits Law](https://www.garnerltd.com/practice-areas/erisa-litigation/ "Situations Where You Might Need an ERISA Attorney") **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Health Insurance, Legal Counsel, Life Insurance, Long Term Disability --- ### [How The Garner Firm Can Help You With an ERISA or Long-Term Disability Claim](https://www.garnerltd.com/how-the-garner-firm-can-help-you-and-your-family/) **Published:** September 24, 2023 **Author:** The Garner Firm **Excerpt:** The Garner Firm helps individuals with ERISA and long-term disability claims and a range of employment law legal matters. **Content:** **See Also: [ERISA Frequently Asked Questions](/erisa-faqs/ "ERISA Frequently Asked Questions")** At the Garner Firm, in addition to handling the ERISA employee benefits matters, we also handle other employment-related claims. That can be discrimination cases where someone has been discriminated against on the basis of their age or their sex, race, or national origin. Those can be cases that are filed in either state or federal court. We also handle other employment matters such as wage and hour class actions, ERISA cases, protecting the employment rights of pilots and military personnel, and also reviewing employment contracts or negotiating the terms of severance or separation agreements if someone’s been let go from their job. In addition to the employment-related matters, we also take on select mass tort and asbestos-related matters, as those are the types of cases that I spent the majority of my career working on prior to joining the Garner Firm in 2020. When an individual is having a problem with their employee benefits, whether it’s life insurance or disability and retirement benefits, or if they’re having a problem with an insurance contract that they purchased on their own, or a problem with their employer, whether they’ve been discriminated against, they have a problem getting paid the wages they’re owed, or they just need help with an employment contract, it’s really important that they reach out to an experienced attorney to give them guidance. The Garner Firm, we’re here, we’re available. We’re ready to answer the questions when people call. Even if we can’t help somebody with their case, we’ll either direct them to somebody who can or we’ll try to point them in the right direction so that if it’s something they can handle on their own without the need for an attorney, they’re well-informed and have the tools to do so. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Employment Contracts, Legal Counsel, Long Term Disability --- ### [Winning Cases for Clients is Personal](https://www.garnerltd.com/winning-cases-for-clients-is-personal/) **Published:** September 25, 2023 **Author:** The Garner Firm **Excerpt:** Melanie Garner's work on behalf of clients is informed by her own experience with a disabled family member. **Content:** For me, these cases are personal. When I was growing up, my father was disabled. He was unable to work, and I experienced both the financial hardship of having a parent who was unable to work and provide for his family. And also, I witnessed the personal health struggles that my dad experienced on a daily basis. He had a lot of issues with chronic pain and recurrent surgeries that failed, and he could have a situation where maybe one day he was able to go out and help his kids out in the yard do something, but then he would be laid up in bed for several days after that in severe debilitating pain. And oftentimes with the clients that we work together with at the Garner Firm, especially those with long-term disability benefits claims, it’s the same types of things that I’m seeing individuals and their families dealing with. And that’s what I find the most rewarding about the work that we do here. And being able to tell an individual and their family members that we have been successful on their behalf and handling their appeal, or perhaps if we ultimately had to litigate the matter, that we’ve received a favorable judgment or reached a settlement for them and for them to know that they are now going to be able to continue to put food on the table and not have to worry about their money and finances like they did before. That’s just a great feeling, and I love doing this work for that reason. **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment, Disability Benefits, Legal Counsel, Long Term Disability --- ### [How Much Time Do I Have to Appeal a Long-Term Disability Claim?](https://www.garnerltd.com/how-much-time-do-i-have-to-appeal-a-long-term-disability-claim/) **Published:** September 24, 2023 **Author:** The Garner Firm **Excerpt:** You have a limited amount of time to appeal a denial of a long-term disability. **Content:** The first thing that someone should do if their ERISA benefits claim has been denied or if they already have benefits that have been terminated is to contact experienced ERISA attorneys, such as those of us at the Garner firm. And the reason for that is that you have a very limited amount of time to appeal a denial or termination of your benefits. In the case of a short-term or long-term disability benefits claim, you typically have 180 days from the time that you received the denial or termination letter to submit an appeal. And that does not allow very much time to compile all of the medical records, documentation, and other supporting information that’s needed in order to submit an appeal. In the case of a denial of pension benefits or life insurance benefits, you have an even shorter amount of time. You only have 60 days from the time that you receive the denial letter to submit an appeal. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Employment Contracts, Long Term Disability --- ### [What Types of Employment Law Does The Garner Firm Practice?](https://www.garnerltd.com/what-types-of-employment-law-does-the-garner-firm-practice/) **Published:** September 24, 2023 **Author:** The Garner Firm **Content:** In addition to handling ERISA claims, the Garner Firm handles several other types of claims. We do various types of employment litigation. We occasionally take on discrimination and retaliation cases related to age, sex, race, national origin, discrimination, and things like that. We handle wage and hour claims. Wage and hour claims are claims where somebody’s been wrongly denied overtime that they’re entitled or they have not been paid all of the wages they have earned and that they’ve been entitled to. And we handle those cases both on an individual and on a class or collective action basis for large groups of people. I handle severance agreements, unemployment contracts, and covenants not to compete. And we also do a fair amount of insurance litigation. If you have an insurance policy that’s not governed by ERISA, perhaps you bought a life insurance policy from a broker many years ago, or you bought a disability insurance policy on your own from a broker, and that claim’s been denied. We handle those claims. They don’t arise under ERISA. They arise under state insurance law. And in some cases, in Pennsylvania in particular, I think there’s something known as a bad faith insurance claim, which allows you to recover additional damages in addition to the insurance proceeds that you claim you’re owed. And in Pennsylvania, that can include punitive damages, attorney’s fees, and significant interest. So we do those sorts of cases. We also handle military service member claims under a statute known as USERRA. USERRA is a federal law that provides that individuals who are on military leave of absence, whether they’ve been activated to go serve in a war or they’re a member of the National Guard and doing drills for a weekend or a week. They have various employment rights, and oftentimes employers misapply that statute and deny people the rights they’re entitled to under USAREF. And so we handle those claims as well. **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment, Disability Benefits, Employee Benefits, Employment Contracts, Employment Discrimination, General Civil Litigation, Health Insurance, Legal Counsel, Life Insurance, Long Term Disability, Severance Agreements, Wage & Hour Law --- ### [Helping Clients Win Means Everything to Us](https://www.garnerltd.com/helping-clients-win-cases-means-everything-to-us/) **Published:** September 24, 2023 **Author:** The Garner Firm **Excerpt:** There's a great need for effective legal representation to help individuals with their long-term disability claims and other employment related claims. The Garner Firm is committed first and foremost to helping clients win their cases. **Content:** I started doing this work, like many young attorneys, early in my career because this was the work that was assigned to me. But I quickly fell in love with it. From an intellectual standpoint, I find it interesting and fascinating. I enjoy doing it. From a personal standpoint, however, having worked as a defense attorney and having won many cases as a defense attorney, which resulted in an individual losing his or her benefits in cases where that individual perhaps wasn’t entitled to them, but my role as the attorney was to litigate it on behalf of the client, I felt that there was a need for individuals to have competent and effective legal representation in this area of the law where they had a voice. One of the things I have found over the last several years of operating the Garner Firm is that feeling that you get when you call a client, and you tell them that their appeal has been successful or that they’ve won a case, and that their benefits are going to be reinstated, and that they’ve been vindicated. There’s nothing that compares to it. When you call somebody who’s had no cash flow for nine months or a year because their disability benefit claim has been denied, and their mortgages and arrears they’re in collections on their electrical bill. They’re having a difficult time putting food on the table and paying for their medication and their medical treatment. And you call them, and you say your financial problems aren’t solved, but they’re going to start getting better real soon. And you’re going to have money coming in the door that will allow you to pay your bills, put food on the table, and go to the doctor. The stress that takes off of somebody’s shoulders, the joy that they have in their voice, and the relief and the genuine thanks that they feel makes getting up and coming to work every day worth it 100%. **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment, Disability Benefits, Employee Benefits, Employment Contracts, Employment Discrimination, General Civil Litigation, Health Insurance, Legal Counsel, Life Insurance, Long Term Disability, Severance Agreements, Wage & Hour Law --- ### [What Sets The Garner Firm Apart from Other Law Firms?](https://www.garnerltd.com/what-sets-the-garner-firm-apart-from-other-law-firms/) **Published:** September 24, 2023 **Author:** The Garner Firm **Excerpt:** Excellent client service is what sets us apart from other law firms. **Content:** I One of the things that sets the Garner Firm apart from other ERISA and employment law firms is our approach to client service. Now, many lawyers talk about client service. We live it. When our clients call, they don’t get handed off to a paralegal. They don’t get handed off to a legal assistant. Of course, if they call the paralegal with a legal assistant, that’s who they’ll speak with. But if they call the attorney and we’re at our desk and not on the other line, we will take your call. We will talk to you about your case. And we will do it for as long as it’s necessary to make sure you are comfortable with what’s going on with the case and that you have an understanding of the issues. We regularly call our clients. We don’t just email. We don’t just text. And it’s not just our paralegals calling. Either Melanie or I will pick up the phone. We will call you, and we will talk to you about your case. And we are available to our clients just about 24 hours a day. I often get text messages and phone calls from clients after hours when we respond to them. When clients call me at my desk at 8 a.m. or 5 p.m., I take the call. If I have to stay two hours late in the office, miss dinner with my family to talk to a client about his or her case, we’ll do so. We are not a volume-based practice. We take a select number of cases. We work those cases up thoroughly. And so that each client who works with us feels that their case has been handled in a thorough, workman-like way and that they have gotten the best possible representation they can at the most reasonable. So there are a number of ERISA firms that handle cases on a very high volume. And there’s really only one way to do that. And that is either have a lot of attorneys or, more likely have a lot of support staff. And that support staff take a very, very prominent role in the managing of the case. And it may be that there are just a handful of attorneys handling hundreds of files that are really being worked up by support staff with little to no involvement from the attorney. It’s really important that the attorney be involved. There is nothing wrong with having paralegals or legal assistants working on a case. That’s an important part of delegating work. And there is a lot of work that should be performed by paralegals and legal assistants as opposed to an attorney because it’s a better use of resources. But an attorney can’t and shouldn’t be stretched so thin that he or she doesn’t know what’s going on with your file or isn’t available to answer a client’s questions. And so one of the things that the approach we take is we are focused on the client, not on the number of cases we have, the number of cases we’ve closed, or the number of cases we settled. We want to talk to our clients. We want to make sure our clients are comfortable and that they feel that they’re being heard in a legal system that can often make it hard for the little guy to feel like he or she has a voice. **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment, Disability Benefits, Employee Benefits, Employment Contracts, Employment Discrimination, Health Insurance, Legal Counsel, Life Insurance, Long Term Disability, Wage & Hour Law --- ### [If Your Long-Term Disability Claim is Denied, It's Critical That You Hire an Experienced ERISA Attorney](https://www.garnerltd.com/if-your-long-term-disability-claim-is-denied-its-critical-that-you-hire-an-experienced-erisa-attorney/) **Published:** September 24, 2023 **Author:** The Garner Firm **Excerpt:** ERISA an incredibly complex statute, and many attorneys that claim to understand it simply do not. **Content:** It’s really important if your long-term disability claim, and in particular your ERISA long-term disability claim, has been denied that you hire an experienced attorney and not somebody who is unfamiliar with ERISA. ERISA is an incredibly complex statute. It’s incredibly voluminous. Many attorneys have no experience dealing with it or simply dabble in it. And one of the things we see is that when attorneys dabble in these claims but don’t really have a deep understanding the statute, a lot of experience litigating these cases, outcomes for clients are not as good. While you can’t guarantee the outcome in any case, certainly having somebody who knows the statute forward and backward has a long history of litigating the cases and litigating them to judgment successfully puts you in a much better position to have a more satisfactory outcome on your case. ERISA is a complicated statute. Many judges have a passing familiarity with ERISA. Some have more experience with ERISA, but oftentimes it’s the defense attorney that crafts a narrative on the case. And so what, my experience, many judges are accustomed to hearing the defense bars spin on what ERISA means, what the law means, and how these cases should be decided, how discovery should be handled, and how the outcome should be reached. When you have an experienced plaintiff-oriented ERISA attorney, you have the opportunity to recraft that narrative in your favor. The law is not so one-sided as the defense bar likes to portray it. In fact, ERISA is a remedial statute. It was passed to protect your benefits, and it should be easier, not harder, to get paid when your claim’s been denied. But unfortunately, over the last 40-plus years, the law has evolved in a different way. And so it’s important to have an experienced ERISA attorney working for you who has deep knowledge of the statute and can put you in the best position to prevail on your case. At the Garner Firm, we have a lot of experience litigating a risk of benefit claims. I began my career as a defense attorney, representing insurers and other plan fiduciaries in a risk litigation, took a number of cases to judgment. I then worked as a plan administrator myself for several years in addition to performing various legal functions with a benefit plan. That experience and now several years of running a plaintiff-oriented risk firm is provided in a wealth of experience. We speak at conferences regularly. Both myself and the other attorneys at the firm are published regularly in ERISA treatises on the topic and are generally thought of as being highly knowledgeable in the field. Most notably, we take cases to judgment. We have taken numerous cases to judgment on behalf of our clients. We don’t settle every case. And when we do take cases to judgment, we have achieved remarkable outcomes for our clients, not in every case, but in many cases. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Legal Counsel, Long Term Disability --- ### [What Can You Expect to Recover If You Bring an ERISA Claim in Court?](https://www.garnerltd.com/what-can-you-expect-to-recover-if-you-bring-an-erisa-claim-in-court/) **Published:** September 24, 2023 **Author:** The Garner Firm **Excerpt:** Learn what you might expect if you are bringing your ERISA claim to court and the scenarios that may affect your situation or case. **Content:** If somebody brings an ERISA claim in court, there are typically two types of claims, sometimes three, that participants will bring. And the recovery that you can expect to receive depends on the nature of the case that you’re bringing. The most common type of ERISA case, and the one we most typically see from our clients, is a claim for benefits, where you are suing over the benefits that you think you’re entitled to and that aren’t being paid to you, whether that’s a retirement benefit that’s too low that you think should be higher, whether that’s a disability benefit that’s been terminated, or a life insurance benefit that hasn’t been paid. And so in those cases, your recovery is typically limited to the benefit you believe you’re owed, interest on the benefit that has been withheld from you for some period of time. And the interest rate is a matter of some debate. And then potentially attorney’s fees and costs. Unfortunately, what you can’t recover when you’re bringing a benefits claim is punitive damages, pain and suffering, anything like that under ERISA. There is a second type of claim, however, called a claim for equitable relief that typically arises from a breach of fiduciary duty. The people who decide ERISA benefit claims are fiduciaries, which means that they have a legal obligation to act in your best interest or the interest of all plan participants and not in their own financial interests. Courts have recognized that those fiduciaries sometimes have a conflict of interest, in particular where they are both responsible for deciding the claim and paying the claim. This most typically occurs with insurance companies. If an insurer or other planned fiduciary has breached their fiduciary duty to you, then you may be able to obtain additional types of relief that sometimes look like the benefits you’re seeking but are qualitatively different under the law or other forms of relief. So a common example would be if you worked for a company and you contacted the benefits department, and you’re in your mid-60s, and you ask if you’re fully vested in your retirement benefit, and what will the amount of your benefit will be. And they tell you that you’re fully vested and that you’re going to get $2,000 a month for the rest of your life when you retire. And in reliance on that information, you choose to retire. You leave your job. There’s no prospect of coming back. You submit your retirement paperwork, and oops, somebody made a mistake. Whether that mistake was intentional or unintentional oftentimes doesn’t matter if it was an equitable. And so under that scenario, while you might not be entitled to the underlying retirement benefit you seek, may be able to bring a claim for equitable relief for an amount equal to the retirement benefit you were promised because you acted in reliance on that representation. Those cases are difficult. They’re not particularly common, and your opportunities to bring them are somewhat limited. But we do see them, and we see them more and more these days. There was a Supreme Court decision about 10 years ago, 12 years ago now, called Amara. And Amara somewhat expanded and clarified the scope of equitable relief somebody can bring. The third type of ERISA claim, which is typically not brought on an individual basis, it’s most commonly brought in a class-wide basis, is a claim for breach of fiduciary duty, but you’re bringing it on behalf of the plan itself. So if you have a case where the fiduciary embezzled money from the retirement plan, for example, you, as a participant in the plan, can sue that fiduciary for doing it, but you can also sue on behalf of or for the damage done to the plan as a whole as a result of the fiduciary’s misconduct. And those claims are, as I said, less common, and they typically arise in relation to retirement benefits, but not always. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Long Term Disability --- ### [Why Do I Need An Attorney for An ERISA Appeal?](https://www.garnerltd.com/why-do-i-need-an-attorney-for-an-erisa-appeal/) **Published:** September 24, 2023 **Author:** The Garner Firm **Excerpt:** It's essential to understand what's required in order to be successful in appealing an ERISA claim. A well-written and thoroughly researched appeal can improve your chances of success. **Content:** ERISA appeals are incredibly important. There is a series of case law that holds that you must appeal the denial of your claim for benefits before you proceed to court. If you don’t go through that appeal process with certain very limited exceptions, your case will likely be dismissed. So for that reason alone, the appeal is incredibly important. But there’s another, more significant strategic reason why your appeal is important. First of all, if you do a thorough, well-written appeal, you have a better chance of being successful on appeal. If, however, the appeal is unsuccessful, you have to assume, once you go into court, that that may be the only thing the judge looks at in the case. Many of us think of litigation, and civil litigation in particular, like we see on television. Most people don’t have much interaction with the court system. And so when we envision a civil lawsuit, what many of us think of is people coming to court, a jury sitting in a jury box, witnesses coming in, testifying in court, providing evidence, the attorney standing up, giving a presentation, and then the case is decided. A risk of benefit claims are typically not handled that way. So as an initial matter, you don’t get a jury. Secondly, the judge will typically only look at the record that is created on appeal. So you have to assume, as the attorney, once you get into court, that your ability to obtain discovery may be limited and that you should approach the appeal with the mindset that you will never have an opportunity to provide additional evidence. We’re going to try in every case to obtain discovery and make the record more robust because we can only add so much to it during the appeal process, but we approach each appeal as if that is the case. So that’s the opportunity to make sure we have all of the relevant plan documents complete copy of the insurer’s file, all of the relevant records. Typically, if we’re talking about a disability or a life insurance claim, that would be medical records. If we’re talking about a retirement plan claim, we’re talking about work history records, payroll records, social security earnings, what have you. But we want to make sure that we have that entire body of evidence, everything we can possibly get our hands on during the appeal process, and submitted to the fiduciary who’s deciding the appeal. The other thing we want to do is make sure if there is any other evidence or documentation that we think would be helpful. For example, if we’re talking about a disability claim, perhaps there’s medical literature that would be helpful in explaining your client’s condition, and that’s particularly so if your client has a somewhat rare medical condition; all of that information you want to submit with the appeal. If your client’s been approved for social security disability, while that’s not controlling on your risk of disability claim, it’s helpful. And so you perhaps want to get the complete Social Security disability file. That takes time, but you want to submit and create a really robust record during the appeal so that if the appeal is unsuccessful and you go to court you have everything you think you need there in that record before the court and that you can cite to it as you are briefing your motion for summary judgment and trying to explain to the judge why you should win the case and why the Decision that you’re suing over was incorrect. If you don’t do that, you could find yourself without critical pieces of information or evidence that could help you win on your case on appeal. That’s why we like to have clients come to us at the beginning, when their claim has, in a perfect world, before they’ve even submitted a claim, but when their claim has been denied, not after they’ve submitted an appeal. In many cases, we’re unable to assist people when they’ve handled the appeal on their own because the record is not sufficiently well-developed for us to do what we need to do in court. So it’s really important, whether you work with a Garner Firm or another law firm, that you hire an experienced ERISA attorney who knows what they’re doing, who can build a robust and fully developed record in connection with your appeal so that you are in the best possible position to litigate that case, if necessary, in court. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Legal Counsel, Long Term Disability --- ### [How Are ERISA Claims Resolved?](https://www.garnerltd.com/how-are-erisa-claims-resolved/) **Published:** September 24, 2023 **Author:** The Garner Firm **Excerpt:** ERISA claims are typically resolved by appealing the denial of a benefit claim, by filing a lawsuit in court or by settlement. **Content:** Erisa claims are typically resolved in one of several ways. The first is if you are appealing the denial of a benefit claim, and the appeal is successful, that’s how the claim’s resolved. So if your claim was denied because perhaps a disability insurer said, we don’t believe you’re disabled and you submit an appeal and the appeal is successful, then what would typically happen is your benefits would be reinstated, retroactive to the date they were denied, and then would be payable in the future subject to the terms of the disability plan, including remaining disabled. If it’s a retirement benefit claim under that same scenario, or perhaps the retirement plan claim determined that you were not fully vested in your benefit in the title to a retirement benefit, and you appeal it, and the appeal is successful, then your retirement benefits would be reinstated and paid for as long as those benefits were payable under the plan, which if we’re talking about a traditional pension plan would be for your lifetime. The second way ERISA claims are resolved is in court. When you file a lawsuit under ERISA, those lawsuits are typically brought in federal court. And they are often resolved on what we call cross motions for summary judgment, which is where both sides provide a written submission to the court explaining why they believe they should prevail. The court will look typically at the record that was created during the appeal process and then make a decision. And again, they’re like if you were doing the internal appeal and the lawsuit is successful, your benefits would typically be reinstated and then paid prospectively, subject to the terms of the benefit plan. Also, when you do this in federal court, you have the possibility of recovering your costs and your attorney’s fees, which typically does not occur when you’re doing an appeal. The third way these claims are often resolved is via settlement. And that settlement most typically looks like a lump sum payment. Not always, but typically. And so when we’re settling a disability benefits claim, for example, we’ll look at a couple of different components. The first thing we’ll look at is what benefits are owed to you in arrears. That’s an easy number. We’ll add a figure for interest. And then we take the present value of your future payments. So we look at the stream of future payments that are potentially payable to you under the terms of the plan. And we figure out what that future stream of payments is worth in today’s dollars. We add those figures together, come up with a lump sum total, and then the parties tend to negotiate off of that figure. And there’s often a dispute as to the value of that future stream of payments, which can typically be the first hurdle that the parties have to work through when they’re trying to negotiate a settlement of an ERISA disability benefits claim or retirement plan claim. It’s less of an issue when you’re dealing with a benefit like life insurance, for example, where there’s a single payment. And so everybody knows what the claim is worth. Then there’s simply a negotiation over the settlement value of that life insurance claim. **Categories:** (ERISA) Litigation, Disability Benefits, Legal Counsel, Long Term Disability --- ### [How Long Does It Take For An ERISA Claim To Be Resolved?](https://www.garnerltd.com/how-long-does-it-take-for-an-erisa-claim-to-be-resolved/) **Published:** September 24, 2023 **Author:** The Garner Firm **Excerpt:** The timeframe for resolving an ERISA case depends on the nature of the benefited issue and also the complexity of the case and where it is in its lifecycle. **Content:** The timeframe for resolving an ERISA case depends a little bit on the nature of the benefit at issue and also the complexity of the case and where it is in its life cycle. If we’re talking about a long-term disability benefit claim, which is the most common type of ERISA claim that gets litigated, the appeal process can take up to 180 days to submit your appeal. Presently, due to the COVID-19 pandemic, those deadlines are extended a bit further. But in a typical case, it takes 180 days to submit an appeal. Sometimes the appeal is submitted sooner, sometimes not. Once the appeal is submitted, the plan fiduciary, typically the insurance company who’s reviewing the claim, has 45 days to consider the disability appeal, and they can take on an additional 45-day extension if necessary. So I like to tell clients that you should expect a disability appeal to take 90 days to be considered once it’s been submitted. If you have 180 days plus 90 days, you are looking at about nine months to have a disability appeal decided from the date your benefits are denied on the long end. It could take longer, especially if there’s an agreement between the insurance company and counsel to extend the deadlines for whatever reason. Once the appeal is decided, again, in a perfect world, if the claim’s denied, that’s it. And your benefits are reinstated. There may be a lag of a week or two to get your payment. But from that point forward, things move fairly smoothly. If the case is going to litigation, on the other hand, it can take months or years. The overwhelming majority of ERISA claims are resolved via settlement, but not every claim. And we have cases, for example, that we’ve been litigating for several years, but we also have claims that we litigate in court, and it takes several months. So it really depends. But once you file the lawsuit, the case will be assigned to a judge, and it takes typically about 60 to 90 days for a case to get moving once it has been filed in federal court. And the reason for that is there is a period of time in which the defendants have been served with a lawsuit, and they have an opportunity to respond. Oftentimes, they get 60 days to respond because they do something called waiving service. So you don’t need to use a formal process server. Then the judge has to set the case in for a scheduling hearing. And then the case proceeds from there. In many cases, in particular in federal court, once the case has been set in for a scheduling conference, you may get referred to a settlement conference, which is a mediation before United States Magistrate Judge. And there’s a good chance the case will resolve at that point. So I would say it’s fairly common if an ERISA claim is going to settle. It will settle within the first six months. It is in litigation, not always. If the case goes the duration, it may take about six to 12 months for the case to be fully briefed for the court to have a motion in front of it to make a decision. And then there’s no timetable for the judge to make a ruling. I would say it’s fairly common for judges to rule on motions for summary judgment within about four to six months. But I have had some judges take far longer, and some take far less time. There are a number of constraints on our ability to move these cases along faster. There are certain things we certainly can do that will move cases along, including providing, applying consistent pressure on the other side who move the case. Time is a defendant’s best friend. The longer they can delay a case, the longer it is before they have to pay on a case. So we can put, we can, and we do push to move these cases along, seek discovery. If we’re going to have a settlement conference, get that settlement conference scheduled sooner rather than later. But the reality of litigation in federal court and in state court is it takes time. And the one thing you cannot push is the judge. And the judge will issue the schedule that the judge wants, and the judge will rule on the case when the judge wants or is able to, and that is unfortunately, part of how this process works. **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability --- ### [What is ERISA and How Does It Govern Benefits?](https://www.garnerltd.com/what-is-erisa-and-how-does-it-govern-benefits/) **Published:** September 24, 2023 **Author:** The Garner Firm **Excerpt:** ERISA governs employee benefit plans by private sector employers. This includes benefit plans regarding your retirement benefits, your health insurance benefits through work, your life insurance benefits through work, disability insurance through work or any other benefit plan your employer may offer. **Content:** ERISA is a federal law. It stands for the Employee Retirement Income Security Act of 1974. The law was passed in 1974 and effective in 1976. It governs employee benefit plans by private sector employers. This includes benefit plans regarding your retirement benefits, your health insurance benefits through work, your life insurance benefits through work, disability insurance through work, or any other benefit plan your employer may offer. ERISA does not apply, however, to governmental employers. So if you work for a state, federal, or local government entity, more likely than not, your benefits are not covered by ERISA. There can be certain exceptions, but typically, it only applies to private sector employers. In addition, there’s an exception for people who work for certain religiously affiliated organizations. For example, Catholic Church. If you work for the Catholic Church and are an employee of an archdiocese, for example, your benefits are probably not governed by ERISA. But for the vast majority of Americans who receive benefits through work, and most Americans receive their health insurance and their retirement benefits through work, those benefits are governed by ERISA. **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability --- ### [Third Circuit Issues Precedential Opinion Upholding Validity of Anti-Assignment Clauses](https://www.garnerltd.com/third-circuit-issues-precedential-opinion-upholding-validity-of-anti-assignment-clauses/) **Published:** January 2, 2023 **Author:** Adam Garner **Excerpt:** The case is a setback for healthcare providers seeking to stand in the shoes of certain ERISA health plan participants when seeking compensation from health plans. **Content:** On May 16, 2018, the United States Court of Appeals for the Third Circuit issued a precedential opinion in *American Orthopedic & Sports Medicine v. Independence Blue Cross Blue Shield, et al.*, Case No. 17-1663, upholding the validity of anti-assignment clauses in health plans governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, *et seq*. (“ERISA”). The case is a setback for healthcare providers seeking to stand in the shoes of certain ERISA health plan participants when seeking compensation from health plans. A copy of the Court’s opinion may be found [here](https://www.garnerltd.com/wp-content/uploads/2018/05/Am-Orthpedic-v-IBC-Opinion.pdf). In October 2015, American Orthopedic and Sports Medicine (“American Orthopedic”) performed shoulder surgery on a patient who was covered by a health insurance plan issued by Independence Blue Cross Blue Shield and/or Horizon Blue Cross Blue Shield (the “Insurers”). After the surgery, American Orthopedic, who was an out-of-network provider, charged the patient for the procedure. It charged the patient $58,400 and submitted a claim in that amount to the Insurers on the patient’s behalf. The claim form identified the various medical services provided to the patient and indicated that he had “authorize\[d\] payment of medical benefits” to American Orthopedic. American Orthopedic’s billed charges far exceeded the health plan’s allowed reimbursement. The Insurers processed the claim according to their out-of-network cap of $2,633, applied the patient’s deductible of $2,000 and his 50% coinsurance of $316. The Insurers issued the patient a small reimbursement check for the remaining $316, and advised him that he would still owe American Orthopedic the remaining $58,083. American Orthopedic appealed the claim through the Insurers’ internal administrative process. At the same time, it arranged for the patient to sign a document entitled “Assignment of Benefits & Ltd. Power of Attorney,” which reflected that the patient was assigning to American Orthopedic his right to pursue claims under his health insurance plan for the surgery. Also, in the alternative, the document granted to American Orthopedic a limited power of attorney to recover the payment on the patient’s behalf through an arbitration or lawsuit. After the Insurers apparently denied the appeal, American Orthopedic filed suit. The Insurers contended that American Orthopedic’s claim was barred by virtue of the health plan’s anti-assignment provision. That provision states: > The right of a Member to receive benefit payments under this Program is personal to the Member and is not assignable in whole or in part to any person, Hospital, or other entity nor may benefits of this Program be transferred, either before or after Covered Services are rendered. However, a Member can assign benefit payments to the custodial parent of a Dependent covered under this Program, as required by law. The Third Circuit agreed with the Insurers. It noted that ERISA does not prohibit anti-assignment provisions like the one contained in the plan at issue. Specifically, it stated: > In sum, we perceive no compelling reason to stray from the “black-letter law that the terms of an unambiguous private contract must be enforced.” *Travelers Indem. Co. v. Bailey*, 557 U.S. 137, 150 (2009); *see also In re Kaplan*, 143 F.3d 807, 818 (3d Cir. 1998) (“Parties are entitled to enforce the terms of negotiated contracts\[.\]” (quoting *RTC v. Holtzman*, 618 N.E.2d 418, 424 (Ill. 1993))). We are left with a gap in the text, reasonable and competing policy arguments that lack grounding in legislative fact finding, and an overwhelming consensus among the Courts of Appeals that “ERISA leaves the assignability or non-assignability of health care benefits under ERISA-regulated welfare plans to the negotiations of the contracting parties.” *City of Hope*, 156 F.3d at 229. We now join that consensus and hold that anti-assignment clauses in ERISA-governed health insurance plans as a general matter are enforceable. The Court went on to note that the power of attorney American Orthopedic obtained was not implicated by the plan’s anti-assignment provision. While an assignment transfers ownership of a claim, the power of attorney simply gave American Orthopedic the authority to act on the patient’s behalf with respect to the claim. Thus, it was fundamentally different than the assignment and not affected by the plan’s anti-assignment provision. Unfortunately for American Orthopedic, however, the Third Circuit declined to remand the claim to the District Court because it “waived its arguments concerning the power of attorney by failing to raise them in its opening or reply brief and, indeed, did not address the significance of the power of attorney until we invited it to do so in supplemental briefing.” If your claim for health benefits has been denied under your employer’s health plan, [contact us today](https://www.garnerltd.com/contact/) for your free consultation. [Adam H. Garner](https://www.garnerltd.com/attorney-profile/), is an experienced [ERISA health benefits lawyer](https://www.garnerltd.com/practice-areas/erisa-litigation/). We may be able to help you obtain the health benefits to which you are entitled. **Categories:** (ERISA) Litigation, Employee Benefits, Health Insurance **Tags:** 1132(a), 502(a), anti-assignment, assignment, assignment of benefits, ERISA, ERISA lawyer, health benefits, health insurance, health plan, out-of-network --- ### [Court Clarifies Meaning of ERISA Long Term Disability (LTD) Plan and Remands for Further Consideration](https://www.garnerltd.com/court-clarifies-meaning-of-erisa-long-term-disability-ltd-plan-and-remands-for-further-consideration/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** On May 9, 2018, the United States District Court for the District of Kansas remanded a long term disability (“LTD”) claim back to the claims administrator for further consideration after it interpreted an ambiguous plan provision. A copy of the Court’s opinion in *Derichs v. AT&T Services, Inc.,* Case No. 16-2346-JWL, can be found [here](https://www.garnerltd.com/wp-content/uploads/2018/05/Derichs-v.-ATT.pdf). The *Derichs* plaintiff was a participant in an employer-sponsored long term disability benefits plan governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, *et seq.* (“ERISA”). (ERISA governs most employer-sponsored employee benefit plans). Sedgwick administered claims for LTD benefits under the plan. Sedgwick is a third party administrator that administers a number of ERISA long term disability plans. In order to receive LTD benefits, the plaintiff had to satisfy the following definition of disabled: “You are considered Totally Disabled when, because of illness or injury, you are unable to perform all of the essential functions of your job. . .” The plaintiff made a claim for LTD benefits that was denied. He submitted an internal appeal that was also denied. After exhausting his appeals under the plan, he filed suit against the plan under section 502(a) of ERISA, 29 U.S.C. § 1132(a). The Court recognized that plan’s definition of disability had two possible meanings. First, it could mean that to show a participant is disabled he or she must show that he or she cannot perform any one of the job’s essential functions. Alternatively, the plan provision could mean that a claimant must show that he or she cannot perform all of the job’s essential functions in order to show that he or she is disabled. The Court found, and the defendant conceded, that Sedgwick had not applied any particular interpretation of the plan. Thus, Sedgwick’s interpretation of the plan was not entitled to any form of deference under the *Firestone* line of cases. The Court interpreted the plan as a matter of law and found that to be disabled a participant must show that he or she could not perform any one of the essential functions of the participant’s position in order to receive long term disability benefits. The Court reasoned that if an employee cannot perform an “essential function” of the job, then he or she cannot perform the job and would be subject to dismissal by his or her employer. It further noted that the plan’s reliance on the inability to perform an essential function of the job negated any risk that individuals could claim disability for the inability to perform trivial job functions. This interpretation was “more reasonable \[than the alternative\] and is more in keeping with the plan’s clear purpose of providing benefits to those who can no longer perform their jobs.” The Court also utilized the doctrine of *contra proferentem*, under which ambiguities in the plan are construed against the drafter and in favor of the plan participant. Having supplied the proper interpretation of the plan, the Court remanded the claim to the long term disability plan’s administrator, Sedgwick, for it to reconsider the plaintiff’s claim for LTD benefits. If you are an ERISA long term disability claimant whose claim has been denied, please [contact us](https://www.garnerltd.com/contact/) today for a free consultation. [Adam H. Garner](https://www.garnerltd.com/attorney-profile/), the founder of The Garner Firm, is an experienced [ERISA long term disability lawyer](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/). We may be able to help you receive and recover the long term disability benefits you are entitled to. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Long Term Disability **Tags:** 29 U.S.C. 1132(a), contra proferentem, disability, disability lawyer, ERISA lawyer, ERISA Section 502(a), ERSA, long term disability, LTD, Sedgwick --- ### [When is a Death “Accidental” for Purposes of an Accidental Death and Dismemberment Insurance Policy](https://www.garnerltd.com/when-is-a-death-accidental-for-purposes-of-an-accidental-death-and-dismemberment-insurance-policy/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Sometimes Accidental Death and Dismemberment (AD&D) insurers will dispute whether an insured’s death was the result of an accident. A recent decision from the United States District Court for the Northern District of Illinois provides some additional guidance. *See* *Tran v. Minn. Life Ins. Co.*, Case No. 17-cv-450 (N.D. Ill. March 5, 2018). A copy of the court’s opinion can be found [here](https://www.garnerltd.com/wp-content/uploads/2018/03/Tran-v.-Minn-Life-Opinion.pdf). The insured in *Tran* was a participant in his employer’s AD&D insurance plan. He died while engaging in autoerotic asphyxiation – a state of asphyxia intentionally induced (as by smothering or strangling oneself) so as to heighten sexual arousal during masturbation. “Autoerotic Asphyxiation.” Merriam-Webster.com. Merriam-Webster, n.d. Web. 7 Mar. 2018. There was no dispute that insured did not intend to take his own life and that his death was an accident, as that term is commonly used. The insured’s widow submitted a claim for AD&D benefits from the insurer. The insurer denied the claim. It relied on a provision of the plan that stated claims were not payable for deaths arising as a result of “self-inflicted injury.” The widow appealed. The insurer denied the appeal after consulting with an expert on the same grounds, but with further explanation. It explained that > Accidental death as defined in the policies must result “from an accidental injury which is unexpected and unforeseen.” The injury in autoerotic asphyxiation of constricting blood flow to the brain is not unexpected or unforeseen but rather the purpose of the autoerotic activity. Based on the above, we have not received sufficient proof that \[the insured’s\] death is the result of an accidental injury as defined in the policy. > > . . . > > The self-inflicted injury of intentionally constricting blood flow to the brain distinguishes autoerotic activity from the other avocation examples listed in your letter of appeal. None of the other activities mentioned in your letter (skydiving, motorcycle riding, or sailing) involve intentionally interrupting an essential bodily function. The widow subsequently filed suit. The Court reviewed the widow’s claim under the *de novo* standard of review, as the parties agreed that standard of review applied, and found that the insurer wrongfully denied the widow’s claim for AD&D benefits. After discussing the fairly well-developed body of case law on the topic, the Court explained its reasoning as follows: > the medical examiner’s report explains that hypoxia, when induced to an extent that does not cause loss of consciousness, can cause drowsiness, impaired judgment, excitement, disorientation, and headache. Reasonable minds could disagree on whether these results are, in and of themselves, “injuries.” Of course, if hypoxia lasts too long, it can result in loss of consciousness; however, there is no evidence in the record that \[the insured\] intended to lose consciousness. > > Attempting to “partially” strangle oneself might, of course, seem like a bad idea to the ordinary person. But just because an activity is risky does not necessarily mean that it is injurious. As the split in case law in the context of autoerotic asphyxiation shows, it is difficult to say where the line should be drawn. Take, for instance, a swimmer who challenges himself to swim underwater for longer and longer periods, and ends up holding his breath too long, blacking out, and dying. Was the swimmer injuring himself intentionally by holding his breath, since that temporarily deprived his brain of oxygen? The Court then considered “whether \[the insured’s\] strangulation, which resulted after he lost consciousness, is ‘an accidental injury which \[w\]as unexpected and unforeseen.’” It concluded it was because “loss of consciousness and strangulation were \[not\] substantially certain to result from his conduct. Although the practice of autoerotic asphyxiation is undoubtedly risky, Plaintiff had engaged (and many others do engage) in the practice without losing consciousness, strangling themselves, or dying.” If you have filed a claim for AD&D benefits and the insurer has denied your claim because the death was not an “accident,” do not take the insurer’s word for it. You should[ consult with](https://www.garnerltd.com/contact/) an [experienced accidental death insurance lawyer](https://www.garnerltd.com/practice-areas/accidental-death-dismemberment-benefits/). You may have a limited time in which to appeal the decision (generally 60 days for employer-sponsored AD&D plans). **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment **Tags:** accidental death and dismemberment, ad&d, employee benefits, ERISA, full and fair review, life insurance --- ### [What to Do After Your Spouse’s Accidental Death](https://www.garnerltd.com/what-to-do-after-your-spouses-accidental-death/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Many people have accidental death and dismemberment coverage through their employer under the [Employee Retirement Income Security Act of 1974 (ERISA).](https://www.garnerltd.com/practice-areas/erisa-litigation/) This coverage can be critical if you learn that your spouse passed away due to an accidental injury, as it can provide benefits to offset the losses you can experience due to sudden death. However, benefits are not automatic, and you must take certain steps to protect your rights as the beneficiary of the accidental death policy and receive the benefits you deserve. If you are in this situation, you might have little to no experience with this type of insurance claim. Insurance companies can be difficult – even when there is a tragic loss involved. It can be wise to consult with a [Philadelphia accidental death insurance lawyer](https://www.garnerltd.com/attorney-profile/) who can guide you through the process. While each situation has different circumstances, the following are some general steps that might follow a spouse’s accidental death. ![photo of mother and daughter following the spouse's accidental death](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_328834962geo-1024x683.jpg "photo of mother and daughter following the spouse's accidental death - The Garner Firm") ### Filing the Initial Claim The insurance company must be properly notified of the accidental death and the request for benefits, and you do so by preparing and filing a claim. The claim process can vary depending on the insurance provider, though the policy should have clear instructions on how to file your claim. ### The Insurance Investigation This type of insurance company will only pay out on claims stemming from accidental death, so it will conduct an investigation to confirm the cause of death. The adjuster might require any records of documents relevant to the death, including police reports, toxicology reports, medical examiner reports, medical records of treatment prior to the death, and more. You want to submit all requested documents promptly because the sooner the adjuster confirms the accidental death, the sooner you can receive your benefits. Many insurance companies delay payment based on claims they do not have enough information to confirm the accidental cause of death. ### Confirming the Status of Your Claim Following the investigation period, the insurance company should notify you promptly whether your claim was accepted or denied. If you do not hear from the company, you should check on the status of your claim. If your claim was accepted, payment should not be delayed. If the insurance company denied your claim, you should determine the exact reason for the denial. It is imperative to contact an attorney at this stage if you have not done so already. Denial is not a final answer, as you have the ability to appeal and even initiate litigation against the insurer if necessary to receive payment on a valid claim. The appeal process is complicated, however, so you want an experienced ERISA litigation attorney advocating for your rights. ### Contact a Philadelphia Accidental Death Claim Attorney for Assistance Sometimes, the sudden death of a loved one is only made worse by the delay or denial of benefits you deserve under an accidental death policy. If you would like assistance filing a claim or appealing a denial, [contact](https://www.garnerltd.com/contact/) The Garner Firm right away. **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment, Employee Benefits **Tags:** accidental death attorney, Accidental death lawyer, AD&D lawyer, denied claim --- ### [A Great Win for ERISA Participants at the Supreme Court](https://www.garnerltd.com/a-great-win-for-erisa-participants-at-the-supreme-court/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Earlier this morning, the Supreme Court of the United States issued a unanimous opinion in *Intel Corp. Investment Policy Committee v. Sulyma*, No. 18-1116, October Term, 2019. Justice Alito authored the Court’s opinion. A copy of the opinion can be found [here](https://www.garnerltd.com/wp-content/uploads/2020/02/Sulyma-Opinion.pdf). The opinion interprets ERISA’s statute of limitations and repose found in Section 413 of the statute, 29 U.S.C. § 1113. Mr. Sulyma was represented by several friends of the firm: [R. Joseph Barton](https://blockesq.com/attorneys/r-joseph-barton/) of Block and Leviton, [Joseph Creitz](http://creitzserebin.com/about/joseph-a-creitz/) of Creitz & Serebin, and [Gregory Porter](https://www.baileyglasser.com/lawyers-gregory-y-porter) of Bailey and Glasser. [Matthew Wessler](http://guptawessler.com/people/matthew-wessler/) of Gupta Wessler lead the brief writing team and argued the case before the Court for Mr. Sulyma. Section 413 of ERISA provides: No action may be commenced under this subchapter with respect to a fiduciary’s breach of any responsibility, duty, or obligation under this part, or with respect to a violation of this part, after the earlier of– (1) six years after (A) the date of the last action which constituted a part of the breach or violation, or (B) in the case of an omission the latest date on which the fiduciary could have cured the breach or violation, or (2) ***three years after the earliest date on which the plaintiff had actual knowledge of the breach or violation***; except that in the case of fraud or concealment, such action may be commenced not later than six years after the date of discovery of such breach or violation. 29 U.S.C. § 1113 (emphasis added). The issue in *Sulyma* was described as follows: “whether a plaintiff necessarily has ‘actual knowledge’ of the information contained in disclosures that he receives but does not read or cannot recall reading.” The Court held “that he does not and therefore affirmed” the decision of the U.S. Court of Appeals for the Ninth Circuit. The Court explained that the statutory text is unambiguous and means what it says. It noted, “Although ERISA does not define the phrase ‘actual knowledge,’ its meaning is plain. Dictionaries are hardly necessary to confirm the point, but they do. When Congress passed ERISA, the word ‘actual’ meant what it means today: ‘existing in fact or reality.'” Thus, in order for Section 413’s three-year statute of limitations provision to apply, “the plaintiff must in fact have become aware of” the alleged fiduciary breach giving rise to his or her cause action. In so doing, the Court expressly rejected Intel’s position that making information available to a plan participant that he or she may not have ever read was sufficient to put the participant on notice of an alleged fiduciary breach. The *Sulyma* decision is a great victory for plan participants and for common sense. We are thrilled for our friends who represent Mr. Sulyma and for the positive impact this decision will have on plan participants in the future. **Categories:** (ERISA) Litigation **Tags:** breach of fiduciary duty, ERISA, erisa litigation, statute of limitations, statute of repose, supreme court --- ### [Adam Garner Speaks at Two Recent American Bar Association ERISA Conferences](https://www.garnerltd.com/adam-garner-speaks-at-two-recent-american-bar-association-erisa-conferences/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** The Garner Firm’s [Adam Garner](https://www.garnerltd.com/attorney-profile/) had the honor of speaking at two recent American Bar Association conferences addressing ERISA employee benefits. The first conference was the ABA’s Torts, Trial, and Insurance Practice Section (“TIPS”) 46th Annual TIPS Mid-Winter Symposium on Insurance and Employee Benefits in Austin, TX. The conference was held from January 16-18, 2020, and Adam moderated a panel on Attorney’s Fees in ERISA Litigation with a nationally recognized panel of ERISA experts. ![erisa and long-term disability lawyer adam garner at aba conference](https://www.garnerltd.com/wp-content/uploads/2023/11/adam-garner-erisa-lawyer-ABA-Conference.webp "adam-garner-erisa-lawyer-ABA-Conference - The Garner Firm") The second conference was the ABA Section of Labor and Employment Law’s Employee Benefits Committee Mid-Winter Meeting, which was held last week in Rancho Mirage, CA. Adam spoke on a panel providing an update on the law regarding multi-employer pension plans. Adam’s portion of the presentation discussed situations in which retirement plans unfairly and unreasonably seek the repayment of pension benefits that were mistakenly overpaid to plan participants through no fault of the of the participant. These claims can often involve tens of thousands of dollars and impose significant financial hardship on retirees. Adam has significant experience litigating these claims on behalf of retirees. Over the years, Adam has developed a national reputation as a leading authority on employee benefits law and ERISA. He is regularly asked to speak to lawyers from both the plaintiff and defense bar at conferences sponsored by various organizations. If your employee benefits claim has been denied, or if you believe your employee benefit plan fiduciary has breached its duties to you or other plan participants, [contact us](https://www.garnerltd.com/contact/) today. We may be able to help. **Categories:** (ERISA) Litigation **Tags:** attorney's fees, ERISA, pension, retirement --- ### [Adam Garner Appears on the Jeff Gross Show on WWDB-AM Talk 860](https://www.garnerltd.com/adam-garner-appears-on-the-jeff-gross-show-on-wwdb-am-talk-860/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** The Garner Firm’s Adam H. Garner appeared on The Jeff Gross Show on WWDB-AM Talk 860 with workers’ compensation attorney [Jeffrey Gross, Esquire](https://www.philaworkerscomp.com/attorneys/jeffrey-s-gross/). Jeff is one of Philadelphia’s premier workers’ compensation attorneys and a long time friend of the firm. You can visit his firm’s website [here](https://www.philaworkerscomp.com/). Thank you Jeff and and co-host, Joe Dougherty, for having Adam on the show. For those interested, you can listen to the broadcast [here](https://wwdbam.com/episodes/the-whos-who-in-philly-labor-show-21/). **Categories:** (ERISA) Litigation **Tags:** Concussion, concussion lawyer, ERISA, erisa attorney, erisa claim, ERISA lawyer, long term disability, long term disability attorney, long term disability benefits --- ### [Adam Garner Named ABA Torts, Trial, and Insurance Practice Section Health and Disability Committee Chair-Elect](https://www.garnerltd.com/adam-garner-named-aba-torts-trial-and-insurance-practice-section-health-and-disability-committee-chair-elect/) **Published:** January 2, 2023 **Author:** Adam Garner **Excerpt:** The Health & Disability Committee concentrates on matters relating to health, disability, long-term care, accident, medical and hospital expense insurance contracts. **Content:** [Adam H. Garner](https://www.garnerltd.com/attorney-profile/) has been named the Chair-Elect of the American Bar Association’s Torts, Trial, and Insurance Practice Section’s (“TIPS”) Health and Disability Committee. His appointment was effective as of the American Bar Association’s Annual Meeting and lasts for one year. [Sherril Colombo of Littler Mendelson, PC](https://www.littler.com/people/sherril-m-colombo) will serve as the Committee’s Chair for the coming year. The Health & Disability Committee concentrates on matters relating to health, disability, long-term care, accident, medical and hospital expense insurance contracts. It examines the laws and the regulation of laws governing the health and disability areas, including state insurance laws, ERISA, ADA, and COBRA, and the interplay between state and federal law. The Committee is also a co-sponsor of the annual TIPS Midwinter Symposium on Insurance and Employee Benefits, which will be held in Austin, Texas this January. Adam will be a featured speaker at the Midwinter Symposium for the third year in a row. Adam will become the Chair of the Health & Disability Committee at the 2020 ABA Annual Meeting. **Categories:** Disability Benefits, Health Insurance --- ### [Court Awards Over $5.8 Million in Life Insurance Benefits and Interest](https://www.garnerltd.com/court-awards-over-5-8-million-in-life-insurance-benefits-and-interest/) **Published:** January 2, 2023 **Author:** Adam Garner **Excerpt:** The United States District Court for the District of Connecticut recently awarded over $5,800,000 in life insurance benefits and prejudgment interest to a life insurance claimant whose husband worked for Stanley Black and Decker. **Content:** The United States District Court for the District of Connecticut recently awarded over $5,800,000 in life insurance benefits and prejudgment interest to a life insurance claimant whose husband worked for Stanley Black and Decker and participated in a life insurance plan governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. (“ERISA”). A copy of the Court’s opinion may be found [here](https://www.garnerltd.com/wp-content/uploads/2019/07/Tyll-v-Stanley-Black-and-Decker-LI-Program-Decision.pdf). The dispute in the case was centered on ambiguous language in the Plan as to the amount benefits payable to designated beneficiaries of Plan participants. My good friend and friend of the firm, [Jonathan Feigenbaum, Esquire](https://www.erisaattorneys.com/attorney-profile/), and his co-counsel, Sean K. Collins, Esquire, represented the plaintiff. The decedent worked for Stanley Black and Decker at the time of his death and earned an annual salary in excess of $1,000,000 per year. He died while traveling and his wife, the plaintiff, submitted a claim for life insurance benefits under the plan. Federal Insurance Company insured the Plan’s life insurance benefits and ultimately paid her $1,000,000 in life insurance benefits. The plaintiff filed suit under Section 502(a) of ERISA, 29 U.S.C. § 1132(a), and claimed that she was entitled to $5,000,000 in benefits, interest and attorneys’ fees. The Court described the life insurance policy and issue in the case as follows: *In the event of a “Loss of Life,” as a Class 1 Insured Person, Mr. Tyll was entitled to benefits equal to 100 percent of a principal sum in the amount of “Five (5) times Salary subject to a Minimum of $100,000 and a Maximum of $1,000,000.” AR 78. The issue in this case is “whether the limiting clause “subject to a Minimum of $100,000 and a Maximum of $1,000,000” modifies the noun . . . Salary (by placing a floor and cap on Salary) . . . or whether the limiting clause places a floor and cap on the benefits overall, as \[the defendants\] argue\[ \].” Plaintiff’s Memorandum in Support of Summary Judgment (Pl.’s Mem. in Supp.) (Doc. No. 59-1) at 2–3. The first question for the court is whether the language defining the applicable principal sum is ambiguous* Opinion at 7. The Court concurred with the plaintiff that the policy was ambiguous, that it had to be construed against the insurer, and that she was entitled to a total $5,000,000. The Court also determined that the plaintiff was entitled to prejudgment interest on the life insurance benefits. After concluding that Connecticut’s statutory rate of prejudgment interest at the rate of 10% per annum did not apply to the Plaintiff’s claim, it determined that it had discretion to determine an equitable rate of interest to be applied to the claim. The Court found that 8% per annum, compounded annually, was equitable and adequate to make the plaintiff whole. As such, the Court awarded her $4,000,000 in back life insurance benefits, $198,308.72 in prejudgment interest on the $1,000,000 Federal had previously (but untimely) paid the plaintiff, and $1,693,134.01 in prejudgment interest on the $4,000,000 in life insurance benefits that had been previously withheld. If you are seeking life insurance benefits under an [ERISA life insurance plan or other life insurance policy](https://www.garnerltd.com/practice-areas/life-insurance/), you should [contact](https://www.garnerltd.com/contact/) an experienced [life insurance lawyer](https://www.garnerltd.com/attorney-profile/) today. **Categories:** (ERISA) Litigation, Employee Benefits, Life Insurance **Tags:** employee benefits, ERISA, erisa attorney, ERISA lawyer, life insurance, life insurance benefits, life insurance lawyer --- ### [Court Finds in Favor of Disability Claimant After Treating Physicians Ignored](https://www.garnerltd.com/court-finds-in-favor-of-disability-claimant-after-treating-physicians-ignored/) **Published:** January 2, 2023 **Author:** Adam Garner **Excerpt:** The United States District Court for the Northern District of Alabama found in favor of a long term disability claimant after an insurer ignored the opinions of his treating physicians. **Content:** Yesterday, the United States District Court for the Northern District of Alabama found in favor of a long term disability claimant after an insurer ignored the opinions of his treating physicians in finding that he was not disabled under the terms of his employer’s long term disability plan. A copy of the Court’s opinion in *Wiley v. United of Omaha Ins. Co.,* Case No. 5:16-cv-1936-CLS (N.D. Ala. May 20, 2019), may be found **[here](https://www.garnerltd.com/wp-content/uploads/2019/05/Wiley-v-United-of-Omaha-Opinion.pdf)**. (The opinion is lengthy due to a large appendix at the end). The plaintiff was employed by Camber Corporation as a “Senior Business Systems Analyst,” a position that required him to provide software analysis, design, and programming support to the United States military and other departments and agencies of national government. He participated in the short and long term disability plans his employer sponsored. Those short and long term disability plans are governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, *et seq.* (“ERISA”). The plans were funded by a contract of insurance issued by United of Omaha Life Insurance Company (“defendant”). The insurer was responsible for administering claims for disability plan benefits. The plaintiff applied for long term disability benefits (“LTD”) under the plan, and his LTD claim was denied after the insurer found that he could perform the material duties of his regular occupation. He then filed suit under Section 502(a) of ERISA, 29 U.S.C. § 1132(a), seeking to recover the benefits owed to him. The U.S. Court of Appeals for the Eleventh Circuit has set forth a multi-factor test for assessing whether a claim for benefits arising under ERISA Section 502(a) should be reversed. That test is as follows: > (1) Apply the *de novo* standard to determine whether the claim administrator’s benefits-denial decision is “wrong” (*i.e.*, the court disagrees with the administrator’s decision); if it is not, then end the inquiry and affirm the decision. > > (2) If the administrator’s decision in fact is “*de novo* wrong,” then determine whether he was vested with discretion in reviewing claims; if not, end judicial inquiry and reverse the decision. > > (3) If the administrator’s decision is “*de novo* wrong” and he was vested with discretion in reviewing claims, then determine whether “reasonable” grounds supported it (hence, review his decision under the more deferential arbitrary and capricious standard). > > (4) If no reasonable grounds exist, then end the inquiry and reverse the administrator’s decision; \[*on the other hand*,\] if reasonable grounds do exist, then determine if \[*the administrator*\] operated under a conflict of interest. > > (5) If there is no conflict, then end the inquiry and affirm the decision. > > (6) If there is a conflict, the conflict should merely be a factor for the court to take into account when determining whether an administrator’s decision was arbitrary and capricious. *Blankenship v. Metropolitan Life Insurance Co.*, 644 F.3d 1350, 1355 (11th Cir. 2011). In applying the test, the *Wiley* court found that United of Omaha had erred in denying the plaintiff’s claim for benefits. First, the Court held that United of Omaha’s decision was *de novo* wrong. The court found that the plaintiff suffered from a variety of physical impairments that prevented him from performing most of the material duties of his regular occupation as a Senior Business Systems Analyst. It also found that he lacked the ability to maintain the concentration required to perform repetitive analytical tasks on a sustained basis, which were essential functions of his position. Because the Court next determined that the insurer had discretionary authority to construe the terms of the LTD plan, it moved on to the other factors to assess whether the insurer acted arbitrarily and capriciously in denying the plaintiff’s claim. The court unequivocally found that “reasonable grounds” to support United of Omaha’s decision to deny the plaintiff’s claim did not exist. The insurer classified the plaintiff’s regular occupation as “Sedentary,” which requires “sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.” Although the insurer’s medical consultant found that plaintiff could sit up and stand/walk each for up to six hours in an eight-hour work day, the Court found that the evidence in the record showed otherwise. One of the plaintiff’s treating physicians, a neurologist, restricted the plaintiff to sitting for not more than four hours during an eight-hour workday, which is insufficient to perform sedentary work. The same doctor also limited the plaintiff to standing for not more than one to two hours, and walking for one to two hours during the remaining four hours of a normal workday. The physician also directed him to alternate between sitting, standing, and walking every ten to fifteen minutes. Thus, the Court held that “\[t\]here is no evidence in the administrative record indicating that plaintiff could perform the material duties of his regular occupation with such frequent changes in position …” Likewise, the restrictions placed by the plaintiff’s primary care physician, were even more restrictive than those of the Plaintiff’s neurologist. The primary care physician limited him to a total of only three hours of sedentary work during any given workday: specifically, one hour of sitting; one hour of standing; and one hour of walking. He also concluded that plaintiff was not able to engage in repetitive work at a constant pace. Lastly, although neither of plaintiff’s treating physicians responded to the insurer’s written correspondence to them in which the insurer asked each doctor to agree with insurers assessment of the plaintiff’s functional abilities, the court found their silence to be afforded little weight in evaluating the reasonableness of defendant’s decisions. The treating doctors’ failure to respond to a follow-up request for additional information was not a valid reason to disregard medical diagnoses “that have been well documented by extensive records of physical examinations, supporting tests, and actual treatments conducted over a period of years. Ignoring the breadth and depth of such objective evidence allows insurance companies to subvert meritorious claims by simply increasing the paperwork burden on a claimant’s physicians.” The insurer’s decision was overturned accordingly. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Long Term Disability **Tags:** 1132(a), 29 U.S.C. 1132(a), 502(a), benefits claims, disability, disability attorney, Disability Benefits, ERISA, ERISA lawyer, ERISA Section 502(a), full and fair review, long term disability, long term disability attorney, LTD --- ### [Settlement Reached: Circuit Split Remains in ERISA Breach of Fiduciary Duty Claims](https://www.garnerltd.com/settlement-reached-circuit-split-remains-in-erisa-breach-of-fiduciary-duty-claims/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** On September 20th, 2018, the Supreme Court of the United States dismissed, at the parties’ joint request, an [ERISA](https://www.dol.gov/general/topic/retirement/erisa) lawsuit ([*Pioneer Centres Hold. v. Alerus Fin.*](http://www.scotusblog.com/case-files/cases/pioneer-centres-holding-company-stock-ownership-plan-trustees-v-alerus-financial-n/)) that could have potentially resolved an existing circuit split over who bears the burden of proof in ERISA breach of fiduciary duty claims. The case was dismissed because the underlying dispute was settled by the parties. For now, this circuit split will remain in place. In this article, our [Philadelphia ERISA litigation lawyer](https://www.garnerltd.com/practice-areas/erisa-litigation/) provides a brief overview of where different circuit courts currently stand in regards to the burden of proof in breach of fiduciary duty actions brought under the Employee Retirement Income Security Act. ![image and illustration showing ERISA breach of fiduciary claims](https://www.garnerltd.com/wp-content/uploads/2023/01/Fotolia_189030785_Subscription_Monthly_M-1024x792.jpg "Justice holding in han judege. Concept buisness vector illustration. - The Garner Firm") ### Some Circuit Courts Put the Burden Squarely on the Beneficiaries In several circuit courts — the Sixth, Ninth, Tenth, and Eleventh — judges have held that beneficiaries and not fiduciaries bear the burden of proving causation when they bring an ERISA-based breach of fiduciary duty [lawsuit](https://www.garnerltd.com/practice-areas/erisa-litigation/). More specifically, it is on the plaintiff to prove that there is a causal link between the fiduciary’s alleged misconduct and the actual financial losses sustained by the beneficiaries of the ERISA plan. ### Some Circuit Courts Shift the Burden of Proof to the Fiduciaries In other circuit courts — Second, Fourth, Fifth, and Eighth — judges have ruled that the burden shifts to the fiduciary as soon as the plaintiff (the beneficiary) is able to establish a prima facie case of breach of fiduciary duty. A prima facie case is one that relies on basic evidence that is sufficient to prove something and that can be accepted until it is refuted. With this legal standard, the hurdles that beneficiaries must clear in ERISA breach of fiduciary duty claims are far lower. ### Will This Circuit Split be Resolved? The circuit split may be resolved at some point in the future. Indeed, most significant circuit splits are eventually resolved: The Supreme Court often grants certiorari in cases that can help to resolve circuit splits and bring uniformity to federal courts across the country. However, until the nation’s highest court actually decides to do so, the circuit split on the ERISA breach of fiduciary question is likely to remain in place. ### Contact Our Philadelphia ERISA Attorney Today At [The Garner Firm](https://www.garnerltd.com/about-us/), we represent executives, workers, and other plan participants in all aspects of ERISA litigation. Our Philadelphia ERISA lawyers has extensive experience handling complex breach of fiduciary duty claims. To find out more about what we can do for you, please do not hesitate to contact our legal team at (215) 645-5955 to schedule a free, fully confidential consultation. **Categories:** (ERISA) Litigation, Employee Benefits **Tags:** ERISA, ERISA lawyer, Fiduciary Duty Claims, Fiduciary Duty Lawsuit --- ### [Unum Ordered to Pay Wrongfully Denied Long Term Disability Benefits to Fibromyalgia Patient](https://www.garnerltd.com/unum-ordered-to-pay-wrongfully-denied-long-term-disability-benefits-to-fibromyalgia-patient/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** On September 21, 2018, the United States District Court for the District of Massachusetts issued an opinion awarding long term disability (“LTD”) benefits to a fibromyalgia patient whose benefits were wrongly terminated by Unum Life Insurance Company and Provident Life and Accident Insurance Company, both of which are owned by Unum Group. A copy of the Court’s decision in *Kamerer v. Unum Life Ins. Co. of Am., et al.*, Case No. 15-cv-40146 (D. Mass. September 21, 2018), can be found [here](https://www.garnerltd.com/wp-content/uploads/2018/09/Kamerer-v-Unum-Opinion.pdf). The plaintiff in the case is represented by long-time friends and friends of the firm, [Talia Ravis](http://www.erisakc.com/) (who was also a law school classmate of mine) and [Jonathan Feigenbaum](https://www.erisaattorneys.com/). There’s a lot to unpack in the *Kamerer [decision](https://www.garnerltd.com/wp-content/uploads/2018/09/Kamerer-v-Unum-Opinion.pdf)*, so I think it is probably best to read it yourself rather than restating the entire case at length in this post. I will, however, provide a brief synopsis. The plaintiff in *Kamerer* worked as a consultant for Accenture. She became disabled in 2004 due to fibromyalgia and a number of related conditions that caused her constant pain. She also struggled with depression. She sought disability benefits under two different Unum LTD plans. One plan was an employer-sponsored LTD plan governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, *et seq.* (“ERISA”). The other plan was an individual disability insurance policy (“IDI”). Both plans contained a two-year limitation for disability benefits caused or contributed to by so-called “mental nervous” disorders. Both LTD policies also required the plaintiff to be disabled from her “regular occupation” in order to receive benefits. Unum approved the plaintiff’s claim and paid benefits without interruption under both policies from 2004 to 2013. Unum did not assert the mental nervous limitation while her benefits were payable due to her fibromyalgia and related conditions. In 2013, Unum decided she could return to her regular occupation. Her treating physicians disagreed. The plaintiff underwent a Unum-ordered “independent” medical exam (“IME”) that the Plaintiff contended in a sworn affidavit lasted approximately five minutes. Her benefits were terminated in September 2014. The plaintiff appealed internally with significant support from her treating health care providers that she was disabled, but Unum nonetheless denied her appeals. The Plaintiff filed suit pursuant to Section 502(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B), and state law in federal court. The Court reviewed Unum’s decision *de novo*. It noted that although Supreme Court precedent has held that the opinions of treating medical providers are not generally entitled special deference as a matter of law, when the participant’s credibility regarding subjective complaints of pain are at issue in the case, it makes sense to give more weight to the opinions of treating physicians who have personally assessed the participant over an insurer’s record reviewing consultants. Moreover, the fact that the plaintiff had undergone extensive treatment for her condition and took numerous strong medications to treat her pain was strong evidence of her continued disability. The Court disagreed with Unum’s assessment that there was no “objective evidence” of her continued disability because her physicians had repeatedly tested her for fibromyalgia via a trigger point test. Lastly, the Court rejected Unum’s attempt to assert the LTD plans’ respective mental nervous limitations after having failed to do so for years. The Court noted that her physical limitations were the cause of her disability and that Unum had failed to factually prove otherwise. This brief post does not really do the *Kamerer* plaintiff justice. This decision is a great win for the plaintiff and others receiving LTD benefits due to fibromyalgia. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Long Term Disability **Tags:** de novo, Disability Benefits, ERISA, ERISA lawyer, ERISA Section 502(a), fibromyalgia, long term disability, LTD, unum --- ### [My Health Insurer Denied My Claim; Now What?](https://www.garnerltd.com/my-health-insurer-denied-my-claim-now-what/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Health insurance provides critical benefits when you become sick or injured. However, some insurers deny perfectly valid claims, which might leave you in shock. After all, you have insurance precisely for emergencies, but here your insurer is denying your claim. Fortunately, you have rights, and it is sometimes possible to get an insurer to reverse course and approve a claim. Persistence will be key, and you should remember to follow the steps below. ## Read Your Denial Letter Your insurer should tell you why your [claim was denied](https://www.garnerltd.com/practice-areas/erisa-litigation/). Sometimes you will receive a detailed denial letter, but more often than not you will only receive an explanation of benefits (“EOB”), which may be difficult to understand. You should also get out a copy of your policy. It might be posted online. If it is not, and if your health benefits are governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), your plan administrator is required to provide you with a copy of your plan documents within 30 days of a written request for them. (Consulting with an experienced health insurance attorney will help you understand your insurer’s decision and your legal rights.) Make sure that the insurer is accurately summarizing the policy language. You would be surprised at how many insurers ignore their own policies when denying a claim. Sometimes, denials are made in error and pointing out the correct policy language can help get your claim approved. ## Check for How to Appeal Your policy should also contain clear instructions for how to bring an appeal. Also check your denial letter, which should also contain this information. Note any deadlines and forms that you need to complete. If you have a question, contact your insurer immediately and ask. You should seriously consider retaining an attorney to assist you with your health appeal if the amount of money at issue is significant to you. An experienced health insurance attorney will be able to help you interpret your legal rights. If your health benefits are provided through your employer or your spouse’s employer, they are likely governed by ERISA, which adds additional complications to the process. An experienced ERISA attorney may be needed. ## Gather Medical Records Your insurer might not really understand the severity of your injury. Often,[ claims are denied](http://guides.wsj.com/health/health-costs/how-to-appeal-a-health-insurance-denial/) because your condition is not well documented, or your provider has not submitted the necessary pre-approval paperwork to the insurer. Collect test results, x-rays, and doctor’s records. You might need to submit them as part of your appeal. You should also write down the names and contact information of all doctors who have treated you. Your insurer might need to talk with them, and collecting all of this information ahead of time can help you. ## Keep Detailed Records of Correspondence Hold onto copies of all letters. If you speak to someone on the phone, then you should also write down the following: - The date and time of the phone conversation - The name of the person you spoke to - A summary of the conversation - The date your insurer will make a decision and/or get back to you ## Stay on Top of Deadlines The appeals process is quite complicated. There are often multiple rounds of appeals, but each appeal has its own deadline, which you must meet. Always find out how much time you have and get your appeal in well before the deadline. ## Consider Hiring a Philadelphia ERISA Lawyer Depending on the circumstances, you might be able to[ bring a lawsuit](https://www.garnerltd.com/practice-areas/erisa-litigation/) against your insurer in federal court. Whether or not you should sue is a difficult decision, which depends on many factors. At [the Garner Firm](https://www.garnerltd.com/), we represent members of employer group health plans in disputes. To find out more and determine if we can help, please [contact us](https://www.garnerltd.com/contact/) by calling 215-645-5955. We offer a free, initial consultation. **Categories:** (ERISA) Litigation, Employee Benefits, Health Insurance **Tags:** denied claim attorney, denied claim lawyer, health benefits, health insurance, insurance claim --- ### [Disability Claims for Lasting Mental Health Issues Stemming from COVID-19](https://www.garnerltd.com/disability-claims-for-lasting-mental-health-issues-stemming-from-covid-19/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** When many people think of the [long-term health effects](https://www.garnerltd.com/practice-areas/long-term-care-claims/) of the COVID-19 pandemic, they might first think of respiratory damage and other physical scarring. However, many people might come away from this crisis with significant mental scarring, as well. This is especially true for many healthcare providers and frontline medical workers. Imagine working as a nurse in an intensive care unit of a busy hospital in Philadelphia. With hundreds of people being confirmed with positive COVID-19 tests daily since March, the number of people being admitted to the hospital regularly increased, many of whom are ICU patients. The hospital is short-staffed, so you are working long hours caring for people while knowing there is no proven treatment or cure. You watch many patients pass away as you feel helpless. You also see many coworkers get sick – and possibly die – as you fear each day of getting fatally sick yourself, possibly due to a shortage of personal protective equipment (PPE). The above is a realistic description of what many people in major cities are facing as they go to work each day. While there is little time to attend to your mental health during this crisis and the extreme pressure you face, you might be one of the many healthcare workers who comes away from the pandemic with PTSD, chronic depression, and other debilitating mental health conditions. In addition to frontline workers, health experts expect many others to suffer mental health issues as a result of the coronavirus pandemic, including: - Business owners - People who lost their jobs - People quarantined alone - People who suffered the tragic loss of loved ones For many people, simply reporting to work will be too much to handle due to serious and lasting mental trauma. ## Disability Claims for Mental Illness Many short and long-term disability policies cover certain types of mental illness. However, making a partial or total disability claim for mental conditions can be an uphill battle – while you are already dealing with plenty of stress and struggle. Insurance companies also might soon be receiving a mountain of disability claims for a variety of reasons, which can result in the wrongful denial of many claims. If you believe you might be eligible for [disability benefits](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) due to a mental illness, you must ensure that you file a timely claim that includes all of the necessary information and supporting documentation. An experienced Philadelphia disability attorney can advise you on what you need, including: - Medical records - Proper visits to your psychologist or psychiatrist - Medication logs - A summary of your symptoms, which can include fatigue, loss of sleep, inability to focus, irrational fears, trigger events, suicidal thoughts, and more. ## Contact a Philadelphia Disability Attorney for Help Today If you believe you need to file a disability claim due to mental illness, or you need to appeal a denied disability claim, you should not wait to seek the right legal assistance from a Philadelphia disability claims lawyer. The Garner Firm is ready to help, so please [contact us](https://www.garnerltd.com/contact/) today. **Categories:** Disability Benefits, Health Insurance **Tags:** disability benefits attorney, disability claim, health insurance, mental disability --- ### [Possible Reasons for Life Insurance Claim Denials](https://www.garnerltd.com/possible-reasons-for-life-insurance-claim-denials/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** You might assume that if a loved one had life insurance coverage; the company should pay benefits to the proper beneficiaries following their death. Unfortunately, life insurance providers will not automatically approve claims, and they can – and do – deny claims for various reasons. If you received a denial, it is important to determine the exact reason why, and you should speak with an experienced[ Philadelphia life insurance appeals attorney](https://www.garnerltd.com/attorney-profile/). The following are only some reasons why a life insurance claim might be denied. ### Cause of Death Life insurance adjusters will look into the cause of death of the policyholder, as policies have exclusions for certain causes of death. Generally, you can learn about such exclusions in the policy, though policy language can be confusing, and it is not always black or white whether a death should be covered. For example, some [life insurance policies](https://www.garnerltd.com/practice-areas/life-insurance/) do not cover death by suicide, so a claim will be denied if the company determines the policyholder committed suicide, if such an exclusion applies. ### Omissions or Misrepresentations People are expected to be honest and forthcoming on life insurance applications. If the policyholder omitted pertinent information or provided inaccurate information on their application, the claim can be denied, even if they paid their premiums and the policy was active. Examples might be lying about alcohol abuse and then dying of liver failure or concealing a diagnosis of a life-threatening medical condition. Life insurance companies will most regularly investigate the information provided if the policyholder died within two years after obtaining the coverage, which is often referred to as the contestability period. ### The Policy Lapsed The life insurance company only agrees to pay death benefits in exchange for agreed-upon premiums from the policyholder. If the policyholder did not maintain payments as agreed, the policy can lapse, and the insurer will likely cancel the policy and refuse to pay out to beneficiaries. ### There was a Wrong Beneficiary or No Specified Beneficiary Part of obtaining life insurance coverage is naming a beneficiary who will file the claim and receive the death benefits. If you file a claim yet are not the named beneficiary, your claim will be denied. If there is no beneficiary designated at all, the death benefits should go to the estate instead of an individual. This would mean the funds would be tied up until the estate goes through probate, which can take time. After a life insurance claim denial, you should have an attorney review the decision and determine the reasoning behind the denial and whether you can appeal. Insurers make mistakes and wrongful decisions, and it is often possible for the right legal professional to fight for the death benefits you deserve. ### Discuss Your Denial with a Philadelphia Life Insurance Attorney Today [The Garner Firm](https://www.garnerltd.com/attorney-profiles/) assists clients with life insurance denials and appeals, and we can evaluate your options if your claim was denied.[ Contact us](https://www.garnerltd.com/contact/) to discuss the next steps in obtaining the death benefits you need and deserve. **Categories:** Life Insurance **Tags:** denied claim, denied insurance claim, life insurance benefits, Life insurance claim, life insurance lawyer --- ### [Disability Claims and Social Media](https://www.garnerltd.com/disability-claims-and-social-media/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** When you file an ERISA insurance claim for short or [long-term disability benefits](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/), you should not expect the insurance company to quickly and willingly grant your claim and begin sending payments. Instead, the insurance company will take many steps to determine whether it can challenge your claim and deny benefits. Insurers use many different tactics, including surveillance of your activities. Traditionally, insurance companies would conduct surveillance when claimants were in public, trying to capture proof that they are not as limited as they state. However, in modern times, some of this surveillance has moved online. We use social media for a variety of reasons – to stay connected, share information and opinions, and show our friends and family snapshots of our lives. You might not think twice before posting a photo to your Facebook or Instagram page when, in reality, it can impact your disability claim. ![photo of social media icons as it related to use of social media if you have claimed long term disability](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_316358631geo-1024x663.jpg "photo of social media icons as it related to use of social media if you have claimed long term disability - The Garner Firm") ### Surveilling Your Social Media A significant percentage of insurance companies use social media surveillance to verify or challenge disability claims. They are looking for any information that might call the credibility of your claim and stated restrictions into question. When you file your claim, companies might even use[ archiving tools](https://web.archive.org/) to find past information you deleted. You cannot rest easy just because your Facebook page is set to private. Did a friend or family member tag you in a post or photo? Is their page private? You would be surprised how many ways insurers have to find information about you on various social media sites. ### How Posts Can Hurt Your Claim Something that you might never consider harmful or controversial might raise red flags to the insurance company. For example, consider the following situations: - Your doctor recommends that you keep up with strength training for your disabling condition, so you see a personal trainer once a week and “check in” online each time. You might suffer through every moment of your training in pain and have many limitations when working out, but the adjuster just sees that you are “able” to exercise, which they assume means you are able to work. - You attend a family wedding or birthday celebration, even though you might sit in one place in pain most of the time, and you might be exhausted for days afterward. For the group photo at the event, you mustered the energy to stand up and join the crowd, smiling and laughing for the photo. If the adjuster sees that photo, they have no context regarding your pain and struggles to attend – they only see that you are able to celebrate at a party. These are only two of endless ways that social media posts can impact your disability claim. It is best to remain off of these sites while your claim is pending. ### Contact a Philadelphia Disability Claims Attorney about Your Situation The Garner Firm helps clients with the ERISA disability claims process, and our [Philadelphia disability claims lawyers](https://www.garnerltd.com/attorney-profiles/) can advise you of the dos and don’ts when it comes to social media and other conduct. [Contact us](https://www.garnerltd.com/contact/) for more information. **Categories:** Disability Benefits **Tags:** disability benefits attorney, disability insurance claim, long term disability, short term disability --- ### [Defined Benefit Plans vs. Defined Contribution Plans: What's the Difference?](https://www.garnerltd.com/defined-benefit-plans-vs-defined-contribution-plans-whats-the-difference/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** The [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) governs two different types of employer-sponsored retirement plans, which are called defined benefit plans and defined contribution plans. Whichever plan you are a part of, it is important to understand your rights under ERISA and when these rights might have been violated. Never hesitate to discuss any [ERISA retirement plan concerns](https://www.garnerltd.com/practice-areas/retirement-plan-benefit-claims/) with a Philadelphia retirement benefit lawyer. ![photo of man and woman reviewing define benefit and defined contribution plans](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_119667913geo-1024x680.jpg "photo of man and woman reviewing define benefit and defined contribution plans - The Garner Firm") ### Defined Benefit Plans This type of retirement benefit plan is commonly referred to as a pension plan. This plan provides qualified employees with guaranteed benefits for life after they retire from their employment. Employees do not have to contribute part of their income to a fund to receive this benefit. Instead, proceeds from a defined benefit plan are either fixed from the start or determined by a formula based on years of service, salary, and other factors. Employees generally have no control over defined benefit plan funds until they are eligible to start receiving benefits. The employer is responsible for investing and distributing these funds to retired employees, so the employer takes the risk that investments might not cover the benefits owed to a retired employee. Due to the risk of an employer regarding defined benefit plans, these funds must be managed according to technical actuarial projections. In addition, the funds are often covered by federal insurance through the[ Pension Benefit Guaranty Corporation (PBGC)](https://www.pbgc.gov/). The requirements to protect and administer defined benefit plans can be costly, so this type of plan has become significantly more rare in recent times in the private sector as companies are choosing to shift solely to defined contribution plans. ### Defined Contribution Plans These are retirement plans that are primarily funded by employees themselves, though some employers offer matching contributions up to set limits. Employees can choose whether or not they want to contribute, as well as how much (up to a maximum annual amount). Examples of defined contribution plans include: - 401(k) plans; - 403(b) plans; - Profit-sharing plans; and - Employee stock ownership plans. The employer makes no promises regarding the available benefits upon retirement, as the employee will receive the amount in their plan based on their contributions, matched contributions, and investment gains or losses. Although Employers are required to act prudently in administering the plans and identifying investment options for participants, they are not obligated to guarantee the performance of specific accounts, so these plans require fewer resources for companies, making them much more popular. Employees are instead responsible for determining how they want to invest their funds, and options generally include mutual funds, money market funds, individual stocks, and annuities. ### Contact a Philadelphia Retirement Benefit Attorney for Assistance Employers must administer retirement benefit plans in accordance with ERISA requirements. It is important to know your rights as an employee under the law, and if you think your employer is in violation of ERISA, discuss the matter with a [retirement benefit plan lawyer](https://www.garnerltd.com/attorney-profiles/) at The Garner Firm, Ltd. [Contact us](https://www.garnerltd.com/contact/) to schedule an appointment to discuss your concerns today. **Categories:** (ERISA) Litigation, Employee Benefits **Tags:** retirement benefit plan, retirement benefits attorney, retirement plan benefits --- ### [What Is an ERISA Claim?](https://www.garnerltd.com/what-is-an-erisa-claim/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** Even among attorneys, [ERISA](https://www.dol.gov/general/topic/retirement/erisa) is often misunderstood. There are few who can claim to really understand this complex and very-detailed law. As an employee, what you need to know is that this statute gives you the right to sue an employer. Simply stated, [ERISA](https://www.garnerltd.com/practice-areas/erisa-litigation/) exists to protect all of your employee benefits. However, the process that you need to follow when your benefits are denied is somewhat different from the traditional denial of an insurance claim. In some ways, the ERISA process is more direct, but it is also more complex, and you want the guidance of a [Pennsylvania ERISA attorney](https://www.garnerltd.com/attorney-profiles/). ![photo of dollar bills relating to ERISA claims](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_431097082geo-scaled-1-1024x768.jpg "photo of dollar bills relating to ERISA claims - The Garner Firm") ### Other Insurance Denials Mean an Immediate Lawsuit When a regular insurance claim is denied, you will proceed directly to a lawsuit against the company. In this court action, you would have a pretty robust discovery process that would shine the spotlight on the insurance company. You can even question their witnesses. Essentially, you are taking on the insurance company in front of the judge. You have the full right to call as many witnesses as you need. ### ERISA Requires an Administrative Appeal The ERISA claims process introduces another step into the process. When your ERISA claim is denied, you need to file an appeal with the insurance company first. Here, you are trying to persuade the insurance company that they made a mistake in denying your claim. You must put on your full case because that will be the record that a judge will use to make a decision later on if you need to file suit. Anything that is not on the record as part of your appeal to the insurance company will not be considered by a judge when they review the decision. It is only after the administrative appeal that you can take the case to court. The time to get an attorney is when your claim is denied. You need legal representation during the appeal process to put on as strong a case as possible, even if there is not much of a chance of the insurance company reversing their decision. There is little denying that ERISA gives some built-in advantages to the insurance company, and they do not have the possible punishment of being sued for bad faith. This is why you need an attorney representing you in the process. The good news is that ERISA imposes a whole set of standards that insurance companies must follow in deciding your claim. The law plus an attorney who knows how to hold the insurance company’s feet to the fire could ensure that you have your say if your claim is denied. ERISA gives you a burden of proof to meet, but an attorney could help you put on the evidence that you need to ultimately get the payment to which you are legally entitled. ### Seek Legal Help from an ERISA Claims Attorney For help with your ERISA claim, contact a Philadelphia long-term disability insurance attorney at The Garner Firm today. Contact us [online](https://www.garnerltd.com/contact/) to schedule your free initial consultation. The sooner you get legal counsel for your ERISA claim, the stronger of a message you can send to the insurance company. **Categories:** Employee Benefits **Tags:** erisa attorney, erisa claim, ERISA lawyer --- ### [Common Conditions That Can Cause Long-Term Disability](https://www.garnerltd.com/common-conditions-that-can-cause-long-term-disability/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** There are a number of reasons why you may be unable to work for the long term. While accident-related injuries could qualify you for long-term disability, there are other conditions that would allow you to receive benefits. Here are five common causes for [long-term disability claims](https://www.garnerltd.com/practice-areas/long-term-care-claims/). ![photo of man considering a condition that caused long term disability](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_227295564-scaled-1-1024x708.jpeg "photo of man considering a condition that caused long term disability - The Garner Firm") ### Cancer You may be entitled to benefits, but not for all cases of cancer. It all depends on the severity of your case. If you are later stages of cancer, you are likely not able to work. You could also qualify if your treatments are so intensive that you are debilitated. More people are filing disability claims for cancer. While there are more cases of cancer, people are also living longer with more advanced cases, making disability benefits a necessity. ### Mental Illness Some don’t think of mental illness as a long-term disability, but those who suffer from it live with its effects every single day. One in five U.S. adults suffers from some type of mental illness. For some, it can be crippling. They are not even able to get out of the house each day, let alone hold down a job. Mental illness is actually one in every ten long-term disability claims. You may even be able to qualify for long-term disability when you are struggling with an addiction. ### Injuries These are the common things that people associate with long-term disability claims. You may be hurt in an accident and suffer injuries severe enough to leave you unable to work. Accident injuries could include: - Fractures - Soft tissue injuries - [Traumatic brain injuries](https://www.cdc.gov/traumaticbraininjury/index.html) ### Cardiovascular Events Heart disease can affect your ability to work. Your doctor may have ordered you to stop working to protect your heart from further damage. Alternatively, you could have suffered a heart attack that prevents you from working. In severe cases, patients suffer a stroke that leaves them partially or completely paralyzed. While some people are able to return to work after some rest and rehabilitation, others find themselves permanently incapacitated. Cardiovascular conditions comprise roughly 10% of disability claims. ### Musculoskeletal Conditions This is perhaps the most common reason for disability claims. This group of disabilities includes: - Arthritis - Neck and back pain and injuries - Disc problems - Tendonitis These are debilitating conditions, and when they get bad enough, people will have problems working. In many cases, these problems are degenerative and cannot even be managed with treatment. When you suffer from any of the above conditions, your long-term disability claim will have to show how and why you are affected enough that you cannot work. The insurance company will start off skeptical of any claim. This is why your package must include detailed medical records and a convincing description of your issue. ### Contact a Philadelphia Long-Term Disability Attorney Your claim may be better off if you get legal help early. At a minimum, you need an attorney if your initial claim was denied. [Contact ](https://www.garnerltd.com/contact/)an attorney at [The Garner Law Firm, Ltd.](https://www.garnerltd.com/attorney-profiles/) to find out how we can help you when you are seeking long-term disability benefits. **Categories:** Disability Benefits, Long Term Disability **Tags:** Arthritis, Cardiovascular Issues, long term disability --- ### [Dealing with a Prudential Denied Disability Claim](https://www.garnerltd.com/dealing-with-a-prudential-denied-disability-claim/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** Millions of workers depend on long-term disability insurance provided through their employer to protect them if an injury, illness, or chronic health condition leaves them unable to work. So, when you need to access these benefits, it can come as quite a shock to have your disability claim denied by a company like Prudential. At [The Garner Firm](https://www.garnerltd.com/attorney-profiles/), we provide skilled legal representation in appealing denied disability claims, and we’ve successfully taken on cases involving Prudential. We have a deep understanding of the actions needed to get [LTD claims](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) approved, and we put our experience to work for you, helping you receive the benefits you deserve. ![photo of woman considering denied disability claim](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_407200110geo-scaled-1-1024x683.jpeg "AdobeStock_407200110geo-scaled - The Garner Firm") ### Who is Prudential? Formed in New Jersey in 1875, Prudential Insurance Company of America (Prudential) has since grown into the nation’s largest insurance company. They provide [group long-term disability benefits](http://groupinsurance.prudential.com/media/managed/LTDFlyer.pdf) for more than 3,100 clients, which translates into more than 2.1 million employees. While many policyholders have positive experiences with Prudential, the company has been the subject of controversy more than once. Its practices have led to several high-profile lawsuits, including one in 1997 that required them to pay policyholders over [$400 million in restitution](https://www.latimes.com/archives/la-xpm-1997-03-11-fi-36951-story.html) for deceptive sales practices. ### Reasons for a Prudential Disability Claim Denial As with any insurer, Prudential is a for-profit business and one of the ways the company protects its bottom line is by reducing payouts on claims. Disability claim denials can happen for a variety of reasons. Among the most common are: - Disputes over the terms of your policy and whether you are currently covered. - Disputes over your condition and whether it falls under policy exclusions. - Disputes over the severity of your condition and whether it qualifies as a long-term disability. - Disputes regarding whether you submitted the appropriate forms or provided enough supporting evidence. Prudential has been known to wrongfully deny disability benefits on many occasions, including [terminating benefits](https://law.justia.com/cases/federal/district-courts/colorado/codce/1:2016cv02142/165281/57/) for a policyholder who was deemed disabled by 16 different medical professionals. But luckily, there is help available for those who need to file an appeal. ### Appealing a Prudential Disability Claims Denial The [Employee Retirement Income Security Act of 1974 (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) is a complex federal law that provides guidelines for administering most employer-provided benefits, as well as for the appeals process. When a Prudential disability claim is denied, our Philadelphia long term disability attorney can guide you in how ERISA is likely to apply in your case while taking the following actions on your behalf: - Reviewing your LTD policy and the terms of coverage. - Reviewing all documents currently submitted to the insurer. - Reviewing the reasons for your LTD benefit denial and gathering evidence in support of your claim. - Appearing at appeals hearings and making strong legal arguments on your behalf to get your claim approved. ### Request a Consultation with Our Experienced LTD Claims Denial Attorney Today Receiving notice of a denied Prudential disability claim can be devastating. When a long-term disability happens, you will likely be counting on benefits provided by your employer to help you support yourself and your family. The Garner Firm understands how critical these benefits can be for working families, and we provide our clients the professional legal help needed to file an appeal. To [request a consultation](https://www.garnerltd.com/contact/), call or contact our LTD claims denial attorney online today. **Categories:** Disability Benefits, Health Insurance, Long Term Disability **Tags:** long term disability attorney, long term disability claim, LTD benefits lawyer --- ### [Cigna Disability Claims Denial](https://www.garnerltd.com/cigna-disability-claims-denial/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** Long-term disability insurance provided by your employer protects you if you are unable to work due to a serious health condition, illness, or injury. Cigna is one of the leading providers of these policies, but its practices have resulted in wrongfully denied claims, leaving some policyholders angry and confused when their benefits are denied. If you have received a Cigna disability claims denial, you are not alone. At The Garner Firm, ou[r experienced long-term disability attorney](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) can guide you through the complex process of filing an appeal. ### Who is Cigna? ![illustration relating to disability insurance claims](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_225279823geo-scaled-1-1024x655.jpeg "illustration relating to disability insurance claims - The Garner Firm") Cigna is a familiar name in the insurance industry, offering a variety of benefits through its numerous subsidiaries, including Insurance Company of North America, or INA. But that familiarity may result in a false sense of confidence. The fact is disgruntled consumers file more than 200 complaints against Cigna each year through the [Better Business Bureau (BBB),](https://www.bbb.org/us/pa/philadelphia/profile/insurance-companies/cigna-0241-80000928) earning it a dismal one-star rating. Denied claims are one of the most common issues listed. These bad experiences are often not isolated incidents, and can even be indicators of system-wide problems. In 2013, Cigna agreed to pay $77 million to settle allegations that its subsidiaries had [improperly handled long-term disability claims](https://www.hartfordbusiness.com/article/cigna-out-77m-in-disability-claims-dispute) in four states, including Pennsylvania, over a period of several years. ### Dealing with a Cigna Disability Claims Denial When you are unable to work due to an injury, illness, or chronic health condition, employer-provided long-term disability benefits can offset income losses. Receiving a Cigna disability claim denial can threaten the financial security of both you and your family. At[ The Garner Firm](https://www.garnerltd.com/attorney-profiles/), we take the steps needed to ensure your rights to these benefits are protected. In denied Cigna disability claims, these actions may include: - Reviewing the terms of your policy to confirm you meet eligibility requirements. - Reviewing policy exclusions, which often result in denied claims. - Reviewing information you sent to Cigna. - Reviewing correspondence you received from the company and the reasons they gave for denying your benefits. ### Appealing a Cigna Disability Claims Denial In dealing with a Cigna disability claims denial, there are complex federal laws that apply. The [Employee Retirement Income Security Act of 1974 (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) provides strict guidelines in how employer-provided insurance benefits are administered and governs the appeals process. It is important to realize you have a limited time to file an appeal and dispute Cigna’s claims. At The Garner Firm, we act as a strong legal advocate on your behalf in this situation. Our Philadelphia LTD appeals attorney can take the following actions for you: - Appealing your Cigna disability claims denial. - Gathering evidence in support of your claim. - Arguing your case in administrative court hearings. - Pointing out places where Cigna failed to comply with ERISA. - Filing a lawsuit against the company in the event your appeal continues to be denied. ### Speak With a Skilled LTD Appeals Attorney Today To get the professional legal representation you need in appealing a Cigna disability claims denial, reach out to the Garner Firm. You can count on our extensive knowledge and experience in ERISA and how it applies to help you get the best possible outcome in your case. To request a consultation, call or [contact our LTD appeals attorney](https://www.garnerltd.com/contact/) online today. **Categories:** Disability Benefits, Health Insurance, Long Term Disability **Tags:** cigna insurance, denied disability, disability claim, long term disability attorney --- ### [How Long Do You Have to Be Out of Work to Apply for Disability Benefits?](https://www.garnerltd.com/how-long-do-you-have-to-be-out-of-work-to-apply-for-disability-benefits/) **Published:** January 2, 2023 **Author:** The Garner Firm **Excerpt:** The process of applying for benefits under an employer governed group disability insurance plan might be more complicated than you would imagine. **Content:** Suppose you sustain a disabling illness or injury that keeps you from performing your occupational duties. In that case, you might rest easier with the knowledge that you have [employer-sponsored disability insurance coverage](https://www.garnerltd.com/practice-areas/erisa-litigation/). What you might not be aware of is that the process of applying for and receiving benefits under an employer governed group disability insurance plan might be substantially more complicated than you would imagine. Many individuals aren’t familiar with this type of insurance process. As such, they don’t grasp how many questionable tactics insurance companies use against policyholders to withhold payments unfairly. These insurance companies attempt to decrease or avoid payments on claims whenever possible, resulting in many disabled claimants experiencing unnecessary delays or denials. Often, this is devastating, considering that you’ve already lost your ability to earn a wage because of your disability. The good news is that you could get the payments you need by turning to an experienced Philadelphia disability benefits lawyer for help. ![photo of wheelchair relating to disability benefits and being out of work](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_228279631geo-scaled-1-1024x683.jpeg "disability benefits and being out of work - The Garner Firm") ### What is ERISA? The [Employee Retirement Income Security Act of 1974 (ERISA) ](https://www.dol.gov/general/topic/retirement/erisa#:~:text=The%20Employee%20Retirement%20Income%20Security,for%20individuals%20in%20these%20plans.)safeguards your disability benefits. It also sets rules for those who administer your plan. Some of which include the: - Requirements for processing benefit claims - The timeline for a decision on your claim - Your rights if your claim is denied ### Applying for Short-Term Disability Short-term disability coverage is more common than long-term disability. Although, many employers do provide both for their workers. Short-term disability provides benefits for employees who are temporarily ill or become injured. Short-term disability coverage usually provides up to three to six months of payments. However, there might also be a waiting period before your benefits begin. Before you apply for short-term disability, study your plan policies to ensure your illness or injury is covered. Some policies exclude specific causes of short-term disability from coverage, such as recovery from cosmetic surgery or any self-inflicted injuries. ### When Can You Apply for Disability Benefits? You can apply for disability benefits as soon as you believe you might qualify for them. You don’t have to wait to apply, although it’s a good idea to hire a skilled [Philadelphia disability benefits attorney](https://www.garnerltd.com/attorney-profiles/) who can help you ensure your application is complete. Under ERISA, disability claims must be decided within a reasonable period of time. For most cases, if you submit a disability claim, the insurance company must make a decision within 45 days of receiving it. However, some circumstances could extend the timeline. Applicants who are denied should file an appeal within 180 days of the denial. Appeals can be complex and require extensive medical evidence to substantiate your benefits request. As such, you should have a Philadelphia disability benefits lawyer assist you in this process. ### Call a Knowledgeable Philadelphia Disability Benefits Lawyer If you’re searching for a knowledgeable Philadelphia disability benefits attorney or simply have questions about how and when to get the claims process started for your illness or injury, look no further than The Garner Firm, Ltd. [Contact](https://www.garnerltd.com/contact/) us today to schedule your complimentary disability claim consultation. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits **Tags:** Disability Benefits, disability benefits attorney, ERISA, short term disability --- ### [Factors That Can Influence Your LTD Payment](https://www.garnerltd.com/factors-that-can-influence-your-ltd-payment/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** Many employers offer [long-term disability (LTD) insurance policies](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) intended to protect an employee’s financial interests in the event they cannot work due to a lasting mental or physical disability. But how much can you expect for your LTD payments if you become disabled? It is important to be familiar with your right to benefits so you can make sure you receive the full amount you deserve if you can no longer work. Many factors can impact this payment amount, as follows. ### Your Policy Terms Each LTD policy should set out the terms for expected payments. Some policies will pay a fixed amount each month regardless of how much you earned prior to your disability. However, most plans will base your payments on the salary you were earning, such as providing a percentage of your prior monthly earnings. Some policies might provide as much as 80 percent of your monthly salary, while others might only pay out 50 percent of your monthly earnings. Always check the terms of your policy, so you know what to expect as your payment amount. ### Cost of Living Adjustments (COLA) Some LTD policies will regularly adjust benefits based on the changing cost of living. Changes for COLA often happen annually and use the [Consumer Price Index](https://www.bls.gov/cpi/) to adjust payment amounts for inflation and other factors, which might amount to one to three percent per year. ### Other Benefits You Might Receive You can be sure that your LTD insurance company does not want to pay full benefits if you are also receiving disability benefits from other sources. Most policies require you to apply for Social Security Disability benefits, and the insurer might even assist in ensuring that your application is successful. If you qualify for SSDI benefits, your private LTD benefits will often be reduced according to the amount of your SSDI benefits. Your LTD insurer might also seek recovery for back benefits provided by SSDI. LTD payments might also be reduced if you are receiving benefits from[ retirement plans](https://www.garnerltd.com/practice-areas/retirement-plan-benefit-claims/), workers’ compensation insurance, injury lawsuit settlements or awards, or other sources. ### Partial Benefits Some people might still be able to work with their disability, though they need to switch to a job that pays substantially less than your previous employment. In this situation, your LTD insurer might provide partial benefits, which are reduced by the amount you are currently able to earn. People who can only earn a small portion of their previous income might still qualify for their full LTD payments. ### Learn How a Philadelphia Long-Term Disability Attorney Can Help You At The Garner Firm, Ltd., we work to ensure that employees in the Philadelphia area receive the full LTD benefits to which they are entitled under ERISA. If you have concerns about your benefits or payment amount, please [contact us](https://www.garnerltd.com/contact/) to discuss the matter with a long-term disability lawyer. **Categories:** Disability Benefits, Long Term Disability **Tags:** disability benefits attorney, long term disability attorney, LTD benefits, LTD benefits lawyer --- ### [What to Do If Your Retirement Benefits Were Denied](https://www.garnerltd.com/what-to-do-if-your-retirement-benefits-were-denied/) **Published:** January 2, 2023 **Author:** The Garner Firm **Excerpt:** An experienced ERISA attorney can help you fight a denial to get the retirement benefits you are owed. The sooner you get legal advice, the sooner you can get your retirement plans back on track. **Content:** A denial letter for any benefits can be frustrating, but especially when you are being denied the retirement benefits you worked years to earn. Do not panic. An [experienced ERISA attorney](https://www.garnerltd.com/attorney-profiles/) can help you fight a denial to get the retirement benefits you are owed. The sooner you get legal advice, the sooner you can get your retirement plans back on track, so don’t wait to schedule your free initial consultation. Follow these steps to protect your legal rights: ![photo of eyeglasses relating to denied retirement benefits](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_80246787geo-scaled-1-1024x683.jpeg "AdobeStock_80246787geo-scaled - The Garner Firm") ### Contact An Erisa Lawyer As Soon As Possible If you wait to get legal advice, you could miss important deadlines. You only have a limited time in which to appeal denials of benefits. Waiting to appeal can also make it more difficult to get back pay for benefits that were owed when the claim was initially denied. The sooner you have a lawyer fighting on your side, the better protected all your legal rights will be. ### Request a Copy of Your Benefits Policy One document that you will definitely need is a copy of your retirement plan policy. This policy is a legal contract that defines when benefits may properly be denied. In order to fight a denial, your attorney will need to review the policy and assess the reasons given for denying your claim. The full policy is often available through your online account. If not, you can request a copy from the plan administrator. ### Gather All Documentation Related To Your Claim It is helpful to have all documentation related to your claim when you meet with an attorney. This includes a copy of your plan policies and the denial letter, but there could be many other documents related to the claim. Your retirement might involve medical issues that need to be documented. You might have other correspondence from the plan administrator or your employer. Anything that seems to be related to your retirement benefits or the claim denial should be brought to your attorney for their review. ### Don’t Panic! It is easy to feel overwhelmed when any benefits are denied, but you should not panic. You don’t have to ace the power of a large company on your own. An experienced lawyer will know the best plan for your unique case. ERISA lawyers know how to fight the unfair denial of benefits. Whether your denial was a violation of your contractual rights under the policy, [federal law under ERISA](https://www.dol.gov/general/topic/retirement/erisa#:~:text=The%20Employee%20Retirement%20Income%20Security,for%20individuals%20in%20these%20plans.), or a violation of state laws and local rules, your lawyer will be sure to protect your right to be paid for the benefits you are owed. ### The Right ERISA Lawyer For All Retirement Benefit Cases Attorney Adam Garner is a skilled benefits lawyer with over a decade of experience handling ERISA claims related to retirement benefits. Call The Garner Firm, Ltd. (215) 645-5955 or [visit our website](https://www.garnerltd.com/contact/) to schedule your free initial consultation. Don’t wait to get advice from an attorney who is on your side. Our office has helped many clients in Philadelphia and New Jersey get the benefits they are entitled to, and we will fight hard for you, too. ### Related Content [Frequently Asked Questions About ERISA and Long-Term Disability Claims](https://www.garnerltd.com/erisa-faqs/ "ERISA Frequently Asked Questions") **Categories:** Employee Benefits **Tags:** denied benefits, retirement benefits, retirement benefits attorney, retirement plan --- ### [Possible Reasons Your Disability Claim Was Denied](https://www.garnerltd.com/possible-reasons-your-disability-claim-was-denied/) **Published:** January 2, 2023 **Author:** The Garner Firm **Excerpt:** There are a number of reasons your claim may be denied. Explore below to learn about the most common reasons. **Content:** Many people who need disability benefits receive a claim denial from their disability insurance company. When this happens, you only have a short time to appeal the decision, and your appeal must comply with all requirements under the [Employee Retirement Income Security Act (ERISA)](https://www.garnerltd.com/practice-areas/erisa-litigation/) for employer-sponsored coverage. The first step of an appeal is to review the reasons for denial, and the following are some common reasons why your claim might be denied. To discuss your specific denial, reach out to an experienced [disability claim attorney](https://www.garnerltd.com/attorney-profiles/) directly. ![](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_295033416-scaled-1-1024x768.jpeg "AdobeStock_295033416-scaled - The Garner Firm") ### Not Filing on Time Many policies have timeframes following your disability to start the claim process. If you fail to notify your insurance company of a new disability by the deadline, the insurer might deny your claim. ### Not Responding to the Insurance Company’s Inquiries Some people might file a claim and assume they did what they needed to do. However, many insurance adjusters require additional information or documentation. Once you begin receiving benefits, the insurance company will need to verify your continued disability throughout the future, and you will need to provide continual information. If you fail to properly respond to these inquiries, the insurer can deny your claim or cut off your benefits. ### Pre-Existing Conditions and Other Policy Exclusions Your policy will have exclusions that set out when the insurer will not provide benefits. A common exclusion involves pre-existing conditions, and if the insurer thinks that you knew about your condition shortly before purchasing your policy, it can deny benefits. ### Insufficient Evidence The insurance company will require significant evidence of your medical condition and the fact that your condition is disabling and prevent you from working. If you fail to provide sufficient evidence to show you are eligible for benefits, you can have your claim denied. In addition, conditions with no objective medical evidence – such as fibromyalgia, chronic pain or fatigue, or some mental illnesses. Your insurance company might state a lack of objective evidence as a denial reason. ### Non-Compliance with Treatment or Medical Care When you have a disability, you should keep up with all medical treatment to improve your situation whenever possible. If your condition improves and you regain the ability to work, you should return to work. If the insurance company thinks you did not comply with doctor’s orders or return to work, it can deny your benefits. ### Credibility Problems You can bet the insurance company will investigate your credibility. The company might check social media or even surveil you to ensure you are not engaging in any activities that should be prohibited by your disability. Credibility questions can lead to a denial. ### Change of Definition If your policy starts as “own occupation” and then switches to “any occupation” after two years, you might lose your benefits. ### Speak with a Philadelphia Disability Lawyer Right Away The Garner Firm, Ltd. helps with disability claim appeals, and we craft specific strategies based on your denial reasons. Please [contact us](https://www.garnerltd.com/contact/) for more information and a consultation today. **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability **Tags:** disability benefits attorney, disability benefits claim appeal, disability claim denial, long term disability claim --- ### [Reasons a Disability Claim May Have Been Denied](https://www.garnerltd.com/reasons-a-disability-claim-may-have-been-denied/) **Published:** January 2, 2023 **Author:** The Garner Firm **Excerpt:** There are some standard reasons for disability claims denials. Working with an experienced and knowledgeable disability attorney can help your odds of a successful claim. **Content:** It is a well-known fact that disability claims through long-term disability insurance are often denied. Even when the entire appeals process is exhausted, you or your disabled loved one may be left without benefits. There are some fairly standard reasons for these denials, some of which you can avoid and some of which you can’t. In either case, working with an experienced and knowledgeable [disability attorney](/practice-areas/) will likely help your odds of a successful claim. Don’t go to battle with your insurance company alone if your disability claim has been denied. Some of the more common reasons for an insurance company denying your claim are discussed below. ![](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_279836108geo-scaled-1-1024x682.jpeg "AdobeStock_279836108geo-scaled - The Garner Firm") ### Lack of Medical Evidence Any application for disability insurance benefits must include strong medical evidence of the disability and the ways in which it prevents the claimant from working. You will need to provide evidence from your doctor and other medical professionals that, in fact, you cannot work any longer, and that you cannot do so because of your disabling illness or injury. Remember, [long-term disability benefits](/practice-areas/disability-benefits-lawyer/) are for only those who are disabled based on the terms of the insurance policy. ### Failure to Follow Treatment In order to demonstrate that your disability is preventing you from working and that you are cooperating with your medical professionals, it is critical to receive appropriate medical care and treatment for your condition. Failure to participate in your medical care program can be viewed as evidence that there is not sufficient medical proof of your disability. At the very least, the claim adjuster may state that it is not possible to decide based on the evidence you presented with your claim. ### Failure to Cooperate in Making Claim When you are making a claim with a private long-term disability insurance company, you must respond to the inevitable requests for additional information and documentation. Even though you may consider these requests burdensome or repetitive, or simply a pain in the neck, the insurance company may deny your claim if you fail to make as complete a response as possible. Handling these requests and putting together your claim file and its attachments is one of the areas where your experienced [long-term disability attorney ](/attorney-profiles/ "Attorney Profiles")can be most valuable for you. ### Failure to Appeal If the insurance company denies your initial claim, it is not appropriate to simply file another claim. Instead, you must file the complex and lengthy appeals process through its end, as dictated by [the law and case law](https://www.dol.gov/general/topic/retirement/erisa). The cumbersome appeals process is far better handled by your experienced disability attorney than by you. Let our experienced lawyers fight with the insurer on your behalf. It is more useful to spend your time healing and learning to live your newly transformed life. ### Contact a Philadelphia Long-Term Disability Attorney Today If an insurance company denies your disability claim, or you are struggling with filing a claim, let a Philadelphia disability attorney assist you with handling your claim. [Contact us](https://www.garnerltd.com/contact/) today and let us help you get the benefits you may deserve. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Long Term Disability **Tags:** denied claim attorney, denied disability, Disability Benefits, disability insurance claim --- ### [What to Know about Long-Term Disability Overpayment Recovery ](https://www.garnerltd.com/what-to-know-about-long-term-disability-overpayment-recovery/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** Managing a long-term disability can be both time-consuming and also very costly. The purpose of disability insurance is to ensure that your basic needs and expenses are covered so that managing your disability is your prime focus instead of worrying about a lack of income. Insurance companies profit by paying out as little as possible, however, and in some instances, they might claim that they paid out too much in benefits and attempt to recover the supposed overpayment. This often occurs after you use the benefit funds to pay your bills, and this can make managing your disability and finances all the more difficult and stressful. An experienced Philadelphia disability attorney from [The Garner Firm, Ltd.](/practice-areas/) is ready to answer questions and advocate for the best possible outcome in your situation involving an overpayment recovery attempt. Read on to learn more about long-term disability overpayments and how a disability attorney can help. ![photo of a check related to long term disability overpayment and recovery](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_285714179geo-scaled-1-1024x682.jpeg "photo of a check related to long term disability overpayment and recovery - The Garner Firm") ### Policy Language and Terms Will Determine Your Options Receiving benefits for your long-term disability would seemingly mean that you are entitled to those benefits and are free and clear to use the funds. However, this is not always the case, and insurance companies may send you bills seeking a return payment for benefits you likely already spent. This can be stressful, to say the least. The [Employee Income Retirement Act of 1974 (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) governs long-term disability insurance coverage sponsored by most private sector employers in the United States. This law does permit insurance companies to pay benefits and then later seek overpayment recovery if the policy terms specifically allow for such recovery attempts and not from the general assets of a benefit plan participant. Some insurance companies seek recovery even though the policy language does not expressly permit them to do so. The purpose of the overpayment recovery is to collect on funds that the insurance company claims that you were not entitled to, after the fact. Generally, claims of overpayment of long-term disability benefits occur if you also began receiving [Social Security disability benefits.](https://www.ssa.gov/benefits/disability/) A disability attorney can independently analyze the recovery effort to determine its legitimacy and negotiate the best possible outcome for you. The experienced[ long-term disability attorney](https://www.garnerltd.com/attorney-profiles/) is ready to advise you on what options are available if your disability insurance company tries to recover an overpayment. You should never simply believe that your insurer has this right to collect from you – instead, always discuss your situation and policy with a skilled attorney first. You should also never ignore a recovery attempt, as the insurer might take legal action against you. ### Connect with a Philadelphia Long-term Disability Lawyer to Discuss Your Overpayment Being pursued for payments that you have already received and may have already spent can be stressful. By seeking a disability attorney to negotiate on your behalf, you can rest assured that the best possible outcome will be achieved and that you can avoid illegitimate attempts at overpayment recovery. In support of the best outcome in your situation, [schedule a consultation](https://www.garnerltd.com/contact/) with The Garner Firm, Ltd. today. **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment, Long Term Disability **Tags:** disability lawyer, disability overpayment, long term disability attorney, long term disability benefits --- ### [How Much Does Long-Term Disability Insurance Pay? ](https://www.garnerltd.com/how-much-does-long-term-disability-insurance-pay/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** A relatively minor injury or illness can change the way in which you live and work for months, while a more severe condition that leads to a lasting disability can change the way in which you live the rest of your life. A long-term disability can impact your ability to work and to engage in the same activities that you enjoyed before the accident. Long-term disability might also entitle you to benefits, and below, we’ll explore how much in long-term disability benefits you might be entitled to and how an attorney can help. One of the experienced long-term disability attorneys from The Garner Firm, Ltd. is here to answer any questions you might have about your claim, so reach out today to discuss your specific situation. ![photo of calculator as it relates to long term disability pay calculations](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_286307638geo-scaled-1-1024x549.jpeg "photo of calculator as it relates to long term disability pay calculations - The Garner Firm") ### Long-Term Disability Covers Your Lost Income Through Calculated Payments When a person is not able to work as a result of sickness or injury, disability insurance should pay out a portion of the income that you are unable to earn. In some situations, you might have [ERISA](https://www.dol.gov/general/topic/retirement/erisa) disability insurance coverage through your employer, while in others, you might have purchased your own disability policy from a private company. However you receive your benefits, it is important that you are paid what is necessary to replace your lost earnings and income – adjusted for inflation and other cost-of-living factors. The way in which your payments are calculated can be complex, and having a disability attorney on your side when filing your claim will help to ensure that your claim is supported and demonstrates your need for benefits. ### Making the Most of Your Long-Term Disability Payments Different factors can impact the amount of disability benefits you receive. Knowing how to approach your long-term disability claim is important to ensure that you do not negatively impact your benefit amount. For example, your benefits are generally calculated based on the salary you were earning before your disability took you out of work. Thus, determining the date of your disability could affect the calculation of your benefit amount. Sometimes, if you have a long-term disability, your insurance company will offer you a lump-sum settlement instead of continuing to pay benefits for the rest of your would-be working years. A settlement might seem like a lot of money at first, but you always want an attorney to review any offers. A lawyer can determine if a settlement is enough to cover your needs. ### Connect with a Philadelphia Long-Term Disability Attorney Now How much disability pays will depend on your prior earnings and whether you decide to accept a lump-sum settlement. In order to speak about how to make the most of your claim, [schedule a consultation](/contact/) with The Garner Firm, Ltd. today. **See Also: [ERISA Frequently Asked Questions](/erisa-faqs/ "ERISA Frequently Asked Questions")** **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment, Long Term Disability **Tags:** long term disability, long term disability benefits, long term disability claim, LTD attorney --- ### [Can Long-Term Disability Benefits Be Terminated?](https://www.garnerltd.com/can-ltd-disability-benefits-be-terminated/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** For many injured or chronically ill employees, long-term disability benefits are the only way that they can continue to make ends meet. Without these payments, they wouldn’t have any way to support themselves or their families. However, having your long-term disability benefits approved doesn’t mean you will be able to receive them for as long as you think you should. In fact, in some situations, your benefits could be canceled. To help prevent and defend against this action, it’s wise to have a well-versed Philadelphia disability benefits lawyer representing your case. ![illustration showing cancelled long term disability benefits](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_69831970geo-scaled-1-1024x1024.jpeg "AdobeStock_69831970geo-scaled - The Garner Firm") ### Reasons LTD Disability Benefits are Terminated: **Failure to Apply for Social Security Disability Insurance (SSDI) Benefits** Most people who are approved for LTD benefits are required by their policy for [Social Security disability insurance (SSDI)](https://www.ssa.gov/benefits/disability/) benefits. Insurance companies that fall under ERISA are legally permitted to “offset” SSDI payments against LTD benefits (subtract the amount you get from Social Security from the benefits they owe you). The insurance company has an interest in seeing you approved for Social Security disability. Failing to cooperate with the insurer related certain requirements can cause your benefits to reduced or in extreme cases terminated. Many permanent [LTD policies](/practice-areas/long-term-disability/) have a 24-month limitation on disabilities arising from mental, nervous, and psychological impairments. Suppose you’re receiving LTD payments due to depression, anxiety, post-traumatic stress disorder, chronic fatigue syndrome, or a similar impairment. In that case, you may be limited to receiving only 24 months of benefits. Sometimes exceptions are made for specific mental disorders like dementia and organic brain disease, as well as schizophrenia and bipolar disorder. Sometimes this limited coverage period also applies to: **Time Limitation on Certain Conditions** - Arthritis - Carpal tunnel syndrome - Back pain - Other chronic pain conditions **Failure to Continue Treatment** Most LTD policies require you to submit periodic proof of your ongoing disability. Sufficient proof might be annual recertification by your physician that you’re still disabled or attending regular medical examinations. One of the most common reasons[ LTD benefits](/practice-areas/long-term-disability/) are terminated is that the claimant didn’t receive regular medical treatment. No matter the circumstances, don’t stop seeing your doctor. Far too many claimants seek the help of a [Philadelphia disability benefits attorney](/attorney-profiles/) after they stop seeing their doctor about their disability, only to find that it’s too late. **Discovery of Activities** Unfortunately, your LTD insurer may arrange for a surveillance company to watch you over a period of several days. They may follow you as you complete daily errands and medical appointments, parking on the street at your house and recording your every move. Exercise caution when interacting with anyone you think might be an investigator. Suppose they observe and record you participating in activities that aren’t consistent with your physical or mental impairments. In that case, the LTD insurance company could decide that your health has improved, and your benefits might be terminated. **Other Reasons** Several other circumstances could cause your LTD benefits to be terminated, including: - Aging out - Shifting definition of disability after 24 months ### Questions about Your LTD Coverage? Reach Out to a Reputable Philadelphia Disability Benefits Lawyer Today At The Garner Firm, Ltd., our Philadelphia disability benefits attorneys know that securing and keeping these well-deserved benefits can, unfortunately, be an uphill battle for many claimants. We are here to make the process less stressful and more successful for you. [Contact](/contact/) our office today to schedule a complimentary consultation. **See Also: [ERISA Frequently Asked Questions](https://www.garnerltd.com/erisa-faqs/ "ERISA Frequently Asked Questions")** **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment, Disability Benefits, Employee Benefits, Long Term Disability **Tags:** long term disability, long term disability attorney, LTD benefits, LTD benefits lawyer --- ### [Questions to Ask Your Long-Term Disability Attorney](https://www.garnerltd.com/questions-to-ask-your-long-term-disability-attorney/) **Published:** January 2, 2023 **Author:** The Garner Firm **Excerpt:** Long-term disability, especially through ERISA-based insurance plans, is notoriously difficult to qualify for, particularly if you don't have an attorney. Be prepared to ask the right questions when hiring an attorney. **Content:** Long-term disability (LTD), especially through ERISA-based insurance plans, is notoriously difficult to qualify for, particularly if you don’t have an attorney. If you or a loved one is considering hiring a [Philadelphia long-term disability attorney](/practice-areas/) to help you with a disability claim, make sure you ask some questions first. Some of the issues you should raise include the following. ### How Much Experience Do You Have with LTD Claims? You will want to engage a firm or attorney that has a practice that concentrates on LTD claims and has done so for many years. The complexities of LTD insurance claims make it critical that you find a [skilled and experienced attorney](/attorney-profiles/) to handle your case. ![photo of man and woman discussing issues related to long term disability attorneys](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_142451077geo-scaled-1-1024x683.jpeg "photo of man and woman discussing issues related to long term disability attorneys - The Garner Firm") ### Have You Worked with My Specific Condition Before? Certain conditions figure into more LTD claims than others do. Those common claims will be familiar and understandable to your lawyer and to any judges and third parties who may be involved in deciding your claim. Other conditions are rarer and may require a knowledgeable practitioner who will not only know the details of your condition but will be able to communicate it to others. Only in this way will your attorney be comfortable explaining how your condition really impacts your ability to work for a living. ### Are You Experienced with Handling Appeals of Denied Claims? Many LTD insurance claims are denied on their initial applications. Your claim may likely proceed through an appeal process. For this reason, it will be wise for you to retain an attorney who is experienced with handling appeals of denials. ### Can You Help Me Qualify for Other Benefits? There may be other benefits available to you even if your LTD claim is denied. A knowledgeable LTD attorney will be familiar with the other programs you might qualify for. ### Can I Recover Attorney’s Fees from My Insurer? You should know that if your LTD is part of an employer-provided plan, under the [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa), the court can order your LTD carrier to pay the attorney’s fees. To get fees, you must litigate a case in court and show a degree of success on the merits and usually one of several other factors. However, the fees awarded will not cover all of your attorney’s efforts, only the time spent in litigation. ### Speak with a Pennsylvania Long-Term Disability Attorney Long-term disabilities can be devastating to your life and career, and the LTD insurance claims process is rarely easy. You likely have many questions about how the right law firm can help, and you should never hesitate to ask our legal team all of the questions you have. We work with clients who have a wide range of disabilities and assist them through the entire process of obtaining the benefits they need and deserve under their policies. If you have any questions at all, reach out to our long-term disability attorneys at The Garner Firm, Ltd. [Contact us today](/contact/) so we can begin assessing your case. **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment, Legal Counsel, Long Term Disability **Tags:** denied claim, ERISA atttorney, LTD attorney, LTD lawyer --- ### [The Hidden Dangers of ERISA: Safeguard Your Disability Benefits](https://www.garnerltd.com/the-hidden-dangers-of-erisa-safeguard-your-disability-benefits/) **Published:** January 26, 2026 **Author:** Adam Garner **Content:** ![](https://www.garnerltd.com/wp-content/uploads/2026/01/generated-image.png "generated-image - The Garner Firm") If you purchased an individual disability insurance (IDI) policy—one where you are the named insured and the contract is between you and the insurer—you or your insurance broker may have assumed your policy would be governed by state law protections, including the ability to sue your insurer for bad faith if they wrongfully deny your claim. Unfortunately, [insurers like Unum Group and its subsidiaries](https://www.garnerltd.com/homepage/insurers-we-litigate-against-in-erisa-benefit-claims/ "ERISA LTD Disability Insurers We Fight for You") have a different playbook. Time and again, Unum has attempted to manipulate the legal landscape by “ERISAfying” individual disability policies into the Employee Retirement Income Security Act (ERISA) framework and by misclassifying injuries as sicknesses to reduce their exposure. These tactics can strip policyholders of critical legal protections and significantly reduce the benefits they deserve. An experienced ERISA attorney can help you fight back against these unfair practices. The recent case of Dr. William P. Potthoff, a Michigan physician who holds an individual disability income policy originally issued by Provident Life and Accident Insurance Company (now part of Unum), illustrates exactly how these tactics play out in practice. At The Garner Firm, our attorneys have decades of combined experience representing individuals and classes of plaintiffs in ERISA and bad faith litigation, and we understand the intricate ways insurers attempt to manipulate the system. This blog post explores Unum’s practices, the specific policy provisions that create financial incentives for manipulation, and what policyholders can do to protect themselves. ## Why the IDI vs. ERISA Distinction Matters The legal framework governing your disability insurance claim can dramatically impact your rights and remedies. Individual disability insurance (IDI) policies purchased directly by the insured—not through an employer-sponsored plan—are typically governed by state insurance law. Under some state laws, like in Pennsylvania, policyholders enjoy robust protections, including the ability to pursue bad faith claims, seek extra-contractual damages, and potentially recover punitive damages if the insurer engages in oppressive or fraudulent conduct. ERISA, on the other hand, provides far fewer remedies. Under ERISA, claimants are generally limited to recovering only the benefits owed under the policy, with no entitlement to consequential damages, emotional distress awards, or punitive damages. Additionally, ERISA cases are tried before judges—not juries—and courts often apply a deferential “abuse of discretion” standard that makes it harder for claimants to prevail. This disparity creates an enormous financial incentive for insurers to argue that ERISA applies whenever possible. If an insurer can successfully invoke ERISA preemption, it effectively immunizes itself from the most significant penalties for bad faith claims handling. ![](https://www.garnerltd.com/wp-content/uploads/2026/01/generated-image-1.png "generated-image (1) - The Garner Firm") ## The Potthoff Policy: A Case Study in IDI Ownership Dr. Potthoff’s policy is a textbook example of an individually owned disability income policy. The policy declaration page clearly identifies Dr. Potthoff as “the Insured,” and the contract states it is “a legal contract between you and us,” meaning between the individual policyholder and Provident Life and Accident Insurance Company. The policy is non-cancellable and guaranteed continuable at guaranteed premiums—a hallmark of individual disability coverage that cannot be altered unilaterally by the insurer. There is no employee benefit plan, which is a necessity for ERISA to apply. While the policy contains a “Salary Allotment Premium Payment” rider that allows Dr. Potthoff’s employer, Thirlby Clinic P.C., to remit premium payments on his behalf, this administrative convenience does not automatically transform an individually owned policy into an employer-sponsored ERISA plan. The rider explicitly states that if the salary allotment arrangement is voided—whether because employment ends, the agreement terminates, or the employer fails to pay—”premiums will be due and payable as required in the policy,” meaning Dr. Potthoff can continue paying directly. Courts have recognized that payroll deduction arrangements and employer facilitation of premium payments do not, standing alone, automatically create an ERISA-governed plan. The Department of Labor’s “safe harbor” regulation excludes insurance programs from ERISA where the employer’s involvement is limited and the policy is voluntary. ## Unum’s Practice of Pigeonholing IDI Claims Into ERISA Despite clear policy language establishing individual ownership, Unum has repeatedly attempted to transform individually owned disability policies into ERISA-governed plans through litigation. This tactic involves asserting ERISA preemption as a defense even when the policy was sold, marketed, and administered as a state-regulated individual policy. In December 2025, a federal court in the Central District of California decisively rejected this tactic in *[Koo v. Unum Group et al.](https://benefitslink.com/src/ctop/koo-v-unum-cdcalif-12162025.pdf)*. In that case, Unum argued that an individually owned disability policy was subject to ERISA preemption. The court disagreed, finding that Unum failed to establish the existence of any ERISA-governed employee benefit plan. The policy was individually underwritten, paid entirely by the insured with post-tax dollars, voluntary, and expressly disclaimed by the employer as non-ERISA. The *Koo* court emphasized that Unum’s own enrollment materials and internal records repeatedly characterized the coverage as an individually owned, state-regulated policy. The court rejected Unum’s attempt to “ERISA-fy” the policy after years of administering it as a California contract. As a result, the insured’s state-law claims—including potential claims for bad faith, extra-contractual damages, and punitive damages—were permitted to proceed. Similarly, in *[Shrago v. Unum Life Ins. Co. of America](https://law.justia.com/cases/federal/district-courts/maryland/mddce/8:2020cv01097/481408/29/)*, a Maryland federal court held that ERISA did not preempt the plaintiff’s state-law contract claims because the policy fell within the Department of Labor’s safe harbor regulation. The court found no evidence that the employer was involved in negotiating, securing, administering, or overseeing the policy, meaning it could not be said to have “established or maintained” a plan under ERISA. It is unclear why Potthoff brought the claim under ERISA, but this may have been a strategic decision. ## The Injury Versus Sickness Classification: Following the Money Perhaps no tactic better illustrates the financial gamesmanship of disability insurers than the strategic classification of claims as arising from “sickness” rather than “injury.” Dr. Potthoff’s policy demonstrates exactly why this distinction matters so much—and why insurers have every incentive to manipulate it. ### The Dramatic Difference in Benefit Periods Under Dr. Potthoff’s policy, the Maximum Benefit Periods for Total Disability differ dramatically depending on whether the disability results from an injury or a sickness: **For Injuries:** - Total Disability starting before the insured’s 65th birthday: **Benefits payable for LIFE** - Total Disability starting on or after 65th birthday but before 75th birthday: 24 months - Total Disability starting on or after 75th birthday: 12 months **For Sickness:** - Total Disability starting before 60th birthday: Benefits payable for LIFE - Total Disability starting on or after 60th but before 61st birthday: To 65th birthday - Total Disability starting on or after 61st but before 62nd birthday: 48 months - Total Disability starting on or after 62nd but before 63rd birthday: 42 months - Total Disability starting on or after 63rd but before 64th birthday: 36 months - Total Disability starting on or after 64th but before 65th birthday: 30 months - Total Disability starting on or after 65th but before 75th birthday: 24 months - Total Disability starting on or after 75th birthday: 12 months The financial implications are staggering. Consider a physician who becomes totally disabled at age 62 due to an accidental injury. Under the policy’s injury provisions, that physician would receive $15,000 per month **for life**. However, if Unum can successfully reclassify the same disability as arising from a “sickness,” the benefit period drops to just 42 months. For Dr. Potthoff, with a monthly benefit of $15,000, the difference between lifetime benefits and a 42-month limitation could easily exceed **one million dollars** in avoided claim payments. The insurer’s financial incentive to misclassify injuries as sicknesses is obvious and enormous. ### Policy Definitions Create Battlegrounds The policy defines “Injuries” as “accidental bodily injuries occurring while your policy is in force” and “Sickness” as “sickness or disease which is first manifested while your policy is in force”. While these definitions appear straightforward, they create significant battlegrounds for insurers seeking to minimize claims exposure. Courts have addressed this very issue. In *[Stein v. Paul Revere](https://www.saul.com/sites/default/files/documents/2023-06/Stein%20v%20Paul%20Revere%20Life%20Insurance%20Co%20%28002%29.pdf)*, the court granted summary judgment in the insured’s favor, determining that the cause of his permanent disability “was an accidental bodily injury” and ordering the insurer to pay the full lifetime benefits the policy provided for injury-based disabilities. Unum has also employed related tactics by labeling physical conditions as primarily “mental” in nature, thereby triggering policy provisions that limit mental health benefits. In *Bencivenga v. Unum Life Ins. Co. of Am.*, a court found that Unum improperly labeled the claimant’s disability as mental so it could apply a 24-month coverage limit, even though the underlying condition had significant physical components. Similarly, *Kamerer v. Unum Life Ins. Co. of Am.* involved Unum’s internal consultant stating “it was clinically reasonable” to conclude the claimant’s disability was mental-based, a characterization the court ultimately rejected. ## Unum’s Documented History of Biased Claims Handling These tactics are not isolated incidents. Unum has a well-documented history of problematic claims administration that stretches back decades. In 2004, Unum agreed to a [Regulatory Settlement Agreement (RSA)](https://www.maine.gov/pfr/insurance/sites/maine.gov.pfr.insurance/files/inline-files/first-unum-life_rsa.pdf) with state insurance regulators and the U.S. Department of Labor to address what investigators described as “a deliberate program of bad faith denial of meritorious benefit claims”. The RSA identified several areas of concern, including excessive reliance upon in-house medical professionals to discount treating physicians’ opinions, unfair interpretation of medical reports, failure to evaluate claimants’ total medical condition, and placing inappropriate burdens on claimants to justify benefits eligibility. Despite the RSA, federal courts have continued to criticize Unum for the same practices it promised to correct. A comprehensive [2021 law review article](https://dc.law.mc.edu/cgi/viewcontent.cgi?article=1775&context=lawreview) catalogued dozens of post-RSA decisions finding that Unum engaged in cherry-picking from medical records, disregarding evidence favorable to claimants, mischaracterizing job duties, ignoring treating physicians’ opinions, and disregarding Social Security Administration disability determinations. As the Supreme Court recognized in *[Metropolitan Life Ins. Co. v. Glenn](https://supreme.justia.com/cases/federal/us/554/105/)*, an administrator’s conflict of interest “should prove more important (perhaps of great importance) where circumstances suggest a higher likelihood that it affected the benefits decision, including, but not limited to, cases where an insurance company administrator has a history of biased claims administration”. ## What Policyholders Can Do to Protect Themselves If you have a disability insurance policy—whether purchased individually or through your employer—understanding your rights is critical. Here are key steps to protect yourself: 1. **Determine whether your policy is governed by ERISA.** Your claim is may *not* be covered by ERISA if you purchased an individual disability policy directly from the insurer, you are self-employed or an independent contractor, or you work for a church, religious organization, or government agency. 2. **Review your policy’s definitions carefully.** Understand how your policy defines “disability,” “injury,” and “sickness,” and what benefit periods or limitations apply to each category. As Dr. Potthoff’s policy demonstrates, the difference can be worth hundreds of thousands—or even millions—of dollars. 3. **Document the cause of your disability thoroughly.** If your disability results from an accidental bodily injury, including repetitive use injuries, ensure your medical records clearly establish the traumatic or accidental nature of the condition. 4. **Consult experienced ERISA and disability insurance counsel.** Navigating these complex issues requires attorneys who understand both ERISA’s intricacies and the specific tactics insurers employ to minimize claims. ## Contact The Garner Firm: An ERISA Attorney or Insurance Attorney Can Help At The Garner Firm, we represent individuals and classes of plaintiffs in disability insurance disputes across the country. Our [attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") have extensive experience challenging improper ERISA preemption arguments, fighting misclassification of injuries as sicknesses, and holding insurers accountable for biased claims handling. If you believe your disability claim has been wrongfully denied, terminated, or underpaid—or if you suspect your insurer is attempting to manipulate the legal framework governing your claim or misclassify the cause of your disability—we want to hear from you. [Contact The Garner Firm today](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") for a confidential consultation. We are committed to ensuring that our clients receive the benefits they are entitled to under the law. **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment, Disability Benefits, Employee Benefits, Long Term Disability **Tags:** bad faith insurance, Disability Benefits, disability insurance claim denial, ERISA, erisa attorney, ERISA lawyer, erisa litigation, long term disability, long term disability attorney, unum --- ### [Own vs Any Occupation: Protect Your LTD Benefits Now](https://www.garnerltd.com/own-vs-any-occupation-protect-your-ltd-benefits-now/) **Published:** March 1, 2026 **Author:** Adam Garner **Content:** ![Graphic explaining the difference between own occupation and any occupation disability benefits.](https://www.garnerltd.com/wp-content/uploads/2026/03/Gemini_Generated_Image_ypt9biypt9biypt9-1024x559.png "Gemini_Generated_Image_ypt9biypt9biypt9 - The Garner Firm") Understanding ERISA own occupation vs any occupation standards is essential for anyone filing a long-term disability claim. The definition of “disability” in your **long-term disability (LTD)** policy determines whether you qualify for benefits. Most **[ERISA disability](https://www.garnerltd.com/erisa-disability-claim-denial-reasons-and-how-to-fight-back/)** policies use one of two standards: “own occupation” or “any occupation.” Understanding the difference between these definitions is critical because the evidence you need to prove your claim—and the likelihood of receiving benefits—varies significantly depending on which standard applies.​ ## What Is the “Own Occupation” Standard? Under an “own occupation” definition, you are considered disabled if you cannot perform the **material and substantial duties of your regular occupation**—the occupation you were doing immediately before you became disabled. This is generally the more favorable standard for claimants because it focuses on your specific occupation rather than work in general.​ For example, if you were a surgeon who developed a hand tremor, you could be considered disabled under an own occupation standard because you cannot perform surgery, even if you could theoretically work as a medical consultant or administrator. Courts have struggled with the precise meaning of “own occupation,” particularly when policies require the claimant to be unable to perform “each and every duty” of the occupation. Different circuits have interpreted this language differently:​ - Some courts hold that you must be unable to perform **all** material duties to qualify - Other courts hold that you qualify if you cannot perform **any** of the material duties - Most courts adopt a middle ground, requiring inability to perform duties that are essential or important to the occupation​ ## What Is the “Any Occupation” Standard? Under an “any occupation” definition, you are considered disabled only if you cannot perform the duties of **any occupation for which you are reasonably qualified by education, training, or experience**. This is a more restrictive standard.​ The “any occupation” standard often includes a “gainful” requirement, meaning the occupation must be one that generates meaningful income that is comparable to pre-disability employment—not just any conceivable type of work. Thus, for example, a surgeon would not be expected to work a minimum wage job. Courts have held that the ability to perform any theoretical job is not sufficient; the occupation must be one the claimant could reasonably perform and that would generate a livelihood.​ ## The 24-Month Transition Most **LTD** policies provide benefits under an “own occupation” standard for the first 24 months of disability, then transition to an “any occupation” standard. This transition point is one of the most common times for insurers to terminate benefits.​ The transition often catches claimants by surprise. Someone who clearly qualified as disabled under the own occupation standard may be found “not disabled” under the any occupation standard, even though their medical condition has not improved. ## How Insurers Manipulate Job Definitions One common tactic insurers use to deny claims is manipulating the definition of your occupation. Instead of analyzing the specific duties of your actual job, insurers may rely on generic job descriptions from the Department of Labor’s Dictionary of Occupational Titles (DOT) or its successor, [O\*NET](https://www.onetonline.org/ "O*NET").​ Courts have criticized this approach when it results in a mismatch between the generic description and the claimant’s actual job duties. For example:​ - A sales representative whose job required extensive travel may be classified as having a “sedentary” occupation - A nurse whose job involved lifting patients may be compared to a generic “nursing” description that omits physical requirements - A manager whose job required constant in-person oversight may be deemed able to work from home ## The Importance of Vocational Evidence Under both standards—but especially under the “any occupation” standard—vocational evidence is often critical. A qualified vocational expert can:​ - Accurately define the material and substantial duties of your occupation - Conduct a transferable skills analysis to determine what other jobs you could perform - Assess whether jobs matching your profile actually exist in the labor market - Evaluate whether you could earn a comparable income in an alternative occupation Courts have differed on whether vocational evidence is required, but many have found that insurers abuse their discretion when they deny claims without any assessment of the claimant’s vocational capabilities.​ ## Accommodations and the Own Occupation Standard A split exists among federal circuits regarding whether insurers can consider workplace accommodations when determining disability under the own occupation standard:​ - The **Ninth Circuit** has held that accommodations cannot be considered—if you need accommodations to perform your job, you may still be disabled - The **First, Second, Seventh, Eighth, and Eleventh Circuits** have permitted insurers to consider accommodations that would enable a disabled person to perform their regular job Understanding how your circuit treats this issue is important when preparing your [appeal](https://www.garnerltd.com/why-your-erisa-disability-appeal-is-the-most-important-step-in-your-benefits-claim/). ## Protect Your Benefits at the Transition Point If you are receiving **LTD** benefits and approaching the 24-month transition, do not wait for the denial to come. Proactively strengthen your claim by: - Obtaining updated medical records and physician statements - Documenting all functional limitations that affect your ability to work - Considering a vocational evaluation - Consulting with an experienced [ERISA disability attorney](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/) ## [Contact ](/contact "Contact ")The Garner Firm The distinction between own occupation and any occupation disability can determine whether you receive years of continued benefits or face a sudden termination. At The Garner Firm, we understand these nuances and know how to build claims that succeed under either standard. Call us at **(215) 645-5955** to discuss your case. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Long Term Disability **Tags:** Disability Benefits, disability benefits attorney, ERISA, ERISA lawyer, long term disability, long term disability attorney, LTD --- ### [Governmental Plan Exemption Sinks Pro Se Plaintiff's ERISA LTD Case](https://www.garnerltd.com/erisa-attorney-governmental-plan-exemption-ltd-case/) **Published:** December 18, 2025 **Author:** Adam Garner **Content:** If you’re facing denied long-term disability benefits, consulting an experienced ERISA attorney is crucial to protect your rights. When you apply for long-term disability benefits through your employer, you might assume that federal law protects your rights. However, a recent decision from the United States District Court for the Western District of Virginia demonstrates that not all employee benefit plans fall under the protections of the Employee Retirement Income Security Act ([ERISA](https://www.garnerltd.com/erisa-faqs/ "ERISA Frequently Asked Questions")). In *[Redwine v. Unum Life Insurance Company of America](https://law.justia.com/cases/federal/district-courts/virginia/vawdce/3:2025cv00029/134909/24/ "Redwine v. Unum Life Insurance Company of America")*, the court dismissed an employee’s ERISA claim against Unum, holding that the University of Virginia’s LTD benefits plan was exempt from ERISA as a “governmental plan.” Had the Plaintiff in *Redwine* had competent counsel represent him in his LTD case, instead of representing himself, he may have been able to avoid this unfortunate outcome. ![Navigating your long-term disability benefits with an ERISA long-term disability attorney at The Garner Firm](https://www.garnerltd.com/wp-content/uploads/2025/12/Redwine-Graphic.jpg "Redwine Graphic - The Garner Firm")## The Facts of Redwine v. Unum Michael Redwine worked for the University of Virginia Medical Center, where he became eligible for long-term disability benefits administered by Unum Life Insurance Company of America. In February 2022, Redwine contracted COVID-19 and subsequently developed long COVID, which significantly impaired his ability to work. He was later diagnosed with severe depression, anxiety, PTSD, and agoraphobia, further interfering with his employment. Redwine applied for both short-term and long-term disability benefits through [Unum](https://www.garnerltd.com/homepage/insurers-we-litigate-against-in-erisa-benefit-claims/ "ERISA LTD Disability Insurers We Fight for You"), which served as the administrator and insurer for UVA’s group LTD policy. While Unum initially approved his short-term disability payments, the company denied his application for long-term disability benefits. After exhausting all internal appeals, Redwine filed a lawsuit in federal court, claiming that Unum violated ERISA by wrongfully denying his LTD benefits. Unum moved to dismiss the complaint, arguing that ERISA did not apply because the benefit plan was a “governmental plan” exempt from ERISA’s coverage. It was at this point, the plaintiff should have amended his Complaint and asserted claims arising under Virginia law, instead of ERISA. ## Understanding the Governmental Plan Exemption ERISA was enacted to protect the interests of employees and their beneficiaries in employee benefit plans by establishing minimum standards for plan administration, funding, and fiduciary conduct. However, ERISA does not apply to all employee benefit plans. Under 29 U.S.C. § 1003(b)(1), ERISA’s provisions do not apply to a “governmental plan.” A “governmental plan” is defined as “a plan established or maintained for its employees by . . . the government of any State or political subdivision thereof, or by any agency or instrumentality of any of the foregoing.” Plans that qualify as governmental plans are exempt from ERISA regardless of whether they are administered by private insurance companies. This means that employees of state universities, public schools, municipalities, and other governmental entities typically cannot bring ERISA claims for wrongful denial of benefits. Instead, the claims are brought under applicable state laws. ## The Court’s Analysis in Redwine The court in *Redwine* conducted a straightforward analysis to determine whether the UVA Medical Center’s benefit plan was a “governmental plan” exempt from ERISA. The court first noted that there was no question UVA established and maintained the plan for its employees’ benefit, as Redwine expressly alleged he was a UVA employee participating in a benefit plan “sponsored by the University of Virginia.” The critical issue was whether UVA and its Medical Center qualified as “agencies” or “instrumentalities” of the Commonwealth of Virginia. The court found this question easily resolved, citing Virginia state court decisions establishing that UVA is a governmental entity whose powers and duties are created by statute and controlled by the General Assembly. The court also cited precedent specifically recognizing UVA’s Medical Center as an “organ of the state.” ### Rejecting the Plaintiff’s Arguments Redwine advanced three arguments in an attempt to salvage his ERISA claim, all of which the court rejected. First, Redwine argued that if the plan were truly exempt, Unum An experienced ERISA attorney could have presented stronger arguments to preserve the claim.should have disclosed that fact from the outset. The court found no statutory requirement that plans disclose their exempt status and held that Redwine’s assertion did not create a legal duty where none existed. Second, Redwine contended that because Unum administered the plan, paid benefits under a policy that referenced ERISA, and applied ERISA procedures, the plan should not be exempt from ERISA’s coverage. The court noted that the plan’s reference to ERISA specifically contemplated that ERISA might not apply to all plans and plan-holders, stating the plan “is governed by the laws of the governing jurisdiction and to the extent applicable by \[ERISA\].” Third, Redwine argued that the plan was not a “governmental plan” because Unum—not UVA—maintained and administered it. The court rejected this argument, emphasizing that the relevant question is whether UVA “established and maintained” the plan for its employees. A private insurer’s involvement as the plan’s administrator does not impact a plan’s governmental status if it is established and maintained by an agency or instrumentality of a state. The court cited its own prior decision in *Rowe v. Rector \\& Visitors of the University of Virginia*, which found a UVA plan to be governmental even when administered by a private insurer. ## What This Means for Employees and Employers The *Redwine* decision illustrates an important but often misunderstood aspect of ERISA law: not all employer-sponsored benefit plans receive ERISA protections. Employees of state universities, public schools, municipal governments, and other governmental entities who are denied LTD benefits by insurers like Unum may have claims arising under state law, including [insurance bad faith law](https://en.wikipedia.org/wiki/Insurance_bad_faith). However, consulting with an ERISA attorney is essential to understand all available legal options and remedies. ## Unum’s Track Record in LTD Claims It is worth noting that [Unum has a well-documented history of problematic claims handling practices](https://dc.law.mc.edu/cgi/viewcontent.cgi?article=1775&context=lawreview). Numerous court rulings have found Unum’s denials to be wrongful, and it is subject to a [regulatory settlement agreement](https://www.maine.gov/pfr/insurance/sites/maine.gov.pfr.insurance/files/inline-files/first-unum-life_rsa.pdf) with state insurance commissioners and the Department of Labor. While the *Redwine* court did not reach the merits of whether Unum properly denied the plaintiff’s claim, it noted that “Unum considered Redwine’s claim on its merits and denied his claim because he did not meet the criteria for the long-term benefits he sought.” It is unclear whether the plaintiff in *Redwine* will be granted leave to amend his Complaint and assert his claims under state law. ## How an ERISA Attorney Can Help At The Garner Firm, our ERISAattorneys have extensive experience handling complex ERISA litigation involving LTD benefits denials, as well as non-ERISA LTD claims. We understand the nuances of ERISA law, including critical threshold issues such as the governmental plan exemption. Our firm has successfully represented clients in disability benefits cases against major insurers, including Unum, and we are skilled at navigating the procedural complexities that can make or break a case. Whether you are a private sector employee whose ERISA-governed LTD benefits have been wrongfully denied, or a governmental employee seeking to understand your legal options under state law, The Garner Firm can provide the knowledgeable representation you need. Our LTD [attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") stay current on the latest developments in ERISA case law and are prepared to fight for your rights to obtain the benefits you deserve. ## Contact Us Today If your [long-term disability](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/ "Long-Term Disability Attorneys") benefits have been denied, time is of the essence. Deadlines for filing administrative appeals and lawsuits are strictly enforced, and missing a deadline can permanently bar your claim. Do not navigate this complex area of law alone. [Contact The Garner Firm today](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") to schedule a consultation and learn how we can help you pursue the LTD benefits you need and deserve. Our experienced attorneys are ready to evaluate your case and provide strategic guidance tailored to your unique circumstances. --- *This blog post is for informational purposes only and does not constitute legal advice. Every case is unique, and outcomes depend on specific facts and circumstances.* **Categories:** (ERISA) Litigation, Disability Benefits, Long Term Disability --- ### [Mentally Ill Killers, Life Insurance & The Slayer Statute](https://www.garnerltd.com/mentally-ill-killers-life-insurance-the-slayer-statute/) **Published:** October 3, 2025 **Author:** Adam Garner **Content:** A state slayer statute may apply to a life insurance payout when the beneficiary is accused of killing the policyholder. It’s a tragic and legally complex question that pits a fundamental legal principle against a grieving family’s right to justice. This scenario, while rare, raises critical legal questions about who is entitled to the insurance proceeds. A recent federal court decision, *[Popanda v. Roth](https://www.courthousenews.com/wp-content/uploads/2025/09/slayer-statute-wisconsin-popanda-v-roth.pdf)*, provides a powerful illustration of how courts navigate these thorny issues using legal tools like the **interpleader** action and state “[slayer statutes](https://en.wikipedia.org/wiki/Slayer_rule).” When an insurance company is faced with competing claims to a policy’s benefits—for instance, from an accused killer and the victim’s estate—it cannot simply choose who to pay. Doing so would expose the company to legal risk. This is where the law provides a safe harbor. At The Garner Firm, our attorneys are deeply experienced in handling these sensitive and complex **[life insurance](https://www.garnerltd.com/practice-areas/life-insurance/ "Life Insurance Claims")** disputes, ensuring that justice prevails and that the proceeds are distributed according to the law. ## What is an Interpleader? The Insurance Company’s Safe Harbor When a **life insurance** company knows it must pay out a death benefit but is unsure of the rightful recipient, it can initiate a legal action called an **[interpleader](https://www.law.cornell.edu/wex/interpleader)**. In the *Popanda* case, [Prudential Insurance Company](https://www.garnerltd.com/homepage/insurers-we-litigate-against-in-erisa-benefit-claims/ "Insurers We Litigate Against in ERISA Benefit Claims") filed an **interpleader** complaint, asking the court to determine whether Adam Roth, who killed his wife, could recover the proceeds from her policy. Under Federal Rule of Civil Procedure 22, an **interpleader** allows a party holding a “stake” (in this case, the insurance money) to bring all potential claimants into a single lawsuit. The stakeholder—the insurance company—essentially tells the court, “We owe this money, but multiple people claim it. We are depositing the funds with you; please determine the rightful owner.” Insurance companies use **interpleader** actions for two primary reasons: 1. **To Avoid Double Liability:** Paying the wrong person could result in the company being sued by the correct beneficiary and forced to pay the claim a second time. An **interpleader** resolves all claims in one action, protecting the company from this risk. 2. **To Consolidate Litigation:** Rather than facing multiple lawsuits from different claimants in different courts, the **interpleader** brings everyone to the same table for a final, binding decision. Once the insurance company deposits the funds with the court, its role in the case is typically over. It can walk away, leaving the claimants to argue their case before the judge. This process is common not only in **life insurance** disputes but also in cases involving certain other benefits governed by the Employee Retirement Security Act (**[ERISA](https://www.dol.gov/general/topic/retirement/erisa)**), where beneficiary designations may be contested. ## Can a Killer Inherit? Understanding “Slayer Statutes” At the heart of cases like *Popanda* is a long-standing legal and moral principle: a person should not be allowed to profit from their own wrongdoing. Nearly every state, including Wisconsin, has codified this principle into law through what are commonly known as “**slayer statutes**“. Wisconsin’s **slayer statute**, Wis. Stat. §854.14, states that an “unlawful and intentional killing of the decedent” revokes any provision in a governing instrument, like an insurance policy, that transfers property to the killer. The core question for any court applying this statute is whether the killing was both **“unlawful”** and **“intentional.”** The statute provides several ways to establish this. A final criminal conviction for an intentional killing is conclusive proof. However, what happens when there is no straightforward conviction, as was the situation in the *Popanda* case? The statute anticipates this, allowing a court to determine “based on the preponderance of the evidence” whether the killing was unlawful and intentional, even in the absence of a criminal judgment. This provision became the central legal battleground in the dispute over Dominique Roth’s **life insurance** proceeds. ## Case Study: *Popanda v. Roth* – Intent, Insanity, and Inheritance ### The Tragic Facts On March 10, 2020, Adam Roth stabbed and killed his wife, Dominique Roth, and her sister, Deidre Popanda. He also attacked his mother-in-law and another sister-in-law. When taken into custody, Roth did not deny his actions, stating, “I did it, I killed them”. Dominique had a **life insurance** policy through her employer that named Roth as the sole beneficiary. ### The Legal Complication: An NGI Plea In his criminal case, Roth pled guilty to first-degree intentional homicide but was found not guilty by reason of mental disease or defect (NGI). This created a unique legal challenge. Roth’s argument in the federal **interpleader** case was that because he was found NGI, his actions could not be considered “unlawful and intentional” under the **slayer statute**, and therefore he should be entitled to the **life insurance** money. ### The Court’s Analysis: Civil vs. Criminal Intent The U.S. District Court for the Eastern District of Wisconsin had to decide what “unlawful and intentional” meant in this specific context. - **Was the Killing “Unlawful”?** The court easily concluded that it was. There was no evidence that the killing was authorized by law, such as in an act of self-defense. The NGI finding excuses a person from *criminal responsibility*; it does not make an illegal act legal. An NGI finding is an “excuse defense,” not a “justification defense.” It acknowledges a wrong was committed but excuses the individual from criminal punishment due to mental illness. - **Was the Killing “Intentional”?** This was the more complex question. The court drew a critical distinction between criminal intent (*mens rea*) and civil intent. Citing a similar case from the Seventh Circuit Court of Appeals, the court reasoned that the **slayer statute** focuses on civil intent. **Civil intent** only requires that a person intended their actions; it does not require that they understood their actions were wrong or criminal. The court found overwhelming evidence that Roth acted with civil intent. - He admitted to the acts during his plea hearing in the criminal case. - He made unprompted confessions, stating, “I killed my wife, I stabbed her in the back and I slit her throat”. - The nature of his guilty plea—admitting to the essential elements of intentional homicide—confirmed that he acted with purpose, even if his mental state prevented him from appreciating the wrongfulness of that purpose. The court concluded that a person can act with the purpose to kill while simultaneously lacking the ability to understand the criminality of their actions. Because the evidence clearly showed Roth’s actions were both unlawful and (civilly) intentional, the Wisconsin **slayer statute** applied. The court granted summary judgment in favor of Dominique’s estate, barring Roth from receiving the **life insurance** proceeds. ERISA did not preempt the slayer statute. ## Navigating Complex Life Insurance and ERISA Disputes The *Popanda* case highlights the intricate legal landscape that families must navigate after a tragedy. These disputes often involve the intersection of federal and state courts, civil and criminal law, and complex statutes like **ERISA** and state **slayer statutes**. The distinction between different legal standards—like civil versus criminal intent—can be the deciding factor in who receives hundreds of thousands of dollars in benefits. At The Garner Firm, our [attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") possess the specialized knowledge required for these challenging cases. We have extensive experience representing families in **life insurance** beneficiary disputes and **interpleader** actions. We understand how to gather the necessary evidence from related court proceedings and present a compelling case to ensure that benefits are distributed fairly and justly. We work tirelessly to see that the principle enshrined in our laws—that no one should profit from their own crime—is upheld. ### Contact The Garner Firm Today If you are a referring attorney or a family member facing a complex dispute over **life insurance** or **ERISA** benefits, you need counsel that is prepared for these unique challenges. [Contact The Garner Firm ](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today")for a consultation to discuss your case. We are here to provide the expert guidance and determined advocacy you need to achieve the right result. **Categories:** (ERISA) Litigation, Life Insurance **Tags:** ERISA, erisa attorney, erisa litigation, interpleader action, life insurance beneficiary --- ### [📢 Recent Update: Gig Workers Under the Current Administration](https://www.garnerltd.com/📢-recent-update-gig-workers-under-the-current-administration/) **Published:** May 5, 2025 **Author:** Melanie Garner **Content:** The U.S. Department of Labor (DOL) has issued new guidance on how it will enforce federal wage laws for gig workers, and it could significantly affect how companies classify workers—and how workers understand their rights. On **May 2, 2025**, the DOL’s Wage and Hour Division (WHD) released two key updates: 1. **[Field Assistance Bulletin No. 2025-1 (FAB 2025-1)](https://www.dol.gov/sites/dolgov/files/WHD/fab/fab2025-1.pdf)**, outlining new enforcement guidance. 2. **[Opinion Letter FLSA2025-2](https://www.dol.gov/sites/dolgov/files/WHD/opinion-letters/FLSA/2025_2_2_5_FLSA.pdf)**, which reinstates a 2019 interpretation about workers using “virtual marketplaces” like delivery or handyman apps. Here’s what you need to know: **The Big Picture: Employee or Contractor?** Federal wage law (the **Fair Labor Standards Act**, or FLSA) only protects employees—not independent contractors. That means only employees are guaranteed minimum wage, overtime pay, and other protections. So the way a worker is classified really matters. **What’s New?** The DOL announced that it will **no longer use the 2024 Rule** to determine who is an employee. That rule is now tied up in court and being reconsidered. Instead, the WHD will return to older guidance: **[a 2008 version of Fact Sheet #13](https://www.dol.gov/sites/dolgov/files/WHD/fact-sheets/whdfs13.pdf)** and the **[reinstated 2019 opinion letter (now FLSA2025-2)](https://www.dol.gov/sites/dolgov/files/WHD/opinion-letters/FLSA/FLSA2019-6.pdf)**. These emphasize the **“economic reality” test**—focusing on whether a worker is truly running their own business or is economically dependent on the company. **So, What Did the DOL Say About Gig Workers?** In FLSA2025-2, the Department analyzed a virtual platform that connects service providers (like food delivery drivers, movers, cleaners) with customers. It concluded that these workers are **independent contractors**, not employees, for reasons including the following: - They set their own hours and prices. - They use their own tools and cover their own costs. - They aren’t trained, supervised, or monitored. - They can work for competitors at the same time (“multi-apping”). - They take on the risk of profit or loss like small business owners. This means they are not entitled to federal wage and hour protections under the FLSA. **Why It Matters for Workers** If you work in the gig economy—or think your job has been misclassified—you should know: - **Independent contractor status** can mean more flexibility, but fewer legal protections. - If a company controls your schedule, work methods, or pay, you **might be misclassified.** - The DOL has made clear it’s ready to **enforce the FLSA** based on the older, worker-friendly standards—not the newer, contested rule. **Need Legal Help?** Misclassification robs workers of wages and security. If you’re unsure about your status or believe you’ve been misclassified, our firm is here to help you evaluate your rights and fight for what you’re owed. [Contact The Garner Firm, Ltd. today](https://www.garnerltd.com/contact/) for a consultation regerding your potential worker misclassification or other potential wage and hour claim. **Categories:** Employment Law --- ### [Court Affirms Denial of Accidental Death Benefits Due to Medical Treatment Exclusion](https://www.garnerltd.com/court-affirms-denial-of-accidental-death-benefits-due-to-medical-treatment-exclusion/) **Published:** April 7, 2025 **Author:** Adam Garner **Content:** Dealing with the denial of[ **life insurance**](https://www.garnerltd.com/practice-areas/life-insurance/) or **[accidental death](https://www.garnerltd.com/practice-areas/accidental-death-dismemberment-benefits/)** benefits is incredibly difficult, especially when grieving the loss of a loved one. When these benefits are part of an employer-sponsored plan, the denial often falls under a complex federal law known as the Employee Retirement Income Security Act of 1974 (ERISA). Understanding how courts review these denials and interpret insurance policies is crucial for anyone seeking the ERISA benefits they believe they are owed. A recent decision from the U.S. Court of Appeals for the Tenth Circuit, *[Jensen v. Life Insurance Company of North America](https://www.ca10.uscourts.gov/sites/ca10/files/opinions/010111215261.pdf)* (LINA), offers valuable insights into two critical aspects of ERISA litigation: the standard of review applied by courts and the methods used to interpret policy language, particularly exclusions. This case highlights the hurdles claimants face and underscores the need for experienced legal counsel, like the team at The Garner Firm, Ltd., when challenging an ERISA benefit denial. ## The *Jensen* Case: A Tragic Death and a Denied AD&D Claim The case involved Jill Jensen, whose husband, Steven, suffered from chronic pain and anxiety. His doctors prescribed oxycodone for pain and clonazepam for anxiety. Tragically, Steven died in 2019 due to the combined toxicity of these prescribed medications. Steven was covered under an ERISA-governed employee welfare benefit plan provided by his employer, which included Accidental Death and Dismemberment (AD&D) coverage through a policy issued by LINA. Jensen filed a claim for AD&D benefits, arguing her husband’s death was accidental. LINA initially denied the claim based on two policy exclusions: voluntary ingestion of drugs and medical treatment of sickness. LINA later dropped the voluntary ingestion exclusion but maintained the denial based solely on the exclusion for losses caused by or resulting from “Sickness, disease, bodily or mental infirmity… or medical or surgical treatment thereof”. Jensen sued LINA under ERISA Section 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B), to recover the denied benefits. ## The Standard of Review: A Critical (But Sometimes Sidestepped) Battle One of the first major battles in a lot **of ERISA litigation is deter**mining the standard of review the court will use to evaluate the insurance company’s (or plan administrator’s) decision to deny benefits. There are generally two possibilities: 1. ***De Novo* Review:** This means the court looks at the case with fresh eyes, without giving any deference to the administrator’s decision. This is generally more favorable, or at least fairer, to the claimant. 2. **Abuse of Discretion (or Arbitrary and Capricious) Review:** This standard is much more deferential to the administrator, which is often an insurer. The court will only overturn the denial if the administrator’s decision was unreasonable, illogical, or without substantial evidentiary support. This standard applies if the benefit plan documents explicitly grant the administrator discretionary authority to interpret the plan terms and determine eligibility for benefits. In *Jensen*, the plan documents granted LINA discretionary authority, which would typically trigger the deferential abuse of discretion standard. However, Jensen argued this clause was unenforceable under a Utah state law prohibiting such discretionary clauses in insurance contracts. LINA countered that the policy chose Delaware law (which allows such clauses) and that federal choice-of-law principles should apply. This dispute highlights a common tactic in **ERISA litigation**: claimants often seek to invalidate discretionary clauses to secure the more favorable *de novo* review. However, the Tenth Circuit in *Jensen* chose not to resolve this complex issue involving state law, choice-of-law rules, and potential **ERISA** preemption. Instead, the court took a practical approach : it assumed, for the sake of argument, that the claimant (Jensen) was correct and that *de novo* review applied. The court reasoned that if LINA’s denial was correct even under the stricter *de novo* standard, then deciding the standard of review issue was unnecessary. Ultimately, the court affirmed LINA’s denial even under *de novo* review. **Takeaway:** The standard of review remains a critical threshold issue in ERISA benefits cases. While plans often include language triggering deferential review, challenges to these clauses are possible, though courts may sometimes bypass the issue if the denial can be upheld under the claimant-friendly *de novo* standard anyway. ## Interpreting the Policy: When “Treatment” Means No Benefits With the standard of review set (or assumed) as *de novo*, the *Jensen* court turned to interpreting the LINA AD&D policy language. Courts interpreting ERISA plans generally apply federal common law principles, aiming to interpret the policy terms according to their “common and ordinary meaning as a reasonable person in the position of the plan participant… would have understood the words to mean”. Unambiguous terms are applied as written, but ambiguous terms (those reasonably susceptible to more than one meaning) are typically construed against the insurer under the doctrine of *contra proferentem*. The core dispute centered on the medical treatment exclusion, which stated benefits would not be paid for loss caused by “Sickness, disease, bodily or mental infirmity, bacterial or viral infection or medical or surgical treatment thereof…”. **1. The Last-Antecedent Rule Argument:** Jensen argued the phrase “medical or surgical treatment thereof” only modified the immediately preceding term, “bacterial or viral infection,” because there was no comma before “or medical or surgical treatment thereof”. This grammatical argument relied on the “last-antecedent rule”. If correct, the exclusion wouldn’t apply because Steven’s treatment was for chronic pain and anxiety (sickness/infirmity), not a bacterial/viral infection. The court acknowledged that a straightforward application of the rule supported Jensen’s reading. However, the court emphasized that interpretive rules like the last-antecedent rule are not absolute and can be overcome by context. Looking at the policy as a whole, the court found overwhelming contextual evidence against Jensen’s interpretation: \* The policy cover page stated it “does not pay benefits for loss caused by sickness”. The definition of “covered accident” required an event “not contributed to by disease, \[s\]ickness, \[or\] mental or bodily infirmity”. The opined that the purpose of AD&D insurance is typically to cover *accidents*, distinct from losses arising from illness or its treatment. The court noted the “normal understanding” is that injuries caused by medical treatment belong “with illness, not with accident”. Based on this context, the court concluded that applying the last-antecedent rule to limit the medical treatment exclusion only to bacterial/viral infections would contradict the clear intent and structure of the policy. It also noted the practical absurdity of excluding treatment for infections but covering treatment for other sicknesses or diseases. Therefore, the court rejected Jensen’s argument that the exclusion unambiguously *did not* apply. **2. The Ambiguity Argument:** Jensen alternatively argued that the exclusion was ambiguous, particularly when read alongside another exclusion for “voluntary ingestion of any narcotic, drug… unless prescribed or taken under the direction of a \[p\]hysician and taken in accordance with the prescribed dosage”. She contended that the “unless” clause in the voluntary ingestion exclusion seemed to allow coverage for deaths from prescribed medications taken correctly, creating a conflict with the medical treatment exclusion which, under LINA’s reading, barred coverage for deaths resulting from prescribed medications used to treat sickness. If ambiguous, the policy should be interpreted in her favor (*contra proferentem*). The court disagreed, finding no conflict or ambiguity. It reasoned that the two exclusions operate on different, though potentially overlapping, circumstances: The Medical Treatment Exclusion applies when the medication is treating *sickness, disease, or infirmity*. The Voluntary Ingestion Exclusion applies more broadly to drug ingestion but has a carve-out (the “unless” clause) for properly taken *prescribed* medication. The court explained that the “unless” clause of the voluntary ingestion exclusion still has meaning because it preserves coverage in situations *not* covered by the medical treatment exclusion. For example, if someone suffers an accidental injury (which is *not* a sickness, disease, or infirmity ), is prescribed medication for that injury, takes it as directed, but dies as a result, the voluntary ingestion exclusion wouldn’t bar the claim (due to the “unless” clause), and the medical treatment exclusion wouldn’t apply either (because the treatment wasn’t for sickness/disease/infirmity). Because Steven Jensen’s medications were prescribed to treat chronic pain and anxiety (sickness/infirmity), his death fell squarely within the unambiguous medical treatment exclusion as interpreted by the court. Takeaway: Courts interpreting ERISA policies look beyond isolated phrases or grammatical rules. They consider the entire policy context and purpose. Exclusions are often interpreted broadly, and arguments for ambiguity require demonstrating a genuine conflict or multiple reasonable interpretations, not just a potential surface-level tension between clauses. ## What *Jensen* Means for You The *Jensen v. LINA* decision serves as a reminder of the challenges inherent in ERISA life insurance and AD&D claims, especially when death results from medical care or prescribed medications: 1. **Exclusions Matter:** Policy exclusions, particularly those related to sickness, medical treatment, and drug use, are powerful tools for insurers denying claims. Careful reading and analysis are paramount. 2. **Context is King:** Courts interpret policy language based on the entire document and the common understanding of terms, not just isolated grammatical rules. 3. **Standard of Review is Key:** While the court sidestepped the issue in *Jensen*, the applicable standard of review significantly impacts a claimant’s chances of success in ERISA litigation. 4. **Complexity Requires Expertise:** Navigating ERISA regulations, plan interpretations, standards of review, and policy exclusions requires specialized knowledge. ## The Garner Firm, Ltd.: Your Advocate in ERISA Litigation If you or a loved one has faced a denial of life insurance, accidental death, or other ERISA benefits, you need experienced legal counsel to fight for your rights. At The Garner Firm, Ltd., we understand the complexities of ERISA litigation. We regularly help clients challenge benefit denials by scrutinizing policy language, contesting unfavorable interpretations, and navigating the procedural hurdles of ERISA. We work with clients and referring attorneys to pursue the benefits rightfully owed under life insurance and AD&D policies governed by ERISA. Don’t face the insurance company alone. [Contact The Garner Firm, Ltd. today](https://www.garnerltd.com/contact/) for a consultation on your ERISA benefits claim. **Categories:** (ERISA) Litigation, Accidental Death and Dismemberment, Employee Benefits, Life Insurance **Tags:** accidental death, accidental death and dismemberment, ad&d, ERISA, ERISA lawyer, life insurance, life insurance claims --- ### [Rule 56 Applied in a Recent Long-Term Disability Case to the Insured's Detriment](https://www.garnerltd.com/rule-56-applied-in-a-recent-long-term-disability-case-to-the-insureds-detriment/) **Published:** March 19, 2025 **Author:** Adam Garner **Content:** Navigating claims for long-term disability (LTD) benefits under ERISA (Employee Retirement Income Security Act of 1974) can be challenging, especially when procedural complexities arise. A recent decision from the U.S. District Court for the Eastern District of North Carolina, *[Routten v. Life Insurance Company of North America](https://casetext.com/case/routten-v-life-ins-co-of-n-am-2?) ,* No. 5:22-CV-467-F (E.D. N.C. 2025), underscores how procedural decisions can profoundly affect ERISA litigation outcomes. Specifically, the Court highlighted why this ERISA benefits case was decided under Federal Rule of Civil Procedure 56, involving summary judgment, rather than Rule 52, which relates to bench trials. ## What is ERISA and How Does It Affect Long-Term Disability Claims? ERISA governs most private sector employer-provided insurance plans, including long-term disability (“LTD”) insurance. ERISA litigation involving LTD benefits typically revolves around whether insurance companies unjustly deny or terminate LTD benefits. At The Garner Firm, Ltd., we represent individuals fighting to secure their rightful ERISA benefits. ## Rule 56 vs. Rule 52: What’s the Difference? The distinction between Rule 56 and Rule 52 is crucial in ERISA litigation. Rule 56 addresses summary judgment, where courts resolve cases without trial if no genuine dispute exists over material facts. Conversely, Rule 52 pertains to bench trials, requiring courts to provide detailed findings of fact and conclusions of law following a trial without a jury. In *Routten*, the plaintiff sought a bench trial under Rule 52. However, the Court chose summary judgment under Rule 56 because the insurance plan explicitly granted discretionary authority to the insurer. When an ERISA plan gives such discretion, the Court reviews the insurer’s decisions under an “abuse of discretion” standard rather than a “de novo” review. Most Courts, including the *Routen* court resolve ERISA benefits claims involving the abuse of discretion standard of review using summary judgment. ## Abuse of Discretion Standard in ERISA Litigation Under the abuse of discretion standard, courts defer significantly to insurers’ decisions. The decision will not be overturned unless found unreasonable, even if the court might have reached a different conclusion independently. This standard can make challenging LTD insurance denials particularly difficult without experienced ERISA legal counsel. In **Routten**, the insurance company denied long-term disability benefits based on two provisions: 1. **Pre-existing Condition Limitation:** The insurer determined the plaintiff’s multiple sclerosis treatment fell within the plan’s pre-existing condition exclusion period. 2. **Claimant Cooperation Provision:** The plaintiff refused to provide further medical documentation, thereby violating the cooperation requirements under the plan. ## Why the Court Applied Rule 56 and Granted Summary Judgment Applying Rule 56, the Court found the insurer’s denial of LTD benefits reasonable and supported by substantial evidence due to the plaintiff’s non-cooperation. Specifically, the Court highlighted the insurer’s efforts to request and review relevant medical records and documentation from the plaintiff. The plaintiff’s refusal to comply halted the insurer’s investigation, which the Court found justified the denial. This case underscores the importance of understanding plan requirements thoroughly and reasonably cooperating with insurers during the long-term disability claims process. Failure to do so can provide insurers with grounds to deny legitimate LTD benefits claims under ERISA. ## Implications for Claimants Seeking ERISA LTD Benefits The **Routten** decision highlights critical lessons for ERISA LTD claimants: - **Understand Your Plan:** ERISA litigation outcomes heavily depend on the specific language of your plan documents. - **Cooperate Reasonably:** Comply promptly with all reasonable insurer requests. Non-cooperation can jeopardize your claim. - **Seek Skilled ERISA Counsel Early:** Navigating these claims and procedural intricacies is significantly easier and more effective with experienced ERISA attorneys. At The Garner Firm, Ltd., we understand the nuances of long-term disability litigation, generally, and ERISA litigation, specifically, and how procedural rules like Rule 56 can affect your claim. Our experienced LTD attorneys are dedicated to fighting for your rightful LTD benefits. ## How The Garner Firm, Ltd. Can Help with Your ERISA Benefits Claim If you’re facing challenges securing your long-term disability benefits under an ERISA plan, don’t navigate these complexities alone. The Garner Firm, Ltd. is here to provide expert guidance, ensuring your rights are protected every step of the way. Our team’s knowledge and experience in ERISA litigation helps clients effectively challenge unfair denials and secure the benefits they deserve. For a consultation on your ERISA litigation concerns, especially regarding long-term disability claims, [contact The Garner Firm, Ltd. today](https://www.garnerltd.com/contact/). We are committed to advocating fiercely on behalf of our clients, ensuring insurance companies uphold their obligations. **Keywords:** ERISA, ERISA litigation, long-term disability, LTD, ERISA benefits, long-term disability claim **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Long Term Disability **Tags:** Disability Benefits, disability benefits attorney, ERISA, ERISA benefits, erisa litigation, long term disability attorney, long-term disability, long-term disability claim, LTD --- ### [Court Reverses Benefit Denial in ERISA Mental Health Benefits Case](https://www.garnerltd.com/court-reverses-benefit-denial-in-erisa-mental-health-benefits-case/) **Published:** March 14, 2025 **Author:** Adam Garner **Content:** ## Understanding the Recent Decision in H.A. v. Tufts Health Plan At The Garner Firm, Ltd., we specialize in representing plaintiffs in ERISA litigation, fighting tirelessly to ensure our clients receive the benefits they deserve. A recent federal court decision in the case of *[H.A. v. Tufts Health Plan](https://www.govinfo.gov/content/pkg/USCOURTS-utd-2_22-cv-00476/pdf/USCOURTS-utd-2_22-cv-00476-0.pdf)*, which was handled by friend of the firm and frequent collaborator [Brian S. King](https://www.erisa-claims.com/bio/brian-s-king.cfm), sheds important light on how courts handle disputes over mental health treatment under ERISA plans. This important decision highlights significant issues in how insurance companies handle ERISA benefits claims, particularly for mental health treatment, and why legal representation is crucial in challenging unfair denials. ## Case Background: Mental Health Treatment Denial This ERISA litigation arose when Tufts Health Plan and its claims administrator, Cigna Behavioral Health, denied coverage for residential mental health treatment provided to a beneficiary, M.A., at Fulshear Ranch Academy. Despite M.A.’s serious mental health diagnoses, including borderline personality disorder and severe anxiety disorders, the insurance plan authorized coverage for only fourteen days of treatment, claiming further treatment was not “medically necessary.” Initially, Cigna authorized treatment for just two weeks, from July 22, 2020, to August 4, 2020. However, M.A.’s condition clearly necessitated continued care. When Plaintiffs sought additional coverage, Cigna denied benefits from August 5, 2020 onward, claiming M.A. no longer met their medical necessity criteria. ## The Legal Standards Under ERISA The Employee Retirement Income Security Act (ERISA) governs employer-sponsored health insurance plans. Under ERISA, insurers must provide coverage if treatment is deemed “medically necessary.” When claims administrators deny benefits, they must clearly communicate the reasons and give plan participants a “full and fair review.” ERISA litigation frequently involves disputes over whether insurance companies properly applied their own medical necessity guidelines. The court, in H.A. v. Tufts Health Plan, analyzed whether Cigna properly interpreted and applied the terms of its ERISA plan when denying residential treatment coverage. ## Court’s Analysis: Arbitrary and Capricious Denial of ERISA Benefits One major issue addressed by the court was whether Cigna had acted arbitrarily by applying criteria intended for acute inpatient care to residential mental health treatment, which is considered subacute under the plan terms. The court found: - Incorrect Criteria Application: Cigna incorrectly applied acute inpatient treatment criteria, which requires imminent risk of harm, to deny coverage for residential treatment—considered subacute under the ERISA plan. The court emphasized that residential treatment should focus on stabilization and reintegration into the community, not solely immediate danger. - Cigna incorrectly required evidence of threats of harm or acute psychiatric crisis—criteria that do not apply to subacute residential treatment. - The court found this misapplication was inconsistent with the ERISA plan’s clear definitions and thus arbitrary and capricious. ## The Importance of Medical Necessity Criteria in ERISA Cases This decision highlights an essential element of ERISA litigation: the critical importance of proper plan interpretation. Insurance companies frequently deny ERISA benefits by misapplying medical necessity guidelines or other benefit plan provisions. This case underscores that insurance plans must fairly interpret and apply the criteria explicitly stated in their ERISA plans. ## Why This ERISA Litigation Victory Matters This judicial decision is significant for ERISA beneficiaries struggling to obtain mental health treatment. Courts are increasingly scrutinizing insurers’ denial decisions, as they should, to ensure fair and proper application of plan terms. In H.A. v. Tufts Health Plan, the court’s reversal serves as a critical message: insurance providers cannot arbitrarily deny claims by applying stricter acute care criteria to subacute residential treatments. Our firm sees this decision as an important precedent that can be leveraged in future ERISA litigation to protect mental health treatment coverage. ## The Remedy Ordered by the Court The court reversed Cigna’s denial and remanded the case, ordering a renewed evaluation under the correct subacute residential treatment criteria. The decision ensures that insurance administrators must clearly justify their coverage determinations and explicitly connect their decisions to the proper plan terms. Additionally, the court awarded attorney’s fees and costs to the Plaintiffs, highlighting accountability and deterring arbitrary denials in ERISA litigation. ## Takeaways for ERISA Beneficiaries If you’ve had your claim for ERISA benefits denied—especially for mental health or substance abuse treatment—it’s important to recognize that you have legal options. Insurance companies must strictly follow their plan guidelines and ERISA regulations when determining coverage. Misinterpretation or misapplication of these guidelines can be challenged in court. The H.A. v. Tufts decision highlights: - Your right to a fair and accurate review process. - The necessity for insurers to use appropriate criteria when evaluating medical necessity. - The ability to challenge improper benefit denials successfully through ERISA litigation. ## How The Garner Firm, Ltd. Can Help At The Garner Firm, Ltd., we have extensive experience in [ERISA litigation](https://www.garnerltd.com/practice-areas/erisa-litigation/). We advocate aggressively for clients facing unjust denials of their ERISA benefits. If your ERISA benefits have been unfairly denied, we will thoroughly review your case, challenge the denial, and work diligently to secure the coverage you deserve. ## Conclusion The decision in *H.A. v. Tufts Health Plan* represents a major victory for ERISA beneficiaries. It reinforces that insurers must not arbitrarily deny coverage by misapplying their own medical necessity standards. Beneficiaries who face similar wrongful denials of ERISA benefits now have stronger legal standing to contest improper denials. For more information on ERISA litigation or to schedule a consultation regarding denial of ERISA benefits, [contact](https://www.garnerltd.com/contact/) The Garner Firm, Ltd. today. We stand ready to help you fight for the coverage you deserve. **Keywords:** ERISA, ERISA Litigation, ERISA benefits, Mental Health Treatment, Residential Treatment, ERISA plan, insurance denial, medical necessity, ERISA benefits denial, litigation **Categories:** (ERISA) Litigation, Health Insurance **Tags:** ERISA, erisa attorney, ERISA benefits, ERISA benefits denial, ERISA lawyer, erisa litigation, health insurance, insurance denial, Mental Health Parity, Mental Health Treatment, MHPAEA --- ### [Thanksgiving](https://www.garnerltd.com/thanksgiving/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Tomorrow is Thanksgiving. I have been thinking about it a lot this year. The trajectory of our lives seldom follows a straight line. The ups and downs in life are a given, but how we respond to them is not. If, for example, you have been [denied a promotion](https://www.garnerltd.com/employment-discrimination/) because of your race or gender, or if you have been denied [long term disability benefits](https://www.garnerltd.com/disability-benefits-lawyer/) even though you clearly cannot work, you could choose to accept that treatment and try to move on with your life. On the other hand, you could choose to stand up for yourself, for your family, and fight the wrongful treatment levied upon you. (I am happy to see if we can help you with that fight.) > ## “We must find time to stop and thank the people who make a difference in our lives.” > > **— JOHN F. KENNEDY** When you stand up for yourself, you take a chance. You may win, you may not. Regardless of the outcome, however, you have tried to change your life for the better. You can thank yourself for trying to effect positive change in your life, but do not stop there. Whether you initially realize it or not, you can seldom attempt to change your life for the better by yourself. Usually effecting positive change in our lives takes the support and guidance of friends, colleagues, and sometimes strangers. Think about the people who have helped you and thank them. This year, I have quite a bit to be thankful for. I am thankful for my health. I am thankful for my incredibly supportive [wife](http://www.lockslaw.com/team/melanie-j-garner/) and parents, my friends, my colleagues, and my dogs. Each has helped me in immeasurable ways in the last year, perhaps in some ways they do not even realize. Most importantly, I am thankful for having the opportunity to do [work](https://www.garnerltd.com/services/) I love, find interesting, and which hopefully makes a positive difference in the lives of others. **I do not know about you, but I am a lucky and thankful man.** **Categories:** Employment Discrimination --- ### [Understanding Your Retirement Plan Information](https://www.garnerltd.com/understanding-your-retirement-plan-information/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** Millions of Americans participate in employer-sponsored retirement plans, though many people know little about their plans or their rights under the law. When individuals work for a private sector employer, these plans are almost always governed by the [Employee Retirement Income Security Act of 1974 (ERISA)](https://www.dol.gov/general/topic/health-plans/erisa), which is a federal law that purports to protect the rights of employee-plan participants and beneficiaries. However, knowing your rights and how to protect them can be complicated, and you should never hesitate to seek help from a [Philadelphia ERISA retirement plan lawyer](https://www.garnerltd.com/attorney-profiles/) who can help you understand what you are entitled to. ![photo of man and woman reviewing retirement plan information](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_129406490-1024x683.jpg "photo of man and woman reviewing retirement plan information - The Garner Firm") ### Types of Plans There are different types of [ERISA](https://www.garnerltd.com/practice-areas/erisa-litigation/) retirement plans, and you should know what type of plan or plans you are enrolled in. These might include: - Defined benefit plan - Defined contribution plan There are several types of defined contribution plans, as well, and you should be familiar with the details of yours. Some details that are important include: - Does your employer make contributions or match contributions? - Do you have to contribute to participate in a plan? - Who manages the plan funds? Do you play a role in managing this investment? - What type of benefits will you receive when you retire and how much? - Are you guaranteed benefits from the federal government? - What happens if you leave the company prior to retirement? If you understand the answers to these questions now, you will have a much better idea of what to expect when it comes time to start receiving benefits under your retirement plan. ### Review Your Plan Information You can request more information about your company’s offerings from the plan administrator or human resources representative. You should always have access to the formal plan document, as well as the Summary Plan Description (SPD). The SPD is a booklet that aims to explain the plan in a manner that is easy to understand. You should also receive notices if the plan changes, as well as have access to the annual financial report of your plan. ### Why Stay Informed? It might seem easiest to simply let your retirement plan carry on without giving it much concern or staying apprised of the details. However, knowing the ins and outs of your retirement plan helps you protect your rights under ERISA. These rights include proper management of the plan (when applicable), receiving notices when required by law, and receiving the full benefits you deserve. If you believe that your rights under the law might be violated due to improper plan management or benefit disbursements, you should speak with an ERISA lawyer who can determine whether you should take legal action. The better you understand your retirement plan, the more likely you are to recognize possible ERISA violations and that you need legal assistance. ### Consult with a Philadelphia ERISA Retirement Plan Claims Attorney Today The Garner Firm, Ltd. helps clients protect their rights under ERISA regarding employer-sponsored retirement and insurance plans. If you have any questions or concerns about retirement benefits, do not hesitate to [contact us](https://www.garnerltd.com/contact/) today for assistance. **Categories:** (ERISA) Litigation **Tags:** benefit plan, ERISA, erisa litigation, retirement, retirement plan --- ### [Are You Protected by ERISA?](https://www.garnerltd.com/are-you-protected-by-erisa/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** The [Employee Retirement Income Security Act](https://www.dol.gov/general/topic/retirement/erisa) of 1974, or ERISA, is a federal law that is intended to protect certain employees’ rights regarding employment benefits, including retirement benefits and certain employer-sponsored insurance coverage. Employees can suffer significant harm if an employer, benefit plan fiduciary, or insurance company mishandles funds or does not apply insurance coverage fairly, and ERISA aims to prevent such harm. Not every employee benefit plan is regulated by ERISA, however. Most governmental employees, both state and federal, are not protected by ERISA. Likewise, many employees who work for religiously affiliated organizations, such as churches or hospitals with religious affiliations, are not covered by ERISA. When it comes to your own benefits, it can be difficult to know what to do if you believe your employer or insurer is acting wrongfully. It is important to consult with an [experienced ERISA employee benefits attorney](/attorney-profile/) in Philadelphia about your rights. Do not hesitate to contact The Garner Firm, Ltd. for more information today. ![photo of man and woman reviewing ERISA policy](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_162076920-300x200.jpg "photo of man and woman reviewing ERISA policy - The Garner Firm") ### Employers that Must Comply with ERISA Simply put, ERISA applies to most employers that conduct business in the private sector and offer insurance plans and retirement plans to employees. These can include corporations, limited liability companies (LLCs), and even partnerships and sole proprietorships. Non-profit corporations and charitable companies can also be regulated by ERISA. Companies do not have to employ hundreds of people to be covered, as the law can apply even with only a few employees. **See Also: [ERISA Frequently Asked Questions](/erisa-faqs/ "ERISA Frequently Asked Questions")** If you work for a private employer that offers benefits plans, and you participate in one or more benefit plans, you are likely protected by ERISA. The following are plans that might fall under ERISA: - Defined-benefit retirement plans - Defined-contribution retirement plans - 401(k) plans - Deferred-compensation plans - Profit-sharing plans - Pension plans - [Long-term disability insurance](/practice-areas/disability-benefits-lawyer/) - [Life insurance](https://www.garnerltd.com/practice-areas/life-insurance/) - [Accidental death and dismemberment insurance](/practice-areas/accidental-death-dismemberment-benefits/) - Health insurance - Dental insurance - Health reimbursement accounts - Flex spending accounts - [Severance plans](/practice-areas/severance-benefits/) - Vacation plans - Housing assistance plans - Welfare benefit plans - Scholarship plans ### When ERISA does not Govern Your Benefit Plans As noted above, ERISA generally does not regulate plans provided by public government employers or churches with employees. In addition, even if ERISA applies to your private employer, it will not regulate all types of benefits. For example, ERISA does not apply to the following: - Non-funded excess benefit plans - IRAs - Plans solely to comply with workers’ compensation laws - Plans for non-resident aliens - Certain “payroll practices,” including some short-term salary continuation programs ### Know Your Rights When it comes to your retirement and insurance benefits provided by your employer, it is important to understand your rights under the law. If you believe your employer is not in compliance with ERISA or you have not received the benefits you deserve, the law gives you the right to take action. ERISA is a complex statute, and it can be difficult to decipher the best course of action. You should never wait to discuss any concerns with a Philadelphia ERISA lawyer who can protect your rights. ### Contact a Philadelphia ERISA Attorney for More Information about Your Rights At The Garner Firm, Ltd., we handle complicated cases involving ERISA and other insurance claims. We can assist you in identifying noncompliance on the part of your employer, as well as taking the necessary legal action. [Contact us](https://www.garnerltd.com/contact/) if you would like to consult with an experienced ERISA attorney in Pennsylvania, Philadelphia, the Delaware Valley, Maryland, and New Jersey. **Categories:** (ERISA) Litigation, Disability Benefits **Tags:** ERISA, erisa claim, ERISA lawyer --- ### [Another ERISA Breach of Fiduciary Duty Claim Based on a Material Misrepresentation Survives a Motion to Dismiss](https://www.garnerltd.com/another-erisa-breach-of-fiduciary-duty-claim-based-on-a-material-misrepresentation-survives-a-motion-to-dismiss/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Following up on [my recent blog post about an interesting breach of fiduciary case in Louisiana](https://www.garnerltd.com/blog/2016/12/16/the-beginning-of-an-interesting-post-amara-erisa-case-in-louisiana), on December 29, 2016, the U.S. District Court for the District of Maryland partially denied a motion to dismiss seeking the dismissal of an ERISA breach of fiduciary duty claim brought by a plan participant as result of a material misrepresentation. See *Damiano v. Inst. for in Vitro Scis.*, No. PX 16-0920, 2016 U.S. Dist. LEXIS 179595 (D. Md. December 29, 2016). A copy of the court’s decision is available [here](https://www.garnerltd.com/wp-content/uploads/2017/10/DamianovInstforinVitroScis.pdf). ![photo of liberty bell in philadelphia, location of erisa attorney adam garner](https://www.garnerltd.com/wp-content/uploads/2023/11/liberty-bell-erisa-lawyer-philadelphia.webp "liberty-bell-erisa-lawyer-philadelphia - The Garner Firm") Damiano was employed by the Institute for in Vitro Sciences (“IIVS”) as an Accounting Assistant/HR Coordinator. IIVS sponsored multiple ERISA-regulated employee welfare benefit plans that included a group health plan with dental benefits (“the Dental Plan”) and group long-term (“LTD”) and short-term disability insurance plans (“STD,” and together “Disability Plans”) for its employees. The Complaint alleges that Paychex Insurance Agency, Inc. is a service provider and, as agent for Paychex, Inc., administered the insurance benefits of the IIVS health plan and Disability Plans. On September 9, 2015, IIVS terminated Damiano’s employment and presented her with a letter containing a severance package (the “Termination Letter”). The Termination Letter states that the severance package includes “continuation of current health and disability insurance benefits paid in full by IIVS, through October 31, 2015.” IIVS consulted with Paychex and received written confirmation that coverage could be continued as described in Damiano’s Termination Letter under the terms of the Disability Plans in existence at the time the promise was made to her. On September 16, 2015 and September 28, 2015, Damiano scheduled and received dental treatment. Damiano was initially approved for coverage associated with her September 16, 2015 dental work, but it was subsequently rescinded. She was then denied coverage outright for her September 28, 2015 dental work. As a result, she was liable for dental expenses for both procedures. Moreover, on October 3, 2015, Damiano had to be hospitalized and undergo emergency brain surgery. On October 8, 2015, Paychex sent Damiano a COBRA notice notifying her that her coverage under IIVS’ group health plan would end on October 31, 2015, as set forth in the Termination Letter. Then, however, Paychex sent a second COBRA notice, dated October 23, 2015 that stated that her group health plan coverage ended on September 9, 2015, the day she was terminated. After her surgery but prior to October 31, 2015, Damiano contacted IIVS seeking benefits under the Disability Plans. IIVS then informed her that she was not eligible for disability benefits under the Disability Plans because, contrary to the terms of the Termination Letter and the October 8, 2015 COBRA notice, she was no longer a participant in the Disability plans due to her termination. On March 28, 2016, Damiano filed suit seeking, among other things, equitable relief under ERISA § 502(a)(3), 29 U.S.C. 1132(a)(3). The defendants sought to dismiss the case in its entirety. The court granted a portion of the motion that dealt with certain state law claims as being subject to ERISA preemption. *See*29 U.S.C. § 1144. The court denied, however, that portion of the motion seeking dismissal of the equitable relief claim. The equitable relief claim asserted that IIVS and Paychex breached their fiduciary duty to Plaintiff by representing in the Termination Letter and October 8th COBRA notice that she would receive coverage under the Disability Plans and Dental Plan after her termination. The Court held that Damiano adequately pled the elements of a breach of fiduciary duty claim under ERISA § 502(a)(3), 29 U.S.C.§1132(a)(3). Specifically, Damiano alleged that both IIVS and Paychex were plan fiduciaries with IIVS alleged to be the plan administrator Paychex Insurance Agency, Inc. a service provider who administered and adjudicated claims under the plans. She adequately alleged that the defendants conveyed material misrepresentations that her health insurance coverage would continue to through October 31, 2015. She also alleged that she relied on the misrepresentation that her employment benefits, including dental insurance, would continue until October 31, 2015 and thus refrained from arranging for alternative coverage and underwent emergency brain surgery after suffering a stroke and sought coverage under the Disability Plans for benefits she believed she was eligible to receive. The court recognized that the complaint seeks redress for Damiano’s damages arising out of the defendants’ material misrepresentations as to when her coverage under the plan would terminate. It noted that “\[n\]o provision of ERISA allows a fiduciary to abrogate its ‘unyielding duty of loyalty’ – and the consequential duty not to make material misstatements or omissions – based on such a general right.” (Citations omitted). The defendants’ alleged misinformation resulted in Damiano being without insurance benefits and not by choice. Damiano did not know that she did not have dental insurance, short-term disability coverage, and long term disability coverage because she relied on the alleged misrepresentations in the Termination Letter. Thus, she did not pursue alternate coverage to her detriment. The claim therefore survived the motion to dismiss. Damiano’s claim, and the plaintiff’s claim in *Lauga v. Applied-Cleveland Holdings*, Case No. 16-14022 SECTION: “H”(3), 2016 U.S. Dist. LEXIS 173464 (E.D. La. December 15, 2016), which was referenced in my [December 16 post](https://www.garnerltd.com/blog/2016/12/16/the-beginning-of-an-interesting-post-amara-erisa-case-in-louisiana), would have been difficult to pursue prior to the Supreme Court’s decision in *CIGNA Corp. v. Amara*, 563 U.S. 421, 440 (2011). Now, however, some ERISA plan participants potentially have better options for seeking redress because of plan fiduciaries’ bad behavior. Like *Lauga*, it will be interesting to see how *Damiano* progresses through the courts. **Categories:** Severance Agreements --- ### [5 Things to Know About Disability Insurance Claims](https://www.garnerltd.com/5-things-to-know-about-disability-insurance-claims/) **Published:** January 2, 2023 **Author:** The Garner Firm **Excerpt:** If you are sick or have been injured and have a long-term disability policy, you may be able to receive benefits under your policy. **Content:** If you are sick or have been injured and have a long-term disability policy, you may be able to receive benefits under your policy. In the U.S., if the policy was provided through your job with a private-sector employer, these disability policies are almost always governed by a law called [ERISA](https://www.dol.gov/general/topic/retirement/erisa#:~:text=The%20Employee%20Retirement%20Income%20Security,for%20individuals%20in%20these%20plans.). Before you file your claim, you should understand these five things both about your individual policy and the law. ![photo of woman with neck brace as it relates to erisa and long-term disability claims](https://www.garnerltd.com/wp-content/uploads/2023/11/woman-with-neck-brace-long-term-disability-claim-600px.webp "woman-with-neck-brace-long-term-disability-claim-600px - The Garner Firm") ### A “Disability” Is Not the Same for Each Policy You would receive benefits when you have a disability, but each policy may define the word “disability” differently. Some may have a more expansive definition than others. For instance, some policies may require you to be unable to do any work, while other policies may give you benefits if you are unable to perform your own job. Make sure that you closely read the terms of your own policy before you file a claim. ### Your Benefits May Be Taxable Whether your disability policy benefits are subject to federal and state taxes depends on the type of plan that you have. Usually, benefits through your employer come out of pre-tax dollars, and the benefits are taxable. However, if you buy a disability plan on your own from after-tax dollars, your benefits may be tax-free. ### Someone May Be Watching You If you feel like someone else is following you after you filed for your claim, it could be because the insurance company has hired an investigator to verify that you are actually disabled. There is even more of a chance that an investigator may be tailing you if you are claiming based on a [disability](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) that is not easily proven through medical evidence. ### The “No” Is Not Final It is a fact of life that insurance companies deny claims. They will be the ones making the initial decision whether your claim is approved. However, you have the right to appeal the denial internally to a higher level within the company. If the answer is still a denial, you can file a lawsuit in court, and a judge will make the final decision about your benefits based on the record of your claim. ### Your Medical Records Will Carry the Most Weight Once you file a claim, your insurance company is going to ask your physician for your medical records. They will also give your doctor forms to complete and will request their opinion about whether you are disabled. It is critical that the file that your physician sends is as complete as possible. If the denial ever went to a judge, the judge may only decide the claim based on the record that the insurance company considered. ### Philadelphia Long-Term Disability Insurance Attorneys Contact the [Philadelphia long-term disability insurance attorneys](https://www.garnerltd.com/attorney-profiles/) at the Garner Firm for help with both filing your disability claim or appealing a denial. [Contact us](https://www.garnerltd.com/contact/) to set up your free initial consultation to learn how we can help you as you file for the benefits that you need. **Categories:** Disability Benefits, Long Term Disability **Tags:** disability, disability claims, long term disability, LTD --- ### [Understanding ERISA Fiduciary Insurance](https://www.garnerltd.com/understanding-erisa-fiduciary-insurance/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** [ERISA](https://www.law.cornell.edu/wex/erisa#:~:text=The%20Employee%20Retirement%20Income%20Security,management%20of%20such%20pension%20plans.) assigns the “highest duty known to law” when a company manages an employee benefits program. This means that companies assume fiduciary duties to their employees when operating employee benefit plans. From a legal standpoint, this means that they have certain obligations that they must meet. Otherwise, the employee may sue them for a breach of their [fiduciary duty](https://www.law.cornell.edu/wex/fiduciary_duty). Employers often carry fiduciary insurance that could cover them in the event of a lawsuit filed by a [Pennsylvania ERISA attorney](https://www.garnerltd.com/attorney-profiles/). ![photo of gavel relating to ERISA fiduciary insurance legal claims](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_335125530geo-scaled-1-1024x683.jpg "photo of gavel relating to ERISA fiduciary insurance - The Garner Firm") ### How a Company Can Breach Fiduciary Duties There are numerous ways that a fiduciary could breach their duty to a plan. They include: - Improper investing - Self-dealing - Failure to pay benefits - Conflicts of interest Employers can be legally responsible for the errors of their [employers](https://www.garnerltd.com/practice-areas/labor-and-employment/) and their agents. If they hire a company to administer their plan, that business is their agent, and they are liable for their acts. In addition to the acts described above, employers can be held responsible if they make any kind of error in administering the plan. This includes situations where they prematurely terminate an employee from coverage, resulting in incorrect or lost benefits. Employers can even be made to pay when they make an error in counseling employees about their health benefits. The range of possibilities where something can go wrong makes it too risky not to have this insurance. Companies never know when an inexperienced or incompetent employee can put them at risk for a large liability. One area where beneficiaries often sue companies is in 401(k) plan investing and fees. Numerous employers have lost lawsuits that have found them liable for millions of dollars of damages. Employee benefit plans can also be sued in civil enforcement actions by the Department of Labor. ### Who Needs Fiduciary Insurance Fiduciary insurance is a good idea for: - The plan sponsor - The plan itself - Third parties who act as fiduciaries If you are a current or former employee who has suffered damages from the negligence or wrongdoing of a company, you may be entitled to financial compensation under the law no matter what. Without fiduciary insurance, the money would come out of the company’s own assets or accounts. They would need to reimburse employees regardless of whether they have a fiduciary insurance policy. Companies can either obtain fiduciary insurance as standalone coverage or as part of other types of management liability policies. The important thing is that they have insurance when a claim is made. When that happens, the insurance company will manage the defense of the claim and decide whether it is covered by the policy. Nonetheless, even if it is not covered, that does not mean that the employer is off the hook when their employee files a lawsuit. Your legal rights remain the same regardless of what the company does. ### Contact an ERISA Disability Attorney At The Garner Firm, we fight for your employee benefits. If your employer made an error or otherwise breached their fiduciary duty, you can file a lawsuit. Contact us [online](https://www.garnerltd.com/contact/) to set up your free initial consultation. **Categories:** (ERISA) Litigation, Employee Benefits **Tags:** ERISA, erisa attorney, erisa litigation --- ### [Fifth Circuit Upholds Judgment in Favor of Long Term Disability Claimant](https://www.garnerltd.com/fifth-circuit-upholds-judgment-in-favor-of-long-term-disability-claimant/) **Published:** January 2, 2023 **Author:** Adam Garner **Excerpt:** The United States District Court for the Southern District of Mississippi correctly held that United of Omaha arbitrarily and capriciously denied the plaintiff long term disability benefits under her employer's LTD plan. **Content:** Earlier today, the United States Court of Appeals for the Fifth Circuit issued a decision in *Smith v. United of Omaha Life Ins. Company,* Case No. 18-60753 (5th Cir. June 11, 2019) in which it held that the United States District Court for the Southern District of Mississippi correctly held that United of Omaha arbitrarily and capriciously denied the plaintiff long term disability (“LTD”) benefits under her employer’s LTD plan, which was governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, *et seq*. (“ERISA”). A copy of the Court’s opinion can be found [here](https://www.garnerltd.com/wp-content/uploads/2019/06/Smith-v-United-of-Omaha-Opinion.pdf). The *Smith* plaintiff was hired on February 6, 2016, as a property manager for a local apartment complex. As a benefit of her employment, she participated in an ERISA-regulated long term disability plan her employer sponsored and which United of Omaha insured. Her coverage under the LTD plan became effective March 1, 2016. The insurance policy funding benefits under the LTD plan contains an exclusion for certain preexisting conditions. It states as follows: We will not provide benefits for Disability: (a) caused by, contributed to by, or resulting from a Pre-existing Condition; and (b) which begins in the first 12 months after You are continuously insured under this Policy A Pre-existing Condition means any Injury or Sickness for which You received medical treatment, advice or consultation, care or services including diagnostic measures, or had drugs or medicines prescribed or taken in the 3 months prior to the day You become insured under this Policy. Three months after the effective date of her coverage, the plaintiff was diagnosed with metastatic ovarian cancer. She underwent surgery and chemotherapy. She applied and was approved for short-term disability (“STD”) benefits for a period of twenty-six weeks. Her claim for LTD benefits, however, was denied under the preexisting condition exclusion referenced above. She appealed that determination under the LTD plan’s appeal procedures. Her internal appeal was denied. The plaintiff filed a lawsuit against United of Omaha under Section 502(a)(1)(B) of the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 *et seq*. challenging the denial of her LTD benefits. After both parties filed cross-motions for summary judgment, the district court entered summary judgment in favor of the plaintiff. United of Omaha appealed, and the U.S. Court of Appeals affirmed the decision in favor of the plaintiff. The Fifth Circuit upheld the entry of judgment in favor of the plaintiff. It noted that the insurer acknowledged that she was not diagnosed with metastatic ovarian cancer until June 1, 2016, three months after the pre-existing condition exclusion period, or “look-back” period, had ended. Nonetheless, United of Omaha contended that her claim was properly denied because the plaintiff had received treatment during the look-back period for a symptom of the ovarian cancer. In response, the plaintiff argued that the symptom of the cancer did not cause her disability. The cancer caused her disability. The Fifth Circuit agreed. Because the cancer is the condition that caused the plaintiff’s disability, it had to be the condition for which she must have received treatment, care, or services to trigger the pre-existing condition exclusion. The Court further noted that although the plaintiff’s cancer caused the symptom for which she received treatment during the look back period, those symptoms could have been caused by conditions other than her ovarian cancer. The symptoms were non-specific to ovarian cancer and the medical records did not indicate that the plaintiff’s medical providers believed at the time that the symptoms were the consequence of metastatic ovarian cancer. Thus, the Court held, the insurer could not “reasonably have concluded that she received treatment ‘for’ metastatic ovarian cancer during the look-back period.” The insurer’s contrary conclusions were held to be arbitrary and capricious. **Categories:** (ERISA) Litigation, Disability Benefits **Tags:** 1132(a), 29 U.S.C. 1132(a), 502(a), benefits claims, denied claims, disability, disability attorney, Disability Benefits, disability claim, disability lawyer, employee benefits, ERISA, ERISA Section 502(a), long term disability, long term disability attorney, LTD, united of omaha --- ### [How to Document a Mental Health Disability](https://www.garnerltd.com/how-to-document-a-mental-health-disability/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Properly documenting a disability is critical to receiving the benefits you deserve. However, documenting a mental health disability is often harder than a physical one. You might find that you have not collected sufficient evidence to convince your insurance carrier that you qualify for benefits. To help your case, follow these tips. ### Meet with a Doctor A doctor should make a diagnosis and include it in your medical records, which are important first steps. Without an official diagnosis, you will not be successful at claiming a mental health disability. In your medical records, your doctor should also note the treatment, such as: ![photo illustration about mental health disability](https://www.garnerltd.com/wp-content/uploads/2023/01/Fotolia_64564172_Subscription_Monthly_M-1024x362.jpg "Diverse Hands Holding The Words Mental Health - The Garner Firm") - Medication - Behavioral therapy - Group counseling - Other options You should meet regularly with your doctor to discuss how your treatment is progressing. Your doctor should keep detailed notes about your continuing difficulties in managing your mental health problems. If you did not find your initial doctor helpful, then be sure to seek a second opinion. Doctors sometimes disagree about whether your disorder qualifies as a mental health disability, and you should not treat the first doctor’s opinion as definitive. ### Document How the Disability Affects Your Life Typically, you will not receive [disability benefits](https://www.garnerltd.com/) simply because you have a mental health disorder. Instead, the disorder must negatively impact your ability to do your job. Each mental health disability manifests itself in different ways. For example,[ anxiety disorders](https://www.webmd.com/anxiety-panic/guide/anxiety-disorders) might render a person unable to leave home. In that situation, you will want to keep a careful record of the dates in which you could not go to work. If you had disabling panic attacks, note the dates and times as well. Other disabilities, such as personality disorders, might frustrate a person’s ability to communicate with other people. You can help your case by noting in detail how the disorder negatively impacts your ability to work. ### Ask for Help Documenting the Disability Another reason it is so difficult to document mental health disabilities is that the underlying disorder might frustrate a person’s ability to plan and think logically. As a result, the person cannot carefully gather evidence of the disability—impeding his or her ability to collect important benefits. Many people reading this article might be concerned family members who want to assist a loved one in applying for[ long term disability](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) benefits. If so, it might be up to you to collect the necessary evidence, such as finding copies of medical records and keeping track of important episodes. As an important witness, you can also document how your loved one has withdrawn from other people, which might be helpful when making a disability claim. If you need assistance, you should contact an experienced employee benefits attorneys who will help you collect the evidence you need. ### Speak with a Disability Lawyer in Philadelphia Mental health disabilities are every bit as serious as physical ones. Unfortunately, they pose unique challenges to obtaining disability benefits. At The Garner Firm, we have helped countless people access the disability benefits they deserve. We can help you make an initial claim or bring an appeal for benefits, but you need to act fast. To schedule your free consultation, please call 215-645-5955 or submit an[ online message](https://www.garnerltd.com/contact/). **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Long Term Disability **Tags:** disability, disability lawyer, long term disability, LTD --- ### [Do I Need to Attend an Independent Medical Exam?](https://www.garnerltd.com/do-i-need-to-attend-an-independent-medical-exam/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** After an employee makes a[ long term disability claim](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/), the insurance company often requests an independent medical exam (IME). During the IME, you will be examined by a doctor chosen by the insurance company. If this sounds a little suspicious, you are right for being skeptical. Often, insurers use IMEs to deny disability benefits by having their doctor minimize your disability. Read on for more information about how to handle your IME. ![photo of Stethoscope on wood with long term care](https://www.garnerltd.com/wp-content/uploads/2023/01/Fotolia_142646291_Subscription_Monthly_M-1024x678.jpg "Stethoscope on wood with long term care word as medical concept. - The Garner Firm") ### Why Insurers Like IMEs An IME gives an insurance company a chance to dispute that you are sufficiently injured to qualify for long term disability benefits. Furthermore, by picking the doctor, the insurance company can send you to someone they know will issue a medical report unfavorable to you. Admittedly, in a few situations, your medical condition might be so complicated that insurance companies really want to fully understand what is wrong with you. However, in a large fraction of cases, the insurer simply does not like the prognosis your own doctor has given and wants an opinion that lets them deny you benefits. ### You Have to Attend Most insurance policies contain a clause giving the insurer the right to terminate the policy if you refuse the independent medical exam. However, you should certainly double check your policy. It might also contain important information about your obligations during the IME, which you also must follow. If you do not have a copy of your policy, contact the plan administrator to obtain one. ### You Will be Filmed There is a good chance that the insurance company will hire a private investigator to film you in the days before and after your IME. These investigators are gathering evidence to use against you. For example, if you claim that you can barely leave bed but are filmed playing with your children outside, then the insurance company has a legitimate reason to deny you benefits. However, [injured employees](https://www.garnerltd.com/practice-areas/long-term-care-claims/) should realize that these tapes will be used selectively. You might struggle to get to the end of your driveway to pick up your mail, but the insurance company will use a two-second clip that makes it look like you move with ease. Be careful about being seen outside in the days before and after your examination. ### Prepare Properly If you must attend your IME, then you should take steps to protect your rights. For example, you might choose to: - Have a friend or family member attend with you. This is an important witness who can testify about whether the doctor performed a full and fair examination. - Say as little as possible during the examination. Some doctors might try to pump you for information to use against you. - Request information from the insurance company about how many employees they refer to this particular doctor. A high number of referrals might suggest the doctor is a “hired gun” who the company trusts to minimize your injuries. ### Worried About an Independent Medical Exam? Speak with a Philadelphia Long Term Disability Lawyer Some IMEs go off without a hitch, but it is best to be prepared for a negative doctor’s report. An attorney can review any doctor’s report and punch holes in it, strengthening your claim for disability benefits. At[ The Garner Firm](https://www.garnerltd.com/), we help injured employees get the disability benefits they deserve. To [schedule your free consultation](https://www.garnerltd.com/contact/), please call 215-645-5955. **Categories:** Disability Benefits, Employee Benefits, Long Term Disability **Tags:** disability, disability lawyer, long term disability, long term disability attorney, LTD --- ### [Aetna Medical Director Admits Not Reviewing Patient Records](https://www.garnerltd.com/aetna-medical-director-admits-not-reviewing-patient-records/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Several news outlets are reporting that California’s insurance commissioner has launched an investigation into Aetna after its former medical director admitted that he did not review patient records when making a decision to deny coverage for various medical procedures. CNN’s article about this shocking revelation and emerging scandal can be found [here](https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html). The revelation came in a deposition in an insurance lawsuit arising under California law in Superior Court in Orange County, California. For those of us who represent participants in health and disability benefit plans, Dr. Jay Ken Iinuma’s admission that he did not review patient records in making medical necessity determinations is additional confirmation that many health insurance plans and disability benefit plans repeatedly, routinely, and wrongfully deny claims for benefits in violation of applicable laws and regulations. ![health insurance graphic](https://www.garnerltd.com/wp-content/uploads/2023/01/Fotolia_131325111_Subscription_Monthly_M-1024x499.jpg "Health Insurance Green Blue Squares Stripes - The Garner Firm") All employee benefits plans covered by the Employee Retirement Income Security Act of 1974 (“ERISA”), including health insurance and disability benefits plans, are required to provide plan participants with a full and fair review of their claims for benefits. Likewise, individual health insurance policies that are not covered by ERISA are required to provide their participants with a full and fair review of their claim. In order to receive a full and fair review, an insurer’s claims personnel, including their medical directors, must review the participant’s relevant medical records before making a decision. Far too often, it is clear when a client’s claim has been denied that the insurer has failed to provide the claimant with a full and fair review of his or her claim. If you believe your health claim or long term disability benefit claim has been wrongly denied, you should contact an experienced [ERISA employee benefits lawyer or insurance lawyer](https://www.garnerltd.com/attorney-profile/) without delay. Your right to appeal the denial will be subject to certain time limitations. At The Garner Firm, your initial consultation is always free. [Contact us](https://www.garnerltd.com/contact/) today, for your free consultation. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Health Insurance, Long Term Disability **Tags:** ERISA, full and fair review, health insurance, long term disability, LTD, STD --- ### [An Unusual PA State Court Case Addressing ERISA Preemption](https://www.garnerltd.com/an-unusual-pa-state-court-case-addressing-erisa-preemption/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** The Superior Court of Pennsylvania issued a non-precedential opinion on Thursday, November 10, 2016, holding that a breach of contract action related to a series of retirement agreements that promised lifetime retiree health care was not subject to ERISA preemption. ***Coggins v. Keystone Foods*, No. 3814 EDA 2015, 2016 Pa. Super. Unpub. LEXIS 4104 (Pa. Super. November 10, 2016)**. Although the rationale underlying the decision is a victory for employees and their advocates, its usefulness is limited because of the Superior Court’s limitations on the citation of unpublished decisions in subsequent cases. A copy of the Court’s decision may be downloaded [here](https://www.garnerltd.com/wp-content/uploads/2017/10/CogginsvKeystoneFoods.pdf). The Plaintiffs in *Coggins* were several former employees of Keystone Foods. During Plaintiffs’ employment, Keystone entered into a written [retirement agreement ](https://www.garnerltd.com/services/)with the Plaintiffs prior to and upon their retirement from the company. The retirement agreements stated: “Keystone also agrees to maintain the existing health care benefits, including medical, prescription, dental and vision and the existing Medical Reimbursement Plan, for Employees and qualified dependents for life.” At the time the retirement agreements were signed, each Plaintiff received all of their health care benefits, including insurance premiums, prescription, dental and vision at no cost. ![](https://www.garnerltd.com/wp-content/uploads/2023/01/Fotolia_127893568_Subscription_Monthly_M-1024x682.jpg "Preemption in the form of binary code, 3D illustration - The Garner Firm") Each Plaintiff retired from his employment with Keystone and satisfied the age and service requirements necessary to receive the health care benefits described in their retirement agreements. On June 2, 2014, the company sent each Plaintiff a letter advising him that, as of January 1, 2015, they were required to pay a portion of the health care premium as well as any copays. On December 30, 2014, Plaintiffs [filed a complaint](https://www.garnerltd.com/) in the Court of Common Pleas of Montgomery County alleging that Keystone’s decision to begin charging them for their retiree health care benefits breached their retirement agreements and also violated the Pennsylvania Wage Payment Collection Law, 43 P.S. § 260.1 et seq. (“WPCL”). Keystone subsequently removed the case the United States District Court for the Eastern District of Pennsylvania claiming that Section 502 of Employee Retirement Income Security Act of 1974 (“ERISA), 29 U.S.C. § 1132, preempted Plaintiffs’ state law claims. The federal court held that Section 502(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B), did not preempt the claims because the Plaintiffs were not seeking benefits from the underlying ERISA-regulated health plans at issue, but rather were seeking to enforce the terms of the retirement agreements, which ERISA did not govern. *Coggins v. Keystone Foods, LLC,* 111 F. Supp. 3d 630 (E.D. Pa. 2015)*.* The case was remanded back to the Court of Common Pleas. On remand, Keystone sought to have judgment entered in its favor pursuant to Section 514 of ERISA, 29 U.S.C. § 1144. That provision provides that ERISA preempts and supersedes any and all state laws “insofar as they may now or hereafter ***relate to*** any employee benefit plan.” 29 U.S.C. § 1144 (emphasis added). The Court of Common Pleas agreed with the company, entered judgment in its favor, and found against the Plaintiffs. On appeal, the Superior Court reversed the Court of Common Pleas and found that ERISA did not preempt the claims because they did not “relate to” an employee benefit plan. It noted: > Although the Benefits Plan undisputedly provides health care benefits covered by ERISA, the Retirement Agreements are separate contracts, which merely set forth Plaintiffs’ claimed right to continue receiving no-cost health care benefits, rather than provide new benefits covered under ERISA. When Keystone entered into the Retirement Agreements with Plaintiffs in 2011, Keystone covered all of Plaintiffs’ existing health care expenses. In the Retirement Agreements, Keystone agreed to “maintain \[Plaintiffs’\] existing health care benefits\[,\]” and those of their qualified dependents, for life. Accordingly, determining Keystone’s liability for Plaintiffs’ claims turns on Keystone’s disputed contractual obligation under the separate Retirement Agreements to continue to pay for all of Plaintiffs’ health care expenses, which claims are properly enforced under state law and not Section 514(a) \[of ERISA\]. *Coggins*, 2016 Pa. Super. Unpub. LEXIS 4104 at \*12-13. The Court distinguished the case at bar from *Barnett v. SKF USA, Inc.*, 38 A.3d 770, 777 (Pa. 2012), a case with somewhat similar facts, because unlike in that case, the Plaintiffs in *Coggins* had based their case on the written employment agreements as opposed to an oral promise purporting to modify a written retirement plan. *Coggins*, 2016 Pa. Super. Unpub. LEXIS 4104 at \*18. ### MY TAKE From the perspective of an individual representing Plaintiffs in an employee benefits cases, I think the *Coggins* case is a great outcome. Nonetheless, I question whether the Superior Court’s decision will stand if this matter is ultimately heard by the Pennsylvania Supreme Court. I will be following this case as it progresses and will report back with further developments. **Categories:** Legal Counsel --- ### ["P" is for Prohibited Transaction, "S" is for Self-Dealing: How Not to Administer a Retirement Plan](https://www.garnerltd.com/p-is-for-prohibited-transaction-s-is-for-self-dealing-how-not-to-administer-a-retirement-plan/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** The Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, *et seq*. (“[ERISA](https://www.garnerltd.com/erisa-litigation/)”), is the federal law that governs most employee benefit plans in the United States. As its name implies, this includes retirement plans like pension plans and 401(k) plans. The law is complicated, comprehensive, and imposes a variety of regulations and obligations on the individuals and entities that administer and service the plans. These regulations and obligations exist for good reason: to prevent corruption and self-dealing; protect the plan’s assets for the benefit for all participants; and to ensure the prudent and impartial administration of covered plans. On Thursday, November 10, 2016, the United States District Court for the Middle District of Tennessee issued an opinion in *Perez v. Eye Centers of Tennessee*, Case No. 2:14-cv-0115, 2016 U.S. Dist. LEXIS 156248 (M.D. Tenn. November 10, 2016), a case brought by the Secretary of Labor, against the sponsor and several fiduciaries of a profit-sharing plan. ([A copy of the opinion may be downloaded by clicking here](https://www.garnerltd.com/wp-content/uploads/2017/10/PerezvEyeCentersofTenn.pdf).) The Defendants’ conduct, as described the court, illustrates the sort of self-dealing and imprudent behavior that ERISA was designed to prevent. ![](https://www.garnerltd.com/wp-content/uploads/2023/01/Fotolia_58092723_Subscription_Monthly_M-1024x680.jpg "Retirement Planning - The Garner Firm") Eye Centers of Tennessee (“ECOTN”) is an ophthalmology practice with multiple offices. ECOTN sponsored a retirement plan (“the Plan”) for the benefit of its employees. The Plan is a contribution based retirement plan that permits discretionary profit sharing contributions to be made by ECOTN. The Plan also allowed participants, through payroll deductions, to contribute a portion of their paycheck to the Plan. ECOTN, its principal owner, and its office manager were the Plan’s named fiduciaries. The individual Defendants in *Eye Centers* were all “parties in interest” of the Eye Centers of Tennessee 401(k) Profit Sharing Plan (“the Plan”). A party in interest includes: - any fiduciary or employee of an employee benefit plan; - a benefit plan’s service provider; - an employer whose employees are covered by the plan; - an owner, direct or indirect, of 50 percent or more of an employer whose employees are covered by the plan; and - certain relatives of a party in interest. 29 U.S.C. §1002(14). Section 406 of ERISA, 29 U.S.C. § 1106, prohibits certain transactions involving “parties in interest.” In addition, some Defendants were also Plan fiduciaries. Section 404 of ERISA, 29 U.S.C. § 1104, requires plan fiduciaries to, among other things, discharge their fiduciary duties solely in the interest of the participants and beneficiaries for the sole purpose of providing plan benefits to participants and their beneficiaries and defraying reasonable administrative expenses of the plan. Fiduciaries are also required to discharge their duties “with the care, skill, prudence, and diligence” of a prudent person acting under the same or similar circumstances. 29 U.S.C. § 1104. The *Eye Centers* Defendants engaged in many prohibited transactions and breaches of their fiduciary duties. They included: - transferring over $782,000 in Plan assets to Maple Leaf Developments, LLC (“MLD”), which was owned by ECOTN’s owner and office manager, without documenting the Plan’s ownership interest in property owned by MLD; - transferring assets worth $50,000 from the Plan back to ECOTN, without documenting a loan, securing a promissory note, or otherwise requiring any form of collateral or repayment to pay for the company’s operations. - Making $344,225.39 in payments from the Plan to Park Street Properties, LLC, another “party in interest,” which the office manager owned. - Having the Plan pay $17,077.24 to a company owned by the office manager’s brother (who was also a ECOTN employee) for undocumented “services;” and - Having the Plan purchase a commercial property for $285,000, leasing it to a business owned by the office manager’s family for $5,000 a year (only 16% of the Plan’s annual mortgage payment), and failing to collect the rent owed. The Court held that each of the above-transactions was a *per se* prohibited transaction in violation of ERISA Section 406(a). Likewise, Defendants engaged in self-dealing in violation of ERISA Section 406(b). The Court further found that no prohibited transaction exemption was applicable to Defendants. Although ERISA Section 408(b)(2), 29 U.S.C. § 1108(b)(2), allows for an exemption for “contracting or making reasonable arrangements with a party in interest for office space, or legal, accounting, or other services necessary for the establishment or the operation of the plan, if no more than reasonable compensation is paid therefor,” it does not exempt violations of self-dealing under ERISA Section 406(b)(1) or (2). 29 C.F.R. § 2550.408b-2. Likewise, any compensation made to other parties in interest must be reasonable to qualify for exemption. The *Eye Centers* Defendants did not show that they met this reasonableness requirement. Finally, Defendants did not dispute that the fiduciary defendants failed to discharge their fiduciary duty in accordance with ERISA Section 404. The Defendants were barred from ever administering another employee benefit plan, and the case will proceed to trial to determine the damages owed to the plan due to Defendants’ misconduct. **Categories:** Wage & Hour Law --- ### [Chronic Pain: A New Appreciation](https://www.garnerltd.com/chronic-pain-a-new-appreciation/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Today, I have a new-found appreciation of pain and what individuals with chronic pain conditions must experience. I am very fortunate that I have spent most of my life pain-free. Sure, I have had injuries, some surgery, and moments of pain, but I have never experienced truly debilitating or chronic pain. That is, until this morning. Last night I felt a twinge in my back while doing some work around the house. It hurt, but I did not think much of it and expected it feel better in the morning. It did not feel better. Instead, the pain woke me several times in the middle of the night. It spread from under my shoulder blade to my neck and down to the bottom of my ribs. I could not roll over in bed. I had back and neck spasms throughout the night. ![](https://www.garnerltd.com/wp-content/uploads/2023/01/Fotolia_142231645_Subscription_Monthly_M-1024x682.jpg "elbow bones injury - The Garner Firm") This morning, I needed help just getting out of bed. I could not sit up by myself. I had muscle spasms in my neck and back as I walked from my bed to my kitchen for a cup of coffee. Unfortunately, even the act of lifting a coffee mug sent shooting pains down my arms and neck. After some ibuprofen kicked in and I took a hot shower, I felt a bit better. I went to work and then to the doctor later this morning. Fortunately for me, I only have a sprain or strain and perhaps a pinched nerve. The pain I am experiencing can be treated with muscle relaxers and ibuprofen. It should resolve in a couple of days, and I will be thankful when it does. I started this firm to represent, among others, individuals who have had their claims for disability benefits denied under their employer-sponsored short or long term disability plan. Oftentimes, individuals with chronic pain conditions such as [fibromyalgia](http://www.mayoclinic.org/diseases-conditions/fibromyalgia/basics/definition/con-20019243) or migraine headaches have their disability benefit claim denied because they cannot produce “objectively verifiable” evidence of the disabling nature of their pain. Given how I have felt over the last 18 hours or so, I have a new-found appreciation for how people afflicted with disabling chronic pain must feel. To experience disabling chronic pain on a daily basis and to be told that such pain is not disabling because there is no “objective” diagnostic evidence of it is not just wrong, it is cruel. If you have had a short term or long term disability benefit claim denied because you could not produce “objective evidence” of a disabling condition like chronic pain or migraine headaches, you may still have a valid claim for benefits. It is important you speak with an [attorney](https://www.garnerltd.com/attorney-profile) who understands [ERISA](https://www.garnerltd.com/erisa-litigation) (the law governing most employer-sponsored employee benefit plans) to assess the merits of your claim. We are available to consult with you. Please click [here](https://www.garnerltd.com/contact/) to send us an email, or call our office at (215) 645-5955. **Categories:** (ERISA) Litigation --- ### [Deadlines for Remanded Disability Claim Reviews: A Recent Decision Says 45 to 90 Days](https://www.garnerltd.com/deadlines-for-remanded-disability-claim-reviews-a-recent-decision-says-45-to-90-days/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Occasionally courts will remand a disability [claim](https://www.garnerltd.com/services/) back to the plan’s claim administrator (often an insurance company) for further consideration if it finds that the claimant has been denied a full and fair review of his or her claim. The Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. (“ERISA”) and its claims regulations are silent as to how long the claim fiduciary has to consider the remanded claim before making another claim determination. A recent decision from the United States District Court for the District of Oregon held that the remanded claim should be treated like any other administrative appeal of a disability claim determination and ruled upon within 45 to 90 days, depending on the circumstances. ![](https://www.garnerltd.com/wp-content/uploads/2023/01/Fotolia_175048167_Subscription_Monthly_M-1024x682.jpg "DISABILITY INSURANCE CONCEPT - The Garner Firm") In *Robertson v. Standard Ins. Co.*, Case No. 3:14-cv-01572-HZ, 2016 U.S. Dist. LEXIS 166079 (D. Or. November 4, 2016), the plaintiff sought to reopen her case against Standard Insurance Company in her quest to recover long term disability (“LTD”) benefits. In 2015, the Court: granted her motion for summary judgment; found that Standard had abused its discretion in denying her claim for LTD benefits; and remanded her claim to Standard for further consideration, including conducting a so-called independent medical examination (“IME”) and review of an award of Social Security Disability benefits to the Plaintiff. Standard did not decide the remanded claim in the months that followed. The Plaintiff filed a motion to reopen the case and the insurer requested that the reopened case be stayed while it completed its review on remand. The Court agreed to reopen the case and denied the motion to stay the action. Instead, the Court held that the remanded [claim](https://www.garnerltd.com/) should be deemed denied on remand and the Plaintiff’s claim should proceed in court. In reaching its decision, the Court held that ERISA’s claims review regulations at 29 C.F.R. § 2560.503-1 set the applicable time limits for the claim fiduciary to decide the claim on remand. Under those the regulations, a disability plan administrator has 45 days in which to consider an administrative appeal of a denial of disability benefits. In certain circumstances, the administrator may receive an additional 45 days to consider the claim. The administrator is not permitted to take longer than 90 days to consider a disability claim appeal. If the administrator takes longer than 90 days to consider the appeal, the claimant and court may consider the [appeal](https://www.garnerltd.com/contact/) to be deemed denied on appeal. The *Robertson* court recognized that there are some courts that have held that the claims regulations do not apply to claims on remand. It noted, however, that there was no binding authority in the Ninth Circuit to that effect. Moreover, the United States Department of Labor (“DOL”) has submitted an amicus brief in a pending case before the United States Court of Appeals for the Second Circuit in which it interprets its claim review regulation as applying to disability benefit claims that have been remanded to the administrator. Given the conflicting authority, as well as the DOL’s stated position on the issue, the Court deferred to the DOL’s position and held that the remanded claim was deemed denied by the insurer and was properly before the court once again. **Categories:** General Civil Litigation --- ### [D.C. Circuit Affirms Dismissal of Stock Drop Lawsuit](https://www.garnerltd.com/d-c-circuit-affirms-dismissal-of-stock-drop-lawsuit/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Happy New Year! Following up on my last two posts that dealt with individual ERISA breach of fiduciary duty claims, this morning’s post deals with the dismissal of a potential breach of fiduciary duty class action. On December 30, 2016, the U.S. Court of Appeals for the District of Columbia Circuit affirmed the dismissal of a “stock drop” lawsuit filed by a former employee of J.C. Penney. See *Coburn v. Evercore Trust Co.*, N.A., No. 16-7029, 2016 U.S. App. LEXIS 23396 (D.C. Cir. December 30, 2016). [ A copy of the opinion is available here.](https://www.garnerltd.com/wp-content/uploads/2017/10/CoburnvEvercoreOpinion.pdf) ![](https://www.garnerltd.com/wp-content/uploads/2023/01/dc-skt.jpg "dc-skt - The Garner Firm") Oops! We could not locate your form. The appellant was a former J.C. Penney employee and investor in a J.C. Penney employee stock ownership plan (“ESOP”) managed by Evercore Trust, who was a plan fiduciary. She claimed that Evercore breached its fiduciary duties of prudence and loyalty when it failed to take preventative action as the value of J.C. Penney stock fell significantly between 2012 and 2013, thereby causing significant losses to the ESOP. While Coburn was employed by J.C. Penney, the company sponsored the J.C. Penney Savings Profit-Sharing and Stock Ownership Plan (the Plan), which is a defined contribution retirement plan governed by ERISA. Once an employee opted into the Plan, the employee could allocate his or her contribution among a variety of investment options, including the Penney Stock Fund, an ESOP that consisted largely of J.C. Penney common stock. Evercore had the authority to restrict or limit the ability of Plan participants to purchase or hold J.C. Penney stock, including the power to remove the Penney Stock Fund as an investment option under the Plan and to sell or dispose of J.C. Penney stock contained in it. From the end of 2012’s first quarter to the end of 2013’s fourth quarter, the company’s stock price fell from $36.72 to $5.92 per share. While the stock price fell, Evercore did not sell the company stock in the Penney Stock Fund or eliminate it as an investment option. Consequently, the appellant sued on behalf of herself and all others similarly situated, alleging that Evercore was liable for $300 million in losses to the Plan for having breached its fiduciary duty under section 409 of ERISA, 29 U.S.C. § 1109. The district court granted Evercore’s motion to dismiss the complaint for failure to state a claim, relying on the United States Supreme Court’s opinion in [*Fifth Third Bancorp v. Dudenhoeffer*, 134 S. Ct. 2459 (2014)](https://www.garnerltd.com/wp-content/uploads/2017/10/FifthThirdBancorpvDudenhoeffer.pdf). The district court held that the allegations that Evercore should have recognized from publicly available information that continuing to invest in company stock was “imprudent” were generally implausible absent “special circumstances” affecting the market, which the Appellant did not plead and disclaimed any need to plead. The Circuit court explained that in *Dudenhoeffer*, the Supreme Court refined the pleading requirements regarding claims that a fiduciary should have recognized from public information alone that a stock was over or under valued. See *Dudenhoeffer*, 134 S. Ct. at 2471. There, the Supreme Court held that “where a stock is publicly traded, allegations that a fiduciary should have recognized from publicly available information alone that the market was over-or undervaluing the stock are implausible as a general rule, at least in the absence of special circumstances.” *Id.* at 2471. As the D.C. Circuit noted: “*Dudenhoeffer* was thus grounded in the efficient capital market theory – the ‘theory that security prices reflect all available information.’” (citations omitted). *Dudenhoeffer,* therefore, requires plaintiffs to allege specific “special circumstances” when bringing a breach of fiduciary duty claim against a fiduciary in some stock drop cases. The D.C. Circuit held the appellant’s claim did not satisfy the pleading requirements set forth in *Dudenhoeffer* because she did not make any allegations of special circumstances such as that the stock was trading in an inefficient market. Although the appellant attempted to distinguish *Dudenhoeffer,* the D.C. Circuit rejected that argument and noted that the plaintiffs in *Dudenhoeffer* made similar arguments that were rejected there as well. Instead, it followed precedent established by the Second, and Sixth Circuits and affirmed the dismissal of her case. For those who are interested in reading more on this topic, the Supreme Court’s *[Dudenhoeffer opinion can be downloaded here](https://www.garnerltd.com/wp-content/uploads/2017/10/FifthThirdBancorpvDudenhoeffer.pdf)*. **Categories:** General Civil Litigation --- ### [Court Declines to Remand Case Involving an Alleged Church Plan and Finds ERISA Controls Instead](https://www.garnerltd.com/court-declines-to-remand-case-involving-an-alleged-church-plan-and-finds-erisa-controls-instead/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Although the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 *et seq.* (“[ERISA](https://www.garnerltd.com/erisa-litigation/)”), regulates nearly all non-governmental employer sponsored benefit plans, a notable exception exists for so-called “church plans.” A church plan is “a plan established and maintained \[\] for its employees (or their beneficiaries) by a church or by a convention or association of churches which is exempt from tax under section 501 of the Internal Revenue Code of 1986.” 29 U.S.C. § 1002 (33). Church plans are a hot topic at the moment as the Supreme Court of the United States is set to hear *Rollins v. Dignity Health*, 830 F.3d 900 (9th Cir. 2016) *cert. granted sub nom. Dignity Health, et al. v. Rollins*, 137 S. Ct. 547 (2016) on March 27, 2017. That case will address and hopefully provide clarification as to the scope of the church plan exemption. ![](https://www.garnerltd.com/wp-content/uploads/2023/01/Fotolia_145855925_Subscription_Monthly_M-1024x702.jpg "wooden bench rows in the church - The Garner Firm") Last week, while I was at a conference where the church plan exemption and *Rollins* case were discussed at length, the United States District Court for the Central District of California issued a decision in *Durham v. Prudential Ins. Co. of Am.*, Case No. 2:16-cv-08202-ODW(KSx), 2017 U.S. Dist. LEXIS 19402 (C.D. Cal. February 10, 2017). In *Durham*, the Court found that a long term disability (“LTD”) benefit plan Loyola Marymount University (“LMU”) sponsored for the benefit of its employees was not a church plan. The Court found ERISA applied to the [claim](https://www.garnerltd.com/services/) instead. The plaintiff in *Durham* was a LMU employee who participated in the university’s LTDplan. The LTD plan was administered and insured by Prudential Insurance Company of America (“Prudential”). He applied for disability benefits under the LTD plan. His claim was denied. The plaintiff filed suit in California state court, specifically alleged that the LTD plan was a church plan exempt from ERISA, and asserted a variety of state law claims against the insurer. Prudential removed the case to federal court and asserted that ERISA completely preempted the plaintiff’s claims. The *Durham* plaintiff moved to remand his lawsuit to California state court and argued that the church plan exemption applied. The Court disagreed. Citing *Rollins*, *supra*, as well as case from the Third and Seventh Circuits, it noted that the church plan exemption requires that the plan in question be both established by a church ***and*** maintained by a church or by a convention or association of churches. With respect to LMU, the Court disagreed with the plaintiff’s assertion at the LMU itself was a church. It noted that the university itself did not believe it was a church, that the university hired Catholic and non-Catholic professors, and that it received funding from sources outside of the Catholic church. The Court further held that the existence of a church on LMU’s campus did not make the university a church. Because the LTD plan was not established by a church, the Court did not address the second prong of the test as to whether the LTD plan was maintained by a church or a convention or association of churches. The motion to remand the lawsuit was denied as was the defendants’ motion to dismiss the [claim](https://www.garnerltd.com/) based on ERISA preemption. **Categories:** (ERISA) Litigation --- ### [A Life Insurance Fiduciary Breach Case Gets Set for Trial](https://www.garnerltd.com/a-life-insurance-fiduciary-breach-case-gets-set-for-trial/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Today’s blog post brings us another[ life insurance case ](https://www.garnerltd.com/services/)in which an insurer and an employer were alleged to have breached their fiduciary duty to a plan participant and his beneficiary. That case, *Keith v. Metro. Life Ins. Co.*, et al., Case No. H-15-1030, 2017 U.S. Dist. LEXIS 37263 (S.D. Tex. March 15, 2017), is now headed to trial because the Court denied the parties’ cross motions for summary judgment yesterday. A copy of the Court’s opinion can be found [here](https://www.garnerltd.com/wp-content/uploads/2017/10/KeithvMetLife.pdf). This is the second life insurance fiduciary breach case I have written about in recent months. (My earlier blog post can be found [here](https://www.garnerltd.com/blog/2016/12/16/the-beginning-of-an-interesting-post-amara-erisa-case-in-louisiana)). ![](https://www.garnerltd.com/wp-content/uploads/2023/01/blog-img5.jpg "blog-img5 - The Garner Firm") The decedent in *Keith* was a Vice President of Central Bank from 2007 until 2013. While employed by Central Bank, he enrolled in a welfare benefit plan offered by his employer that provided life insurance and related benefits (“the Plan”) through policies issued by MetLife, which served as the Plan’s claim administrator. The decedent named Linda Keith, the plaintiff, as the beneficiary of his life insurance policy. Towards the end of his employment, the decedent was diagnosed with amyotrophic lateral sclerosis (“ALS” or Lou Gehrig’s Disease). The decedent began a leave of absence under the Family Medical Leave Act on March 6, 2013. He never returned to work. While on FMLA leave, the decedent applied and was approved for long term disability benefits under his employer’s disability plan, which MetLife also insured. During an exit interview from his employment, the decedent reiterated his desire: 1) not to make any changes to his insurance elections for plan year 2013-2014; and 2) to maintain Keith as the beneficiary for his life insurance policy. MetLife subsequently generated an internal claim for continuation of group life insurance for the decedent. Central Bank was not notified of the claim. On or about May 9, 2013, MetLife wrote the decedent a letter acknowledging receipt of the internal claim for continuation of his life insurance benefits. The letter stated that the life insurance plan “‘includes a provision that continues your coverage while you are not actively at work,’ advised White that a representative ‘may be in contact’ and that ‘\[n\]o action is required from you at this time.’” MetLife wrote to the decedent twelve days later and stated “that his insurance plan required him to be totally disabled continuously for nine consecutive months before he would be eligible for continuation of group life insurance coverage during his absence from work.” Unfortunately for the decedent and the plaintiff, neither letter advised the decedent that there were other ways for him to maintain continuation of his life insurance coverage, or that the decedent did not qualify for continuation under the provision with the nine-month waiting period. Central Bank, which appears to serve as the Plan’s Administrator, also received the second letter from MetLife. A Senior Vice President of the bank called MetLife to “get an understanding of \[its\] meaning.” She was told that the decedent was required to convert his life insurance to an individual policy to maintain coverage. Central Bank made its last premium payment on June 1, 2013, and the decedent’s employment formally terminated four days later. No one told the decedent that he needed to convert his policy to an individual policy to maintain coverage, or that he was required to make premium payments following his termination. The decedent passed away on or about September 14, 2013. After the plaintiff made a [claim for life insurance benefits](https://www.garnerltd.com/services/) and her claim was denied, she filed suit against MetLife, Central Bank, and the Plan. The plaintiff contends that the defendants breached their fiduciary duties to the decedent and to her by failing to adequately advise him of his right to convert his life insurance policy to an individual policy prior to his death. Following the close of discovery, the parties all filed cross-motions for summary judgment. The Court denied them all. With respect to MetLife’s motion for summary judgment, it contended that it was not required as a Plan fiduciary to notify the decedent of his options to maintain his life insurance, because it was only a claim administrator. Although it was “undisputed that MetLife had no routine obligation to notify plan participants of their options upon termination,” the Court found that there was a triable issue of fact as to whether MetLife acted as a fiduciary by generating an internal life insurance continuation claim on the decedent’s behalf and that its subsequent letters to the decedent were misleading or confusing. Thus, it concluded that there were genuine issues of material fact as to whether MetLife “acted as a fiduciary and whether it breached a fiduciary duty to communicate in a manner calculated to avoid confusion and misunderstanding.” With respect to Central Bank, its motion contended “that in the absence of a specific employee-initiated inquiry it had no fiduciary duty to notify \[the decedent\] of his option to convert his plan and that, at any rate, he was made aware of those options upon receipt of the summary plan description.” The Court rejected that argument based on the facts of the case and noted that the bank’s Senior Vice President was aware of the decedent’s condition and was actively involved in the claim process by, among other things, contacting MetLife regarding its correspondence to the decedent. Thus, the Court found that trier of fact could find that the Senior Vice President’s actions were fiduciary functions and she had a duty to prudently: 1) avoid misunderstanding and confusion on the part of the decedent; and 2) take steps to maintain the decedent’s coverage because of his misunderstanding or confusion. Finally, the plaintiff’s motion for summary judgment was denied because a genuine issue of material fact remained as to whether she was damaged by any alleged fiduciary breach. The Court noted that the trier of fact could conclude: 1) the decedent was ignorant of or confused and that confusion led to her loss of life insurance benefits; or 2) that the decedent “never intended to pay for life insurance out of his own pocket and would not have converted his policy regardless of the actions of MetLife or the Central Bank Defendants.” Thus, the Court determined that the case could only be resolved at full trial on the merits. **Categories:** Legal Counsel --- ### [Fourth Circuit Rules in Favor of Employer in Retiree Health Benefits Case](https://www.garnerltd.com/fourth-circuit-rules-in-favor-of-employer-in-retiree-health-benefits-case/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** In a blow to retirees, the United States Court of Appeals for the Fourth Circuit recently affirmed a decision granting summary judgment to an employer in a case involving changes to a retiree health benefits plan. *See* *Barton v. Constellium Rolled Products-Ravenswood, LLC*, Case No. 16-1103, 2017 U.S. App. LEXIS 5087, \_\_ F.3d \_\_ (4th Cir. March 22, 2017). A copy of the Fourth Circuit’s opinion can be found [here](https://www.garnerltd.com/wp-content/uploads/2017/10/BartonvConstelliumRolledProducts.pdf). The *Barton* individual plaintiffs retired from Constellium’s aluminum plant and were represented by a labor union during their employment, which served as a co-plaintiff. Going back to 1988, the Union entered in several collective bargaining agreements (“CBA”) with Constellium related to the individual plaintiffs’ employment and each individual class member retired while a CBA was in effect. ![](https://www.garnerltd.com/wp-content/uploads/2023/01/Fotolia_72908139_Subscription_Monthly_M-1-1024x691.jpg "Retirement Concept - The Garner Firm") Each CBA contained a nearly identical Article 15 that contained a provision for group health insurance benefits and referred to a booklet entitled “Retired Employees’ Group Insurance Program.” That booklet served as the summary plan description (“SPD”) of the retiree health benefits program for retirees. During bargaining negotiations over a new CBA in July 2012, Constellium proposed amending Article 15. It wanted to extend a cap on its “contributions to retiree health benefits to employees who retired before January 1, 2003 and to freeze its Medicare Part B premium reimbursement amount for all hourly retirees at $99.90.” The union, contended that the retiree health benefits were vested and would not bargain on the issue. Thus, Constellium sent the union “a written notice that it planned to make these changes beginning January 1, 2013,” and it did just that. In February 2013, the individual retirees and the union [filed suit](https://www.garnerltd.com/) against Constellium (and its pension plan) and amended their complaint about a year later. The Amended Complaint contained class and individual allegations asserting a violation of Section 301 of the Labor Management Relations Act, 29 U.S.C. § 185. The individual plaintiffs also brought a claim for violation of Section 502(a)(1)(B) of the Employee Retirement Income Security Act, 29 U.S.C. § 1132(a)(1)(B) (“ERISA”). The plaintiffs’ claims were premised on the contention that their retiree health benefits were vested. The U.S. District Court for the Southern District of West Virginia granted summary judgment in favor Constellium on all counts and the plaintiffs appealed. The Fourth Circuit affirmed the District Court’s decision. Relying on the Supreme Court’s relatively recent decision in *M&G Polymers USA, LLC v. Tackett*, 135 S. Ct. 926, 933 (2015), the Fourth Circuit held that Article 15 of the CBA must be interpreted “using ordinary contract principles. And in doing so, we must recognize that these principles foreclose holding that the retiree health benefits have vested unless unambiguous evidence indicates that the parties intended that outcome.” The Court noted that the “\[t\]he plain language of the CBA and SPD clearly indicates that the retiree health benefits did *not* vest.” (emphasis in original). Article 15 of each CBA contained “explicit durational language stating that the retiree health benefits continue ‘for the term of’ the governing CBA.” That durational language was also contained in the plan’s SPD. Although the plaintiffs pointed to additional side agreements called “Cap Letters” between the union and employer as evidencing an intent to vest the retiree health benefits, the Court rejected the argument, noting among other things that the side letters allowed the parties to change the nature and structure of the[ benefits.](https://www.garnerltd.com/services/) **Categories:** Employment Discrimination --- ### [Court Endorses Disability Claimant’s Right to Review and Respond to New Information Prior Reaching ERISA Benefit Determination](https://www.garnerltd.com/court-endorses-disability-claimants-right-to-review-and-respond-to-new-information-prior-reaching-erisa-benefit-determination/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** I was shocked to find that I have not written a blog post since late March. Time flies when you are having fun. In any event, this post will be brief and relates to a recent case in [which I was involved](https://www.garnerltd.com/attorney-profile/). ![photo illustration of stethoscope and disability claimants rights in ERISA benefit determination](https://www.garnerltd.com/wp-content/uploads/2023/01/Fotolia_138030639_Subscription_Monthly_M-1-1024x682.jpg "Stethoscope on notebook and pencil with ERISA (The Employee Retirement Income Security Act) words as medical concept. - The Garner Firm") I recently wrote an article for the ABA’s Torts Insurance Practice Section (“TIPS”) Health, Disability, and Life Insurance Committee summer newsletter, which was published on Monday, July 31, 2017. A copy of the newsletter can be found [here](https://www.garnerltd.com/wp-content/uploads/2017/10/health_disability_life_insurance_summer_2017.authcheckdam.pdf). In the article, I discussed how the Department of Labor’s (“DOL”) new ERISA disability claims regulations, which are effective for claims arising on or after January 1, 2018, can potentially have a meaningful impact on ERISA claims arising before that date. The new regulations require disability plan claim administrators, among other things, to provide claimants the opportunity to review and respond to new information or rationales for denying their claim before the administrator makes a claim determination. See 81 Fed. Reg. 92316, 92341–92342. DOL’s commentary on this new language states that this requirement really is not new: “\[T\]he Department has interpreted ERISA section 503 and the current Section 503 Regulation as already requiring that plans provide claimants with new or additional evidence or rationales upon request and provide them an opportunity to respond in at least certain circumstances.” 81 Fed. Reg. at 92324 (citing *Saffon v. Wells Fargo & Co. Long Term Disability Plan*, 511 F.3d 1206, 1215 (9th Cir. 2008)). Based on DOL’s commentary, I argued in the article that “Plans would be best served by providing participants with any new information obtained during the appeal process and the opportunity to respond to it, regardless of whether it is requested, prior to issuing a final claim determination on appeal. Plans that fail to provide this opportunity to review and respond risk being found to have denied their claimants with a full and fair review of their claims under section 503, 29 U.S.C. § 1133.” Well, as fate would have it, the same day that the article was published, the United States District Court for the Northern District of Illinois issued an opinion agreeing with that very argument in a case in which I served as co-counsel with my friend, colleague, and lead counsel [Michael Bartolic](https://www.robertsbartolic.com/michael-bartolic-alameda-attorney/) of [Roberts ](http://www.robertsbartolic.com/)[Bartolic LLP](http://www.robertsbartolic.com/). *See Suson v. The PNC Financial Services Group, Inc. and Affiliates Long Term Disability Plan*, Case No. 15-cv-10817, 2017 U.S. Dist. LEXIS 119473 (N.D. Ill. July 31, 2017). A copy of the Court’s decision can be found [here](https://www.garnerltd.com/wp-content/uploads/2017/10/SusonvPNC8-5-17.pdf). In *Suson*, Plaintiff claimed that she was disabled from her regular occupation. Her claim was denied and she appealed. The Plan’s claim administrator obtained the opinion of a vocational consultant during the appeal of the denial of the Plaintiff’s claim for benefits. The vocational consultant prepared an occupational analysis dated June 4, 2015. The analysis indicated that the Plaintiff’s regular occupation is performed at a sedentary to light level of physical demand, depending on the specific work environment. Because a separate consulting expert concluded that the Plaintiff could work at a light level of exertion, the claim administrator denied her claim that day without affording her any opportunity to respond to the vocational assessment. We argued, and the Court agreed, that denying the Plaintiff the opportunity to review and respond to the occupational analysis before issuing a final determination was arbitrary and capricious. Specifically, the Court held: The occupational analysis was dated the same day as the letter denying \[Plaintiff’s\] appeal. The use of the occupational analysis constituted “new standards or expectations” that had not been previously communicated which “frustrates fair claim resolution and is evidence of arbitrary and capricious behavior.” *Holmstrom*, 615 F.3d at 775-76. Further, \[Plaintiff\] was not given the opportunity to address “the determinative issues on appeal and . . . ensure meaningful review of the denial.” *Love*, 574 F.3d at 396. Liberty acted arbitrarily and capriciously in receiving an occupational analysis and using that as a basis to deny \[Plaintiff’s\] appeal the same day, without any opportunity for \[Plaintiff\] to respond. *Suson*, 2017 U.S. Dist. LEXIS 119473 at \*37-38 (internal record citations omitted). As a result, the Plaintiff’s [claim ](https://www.garnerltd.com/services/)was remanded to the Plan’s claim administrator for further proceedings consistent with the Court’s opinion. Id. at \*49-50. **Categories:** Employee Benefits --- ### [How do Insurance Companies Define Disability?](https://www.garnerltd.com/how-do-insurance-companies-define-disability/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Many long-term disability insurance claims are denied because the claimant does not qualify as having a “disability” under the policy. Even if you know your condition keeps you from working, you can still be surprised to receive a denial for this reason. Policies can vary significantly in how they define disability, and you want to be sure that you provide the information and supporting evidence necessary to demonstrate your disability to the insurer. Too many people receive [claim denials](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) because they did not adequately show they have a disability that qualifies under their policy. If you would like assistance with a claim or already received a denial, you should consult with an experienced [disability claim attorney](https://www.garnerltd.com/attorney-profile/) right away. The Garner Firm, Ltd. assists clients in Pennsylvania, Philadelphia, the Delaware Valley, Maryland, and New Jersey with all stages of the disability claim process, so do not hesitate to call today. ![photo of long term disability claim form](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_188921465-1024x683.jpeg "photo of long term disability claim form - The Garner Firm") ### Understanding Your Policy It is important to understand the language of your insurance policy and how it defines a “disability.” You should not hesitate to request a copy of your long-term disability insurance plan from your employer or plan administrator for your review. The policy should specifically set out what does and does not qualify as a disability, which might include: - Specific named conditions - A condition that prevents you from returning to your specific job - A condition that prevents you from performing any type of work Sometimes, it can be challenging to understand definitions included in your policy, as the language can be complex and dense. You can always consult with a disability lawyer if you have questions about your qualifications under your specific plan or need assistance proving you deserve benefits. ### Total Disability Many long-term disability plans require claimants to be “totally disabled.” This generally means that a long-term injury or illness prevents you from performing the substantial duties of your occupation. Proving total disability requires significant medical documentation and the opinions of medical professionals. Your healthcare provider will likely need to submit a letter stating that your impairment is such that you are disabled, as well as detailing how your condition impairs your ability to work. It is important to have legal assistance when gathering evidence for your claim, as the right attorney can determine whether you have sufficient documentation to qualify as disabled. In certain situations, your disability policy might not require total disability, as it may provide partial disability benefits. This might be the case if your injury or illness keeps you from working at your current full-time job, but you might be able to work at the same or different job part-time. ### Contact a Philadelphia Disability Claim Attorney for Assistance Compiling evidence for a successful long-term disability claim is a difficult task. If you have a qualified disability, it can be wise to enlist the help of an experienced long-term disability lawyer in Pennsylvania, Philadelphia, the Delaware Valley, Maryland, and New Jersey. The Garner Firm, Ltd. assists with the claims process, including filing initial claims and appealing denials. [Contact us](https://www.garnerltd.com/contact/) to learn more today. **Categories:** Disability Benefits, Long Term Disability **Tags:** disability, Disability Benefits, disability benefits attorney --- ### [The Hartford Disability Insurance Claim Process: What to Expect](https://www.garnerltd.com/the-hartford-disability-insurance-claim-process-what-to-expect/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Understanding disability insurance benefits can be confusing, and having your claim denied by your insurer is all too common. If you are preparing to file a long-term disability claim with The Hartford, or if your claim has been denied, an experienced disability benefits attorney may be able to help you present a stronger case and increase your chances of obtaining benefits. Attorney Adam H. Garner of The Garner Firm, Ltd. has successfully represented many clients in their fight to receive[ disability benefits](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) from The Hartford. In this blog post, we’ll discuss some typical methods used by The Hartford and other long-term disability insurers during the claims process and possible next steps after a denial. While the information here is intended to give a helpful overview of what many disability plan participants experience, it’s important to remember that no two cases are the same, and many factors can influence the outcome of a disability claim or appeal. To discuss the specifics of your claim, please contact our office today to schedule a consultation. ![photo of questions related to ERISA claims law](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_134520603-1024x692.jpeg "photo of questions related to ERISA claims law - The Garner Firm") ### The Hartford Disability Claims Process The Hartford Financial Services Group, Inc., commonly known as The Hartford, is[ one of the largest](https://www.thebalancesmb.com/top-u-s-property-casualty-insurers-462505)[ providers](https://www.thebalancesmb.com/top-u-s-property-casualty-insurers-462505) of group and employee benefits in the United States. Most claimants obtain coverage under a long-term disability insurance policy from The Hartford through their employer as part of a group disability plan. After a claim has been filed, The Hartford may use surveillance to monitor claimants’ behavior, including online posting. Claimants have reported being followed and recorded by private investigators hired to presumably find evidence that their disability claim is not valid. To help defend against this tactic, it is important that you observe any restrictions your doctor has given you regarding movement or physical activity. You are not required to be a prisoner in your own home, but your physical activities should be consistent with your disability. Surveillance footage rarely tells the full story of a person’s limitations, and a skilled disability benefits attorney can help you document the true impact of your condition. Another common tactic used to declare a claim invalid involves gathering biased or inaccurate information about the claimant’s health. Large insurers like The Hartford may request that the claimant visit multiple doctors or specialists, request the same document numerous times, or send a questionnaire to the claimant’s doctor. These moves are often designed to trick you or your doctor into saying or documenting something that conflicts with your claim and can be used to deny your benefits. Likewise, long-term disability insures, like The Hartford, have been known to cherry-pick participants’ medical evidence, focusing only on those medical records that support denying a claim while ignoring those records that support a finding of disability. ### What to Do If You’ve Been Denied Disability Benefits by The Hartford Denial of long-term disability benefits from The Hartford is common, but there are ways to fight back. Group insurance policies issued by The Hartford for short-term and long-term disability are often regulated by the Employee Retirement Income Security Act of 1974, also known as[ ERISA](https://www.garnerltd.com/practice-areas/erisa-litigation/). This law gives policyholders specific rights, including the ability to appeal a denial of benefits. A skilled ERISA lawyer can explain all the options in your case, and if applicable, help you file an appeal. The deadlines for filing an appeal are strict, so it’s important that you reach out to an attorney early in the process. ### If Your Disability Insurance Claim was Denied, The Garner Firm, Ltd. May Be Able to Help At The Garner Firm, Ltd., our [attorney](https://www.garnerltd.com/attorney-profile/) understands that disability benefits exist to help those in need support themselves and their families. We know how devastating a denial can be, and we have helped many families through this difficult process. If you believe that your disability insurance claim is being wrongly delayed or denied by The Hartford, contact The Garner Firm, Ltd. today to[ schedule a consultation](https://www.garnerltd.com/contact/) and discuss how we may be able to help. **Categories:** (ERISA) Litigation, Disability Benefits **Tags:** denied claim lawyer, Disability Benefits, disability benefits attorney, disability insurance claim --- ### [What to do if Your Accidental Death and Dismemberment Benefits Claim is Denied](https://www.garnerltd.com/what-to-do-if-your-accidental-death-and-dismemberment-benefits-claim-is-denied/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** You can purchase an accidental death and dismemberment policy, known as an AD&D policy, as an addendum to a life insurance policy. These are also commonly included as a supplemental or secondary benefit with employer-sponsored life insurance benefit plans. In most situations, the benefit plan is regulated by ERISA, the Employee Retirement Income Security Act of 1974. ERISA only regulates private sector employee benefit plans—it does not cover any benefits employees receive from any federal, state, or local governments. Because there is often a lack of understanding of how AD&D benefits work, families assume that they are automatically entitled to these benefits when the employee passes away. In some cases, accidental death and dismemberment benefits would not be applicable because the individual in question did not die in an accident. However, there are numerous other cases in which the employee did die accidentally, but the insurance company claims it was not an accident or tries to inappropriately apply certain policy exclusions. No matter whether you are the covered employee or a member of their family, it is important to understand how AD&D benefits work. If you have a loved one who passed away due to an accident and the insurance company is denying the claim, it is imperative to speak with a[ Pennsylvania accidental death and dismemberment benefits attorney](https://www.garnerltd.com/practice-areas/accidental-death-dismemberment-benefits/) right away. ![photo of claim denied button as it relates to accidental death and dismemberment benefits claim denials](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_290346053-1024x684.jpg "photo of claim denied button as it relates to accidental death and dismemberment benefits claim denials - The Garner Firm") ### Importance of Understanding what an AD&D Policy Covers The benefits provided under an AD&D policy are designed to pay out if your loved one dies in some type of accident. A common example is a car accident. If you were severely incapacitated in the accident, like losing a limb, you also could potentially receive benefits under your own AD&D policy. Because the policy is confusing and insurance companies are looking for any way to reduce their payout or deny a claim entirely, there are numerous exclusions and policy provisions in place to limit their exposure towards AD&D benefits. For example, maybe you get into an accident and lose your leg, but you still live for another six months. Depending on the policy language, your loved ones may not receive the full death benefit payout as the insurance company only pays a death benefit if you pass away within a certain timeframe. Also, if you are engaged in high-risk behavior and you die accidentally, they may deny the claim entirely. Examples of high-risk behavior include skydiving or driving while under the influence of alcohol, suicide or attempted suicide, bungee jumping, drag racing, etc. ### Appealing a Denial of AD&D Benefits If you are appealing the denial of an AD&D benefits policy and it is covered under ERISA, you only have a limited time to file the appeal. In addition, there will be a specific mandated appeal process you must go through prior to seeking any type of relief in court. This is where the experience of an [accidental death and dismemberment benefits attorney](https://www.garnerltd.com/attorney-profile/) is important. Your attorney can explain the appeals process and help you seek relief in court. ### Contact an AD&D Benefits Lawyer Today If you have questions or need assistance with appealing a denial for accidental death and dismemberment benefits, do not attempt to go at it alone.[ Contact The Garner Firm](https://www.garnerltd.com/contact/) today to schedule an initial consultation. **Categories:** Accidental Death and Dismemberment **Tags:** accidental death, accidental death and dismemberment, ad&d, ad&d benefits, benefits --- ### [Retirement Plan Claims and Overpayment: Understanding Your Rights](https://www.garnerltd.com/retirement-plan-claims-and-overpayment-understanding-your-rights/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Imagine that you are receiving monthly benefits from your employer-sponsored retirement plan. One day, you receive a surprising letter in the mail stating that you have been “overpaid” all along. Your plan administrator wants to reduce your benefits going forward and, worse yet, wants you to repay to make up for the overpayment. What happens now? Do you always have to repay the plan? What are your rights as a retirement plan beneficiary? Here, our [Philadelphia retirement plan claims attorney](https://www.garnerltd.com/practice-areas/retirement-plan-benefit-claims/) explains the key steps that you should take if you have received an overpayment notice from your retirement plan administrator. ![photo of retirement plan graphic retirement plan claims and overpayment](https://www.garnerltd.com/wp-content/uploads/2023/01/Fotolia_235086026_Subscription_Monthly_M-1-1024x731.jpg "Retirement plan - The Garner Firm") ### Did You Receive an Overpayment Notice? Here is What You Should Do Next - ***Do Not Panic: Carefully Review the Notice*** Unexpectedly receiving a notice that your retirement benefits will be reduced and/or that your plan administrator is seeking recoupment for the overpayment can be stressful and deeply frustrating. Do not panic. You should carefully review the notice and make sure that you understand exactly what is happening and why. - ***Ask for a Full Accounting of the Mistake/Calculations*** Under the [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa), you have the right to get basic information on how your plan administrator reached its conclusion regarding the alleged overpayment. You should never hesitate to ask for a more detailed explanation of how the mistake happened or to ask for a full accounting of the calculations used by your plan. - ***Explore Your Right to Get a Hardship Waiver*** Depending on the nature of your situation, you may be entitled to a hardship waiver. Under federal rules, pension plans and retirement plans may be able to waive recoupment if the beneficiary would face significant financial hardship by being required to make payments. If you are in a financially difficult position, this type of option should be explored. - ***Get Professional Legal Help*** If you received a recoupment notice, you should be ready to seek professional legal support. Overpayment cases are among the most complex types of retirement plan claims. An experienced Philadelphia retirement plan lawyer will conduct a comprehensive assessment of your case and help you determine what options are available. Among other things, you may be able to negotiate a settlement, or you may even have the right to avoid paying back the plan at all. ### Speak to Philadelphia Retirement Plan Claims Lawyer Today At The Garner Firm, our [Pennsylvania ERISA attorney](https://www.garnerltd.com/attorney-profile/) has experience representing beneficiaries in the full range of retirement plan litigation, including in overpayment cases. If your retirement plan administrator is seeking the recoupment of an overpayment, we can help. For a free, no obligation review of your case, please [contact us](https://www.garnerltd.com/contact/) at our Philadelphia law office today. **Categories:** (ERISA) Litigation **Tags:** benefits claims, ERISA, overpayment, recoupment, retirement, retirement benefits --- ### [Long Term Disability Claims: What is the Claim File or so-called “Administrative Record?”](https://www.garnerltd.com/long-term-disability-claims-what-is-the-claim-file-or-so-called-administrative-record/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** If you or your family member is covered by a long term disability plan obtained through a private-sector employer, it is likely that the policy is governed by a federal law called the[ Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa). Unfortunately, some employees and beneficiaries struggle to get access to long term disability benefits when they need them the most. If your claim was denied, you have the right to file an appeal. In fact, ERISA guarantees all applicants a “full and fair” review of their long term disability denial. Here, our[ Philadelphia long term disability lawyer](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) provides an overview of some of the important elements of a long term disability appeal — the administrative record. ![photo of graphic as it relates to long term disability claim and administrative record](https://www.garnerltd.com/wp-content/uploads/2023/01/Fotolia_126913934_Subscription_Monthly_M-1-1024x682.jpg "Archive Bookmarks of Card Index with Claims. 3D. - The Garner Firm") ### The Claim File (or so-called “Administrative Record”) Includes All Information Provided to the Administrator In ERISA disability claims, the claim file, which is sometimes inaccurately and incorrectly described as the “administrative record” is made up of all of the documents, records, and information sent to the disability plan fiduciary responsible for adjudicating claims for disability benefits. In many cases, that fiduciary is a disability insurance company. Under United States federal law and its implementing regulations (29 U.S.C. § 1133 and[ 29 CFR § 2560.503-1](https://www.law.cornell.edu/cfr/text/29/2560.503-1)), the claim file or “administrative record” includes any and all documents that were “considered” or “generated” by the plan administrator or insurance company in the denial of your long term disability claim. Notably, the claim file or so-called “administrative record” cover the time from when an applicant first submitted a claim for benefits to when the administrator or insurance company issued its final denial. ### ERISA Litigation: Courts are Often Only Review the Claim File In ERISA disability claims, the claim file matters. To ensure that your legal rights are protected, it is crucial that the administrator or disability insurance company receives all evidence relevant to your case. Certainly, this is important to help facilitate the proper handling of your claim; ideally, the administrator or insurer will issue benefits without the need to get a court involved. Should litigation prove to be necessary, and depending on the standard of review applicable to your claim, the court may limit its review to the evidence contained within the so-called “administrative record.” Put another way, judicial precedent and court rulings may prevent disability benefit plan participants and beneficiaries from submitting additional evidence to support their lawsuit, unless an exception applies to the case. The bottom line is that you need to make sure that all relevant evidence is submitted to the insurance company and gets into the claim file or “administrative record.” You have the right to get a copy of the “administrative record” to confirm that it is complete and accurate. Any issues/problems should be corrected immediately. ### Was Your Long Term Disability Claim Denied in Philadelphia? We are here to help. At The Garner Firm, our [Pennsylvania ERISA Disability attorney](https://www.garnerltd.com/attorney-profile/) has extensive experience handling long term disability claims. If you were denied long term disability benefits, it is imperative that you take immediate action to protect your rights. To get a free, fully private case evaluation, please[ contact our law firm](https://www.garnerltd.com/contact/) today. **Categories:** (ERISA) Litigation, Disability Benefits **Tags:** denied claims, disability attorney, disability claim, ERISA, erisa attorney, long term disability --- ### [What to do if Your New Jersey Long-Term Disability Claim is Denied?](https://www.garnerltd.com/what-to-do-if-your-new-jersey-long-term-disability-claim-is-denied/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** If your long-term disability claim was denied, you are likely considering filing an administrative or internal appeal. This can be a complex process, and we recommend retaining an experienced[ New Jersey long-term disability attorney](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) for assistance. At [The Garner Firm, Ltd.,](https://www.garnerltd.com/attorney-profile/) we have extensive experience handling long-term disability claims and subsequent administrative appeals. You only have a limited amount of time to file an appeal, which is why you need to make a decision on whether to appeal and retain an attorney right away. Failure to meet the deadline means your appeal could be denied. If you received your claim denial letter, there will be a deadline listed. If you do not have the letter, your policy should also list the timeframe you have to bring an appeal. Federal law mandates that your insurer has to give you a minimum of 180 days to file an appeal, but some long-term disability policies may allow a longer timeframe. ![photo of rubber stamp showing long term disability claim denied](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_154247781-1024x791.jpg "Claim denied stamp - The Garner Firm") ### Start by Reading Your Denial Letter Closely One of the most critical elements of filing an appeal is understanding exactly why your claim was denied. The denial letter should contain this information and should also contain information that discusses the requirements for filing your appeal. Just like missing the deadline, an improperly filed appeal could cause you to be denied. One of the first steps you should take is to make a written request for your entire claims file from the insurance company. Under federal law, your insurer or the plan administrator has to give you a free copy. ### Get Supporting Documentation If your denial letter states that your claim lacked “objective” support, you will also want to get any diagnostic test results like X-rays, CT scans, or MRIs. You need all relevant documentation that can help your case. Review your existing case file and determine whether all your medical records are there. You want everything possible — including surgical reports, radiology notes, doctor notes, and any reports from an emergency room visit. If documents are missing, you will need to start requesting them as soon as possible. ### Get Your Doctor’s Written Opinion It is helpful to have your doctor write a document that outlines his or her opinion on your condition. This should include your physical and mental limitations. Get specific with your doctor and ask pointed questions on how your impairments will affect your daily life and activities. If this particular doctor does not want to assist, find one who does take your case seriously. ### Understand What Disabled Means Under Your Policy Before filing your appeal, you also want to familiarize yourself with what your insurer’s definition of disability is. Insurers can have different meanings, and that can make a huge difference in your appeal. One policy might say that a disability is your inability to perform any job, while another policy might state that a disability is when you cannot work again in your particular profession. ### Contact a New Jersey Long-Term Disability Attorney If your claim for long-term disability has been denied,[ contact The Garner Firm, Ltd](https://www.garnerltd.com/contact/)., right away to schedule an initial consultation so we can review your claim in its entirety. Do not attempt to go into the appeals process without a New Jersey disability benefits lawyer on your side. **Categories:** Long Term Disability **Tags:** claim, denial, disability, Disability Benefits, long term disability, LTD --- ### [Situations Where You Might Need an ERISA Attorney](https://www.garnerltd.com/situations-where-you-might-need-an-erisa-attorney/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** ERISA stands for the Employee Retirement Income Security Act of 1974 and governs many employer-backed benefits and retirement programs around the United States. Employees who have had benefits denied under ERISA plans can benefit from the services of a skilled ERISA attorney, but they are not the only ones. It is essential to first verify whether or not your plan is governed by ERISA. It typically does not cover government employers or churches, for example. Here is a look at some of the situations in which you may need to retain a[ Pennsylvania ERISA attorney](https://www.garnerltd.com/practice-areas/erisa-litigation/). ![photo of hands in courtroom relating to ERISA attorneys](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_247963248-1024x683.jpg "Good service cooperation, Consultation of Businessman and Male lawyer or judge counselor having team meeting with client, Law and Legal services concept - The Garner Firm") ### When Employees Need an ERISA Attorney Do you suspect that your company is mismanaging your pension funds? Is there a chance people are embezzling money from employees? Or maybe you think they are improperly investing in company stock? If you are concerned about major losses to your 401K or there are large fees associated with your pension plan, you may want to speak with an ERISA attorney. Advisors and managers have a fiduciary duty to act in the best interest of all plan participants. If you report your suspicions and suffer repercussions, like getting fired, you may have additional protection under the Act. Likewise, if you have made a claim for long-term disability benefits, life insurance benefits, or accidental death and dismemberment benefits under a benefit plan offered by your employer or that of a loved one, you may need an ERISA lawyer. Often, the insurance companies responsible for deciding and paying these claims make mistakes in the process of doing so. As a result, meritorious claims frequently get denied. If an ERISA benefits claim is denied, you have a limited amount of time to submit an appeal of the denial (the amount of time depends on the type of claim). It is important to retain an ERISA lawyer during that appeal process so that he or she can build a detailed record of the reasons why your claim should be approved. If the appeal is denied, the courts often decide only to review the record that was created during the appeal process. Thus, the quality and completeness of that record is critically important. ### Contact a Pennsylvania ERISA Attorney If you are an employee or plan administrator who has ERISA-related questions,[ contact The Garner Firm, Ltd.](https://www.garnerltd.com/contact/) today to schedule an initial consultation. [Adam Garner](https://www.garnerltd.com/attorney-profile/) has experience litigating ERISA claims in Pennsylvania, New Jersey, and Maryland, as well as elsewhere throughout the United States. **Categories:** (ERISA) Litigation, Employee Benefits **Tags:** benefits, benefits claim, disability, ERISA, erisa claim, erisa litigation --- ### [Common Reasons for Disability Claims](https://www.garnerltd.com/common-reasons-for-disability-claims/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** Some people are born with certain disabilities, while others never imagine that they will sustain a disabling condition. This type of diagnosis and recognition of your limitations can be devastating, especially if your condition prevents you from working. Reports indicate that more than five percent of working individuals in the United States will experience short-term disabilities that cause them to miss six months or less of work each year. Further, about 25 percent of people can expect to miss work for one year or longer due to a disability before they reach retirement age. It is important to stay aware of the common reasons for disability claims, which can vary widely. This can also help you recognize when you might qualify for disability benefits and need to start the claims process. ![photo of elderly person's hand holding hands with younger person as it relates to disability claims](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_198923929geo-1024x683.jpg "photo of elderly person's hand holding hands with younger person as it relates to disability claims - The Garner Firm") ## Short Term Disabilities Short term disability benefits help with financial support if you cannot work for a period of time due to temporary conditions. The following are some of the most common reasons for short term disability claims: - Musculoskeletal disorders, especially in the back, spine, shoulders, hips, or knees - Pregnancy and related conditions - Gastritis, hernias, and other digestive disorders - Muscle and ligament sprains and strains - Fractures and other injuries - Mental health conditions, including anxiety and depression ## Long Term Disabilities Some conditions are not expected to improve anytime soon to the point where you can return to work. These benefits are meant to last indefinitely unless your condition improves. Some causes of [long term disability claims](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) include: - Chronic musculoskeletal disorders - Cancer - Cardiovascular conditions - Permanently disabling injuries - Severe mental health conditions - Nervous system disorders - Respiratory conditions ## The Impact of a Disability Having your abilities restricted can be devastating enough, but that is in addition to all of the other effects of disabling conditions. Such conditions can require ongoing medical care, home assistance, medical equipment, and more, and they can prevent you from working. Medical bills and unemployment are two of the leading causes of bankruptcy in the United States, demonstrating how a disability can lead to financial struggles very quickly. It is important to get all the financial support you can when a disability keeps you out of work. Workers’ compensation benefits help some people, but only if the disability stemmed from job-related injuries or illness. You should always explore whether you can qualify for disability benefits through your [employer-sponsored ERISA insurance coverage](https://www.garnerltd.com/practice-areas/erisa-litigation/). ERISA disability insurance claims are complicated, and many people receive initial denials. You want to seek help from an experienced disability claims attorney who can help you: - Prepare a persuasive claim - Present all necessary documentation to support your claim - Negotiate and communicate with insurance adjusters on your behalf - Navigate the appeal process if your claim was denied ## Contact a Philadelphia Disability Claims Attorney about Your Situation If you believe you need to file for disability benefits with your insurance company in Philadelphia or New Jersey, you want the help of a disability claims lawyer from The Garner Firm. Please [contact us](https://www.garnerltd.com/contact/) to learn more about how we can help. **Categories:** (ERISA) Litigation, Disability Benefits **Tags:** long term disability attorney, long term disability benefits, LTD benefits --- ### [Can You Work While Receiving LTD Benefits?](https://www.garnerltd.com/can-you-work-while-receiving-ltd-benefits/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** Some people who are receiving [long-term disability (LTD) benefits](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) from their insurance policy might want to return to work if they believe they are able to do so. However, it is important to realize that in many situations, your LTD benefits can be in jeopardy once you begin earning income again. It is important to have an experienced [long-term disability attorney](https://www.garnerltd.com/attorney-profiles/) review your policy and your options before you make the decision to go back to work. ![photo of african american woman seeking information about long term disability benefits](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_258993994geo-1024x683.jpg "photo of african american woman seeking information about long term disability benefits - The Garner Firm") ## Policy Variations Each LTD policy has different terms, including different restrictions and allowances when it comes to working and earning income. The following are two different types of policies that are common. ## “Own Occupation” Policies This type of policy generally considers you to be “disabled” and eligible for benefits when your medical condition prevents you from performing the material and substantial job duties expected of your chosen occupation. For example, if your job requires heavy lifting or physical work, your medical condition might prevent you from continuing in that particular job, though you might be able to perform less physically demanding work. If you have an “own occupation” policy, it might allow you to work outside your chosen profession and still receive LTD benefits, with some possible exceptions. If you are earning 80 percent or more of your pre-disability earnings in another occupation, you likely will become ineligible for continuing LTD benefits. If you have a professional license, your “own occupation” under the policy terms might include any work that requires that same license, even if it requires different work from your previous job duties. It is important to examine the exceptions to the “own occupation” rule in your policy before you begin a different type of work. ## “Any Occupation” Policies This type of LTD policy considers you to be disabled and eligible for benefits if your medical condition renders you unable to perform any type of occupation that would be suitable for you based on your education, experience, and training. Some disability policies might switch from “own occupation” to “any occupation” after 24 months or another specified time period. Your eligibility for LTD benefits while returning to work under this type of policy will generally depend on how much you are earning. If you are only earning 20 percent or less of your previous income, you might be able to continue with your benefits uninterrupted. If you earn more, your benefit amount will likely be reduced. If your work pays 80 percent or more of what you previously earned, your benefits could be completely terminated. ## Contact a Philadelphia Long-Term Disability Benefits Lawyer Before you return to work while receiving LTD benefits, you want to first fully understand the terms of your policy. It might be wise to discuss your options – and how your benefits might be affected – with an experienced Philadelphia long-term disability attorney. If you believe your insurer wrongfully terminated your LTD benefits, you should contact The Garner Firm right away. [Contact us](https://www.garnerltd.com/contact/) about your concerns today. **Categories:** Disability Benefits, Long Term Disability **Tags:** long term disability attorney, LTD benefits, LTD benefits lawyer --- ### [What is the Life Insurance Contestability Period?](https://www.garnerltd.com/what-is-the-life-insurance-contestability-period/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** Once you have purchased a new life insurance policy, your beneficiaries are not guaranteed to receive payment on any claim for the first two years of the policy. This is known as the contestability period, and the insurance company uses it to protect itself. It may refuse to pay claims if it finds that there was fraud or the applicant lied on their application. This is when you need to contact a [Philadelphia life insurance attorney](https://www.garnerltd.com/attorney-profiles/). ![photo of house and family as it relates to life insurance constestability period](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_204402874-1024x683.jpg "photo of house and family as it relates to life insurance constestability period - The Garner Firm") ### Expect the Insurance Company to Review a Claim Made During this Period Just because the life insurer has the right to review all claims made within the first two years does not mean that it will deny every claim. The insurance company is still obligated to pay out on claims if someone dies during the contestability period unless the investigation uncovers a reason for the carrier to rescind coverage. However, it does mean that it may take more time to investigate, and it could delay the payment of your claim. You can expect that insurance companies will always investigate further if the policyholder dies in the first two years. The insurance company will end up paying in a majority of cases. It might ask some more questions depending on the cause of death. You can expect even more inquiry if the cause of death is any of the following: - Certain types of cancer; - Drug overdoses; - Single-vehicle accidents; or - Gunshot wounds The insurance company does not, however, have the absolute right to deny every claim. Instead, it must find evidence of material misrepresentation on the policy application. The insurance company may also contest the payment of a claim if it discovers that the payment of policy premiums had lapsed. ### What the Insurance Company May Try to Do During Contestability If the insurance company does find evidence of inaccuracies on the application, it has three options: - Increase the premiums that one should have paid and use the money to reduce the death benefit - Deny the claim for the death benefit in its entirety - Reduce the death benefit Insurance may still try to deny or reduce the claim even if the cause of death had nothing to do with what it claims was a misrepresentation. The insurance company does not have the final say if it chooses to deny benefits. The first thing that you can do is to go through the insurance company’s appeals process. This is not always easy to do, especially at a time when you and your family are grieving. Nevertheless, you could try to persuade the life insurance company that it made a mistake. The more likely way to contest the denial of benefits is to file a lawsuit against the [insurance](https://www.garnerltd.com/practice-areas/life-insurance/) company. ### Philadelphia Life Insurance Attorney If you have filed a claim that was denied by the life insurance company, you have legal rights to appeal.[ Contact ](https://www.garnerltd.com/contact/)the Philadelphia life insurance attorneys at the Garner Firm to schedule your free initial consultation and learn if you can challenge the decision that denied you the money that you needed. **Categories:** Life Insurance **Tags:** insurance, insurance claims, life insurance, life insurance claims --- ### [How to Appeal a Long-Term Disability Denial](https://www.garnerltd.com/how-to-appeal-a-long-term-disability-denial/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** Insurance companies are notorious for being extremely stringent on initial long-term disability claims. They lose nothing by denying claims and making you fight for benefits. There is no obligation for these companies to show any good faith when considering your claim. Therefore, you may be in a position where you have to appeal a denial of your claim. The first step in the appeal process should be hiring a [Philadelphia disability attorney](https://www.garnerltd.com/attorney-profiles/) if you do not already have one. The strength and quality of your appeal matters because it forms the record if you have to go to court in the future. Your attorney may find it helpful to speak with the insurance company. Your denial may have been based on a misunderstanding. If so, you can clear it up and give the insurance company the necessary information. This is the best-case scenario. ![photo of woman relating to long term disability claim denial](https://www.garnerltd.com/wp-content/uploads/2023/01/AdobeStock_415517206-scaled-1-1024x682.jpeg "photo of woman relating to long term disability claim denial - The Garner Firm") ### The Insurance Company Has an Appeals Process In many cases, you have to go through the insurance company’s appeals process. While it does not always seem fair, you have to file your initial appeal with the same company that denied your claim in the first place. You need to take the appeals process seriously. You must provide the insurance company with information that shows you are entitled to long-term disability. This includes medical records and supporting documentation for your claim. Here are some forms of helpful documentation: - Personal statements - Witness statements from people you know - A statement from your employer if they will give it - Evidence that other agencies are paying you benefits - Statements from your doctor Your hope is that this will persuade the insurance company to [grant benefits](https://www.ssa.gov/benefits/disability/qualify.html) on review. In many cases, it is. Litigation costs the insurance company money, and they may back down if they see that you have a strong record. Even if the insurance company will not reverse their initial decision, the record that you have established on review could help you in the next step. ### You Can Sue if Your Appeal Is Denied If your administrative appeal is denied, you will have no choice but to go to court. The catch is that you cannot introduce any new evidence. The federal judge will take the file from your appeal and make their own decision about whether you are entitled to benefits. This is why you must submit a strong file at the appeal stage. Many people who fight their denial are ultimately successful. It is critical to speak with an attorney right after your claim is denied, so you can file a strong appeal within the allowable time frame. Otherwise, you could end up with gaps in the record and nothing you could do if you lose the appeal. It is better to begin fighting hard as soon as possible. ### Contact a Philadelphia Long-Term Disability Insurance Attorney The long-term disability attorneys at [The Garner Firm, Ltd.](https://www.garnerltd.com/reviews/) are experienced at taking on the insurance companies to help clients who have been denied benefits. [Contact](https://www.garnerltd.com/contact/) us today for your free initial consultation to discuss your case. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Long Term Disability **Tags:** Claims, Company Payout, long term disability --- ### [Plan Sponsor's Contractual Dispute with Insurance Carrier Subject to ERISA Preemption](https://www.garnerltd.com/plan-sponsors-contractual-dispute-with-insurance-carrier-subject-to-erisa-preemption/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** The United States District Court for the Eastern District of Pennsylvania recently issued an opinion holding that a contractual dispute between a health plan sponsor and the insurance carrier that it contracted with to provide health benefits to its employees was subject to ERISA preemption. *See Shore v. Independence Blue Cross*, Case No. 16-5224, 2016 U.S. Dist. LEXIS 160585 (E.D. Pa. November 18, 2016). [A copy of the opinion may be downloaded here](https://www.garnerltd.com/wp-content/uploads/2017/10/ShorevIBX.pdf). The Shore plaintiff is a law firm that sponsored a group health plan (“the Plan”) for the benefit of its employees. As such, the Plan is governed by ERISA. Plaintiff entered into a contractual relationship with Independence Blue Cross (“IBC”) to serve as the Plan’s insurer and claim fiduciary. Plaintiff contended that IBC violated their contract by accidentally denying coverage for some claims that it was obligated to pay per the terms of the Plan. IBC subsequently offered in writing to freeze Plaintiff’s premium rates for 16 months as compensation for its prior mistake. Plaintiff accepted Defendant’s rate freeze offer. IBC later advised Plaintiff that it would not honor the premium freeze agreement because it had a mistake. Plaintiff sued IBC in state court for common law fraud, breach of contract, statutory bad faith, promissory estoppel, breach of fiduciary duty, and violation of the Pennsylvania Unfair Trade Practices and Consumer Protection Law. IBC responded by removing the action to federal court and moving to dismiss it by claiming that ERISA preempted Plaintiff’s state law claims. Plaintiff then moved to remand the action to the Court of Common Pleas. The Court held that [ERISA](https://www.garnerltd.com/) completely preempted Plaintiff’s state law claims. It stated: > A claim is preempted where (1) it could have been brought under ERISA’s Section 502(a) (see 29 U.S.C. § 1132), and (2) it alleges breach of a legal duty that is not independent of the ERISA plan. *Pascack Valley Hosp. v. Local 464A UFCW Welfare Reimbursement Plan*, 388 F.3d 393, 398 (3d Cir. 2004), as amended (Dec. 23, 2004). Applying this test, I find that the rate freeze agreement at issue here cannot be evaluated without an understanding of the underlying plan. Furthermore, because Plaintiff’s claims could have been brought under ERISA, and because they rest on a legal duty dependent upon the existence of an ERISA plan, they are necessarily preempted by federal law. *Shore*, 2016 U.S. Dist. LEXIS at *4.* The Court reasoned that Plaintiff was suing to enforce a “plan benefit” – the rate freeze – and, thus, the claim could have been brought under ERISA Section 502(a)(3), 29 U.S.C. 1132(a)(3). Plaintiff’s claims were not independent of the existence of an ERISA plan because they were dependent upon the existence of the Plan. Thus, the motion to remand the matter to state court was denied, some of Plaintiff’s state law claims were dismissed outright, and several other claims were reformed as claims for equitable relief under ERISA Section 502(a)(3). Plaintiff was also granted leave to amend its complaint to further conform its claims to [ERISA](https://www.garnerltd.com/erisa-litigation/). **Categories:** Employment Contracts --- ### [Reasons Your New Jersey Long Term Disability Claim Might be Denied](https://www.garnerltd.com/reasons-your-new-jersey-long-term-disability-claim-might-be-denied/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Many long-term disability, or LTD, policies are regulated under ERISA. This is a federal law that stands for the Employee Retirement Income Security Act. When you make a claim for benefits, it is typically evaluated by a claims adjuster who works for the insurance company. Unfortunately, it is not uncommon to have claims adjusters deny valid long-term disability claims, even when there is evidence of a claim’s validity. While it’s certainly not fair, the fact remains that claims administrators routinely deny claims. It is important to understand some of the potential reasons for denial, some of which are legitimately valid. Also, it is important to contact a knowledgeable[ long-term disability lawyer admitted to practice law in New Jersey](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/). The Garner Firm has extensive experience representing clients who have been unfairly denied for long-term disability benefits under an ERISA-regulated benefits plan. ### You Do Not Meet the Policy’s Definition of Disabled This is one of the most common reasons for denial of LTD benefits. The definition of disabled is exact, and if you do not meet it, you will be denied. To make it even more confusing, the terms change over time. For example, it transitions from unable to perform the duties of “your regular occupation” to “any occupation” after the first 24 months. ### Surveillance and Online Evidence You can expect that the claims administrator will be looking at your online activity and social media accounts. They may even hire an investigator to surveil you in person. They are looking for proof of your daily activities and video evidence of you doing something that proves (in the mind of the claims administrator) that you are not disabled. Expect them to show things out of context, as well. Perhaps your claim is for fibromyalgia. Most patients report having some good days. If you are outside and lifting a light object or doing some maintenance work around your yard, that may be enough for them to contend that you are not disabled. ### Pre-Existing Conditions and Exclusions If you have a pre-existing condition, it can limit your benefits. Some policies may consider a pre-existing condition to exist if you sought treatment or took prescription medication for a condition and went to the doctor in the months before your insurance took effect. Your insurance company could then deny benefits for a 12-month period after your insurance became effective. Once the 12-month waiting period is over, you would be covered for LTD, in theory. In some cases, conditions themselves are excluded. These can include impairments related to substance abuse or alcohol. Conditions that include subjective complaints rather than objective ones (like chronic fatigue syndrome) may be limited in duration, typically the first two years. ### Missed Deadlines There are strict deadlines when it comes to long-term disability benefits. If you miss one, it could result in a denial. In most ERISA-governed plans, you only have 180 days to appeal an initial LTD denial. ### Contact a New Jersey Long-Term Disability Insurance Attorney Today Making sure you meet deadlines and present all valid evidence during the claims process is key. Let a [New Jersey LTD insurance attorney](https://www.garnerltd.com/attorney-profile/) help.[ Contact The Garner Firm](https://www.garnerltd.com/contact/) today to schedule an initial consultation today. **Categories:** Disability Benefits, Long Term Disability **Tags:** benefits, disability, Disability Benefits, long term disability, long term disability benefits, LTD --- ### [What Does Accidental Death and Dismemberment Insurance Cover?](https://www.garnerltd.com/what-does-accidental-death-and-dismemberment-insurance-cover/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** Many employers offer a type of insurance called accidental death and dismemberment (AD&D) coverage. This is a type of policy that supplements a life insurance policy, often increasing – or even doubling – the benefits you or your family receives under certain circumstances. If you choose to carry AD&D coverage, you should understand what it does and does not cover, as should your beneficiaries. If you have any specific questions regarding an accidental death and dismemberment claim or claim denial, speak directly with a [Philadelphia AD&D lawyer](https://www.garnerltd.com/attorney-profiles/) today. Different policies have different specifications, but the following is a general idea of what an AD&D policy will cover. If you would like to discuss your policy, do not hesitate to contact The Garner Firm, Ltd. ### Accidental Death Coverage As the name of the coverage implies, accidental death and dismemberment policies cover accidental death under certain circumstances. Some causes of death that might lead to benefits include: - Traffic crashes - Accidental drowning - Accidental falls - Heavy machinery accidents You should always be familiar with your policy and the types of accidental death that are covered, so your beneficiaries will be aware of their rights if something suddenly happens to you. ### Dismemberment You do not have to pass away tragically for your [AD&D](https://www.garnerltd.com/practice-areas/accidental-death-dismemberment-benefits/) insurance to pay benefits to you or your family. You can also be eligible for a percentage of benefits if you: - Lose a limb, extremity, or digit - Lose the use of certain parts of your body - Suffer permanent paralysis - Lose your hearing, sight, or speech Again, each policy will be different in the injuries it covers and the percentage of benefits it pays for each type of injury. ### Exclusions from Many AD&D Policies In addition to listing what is covered by your accidental death and dismemberment insurance, your policy should detail what causes of death and types of serious injuries will not be covered. While you should examine your own policy, some common exclusions include: - Death from a drug overdose - Death stemming from drug or alcohol impairment, such as a drunk driving accident when the policyholder was the impaired driver - Death from natural causes or illnesses - Suicide - Injuries or death from war participation - Injuries or death from felonious conduct on the part of the policyholder Sometimes, a policy will claim that the cause of injury or death was excluded when, in reality, it should be covered. Families of deceased policyholders and dismembered policyholders should never accept a wrongful denial of an AD&D claim. ### Contact a Philadelphia Accidental Death and Dismemberment Insurance Attorney for Help Employer-sponsored accidental death and dismemberment claims are usually governed by [ERISA](https://www.dol.gov/general/topic/health-plans/erisa), a complex federal law that often favors the insurer, not the policyholder or beneficiaries. If you need assistance with a claim, do not wait to contact an AD&D attorney from The Garner Firm, Ltd. We are ready to help, so please [contact us](https://www.garnerltd.com/contact/) today. **Categories:** Accidental Death and Dismemberment **Tags:** accidental death, accidental death and dismemberment, ad&d, insurance --- ### [Understanding the ERISA Claim Process](https://www.garnerltd.com/understanding-the-erisa-claim-process/) **Published:** January 2, 2023 **Author:** The Garner Firm **Content:** When you or a loved one need to file a claim with your insurance providers, such as a disability or life insurance claim, you may come across a law known as ERISA. The Employee Retirement Income Security Act of 1974, or ERISA for short, is a federal law that sets forth requirements for a majority of employer-backed benefit plans throughout the country. ERISA claims can be complex, as larger insurance companies have spent the past few decades developing strategies that help them process claims in their own favor. If you’re new to the ERISA claims process, or your claim has been denied, you might not be sure what to do next. New Jersey ERISA attorney Adam Garner has helped many people navigate the claims process and can offer guidance on what to expect. ## ERISA Benefit Claims Under ERISA benefits law, some valid claims may include: - 401(k) benefits - [Long-term disability (LTD) benefits](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) - Pension benefits - Short-term disability (STD) benefits - Life insurance benefits - Accidental death and dismemberment (AD&D) benefits - Health insurance benefits - Other employee benefits The Garner Firm, Ltd. represents employees, former employees, executives, plan participants, and their beneficiaries in all aspects of ERISA law and the aforementioned types of claims. ## How the ERISA Claim Process Works The initial process for filing a claim will be determined by your insurance provider or the plan’s claim fiduciary. Just as there are regulations that insurers and other plan administrators must follow to comply with ERISA, beneficiaries must also follow the claims procedures required by their insurer. Failing to do so can reduce your ability to successfully obtain benefits. Plan participants and their named beneficiaries are owed a full review of any claim for benefits. However, this does not always occur, which is one of many reasons why claimants might seek the help of an [experienced ERISA lawyer](https://www.garnerltd.com/practice-areas/erisa-litigation/). Having someone on your side who deeply understands ERISA regulations can help, as the same people who are reviewing your claim for benefits are often the same ones who pay the claims. This creates a conflict of interest and an incentive for them to deny your claim since it benefits their bottom line. ## What to Do if Your ERISA Claim is Denied If your benefits are denied, you must take specific steps to start the appeals process and ensure your rights are protected. If you do not handle it correctly, your appeal could be denied. That means you will have a hard time challenging the ruling in court, or you may even be barred from doing so. Your appeal has to be filed quickly, as you only have 60-180 days at most, depending on the type of benefit claim. Failure to take action until after the deadline means your case could be dismissed automatically. Sadly, you cannot rely on your employer to help with your ERISA claim or the subsequent appeal. When you work with a knowledgeable ERISA lawyer, you get the benefit of skilled representation from an attorney who has extensive experience handling these types of claims. ## Let an Experienced ERISA Benefits Lawyer Help At The Garner Firm, Ltd., our ERISA lawyers work to develop a unique strategy to help improve your chances of prevailing. No two situations or claims are identical, which is why we develop an individualized plan. If required, we can also work with you through the appeals process and help you pursue payment through the court. If you need assistance with ERISA benefits, our New Jersey ERISA benefits attorney can help. [Call The Garner Firm, Ltd.](https://www.garnerltd.com/contact/), or contact us online today to schedule an initial consultation and free, no-obligation review of your ERISA claim. **Categories:** (ERISA) Litigation **Tags:** ERISA, erisa attorney, ERISA lawyer --- ### [Adam H. Garner Appointed Chair of the ABA's Torts, Trial, and Insurance Practice Section's Health and Disability Insurance Committee](https://www.garnerltd.com/adam-h-garner-appointed-chair-of-the-abas-torts-trial-and-insurance-practice-sections-health-and-disability-insurance-committee/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** The Garner Firm’s founder, [Adam H. Garner](https://www.garnerltd.com/adam-h-garner/), was recently appointed as the Chair of the [American Bar Association’s](http://www.americanbar.org) Torts, Trial, and Insurance Practice Section’s (TIPS) Health and Disability Insurance Committee. This one-year, national leadership, appointment commenced in August 2020 and runs to August 2021. Adam has a long-standing commitment to furthering the development health and disability insurance law, and is involved in a number of ABA committees dedicated to the topic. Adam also serves as an editor of the leading employee benefits treatise: *Employee Benefits Law*, which is now in its 4th edition. **Categories:** (ERISA) Litigation, Disability Benefits, Employee Benefits, Health Insurance, Long Term Disability **Tags:** disability insurance, ERISA, erisa attorney, ERISA disability, health insurance --- ### [The Beginning of an Interesting Post-Amara ERISA Case in Louisiana](https://www.garnerltd.com/the-beginning-of-an-interesting-post-amara-erisa-case-in-louisiana/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** This morning, I came across a brief and interesting decision issued by the United States District Court for the Eastern District of Louisiana addressing the scope of equitable remedies available to participants in [ERISA](https://www.garnerltd.com/erisa-litigation/) cases. In *Lauga v. Applied-Cleveland Holdings*, Case No. 16-14022 SECTION: “H”(3), 2016 U.S. Dist. LEXIS 173464 (E.D. La. December 15, 2016), the Court denied a motion to dismiss filed by MetLife in which it sought to apply a suicide exclusion in a [claim](https://www.garnerltd.com/services/) seeking life insurance benefits. The reason for the Court’s decision may make this a case to watch if it proceeds through litigation. The *Lauga* plaintiff seeks to collect the proceeds of an optional life insurance policy covering her deceased husband, which was offered through an ERISA-regulated employee benefit plan offered by his employer. The plaintiff is the designated primary beneficiary under the plan. MetLife insures the plan’s benefits. At the time that he was hired in 2009, the plaintiff’s late husband did not elect [optional life insurance benefits](https://www.garnerltd.com/services/). In March 2013, he decided to obtain $200,000 in optional lie insurance benefits through his employer. He was required to complete a form describing his health and submit to a medical exam. He submitted the form on March 14, 2013. About a week later, the plan administrator returned the form and claimed it was incomplete. The decedent resubmitted the form by April 5. The administrator conducted a medical exam on July 5, 2013 (the opinion appears to contain a typo and identified the year as 2016) and the requested coverage was approved on July 11. The additional coverage went into effect on August 1, 2013. The plaintiff’s husband committed suicide on July 9, 2015, less than two years after the effective date of the policy. The plan contains a suicide exclusion that provides that policy proceeds are not payable if the insured commits suicide two years from the date the coverage takes effect. MetLife denied the plaintiff’s claim for benefits, invoking the suicide exclusion. What makes the case interesting is the Plaintiff’s argument as to why she should receive the benefits. She contends that the defendants breached their fiduciary duties to her and the decedent by failing to promptly process the decedent’s application for optional life insurance coverage. She contends that the defendants’ untimely processing of his application gave the policy a later effective date, causing the decedent’s death to fall just inside the 2-year suicide provision. She seeks reformation of the policy under section 502(a)(3) of ERISA, 29 U.S.C. § 1132(a)(3). The Court denied MetLife’s motion to dismiss and held that the plaintiff had properly pled a claim for relief under Section 502(a)(3) and cited the Supreme Court’s decision in *CIGNA Corp. v. Amara*, 563 U.S. 421, 440 (2011), which clarified and expanded the types of equitable relief available in ERISA cases. The *Lauga* plaintiff’s claim would have been very difficult, if not impossible, prior to *Amara*. Since *Amara*, there have been some interesting cases that provide plan participants with better tools to recover their wrongly withheld benefits. *See, e.g., McCravy v. Metro. Life Ins. Co.*, 690 F.3d 176 (4th Cir. 2012) (remanding a case to the District Court to determine whether the plaintiff had made out a claim for equitable relief based on a theory of estoppel with surcharge of the fiduciary as the equitable remedy). It will be interesting to see how this matter plays out and if it will add to the developing body of law determining the scope of equitable remedies available under Section 502(a)(3) in light of *Amara*. **Categories:** Legal Counsel --- ### [The Impact of a Layoff on a Long Term Disability Claim](https://www.garnerltd.com/the-impact-of-a-layoff-on-a-long-term-disability-claim/) **Published:** January 2, 2023 **Author:** Adam Garner **Content:** Things have been busy at The Garner Firm, and I am behind on my blog posts. Last week, I was fortunate to attend the American Bar Association’s Torts Insurance Practice Section (“TIPS”) Mid-Winter Symposium on Insurance and Employee Benefits. During the conference, a speaker discussed the impact a lay off can have on a disabled employee’s long term disability claim. Well, the speaker’s timing was impeccable because The United States District Court for the District of Arizona issued a decision on that very topic yesterday. *See Nieves v. Prudential Ins. Co. of Am.*, Case No. CV-16-00768-PHX-DGC, 2017 U.S. Dist. LEXIS 6187 (D. Ariz. January 17, 2016). A copy of the decision can be downloaded [here](https://www.garnerltd.com/wp-content/uploads/2017/10/NievesvPrudential.pdf). Oops! We could not locate your form. The *Nieves* plaintiff was a technician who made repairs on satellite communications equipment and who participated in an ERISA-regulated benefit plan that provided coverage for short-term and long term disability (the “Plan”). His job required the continual use of his hands and constant sitting, standing, climbing, and crouching. In 2011, he began suffering severe back and arm pain related to his spinal condition. He went on light duty work in 2011 at his physician’s request and was restricted in “sitting, standing and lifting.” The plaintiff continued to work full-time with the aid of pain relieving shots and medication. The plaintiff learned that his employment could be terminated under a reduction in force (“RIF”) on March 9, 2015. He immediately spoke with his company management and asked permission to file for disability benefits instead of being laid off. The plaintiff claimed he was assured: “you’re good,” which caused him to believe his employment was safe and that he should not file for disability benefits. His employment was terminated the next day as part of the RIF. At the termination meeting, the plaintiff inquired again about filing for disability benefits under the Plan, and he asked the company’s human resources staff for the paperwork to make a [claim](https://www.garnerltd.com/services/). The paperwork was not provided to him. The plaintiff filed for short and long term disability benefits under the plan after his termination. His claim was denied because the insurer found that he was not employed by the employer at the time his of disability. The disability insurer, who served as the Plan’s claims administrator, did not investigate whether the plaintiff satisfied the Plan’s definition of disability. The Plaintiff appealed the denials of his claims and ultimately filed suit seeking the benefits he believed were owed to him. The Court made several interesting findings in evaluating the plaintiff’s claim. First, it found that the denial of the plaintiff’s benefits was to be reviewed under the *de novo* standard of review because the insurer was not granted discretionary authority to construe the terms of the plan and determine eligibility for plan benefits in the plan document itself. The only grant of discretionary authority was contained in the Plan’s summary plan description, which had not been incorporated into the Plan as a Plan document. Likewise, although the Plan document provided that proof of disability had to be “satisfactory to” the insurer, such language was not sufficient to confer an arbitrary and capricious standard of review upon its decision. Second, the Court held that the plaintiff’s disability arose prior to his termination from his employer while he was still a Plan participant. It noted that the plaintiff attempted to file for disability before his employment ended. He provided a declaration to the insurer during the appeal process in which he stated that in early 2015 he informed his superiors that he was planning to claim disability in August 2015 and that when he was told of his layoff, he advised company’s human resources personnel that he wanted to file for disability benefits prior to his layoff. He further claimed the company would not provide his with the necessary paperwork and he was escorted from the work site. The company seemingly admitted as much in a later email exchange. Thus, the Court found that his disability arose prior to his termination while still a Plan participant. Third, the Court found that instead of remanding the claim to the Plan for further consideration as to the plaintiff’s disabled status, the plaintiff was entitled to short and long term disability benefits. Because the insurer had not included any basis for the denying the plaintiff’s claim other than its determination that his claimed disability arose after his participation in the Plan terminated, it was barred from advancing an alternate basis for denying his claim in the ensuing litigation. The Court held that permitting it to do so would deny the plaintiff a full and fair review of his claim as is required under Section 503 of ERISA, 29 U.S.C. §1133 and its implementing regulations at 29 C.F.R. § 2560.503-1. Thus, the insurer was “ordered to pay back benefits under the STD and LTD coverages, and to continue to pay the plaintiff benefits so long as the plaintiff remains disabled under the terms of the Plan.” **Categories:** Employment Discrimination --- ## Pages ### [Homepage](https://www.garnerltd.com/) **Published:** November 4, 2022 **Author:** Kevin Sparkman --- ### [Life Insurance Claims](https://www.garnerltd.com/practice-areas/life-insurance/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** If your claim was denied, an experienced ERISA life insurance lawyer can help you fight back and hold the insurer accountable. Life insurance benefits provide critical financial security when you or a loved one dies. People typically obtain life insurance coverage in two ways: through their employment, or by purchasing a policy on their own. The laws that govern a life insurance policy vary depending on how you obtained coverage and the state that issued the policy. No matter how you obtain coverage, the policy offers little value if the insurer denies the claim after the insured person dies. Insurers deny life insurance claims for many reasons. A knowledgeable life insurance lawyer can review your denial, determine whether the insurer acted wrongly, and help you recover the benefits you are owed. ## When ERISA Governs Your Life Insurance Claim The Employee Retirement Income Security Act of 1974 (“ERISA”) often governs life insurance provided through an employer’s benefit plan. This federal law covers employee benefit plans at nearly all private-sector employers. It does not cover benefits from federal, state, and local governments, and it does not cover benefits from many employers affiliated with religious organizations. Keep in mind that an [ERISA](https://www.dol.gov/general/topic/health-plans/erisa "ERISA") life insurance plan may give you fewer protections than a comparable policy you buy on the individual market. ### If you have made a claim under an ERISA life insurance policy provided through an employer-sponsored employee benefit plan, and your claim has been denied, it is important that you [contact](/contact/) an experienced ERISA life insurance lawyer to assist you with your claim. ## The ERISA Life Insurance Appeal Process All ERISA-regulated life insurance plans require you to complete a mandatory administrative appeal before you can file suit. This appeal process often has short deadlines and confusing requirements. An experienced ERISA life insurance lawyer can walk you through each step, explain the potential weaknesses in your claim, and help you build a strong administrative record before your appeal deadline. ## Non-ERISA and Individual Life Insurance Claims State law, rather than ERISA, generally governs life insurance policies you buy on your own through a broker or directly from an insurer. Many state laws give policyholders stronger consumer protections than ERISA provides. Even so, you should not face the insurance company alone. If the insurer denied your individual life insurance claim, consult an experienced life insurance lawyer to understand your legal rights. The Garner Firm handles life insurance claims under Pennsylvania, New Jersey, and Maryland law. ## Contact an Experienced Life Insurance Lawyer ### Adam H. Garner is an experienced life insurance attorney who has litigated numerous ERISA and Non-ERISA life insurance claims. In addition, [Adam Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/ "Adam H. Garner") has spoken on life insurance claims and litigation at several national insurance and employee benefits conferences over the years. If you have questions regarding your ERISA life insurance claim or non-ERISA life insurance claim, please [contact](/contact/) The Garner Firm today. --- ### [Employee Benefits (ERISA) Litigation](https://www.garnerltd.com/practice-areas/erisa-litigation/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** ## Philadelphia ERISA Attorney for Denied Employee Benefits Claims ### Helping Those Who Have Had Their Employee Benefits Claim Denied As an experienced ERISA attorney, [Adam H. Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/adam-garner-4/ "Adam Garner") and the [other attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") at The Garner Firm help clients across Philadelphia and nationwide fight wrongful benefit denials.We represent executives, employees, former employees, plan participants, and their beneficiaries in all aspects of ERISA employee benefits law. This includes claims for: - [short-term disability (STD) benefits](/practice-areas/long-term-disability/); - [long-term disability (LTD) benefits](/practice-areas/long-term-disability/); - [life insurance and accidental death and dismemberment (AD&D) benefits;](https://www.garnerltd.com/practice-areas/accidental-death-dismemberment-benefits/ "Accidental Death & Dismemberment Benefits") - [pension benefits](/practice-areas/retirement-plan-benefit-claims/); - [401(k) benefits](/practice-areas/retirement-plan-benefit-claims/); and - other types of employee benefits. ### What is ERISA? ERISA is an acronym that stands for the Employee Retirement Income Security Act of 1974. It is a federal law that governs nearly all employee benefit plans in the United States. The biggest exceptions are for so-called “church plans,” which are employee benefit plans sponsored by certain religious organizations, and “governmental plans,” which are plans sponsored by the federal, state, and local governments. ERISA is complicated, sometimes counter-intuitive, and can be a potential minefield to those individuals who do not interact with ERISA-regulated plans regularly. > Many insurers responsible for deciding your claim for benefits are often responsible for paying the claims. As a result, they have a conflict of interest and a financial incentive to deny your claim. Because of this conflict, a knowledgeable ERISA attorney can level the playing field and hold the insurer to its obligations. The law entitles all plan participants and their beneficiaries to a full and fair review of their benefits claims. Unfortunately, that review often does not happen. When an insurer denies a benefit claim, you must take specific steps to appeal the denial and protect your rights. Moreover, missing a deadline can result in a denied appeal. As a result, it can also bar you from challenging the decision in court altogether. Therefore, you should document your claim thoroughly, persuasively, and accurately. Doing so protects your rights and puts you in the best position to win approval. ### Also See: [ERISA Frequently Asked Questions](/erisa-faqs/) and [ERISA and Long-Term Disability Informational Videos](https://www.garnerltd.com/blog/?_story_type=videos) We will work with you every step of the way through the benefits claim process by developing a strategy designed to help you prevail on your claim. No two claims are alike, and we treat each client as an individual who has specific needs, goals, and problems. We will help you complete claim forms, obtain the necessary records, and counsel you regarding your claim. If necessary, we will work with you through the claims appeal process and seek payment of your benefits in a court of law.When you work with an ERISA attorney early in the process, you protect your rights and strengthen your claim. ### Breaches of Fiduciary Duty In addition to benefits claims, we handle claims alleging breaches of fiduciary duty by the people, organizations, and vendors that administer employee benefit plans, on both an individual and class basis. Plan fiduciaries, including insurance companies, must act prudently and in the interest of participants and beneficiaries. However, fiduciaries sometimes put their own interests first. For example, they may charge the plans excessive fees or engage in self-dealing. When that happens, they breach their fiduciary duty. As a result, they must be held accountable, and The Garner Firm holds them accountable for their bad acts. --- ### **VIDEO: What Can You Expect to Recover If You Bring an ERISA Claim in Court?** --- ### ERISA Claims Are Complicated — An Experienced ERISA Attorney Can Help The laws governing employee benefit plans are complicated. [Adam H. Garner ](/attorney-profile)is an experienced ERISA employee benefits lawyer who has years of ERISA employee benefits litigation experience. If you have questions regarding your employee benefits, the claims process, or the denial of your claim for benefits, [contact The Garner Firm ](/contact)today. > “ERISA is, we have observed, a ‘comprehensive and reticulated statute,’ the product of a decade of congressional study of the Nation’s private employee benefit system.” > > — MERTENS V. HEWITT ASSOCS., 508 U.S. 248, 249 (1993) (SCALIA, J.) --- ### Related [Frequently Asked Questions About ERISA and Long-Term Disability Claims](https://www.garnerltd.com/erisa-faqs/ "ERISA Frequently Asked Questions") [Questions to Ask Before Hiring an ERISA Attorney](/questions-to-ask-before-hiring-an-erisa-attorney/ "Questions to Ask Before Hiring an ERISA Attorney") [What is ERISA and How Does It Govern Benefits?](/what-is-erisa-and-how-does-it-govern-benefits/) [How Long Does It Take for an ERISA Claim to be Resolved?](https://www.garnerltd.com/how-long-does-it-take-for-an-erisa-claim-to-be-resolved/)[Informational Videos About ERISA and Long-term Disability Claims (VIDEOS)](https://www.garnerltd.com/blog/?_story_type=videos)[ERISA Fact Sheet – Employee Retirement Income Security Act](https://www.dol.gov/node/64128) (external link) --- ### [ERISA LTD Disability Insurers We Fight for You](https://www.garnerltd.com/homepage/insurers-we-litigate-against-in-erisa-benefit-claims/) **Published:** August 11, 2025 **Author:** Adam Garner **Content:** When insurance companies deny or terminate your ERISA-governed benefits, you need experienced legal advocates who know how to fight back. At The Garner Firm, we take on the ERISA disability insurance companies that routinely deny legitimate claims. We handle long-term disability (LTD), short-term disability (STD), life insurance, and accidental death and dismemberment (AD&D) benefits. The Employee Retirement Income Security Act (ERISA) governs most employer-sponsored benefit plans, creating a complex legal framework that heavily favors insurance companies. These insurers employ sophisticated tactics to minimize payouts, often denying valid claims through biased medical reviews, surveillance, and procedural technicalities. Our experienced [ERISA litigation attorneys](https://www.garnerltd.com/attorney-profiles/) understand these strategies and know how to counter them effectively. ## Understanding ERISA Welfare Benefit Claims ERISA covers four primary types of welfare benefit claims that our firm regularly litigates: **Long-Term Disability (LTD):** Provides income replacement when illness or injury prevents you from working for an extended period, typically after a waiting period of 90-180 days. **Short-Term Disability (STD):** Offers temporary income replacement for shorter periods of disability, usually lasting weeks to months. **Life Insurance:** Employer-sponsored life insurance benefits that should pay out to beneficiaries upon an employee’s death. **Accidental Death & Dismemberment (AD&D):** Additional coverage that pays benefits for deaths or serious injuries resulting from accidents. ## ERISA Disability Insurance Companies We Sue Our firm has extensive experience litigating against the following ERISA disability insurance companies in benefit denial cases: ### **Berkshire Life Insurance Company / The Guardian Life Insurance Company of America** [Guardian Life](https://www.guardianlife.com/) is a large mutual insurer that provides group and individual life and disability coverage through The Guardian Life Insurance Company of America or Berkshire Life Insurance Company of America. While Guardian maintains a reputation for financial strength, claimants who file disability claims under ERISA-governed plans often find that financial strength does not necessarily translate into a fair claims process. ### Lincoln Financial Group/Lincoln National Life Insurance Company [Lincoln Financial](https://www.lincolnfinancial.com), which is based in Radnor, Pennsylvania, provides group benefits through employer-sponsored plans and has grown significantly through acquisitions. They are presently one of the largest, if not the largest, group disability insurer. Their claims handling practices have become increasingly aggressive as they seek to improve profitability. We frequently handle appeals of wrongly denied disability claims against Lincoln Financial, and the company has become a frequent target of litigation. ### MetLife / Metropolitan Life Insurance Company [MetLife](https://www.metlife.com) is one of the largest group benefits insurers in the United States, providing long-term disability, short-term disability, life insurance, and AD&D coverage to millions of employees through employer-sponsored plans governed by ERISA. Headquartered in New York City and the namesake of MetLife Stadium in East Rutherford, New Jersey, MetLife has deep roots in the tri-state region — and its group benefit plans are among the most commonly offered by employers throughout the Philadelphia and New Jersey markets. MetLife’s size and market reach mean that a significant volume of denied claims flows through its claims operation — and with volume comes a systematic approach to claim management that can result in wrongful denials and terminations. ### **Mutual of Omaha / United of Omaha Life Insurance Company** [Mutual of Omaha](https://www.mutualofomaha.com/) is a well-known provider of group and individual insurance products. United of Omaha Life Insurance Company is the subsidiary that typically underwrites and administers group benefit plans subject to ERISA, and it is the entity claimants most often encounter when their benefits are denied or terminated. Despite Mutual of Omaha’s long-cultivated image as a trusted insurer, United of Omaha’s claims handling practices in the ERISA context can be aggressive. Claimants frequently encounter paper-only reviews, narrow policy interpretations, and denials that minimize or disregard treating physician opinions. ### New York Life Insurance Company/Life Insurance Company of North America (LINA) [New York Life](https://www.newyorklife.com) is one of the largest mutual life insurance companies in the United States, providing group life and disability benefits to millions of employees. Despite their marketing emphasis on financial strength and reliability, New York Life frequently denies legitimate ERISA claims. LINA, formerly part of the Cigna Group and now part of New York Life, is known in the ERISA litigation community for aggressive claim denial practices. They handle millions of employer-sponsored benefit claims and have faced numerous lawsuits due to their claim handling. ### The Prudential Insurance Company of America [Prudential](https://www.prudential.com) is a major player in the group benefits market, providing disability and life insurance through employer-sponsored plans. Prudential has previously described disability as a “choice” and the company as the “return to work” company. Our experience has shown that Prudential also employs carefully crafted tactics designed to minimize claim payouts. ### Reliance Standard Life Insurance Company [Reliance Standard](https://www.reliancestandard.com), part of the Tokio Marine group, is based in Philadelphia and focuses primarily on group benefits and has developed a reputation for thorough but sometimes overly aggressive claim investigations. It has been subject to [withering criticism in judicial opinions](https://cases.justia.com/federal/district-courts/mississippi/mssdce/3:2017cv00042/94525/25/0.pdf?ts=1530348817) for its claim handling practices. In our experience, its claims handling practices often fail to comply with ERISA’s regulatory requirements, resulting in claim denials that cannot withstand judicial scrutiny. ### Sun Life Assurance Company of Canada [Sun Life](https://www.sunlife.com) operates extensively in the U.S. group benefits market. Like the other insurers listed above, Sun Life has developed a reputation for wrongly denying ERISA benefits claims. Recently, The Garner Firm’s [Adam Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/) served as lead counsel in a nationwide class action against Sun Life related to its administration of dependent child life insurance benefits. You can read the Court’s [opinion granting final approval](https://erisasettlementsunlife.com/wp-content/uploads/2025/03/Sun-Death-ECF142-Order-Granting-Final-Approval-03-20-2025.pdf) of the class action settlement reached in that case here. Information regarding the settlement itself may be found [here](http://www.erisasettlementsunlife.com). ### **The Hartford / Hartford Life and Accident Insurance Company** [The Hartford](https://www.thehartford.com) is a major provider of group disability, life, and AD&D benefits through employer-sponsored plans. Hartford Life and Accident Insurance Company is the entity that typically appears on plan documents and denial letters for those claims. Headquartered in Hartford, Connecticut, The Hartford has a substantial presence across the Northeast — including New Jersey and the greater Philadelphia area — and its acquisition of Aetna’s group life and disability business made it one of the largest group disability insurers in the country. The Hartford has faced substantial litigation over its claims handling, with courts on multiple occasions finding that its denial decisions failed to satisfy ERISA’s requirements. In our experience, The Hartford relies heavily on file reviews conducted by non-examining physicians and on selective readings of medical records to support denial decisions that are often challenged in federal court. ### **The Standard / Standard Insurance Company and The Standard Life Insurance Company of New York** [The Standard](https://www.standard.com/) is a Portland, Oregon-based insurer that provides group long-term disability, short-term disability, life insurance, and AD&D benefits through employer-sponsored plans. Standard Insurance Company is the primary underwriting entity for most group plans, while The Standard Life Insurance Company of New York issues policies for New York-based plan participants. The Standard, like many other insurers, often relies on vocational assessments and medical reviews that support denial rather than objective evaluation of a claimant’s functional limitations. ### Unum Group [Unum Group](https://www.unum.com) is a Fortune 500 company and one of the world’s largest providers of long-term and short-term disability insurance, often through employer-sponsored plans governed by ERISA. The company operates through a number of major subsidiaries, including Unum Life Insurance Company of America, Provident Life and Accident Insurance Company, The Paul Revere Life Insurance Company, and Colonial Life & Accident Insurance Company. Despite its prominence in the insurance market, [Unum has a well-documented and checkered history of allegations involving the systematic and wrongful denial of valid disability claims.](https://dc.law.mc.edu/cgi/viewcontent.cgi?article=1775&context=lawreview) This history has led to significant [multi-state regulatory settlements](https://www.maine.gov/pfr/insurance/publications/financial-market-conduct-exam-reports/unum-provident-multistate-exam-settlement-agreement), widespread litigation from policyholders, and media scrutiny for what critics describe as bad-faith tactics designed to prioritize profits over paying legitimate claims, a pattern that continues to affect countless individuals who find their benefits unjustly denied or terminated. #### Unum Life Insurance Company As the primary United States-based underwriting subsidiary of its parent corporation, Unum Life Insurance Company of America is the specific legal entity that issues and administers a vast number of the group, long-term disability (LTD), and short-term disability (STD) insurance policies sold nationwide. For policyholders, this is the name most often seen on official plan documents, correspondence, and, crucially, claim denial and termination letters. Unum Life was at the very center of the regulatory actions and widespread litigation that exposed a corporate culture allegedly rooted in bad-faith claim denial strategies, particularly for claims governed by ERISA. Consequently, when an individual’s disability claim is denied by Unum Life Insurance Company of America, it may not be an isolated event but rather a potential continuation of a long-standing business practice that frequently necessitates legal intervention to secure rightful benefits. #### Paul Revere Life Insurance Company Paul Revere, now owned by Unum, was historically known for providing high-quality disability insurance to professionals. However, under Unum’s ownership, Paul Revere policies are often subject to the same aggressive claim handling practices. #### Provident Life and Accident Insurance Company Provident, also owned by Unum, handles both group and individual disability claims. Like other Unum subsidiaries, Provident has repeatedly been accused of employing systematic denial practices that prioritize cost savings over legitimate claim payments. ## Why Choose The Garner Firm for Your ERISA Litigation When you take on ERISA disability insurance companies, our firm brings unique advantages to your case: **Nationwide Authority:** Led by [Adam Garner](/attorneys/adam-garner/) and [Melanie Garner](/attorneys/melanie-garner/), our team focuses exclusively on ERISA and employment law, providing deep knowledge of insurance company tactics and federal court procedures. **Proven Track Record:** We have successfully recovered millions of dollars in benefits for clients, including landmark cases that have influenced ERISA jurisprudence. **Comprehensive Approach:** From initial claim reviews to federal court litigation, we handle every aspect of ERISA benefit disputes. **No Upfront Fees:** We often work on a contingency basis, meaning you pay no attorney fees unless we recover benefits for you. **Personal Attention:** Unlike larger firms that treat ERISA cases as commodities, we provide personalized service and direct attorney access. ## Take Action: Contact The Garner Firm Today Don’t let ERISA disability insurance companies deny you the benefits you’ve earned and deserve. Time limits apply to ERISA appeals and litigation, making prompt action essential. **Call us today at (215) 645-5955** for a free consultation, or [contact us online](/contact/) to discuss your case. Our experienced attorneys take on the ERISA disability insurance companies every day and are ready to fight for your rights and recover the benefits you need. ## Frequently Asked Questions About Suing Insurance Companies Under ERISA ### Can I sue my insurance company for denying my ERISA benefits? Yes, you can sue insurance companies under ERISA, but typically only after exhausting the plan’s administrative appeal process. ERISA provides a federal cause of action for wrongfully denied benefits, but strict procedural requirements and deadlines must be followed. ### How long do I have to appeal a denied ERISA claim? Most ERISA plans require disability appeals to be filed within 180 days of receiving a denial notice, though some benefits, like life insurance, have shorter 60-day appeal deadlines. Missing these deadlines can permanently bar your right to benefits, making prompt action essential. ### What standard of review applies to ERISA benefit disputes? Many ERISA plans grant discretionary authority to plan administrators, resulting in “arbitrary and capricious” review that heavily favors insurance companies. However, courts can apply deg novosibirsk review if the plan doesn’t grant discretion or if certain state laws ban the use of discretionary clauses. ### Can insurance companies offset my disability benefits with other income? Yes, most ERISA disability plans contain offset provisions that reduce benefits by Social Security disability, workers’ compensation, and other income sources. However, improper offset calculations are common and can be challenged. ### What are independent medical examinations (IME), and can I refuse them? IMEs are medical evaluations arranged by insurance companies, often by doctors who rarely find claimants disabled. Despite their name, Independent Medical Exams are often not independent. While you often cannot refuse an IME without risking benefit termination, you have rights regarding the examination process that should be protected. ### How long does ERISA litigation typically take? ERISA lawsuits usually take 6-24 months from filing to resolution, though complex cases can take longer. The timeline depends on factors such as court schedules, discovery requirements, whether the case settles or goes to judgment, and whether appeals are necessary. ### Can insurance companies conduct surveillance on disability claimants? Yes, insurance companies routinely conduct surveillance of disability claimants, including social media monitoring, video surveillance, and hiring private investigators. While generally legal, surveillance evidence can be challenged if improperly obtained or misrepresented. ## Do You Have More Questions? [Contact ](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today")The Garner Firm today. We offer free consultations and may be able to help you with your ERISA claim. --- ### [Practice Areas](https://www.garnerltd.com/practice-areas/) **Published:** November 4, 2022 **Author:** Kevin Sparkman **Content:** ## Let Us Take on the Insurers for You and Your Family Nationally recognized ERISA litigators with proven experience across employee benefits, insurance, and employment disputes. When the stakes are high, it matters who you hire. ### Our Practice Areas - [**ERISA Claims**](/erisa-litigation/) - [**Long-Term Disability Claims**](/practice-areas/long-term-disability/) - [**Wage & Hour Law**](/wage-hour-law) - [**Labor & Employment**](/labor-and-employment) - [**Long-Term Care Claims**](/long-term-care-claims) - [**Employment Contracts**](/employment-contract-reviews) - [**Bad Faith Insurance Denials**](https://www.garnerltd.com/insurance-bad-faith-lawyers-for-disability-and-life-insurance-claims/) - [**Retirement Plans**](/retirement-plan-benefit-claims) - [**Executive Compensation**](/serp-and-other-executive-deferred-compensation-claims) - [**Severance Benefits**](/severance-benefits) - [**Accidental Death & Dismemberment Benefits**](/accidental-death-dismemberment-benefits) - [**Life Insurance Claims**](/practice-areas/life-insurance/ "Experienced Life Insurance Attorney in Philadelphia") We have decades of experience helping individuals and families with a full range of employment law matters with a special focus on [ERISA](https://www.garnerltd.com/practice-areas/erisa-litigation/ "Employee Benefits (ERISA) Litigation") and [long-term disability](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/) cases. ### How The Garner Firm Can Help You --- ### [Insurance Bad Faith Lawyers for Disability and Life Insurance Claims](https://www.garnerltd.com/insurance-bad-faith-lawyers-for-disability-and-life-insurance-claims/) **Published:** August 9, 2026 **Author:** Adam Garner **Content:** ![A hand turns a sheet labeled 'DENIED' over a stack of policy documents on a desk, including an 'INDIVIDUAL POLICY' folder and accessibility graphics.](https://www.garnerltd.com/wp-content/uploads/2026/08/insurance-bad-faith-featured-no-wordmark-1024x576.png "insurance-bad-faith-featured-no-wordmark - The Garner Firm") If you bought your own disability income or life insurance policy and the insurer denied, delayed, or terminated your benefits without a reasonable basis, you may have a bad faith claim that reaches well beyond the benefits themselves. Unlike claims governed by ERISA, a bad faith action on a privately purchased policy can expose the insurer to punitive damages, statutory interest, and your attorneys’ fees. The Garner Firm litigates these cases in Pennsylvania and New Jersey, and we handle the threshold question most firms get wrong: whether your policy is subject to ERISA at all. As an insurance bad faith lawyer, we hold carriers accountable for how they handle your claim. That distinction decides your case. Get it wrong and you file a bad faith suit that is dismissed on preemption grounds. Get it right and you may hold the insurer accountable for how it handled your claim — not just for the money it withheld. ### Why the source of your policy determines your remedies Two people can be denied by the same insurer, for the same condition, on the same policy language, and have completely different legal rights. What separates them is where the policy came from. **If your employer provides the coverage**, the plan is almost certainly governed by ERISA, and federal law displaces state bad faith remedies. The Supreme Court held in *Pilot Life* that ERISA “pre-empts state common law tort and contract actions asserting improper processing of a claim for benefits under an insured employee benefit plan,” reasoning that ERISA § 502(a) was intended to be the exclusive vehicle for such claims. State bad faith law is not rescued by ERISA’s insurance saving clause when it is rooted in general tort and contract principles rather than being specifically directed at the insurance industry. **If you bought the policy yourself** — through an agent, a professional association, or a broker — ERISA generally does not apply and state insurance law governs in full. This is the world of individual disability income policies sold to physicians, dentists, attorneys, and business owners, and of individually underwritten life insurance. It is not a small market: annualized non-cancelable individual disability premiums in force in the United States exceeded 4.1 billion dollars in 2019. **The gray zone matters most, and the burden is on the insurer.** Under the Department of Labor safe harbor, 29 C[.F.R. § 2510.3-1(j)](https://www.ecfr.gov/current/title-29/section-2510.3-1), certain employee-pay-all voluntary arrangements fall outside ERISA. The Third Circuit has made clear that all four safe harbor criteria must be established, and that the burden rests with the party asserting the exception. The decisive question is usually employer endorsement: whether the employer “has strayed from the equilibrium of neutrality,” which turns on a holistic assessment of material employer involvement in creating or administering the program rather than a mechanical checklist. Selecting a sole carrier and setting eligibility criteria can be enough to constitute endorsement and pull the coverage into ERISA. Association-issued and multiple-employer arrangements raise related questions. We analyze policy documents, applications, premium-payment history, enrollment materials, and plan filings to determine which regime applies before choosing a forum and a theory. ### Individual disability income insurance bad faith Individual DI policies are bought by high earners precisely because they are stronger than group coverage: true “own occupation” definitions, residual and partial benefits, non-cancelable and guaranteed-renewable terms, and benefits that are typically tax-free. Those same features make them expensive claims for insurers to pay. Conduct we see and litigate: - **Rewriting “own occupation.”** Where a policy defines occupation by reference to a recognized medical specialty, the insurer cannot redefine it by counting billing units or comparing generalist tasks. The Third Circuit rejected exactly that approach for an interventional radiologist whose specialty involved procedures a diagnostic radiologist could not perform. - **Paper reviews over treating physicians.** File-review physicians who never examine the claimant, retained repeatedly by the same insurer, producing opinions that consistently favor denial. Clinical guidance cuts against this: in persistent pain, physicians “must not over-interpret either the presence or absence of objective findings unless they are consistent with the history and physical examination,” and assessment should include physical functioning, not imaging alone. - **Surveillance and social media investigation** used selectively — a few hours of activity presented as proof of capacity while surrounding recovery time is ignored. - **Mental-nervous and self-reported-symptom limitations** stretched to cap benefits for conditions with organic bases, including chronic pain, long COVID sequelae, and cognitive impairment. - **Retroactive pre-existing condition and misrepresentation defenses** raised years into a claim, after premiums have been accepted throughout. - **Manufactured occupational reclassification** at claim time, inconsistent with the occupation class the insurer underwrote and priced. - **Lowball buyout offers** timed to arrive when a claimant’s savings are exhausted. - **Indefinite delay** — repeated requests for records already produced, serial examinations, and “under review” status maintained for months without decision. If your policy is individual, none of this is shielded by ERISA. The claim file, internal guidelines, reserve and claim-closure data, compensation of file reviewers, and handling patterns in other claims are all potentially discoverable. That discovery is often what moves these cases. Carriers we handle claims against: Unum, Northwestern Mutual, Guardian and Berkshire Life, MassMutual, Principal, Standard, Ameritas, Hartford, MetLife, Prudential, Lincoln Financial, New York Life, and others. ### Life insurance bad faith and wrongful denial Life insurance denials arrive at the worst possible moment, and the insurer’s leverage is that beneficiaries are grieving and unrepresented. Recurring patterns: - **Contestability-period rescissions.** Most policies allow the insurer to contest for two years after issue, and insurers use that window to order full medical histories and hunt for discrepancies. Claimants should understand what the standard actually is in New Jersey, because it is demanding: an insurer need not show the insured intended to deceive, and even an innocent misrepresentation can constitute equitable fraud justifying rescission. The fight is therefore over **materiality** — whether the misstatement would naturally and reasonably have influenced the underwriter’s decision to issue at all, to assess the risk, or to set the premium — and over whether the question asked was objective or subjective. Objective questions call for facts within the applicant’s knowledge, such as whether a physician examined or treated the applicant; subjective questions probe the applicant’s state of mind about their own health, and courts review answers to those more leniently. An insurer also generally has no duty to independently investigate an applicant’s medical history absent knowledge of conflicting facts, which is why the record built at underwriting matters so much later. **\[** - **Post-contestability denials**, where the insurer is generally limited to narrow defenses but denies anyway. - **Manufactured lapse.** Premium notices sent to stale addresses, grace periods miscalculated, reinstatement requests ignored, or automatic-premium-loan provisions not applied as written. - **Cause-of-death and exclusion disputes** — suicide clauses, intoxication and drug exclusions, aviation and hazardous-activity exclusions, and “accidental means” fights on AD&D riders. - **Beneficiary disputes and interpleader** — competing claimants after divorce, defective beneficiary changes, slayer-statute questions, and insurers using interpleader to sit on funds. - **Open-ended investigation** with no decision. ### What Pennsylvania and New Jersey law lets us recover **Pennsylvania — 42 Pa. C.S. § 8371.** On a finding of bad faith toward the insured, a court may award interest on the amount of the claim from the date the claim was made at the prime rate plus 3%, punitive damages, and court costs and attorneys’ fees. The governing test, adopted by the Pennsylvania Supreme Court in *Rancosky*, requires **clear and convincing evidence** that (1) the insurer lacked a reasonable basis for denying benefits under the policy and (2) the insurer knew of or recklessly disregarded that lack of a reasonable basis. Critically, **a motive of self-interest or ill will is not a prerequisite** — such evidence is probative of the second prong, but knowledge or recklessness suffices. There is also no heightened standard of proof for punitive damages under the statute, because § 8371 does not distinguish between bad faith generally and bad faith supporting punitive damages. What the statute does not reach is ordinary error: simple negligence or bad judgment is not bad faith. **New Jersey — common law.** New Jersey recognizes a first-party bad faith claim, but the “fairly debatable” standard is a real hurdle. A plaintiff must show that **no debatable reasons existed** for the denial. This generally means a claimant who could not have won summary judgment on the underlying substantive claim cannot assert bad faith. Simple negligence will not do, and mere failure to settle a debatable claim is not bad faith. Punitive damages on a first-party denial are generally unavailable absent egregious circumstances, and the New Jersey Supreme Court has expressly declined to resolve the availability of counsel fees in this posture. That is precisely why, in New Jersey, the coverage case and the bad faith case must be built together — the strength of the benefits claim is the gating condition for the conduct claim. **Practical consequence.** On an individual policy in Pennsylvania, exposure is not capped at the benefit withheld. That changes settlement dynamics, and it is why the ERISA-versus-individual analysis is the first thing we do. The ERISA contrast. Section 502(a)(1)(B) recovers benefits due and enforces rights under the plan; § 502(a)(3) permits limited equitable relief; fees are discretionary under § 502(g). Punitive damages are not available — ERISA’s fiduciary-breach provision supplies no express authority for a punitive award to a beneficiary. ### How we build a bad faith case 1. **Policy and ERISA analysis.** Every governing document, the application, enrollment materials, premium records, and plan filings — including whether the employer stayed neutral or endorsed the program. 2. **Claim file reconstruction.** The complete file, including internal notes, claim-manager entries, reserve entries, referral records, and the identity and compensation of every reviewing physician. 3. **Conduct discovery.** Claim-handling guidelines, training materials, performance metrics, vendor relationships, and patterns across similar claims — what distinguishes a mistake from a practice. Under *Rancosky*, shoddy claims handling, non-responsiveness, and haphazard investigation can support bad faith without any proof of ill will. 4. **Expert development.** Treating and independent physicians, vocational and occupational experts, claim-handling standards experts, and economists where earning capacity is at issue. 5. **Litigation and resolution.** Filing in the right forum, moving for the discovery insurers resist, and trying the case when the offer does not reflect the exposure. ### Other first-party insurance bad faith we handle - **Long-term care insurance** — benefit-trigger disputes, ADL and cognitive-impairment assessments, elimination-period gaming, facility-licensure denials, and rescission attempts. - **Accidental death & dismemberment** — “accidental means” versus “accidental results,” intoxication and medical-treatment exclusions. - **Critical illness, hospital indemnity, and specified-disease policies.** - **Health insurance denials outside ERISA** — individual marketplace and church-plan coverage. - **Annuity and structured settlement disputes.** ### Frequently asked questions **Can I sue my disability insurer for bad faith?** It depends on who bought the policy. If you purchased it yourself, state bad faith law generally applies and punitive damages, interest, and attorneys’ fees may be available in Pennsylvania. If your employer provided it, ERISA usually preempts those remedies and limits you to the benefits due. **How do I know whether my policy is governed by ERISA?** Employer-sponsored group coverage is presumptively ERISA-governed; a policy you bought individually usually is not. In the middle cases, the party claiming the DOL safe harbor must establish all four of its criteria, and the key question is whether the employer stayed neutral or materially involved itself in creating or administering the program. **What damages are available in a Pennsylvania bad faith case?** Under 42 Pa. C.S. § 8371, a court may award interest on the claim from the date it was made at the prime rate plus 3%, punitive damages, and court costs and attorneys’ fees, in addition to the benefits owed. You must prove by clear and convincing evidence that the insurer had no reasonable basis to deny and knew of or recklessly disregarded that fact — but you do not have to prove ill will. **Is New Jersey law different?** Yes, and it is harder on first-party claims. New Jersey requires a showing that no debatable reasons existed for the denial, negligence is not enough, and the Insurance Fair Conduct Act’s treble-damages remedy is limited to uninsured and underinsured motorist claims rather than disability or life policies. **My life insurer says my husband misstated something on his application. Is the policy void?** Not automatically. In New Jersey the misstatement must be material — meaning it would naturally and reasonably have affected the underwriting decision or the premium — and answers to subjective questions about one’s own health are reviewed more leniently than answers to objective questions about tests and doctor visits. **How long do I have to file?** Deadlines vary by claim type and state, and policies often contain contractual limitations periods shorter than the statutory period. **Does filing an appeal hurt my ability to sue later?** No. On an individual policy the internal appeal is optional but still forces the insurer to commit to its reasoning. **What does it cost to hire you?** We typically handle these matters on a contingency basis, with no fee unless we recover. Hourly arrangements are available as well. ### Contact The Garner Firm If You Believe Your Insurer Has Acted in Bad Faith If a disability, life, long-term care, or AD&D insurer has denied, delayed, or terminated your benefits, we will review your policy and your denial letter at no charge — including the threshold question of whether ERISA applies. [Contact us](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today") today online or by phone at (215) 645-5955. --- ### [How to Win a Wrongfully Denied Disability Claim](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/) **Published:** August 10, 2025 **Author:** Adam Garner **Content:** ## When Your Short-Term Disability or Long-Term Disability Benefits Are Denied, The Garner Firm Fights Back. ### Experienced ERISA Long-Term Disability Attorneys Fighting for Your Benefits When you’re facing a disability that prevents you from working, your employer-provided short-term disability (STD) and long-term disability (LTD) benefits serve as crucial financial lifelines for you and your family. However, the path to receiving these benefits is often fraught with obstacles, delays, and outright denials. Nearly all private employer disability benefit plans are governed by the Employee Retirement Income Security Act of 1974 (ERISA), a federal law that unfortunately stacks the deck in favor of insurance companies who administer and pay these benefits. At The Garner Firm, our experienced ERISA[ long-term disability attorneys](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles") understand the complex web of regulations, deadlines, and procedures that govern disability claims. We have successfully helped hundreds of clients navigate the challenging appeals process, recover wrongfully denied benefits, and secure the financial support they desperately need during their most vulnerable times. Whether your initial claim was denied, your benefits were terminated, or you’re facing a complex appeals process, our legal team has the knowledge and tenacity to fight for your rights. [Insurance companies](https://www.garnerltd.com/homepage/insurers-we-litigate-against-in-erisa-benefit-claims/) have a clear [conflict of interest](https://supreme.justia.com/cases/federal/us/554/105/) when evaluating disability claims. They profit by denying legitimate claims and often use biased medical professionals to review cases. The Supreme Court recognized this inherent bias in [MetLife v. Glenn](https://supreme.justia.com/cases/federal/us/554/105/ "MetLife v. Glenn"), but unfortunately did not require courts to give greater weight to this conflict when reviewing denied claims. When your disability benefits are denied, it’s crucial to understand the strict ERISA claims procedure regulations found in 29 CFR 2560.503-1. These federal regulations set forth specific timelines for appeals and requirements for the insurance company’s review process. Missing these deadlines can permanently bar your claim. ## Short-Term Disability (STD) Claims and Appeals Short-term disability benefits typically provide 50-70% of your pre-disability earnings for periods ranging from 3 to 24 months (usually about 6 months), depending on your plan’s terms. These benefits are designed to bridge the gap between when you become disabled and when long-term disability benefits may begin. However, STD claims face high denial rates due to insurance companies’ aggressive cost-cutting measures. **Common reasons for STD claim denials include:** - Insufficient medical documentation to support disability - Failure to meet the plan’s definition of “totally disabled” - Missing deadlines for claim submission - Disputes over when the disability began - Lack of objective medical evidence - Conflicting medical opinions When your STD claim is denied, you typically have 180 days to file an administrative appeal with the insurance company or claim fiduciary. This appeal must be thorough and include all relevant medical evidence, vocational evidence, and legal arguments supporting your disability. Our attorneys work closely with your healthcare providers to ensure your appeal presents the strongest possible case for your continued disability. ## Long-Term Disability (LTD) Claims and Appeals Long-term disability benefits typically become available after short-term benefits are exhausted or after a specified elimination period (usually 90-180 days). LTD benefits can continue until age 65 or longer, depending on your plan terms. These claims involve more complex medical and vocational assessments, making legal representation especially crucial. **Key challenges in LTD claims include:** - **Definition changes**: Many LTD policies change from “own occupation” to “any occupation” after 24 months - **Ongoing medical requirements**: Insurance companies require continuous proof of disability - **Surveillance**: Some insurers conduct physical surveillance of claimants - **Independent medical examinations**: Insurance companies may require you to see their chosen doctors - **Vocational assessments**: Insurers often claim you can perform other work based on flawed analyses - **Mental health limitations**: Many policies limit mental health benefits to 24 months - **Pre-existing condition exclusions**: Many long-term disability policies limits or bar claims arising from pre-existing conditions Our experienced attorneys understand these challenges and develop comprehensive strategies to protect your LTD benefits throughout the claims process. We work with medical experts, vocational specialists, and other professionals to build an unassailable case for your continued disability. ## How ERISA Appeals Work and Why the Administrative Record Matters ERISA creates a unique legal framework that differs significantly from other types of insurance disputes. Under ERISA, you must exhaust all “administrative remedies” or internal appeals before filing a lawsuit. This means you generally get only one chance to present your case to the insurance company before going to court. The so-called “administrative record” developed during your appeal becomes crucial because federal courts reviewing ERISA disability cases often limit their review to the evidence that was before the insurance company during the administrative or internal review. This makes it essential to build a complete and compelling administrative record during the appeals process. **The ERISA appeals process typically involves:** - **Initial denial**: Insurance company issues denial letter explaining reasons - **Request for administrative record**: Obtaining all documents the insurer relied upon - **Medical evidence gathering**: Collecting comprehensive medical documentation - **Expert opinions**: Securing supportive opinions from treating physicians - **Vocational evidence**: Demonstrating inability to perform work activities - **Legal brief**: Presenting legal arguments for benefit entitlement - **Final administrative decision**: Insurance company’s response to appeal - **Federal court lawsuit**: If administrative appeal is denied Our attorneys have extensive experience navigating this complex process and understand exactly what evidence and arguments are most effective in ERISA disability appeals. ## Deadlines and Evidence You Need ERISA disability claims are governed by strict deadlines that, if missed, can permanently bar your claim. Understanding and meeting these deadlines is crucial to preserving your rights. **Critical ERISA disability deadlines:** - **Initial claim filing**: Often must be filed within plan’s specified time frame (usually within one year of disability) - **Appeal deadline**: Generally 180 days from denial to file administrative appeal - **Lawsuit filing deadline**: Typically within 3 years of final benefit denial, but this can vary significantly from plan to plan and state to state - **Response to insurer requests**: Usually 45 days to respond to requests for additional information **Essential evidence for your disability claim:** - **Complete medical records**: All treatment notes, test results, and diagnostic reports - **Treating physician statements**: Detailed opinions on your functional limitations - **Objective medical evidence**: MRIs, CT scans, laboratory results, and other diagnostic tests - **Mental health records**: If applicable, psychological and psychiatric evaluations - **Vocational evidence**: Job descriptions, work demands analysis, and functional capacity evaluations - **Personal testimony**: Your own detailed account of how the disability affects daily activities - **Third-party statements**: Testimony from family members, colleagues, and friends about observed limitations Our legal team works systematically to gather and present this evidence in the most compelling manner possible. ## Why Choose Our Long-Term Disability Attorneys for Your ERISA Appeal At The Garner Firm, we focus exclusively on ERISA and employment law, giving us deep experience in the complex regulations and procedures that govern disability benefits. Our track record of success includes recovering millions of dollars in wrongfully denied disability benefits for our clients. **What sets us apart:** - **ERISA focus**: We focus exclusively on ERISA and employment law cases - **Proven results**: Successful track record of overturning benefit denials - **Comprehensive approach**: We handle every aspect of your claim from initial denial through federal court litigation - **No upfront costs**: We often work on a contingency basis – you pay nothing unless we recover benefits - **Personalized attention**: Direct access to experienced attorneys, not paralegals or case managers - **Nationwide practice**: We represent clients throughout the United States, with a focus on cases in Pennsylvania, New Jersey, and Maryland. We understand the financial stress of losing your income due to disability, and we’re committed to fighting for every dollar you’re entitled to receive. ## Meet Your Attorneys Our experienced ERISA disability attorneys bring decades of combined experience to your case. [Adam Garner](/attorneys/adam-garner/) founded The Garner Firm with a mission to level the playing field between disabled individuals and powerful insurance companies. His extensive experience in ERISA law and employment litigation has resulted in tens of millions of dollars recovered. [Melanie Garner](/attorneys/melanie-garner/) brings a unique perspective to disability cases, combining her background in mass torts with experience in employee benefits law. This dual background allows her to effectively communicate with medical providers and present medical evidence in the most compelling manner. Together, our legal team provides the knowledge, experience, and dedication needed to successfully challenge denied disability benefits and hold insurance companies accountable for their obligations under ERISA. ## Frequently Asked Questions About ERISA Disability Appeals ### How long do I have to appeal a denied disability claim? Under ERISA, and for disability claims specifically, you typically have 180 days from the date of the denial letter to file an administrative appeal. However, some plans may have longer deadlines, so it’s crucial to review your denial letter and plan documents carefully. Missing this deadline can permanently bar your claim. ### Can I sue my insurance company immediately after my claim is denied? Usually, no. Under ERISA, you typically must exhaust the plan’s administrative remedies before filing a lawsuit in federal court. This means you must complete the appeals process with the insurance company first. ### What happens if my appeal is denied? If your administrative appeal is denied, you can file a lawsuit in federal court. The court will typically limit its review to the so-called “administrative record” and determine whether the insurance company’s decision was reasonable or correct. Having strong evidence in the administrative record is crucial for success in federal court. ### How long does the appeals process take? The insurance company typically has 45 days to review your appeal, with one possible 45-day extension. However, this timeline can vary depending on the complexity of your case and whether additional medical evidence is needed. ### Should I hire an attorney for my disability appeal? Given the complexity of ERISA law and the high stakes involved, having experienced legal representation significantly improves your chances of success. Insurance companies have teams of lawyers and medical consultants working to deny claims – you should have experienced advocacy on your side as well. ### What if my employer’s plan administrator or claim administrator is also the insurance company? This creates an inherent conflict of interest, as recognized by the Supreme Court in MetLife v. Glenn. While this conflict should be considered in reviewing your claim, courts unfortunately don’t always give it the weight it deserves. Skilled legal representation becomes even more important in these situations. ### Can I get benefits while my appeal is pending? Generally, benefits stop when your claim is denied, and they don’t resume until your appeal is successful. ### What if I have a pre-existing condition? Pre-existing condition exclusions are common in long-term disability policies, but they’re often misapplied by insurance companies. These exclusions typically only apply if you received treatment for the condition within a specified period before your coverage began. An experienced attorney can help determine whether the exclusion is being properly applied. ## Contact The Garner Firm Today Don’t let insurance companies deny you the benefits you’ve earned and deserve. Time is critical in ERISA disability cases due to strict deadlines. Contact The Garner Firm today for a free consultation about your denied disability claim. Our experienced ERISA disability attorneys are ready to fight for your rights and recover the benefits you need to support yourself and your family. Call us at (215) 645-5955 or [contact us online](/contact/) to discuss your case with our legal team. --- ### [Accidental Death & Dismemberment Benefits](https://www.garnerltd.com/practice-areas/accidental-death-dismemberment-benefits/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** The **accidental death and dismemberment [lawyers](https://www.garnerltd.com/attorney-profiles/ "Attorney Profiles")** at The Garner Firm help beneficiaries nationwide fight back after an insurer wrongfully denies an AD&D claim. Employers commonly include Accidental Death and Dismemberment (“AD&D”) coverage as a supplemental benefit within a group life insurance plan. The [U.S. Department of Labor](https://www.dol.gov/general/topic/health-plans/erisa) regulates most employer-sponsored AD&D plans under the Employee Retirement Income Security Act of 1974 (“[ERISA](/practice-areas/erisa-litigation/)“). Federal, state, and local government plans fall outside ERISA, as do plans offered by certain religiously affiliated employers. > If the insurance company denies your accidental death and dismemberment claim, do not assume the insurer’s explanation for the denial is valid. ## What Counts as an “Accidental” Death or Dismemberment? Many people assume a beneficiary automatically qualifies for AD&D benefits whenever a covered individual dies. That is often not true. The death or injury must usually result from an “accident” as the policy narrowly defines that term. Insurance companies frequently deny AD&D claims by arguing the death was not accidental, or by improperly applying a policy exclusion. These disputes commonly arise in cases involving: - Certain motor vehicle and motorcycle accidents - Inadvertent fatal asphyxiation - Accidental overdoses involving prescription medications - Drowning or other unwitnessed deaths - Other instances of unexplained or unattended death ## Common Reasons Insurers Deny AD&D Claims AD&D policies typically contain a lengthy list of exclusions. Insurers use these exclusions to justify denying otherwise valid claims. The most frequently litigated exclusions include intoxication or drug use, “sickness or disease,” self-inflicted injury, and injuries sustained during illegal activity. Insurers also dispute whether the injury was the sole and direct cause of death, or claim the beneficiary missed a filing deadline. An experienced [accidental death and dismemberment attorney](/attorney-profiles/) can evaluate whether the insurer properly applied an exclusion to your loved one’s death. ## ERISA Appeal Deadlines and the Mandatory Appeal Process ERISA gives you a relatively short window to appeal a denied AD&D claim. Every ERISA AD&D plan requires you to exhaust this mandatory internal appeal before filing suit in court. Missing the deadline, or submitting an incomplete appeal, can permanently bar you from recovering benefits. An experienced ERISA accidental death and dismemberment attorney can explain this process, flag the potential issues with your claim, and help you build a strong administrative record for your appeal. ## How an Accidental Death and Dismemberment Lawyer Helps Consult an experienced ERISA accidental death and dismemberment attorney before you accept an insurer’s denial. An experienced [accidental death and dismemberment attorney](/attorney-profiles/) will review the facts of the insured’s death, review your policy language, and explain your rights. The Garner Firm’s attorneys have recovered significant benefits for beneficiaries in ERISA life insurance and AD&D disputes. We regularly l[itigate against major insurers](https://www.garnerltd.com/homepage/insurers-we-litigate-against-in-erisa-benefit-claims/ "ERISA LTD Disability Insurers We Fight for You"). ## Frequently Asked Questions About AD&D Claims ### Is AD&D the same as life insurance? No. AD&D pays out only when a death or dismemberment results from a qualifying accident. Basic life insurance pays out regardless of the cause of death, subject to standard exclusions like suicide within the contestability period. ### How long do I have to appeal a denied ERISA AD&D claim? Most ERISA-governed AD&D plans set an appeal window of 60 or 180 days from the denial letter. Courts strictly enforce this deadline, and your administrative appeal record often decides the outcome of any later lawsuit. Contact an ERISA accidental death and dismemberment lawyer as soon as you receive a denial. ### Can I sue my insurer directly if my AD&D claim is denied? If ERISA governs your plan, you must first exhaust the plan’s internal appeal process before filing suit, and courts generally limit your remedies to the benefits owed under the plan. If your policy falls outside ERISA, you may have additional remedies, including bad-faith claims, depending on your state’s insurance law. ### What should I do if my AD&D claim was denied? Do not assume the denial is correct or final. Request a complete copy of your claim file and the governing plan documents, note your appeal deadline, and contact an experienced accidental death and dismemberment attorney to evaluate the insurer’s stated reasons before you respond. ## The Garner Firm’s Attorneys Can Help With Your Accidental Death and Dismemberment Insurance Claim Adam H. Garner is an experienced [accidental death and dismemberment insurance](https://www.garnerltd.com/when-is-a-death-accidental-for-purposes-of-an-accidental-death-and-dismemberment-insurance-policy/) attorney and who formerly chaired the ABA Tort Trial & Insurance Practice Section’s Health & Disability Insurance Committee. If you have questions about your accidental death and dismemberment insurance claim, [contact](/contact/) The Garner Firm today for a free case review. ### Related Reading - [AD&D Benefits Denied to Executive’s Widow in ERISA Life Insurance Case](https://www.garnerltd.com/add-benefits-denied-to-executives-widow-in-erisa-life-insurance-case/) - [When Is a Death “Accidental” for AD&D Purposes?](https://www.garnerltd.com/when-is-a-death-accidental-for-purposes-of-an-accidental-death-and-dismemberment-insurance-policy/) - [Life Insurance Claim Denials](/practice-areas/life-insurance-claims/) - [ERISA Litigation Attorneys](/practice-areas/erisa-litigation/) --- ### [Cookie Policy](https://www.garnerltd.com/cookie-policy/) **Published:** July 23, 2026 **Author:** Adam Garner **Content:** This page provides comprehensive information about how we use cookies on our website to enhance your browsing experience, improve website performance, and deliver personalized content. Cookies are small text files that are stored on your device when you visit our site. They help us understand how visitors interact with our website, allowing us to offer a smoother and more efficient user experience. In the table below, you will find detailed information about each type of cookie we use, their purpose, and how long they remain on your device. We are committed to respecting your privacy and providing transparency about the data we collect through cookies. For more information on how we handle your personal data, please see our [Privacy Policy.](https://www.garnerltd.com/privacy-policy/) ## Essential Essential cookies enable basic functions and are necessary for the proper function of the website. 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The intention is to show ads that are relevant and engaging to the individual user. ### Google Maps Google Maps is a web mapping service providing satellite imagery, real-time navigation, and location-based information. [Learn more](https://policies.google.com/privacy) NameDescriptionDurationOGPCThese cookies are used by Google to store user preferences and information while viewing Google mapped pages.1 monthOGPThis cookie is used by Google to activate and track the Google Maps functionality.2 months### Optinmonster OptinMonster is a powerful lead generation tool that helps businesses convert visitors into subscribers and customers. [Learn more](https://optinmonster.com/gdpr/cookies/) NameDescriptionDuration\_omraUsed to store interaction and conversion data for campaigns in conjunction with Revenue Attribution1 yearomCountdown-{id}-{elementId}Used for countdown elements {elementId} in campaigns {id} to determine when it should completeSessionom-{id}-closed / omSlideClosed-{id}Used specifically with slide-in campaigns {id} to determine if it has been closed or not by a visitor. 30 daysom-success-cookie / omSuccessCookieused to determine if a visitor has successfully opted in to any campaign on your site to unlock content when using the Content Locking feature.365 daysom-success-{id} / omSuccess-{id}Used to determine if a visitor has successfully opted in to a campaign with the ID of {id} on your site365 daysomSeen-{id}Used to determine if a visitor has been shown a campaign by the slug. No expiration date30 daysom-{id}used to determine if a visitor has interacted with a campaign ID of {id} on your site.30 daysom-interaction-cookie / omGlobalInteractionCookieUsed to determine if a visitor has interacted with any campaign on your site.Sessionom-global-cookie / omGlobalSuccessCookieUsed to prevent any future OptinMonster campaigns from showing on your site. Session\_omappvsCookie is used to identify returning visitors1 day\_omappvpCookie is used to identify returning visitors1 day --- ### [Contact The Garner Firm Today](https://www.garnerltd.com/contact/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** ## Don’t fight alone. Call to schedule a free consultation. Our initial consultation is always free. Use the form below to contact us regarding your legal inquiry. To help us best serve your inquiry, we recommend that you first describe the issue you’re having before telling us what you want to achieve. You may also email or call us to make an appointment. Please note, however, that completing the form below or contacting The Garner Firm, Ltd. does not create an attorney-client relationship. --- **Office Location** The Garner Firm [1617 John F. Kennedy Blvd., Suite 1111 Philadelphia, PA 19103](https://maps.app.goo.gl/n1UBxbQtpihJeBjx9 "1617 John F. Kennedy Blvd., Suite 550 Philadelphia, PA 19103") **Phone** [(215) 645-5955](tel:2156455955 "(215)645-5955") (Tel) (215) 645-5960 (Fax) **Office Hours** Mon. – Fri. (9 a.m. – 5 p.m.) ### Contact Us for a FREE Legal Consultation Call us at (215) 645-5955 for a FREE consultation or complete the form below. We look forward to hearing from you! First Name Email Address Last Name Area Code Telephone Number DescriptionPlease provide a brief description of the reason for your inquiry. ### Directions to Our Offices  --- ### [Award Methodologies](https://www.garnerltd.com/award-methodologies/) **Published:** April 17, 2026 **Author:** Lauren Forbes **Content:** Some of our attorneys have earned recognition from the following organizations. Selection methodologies are linked below. [Avvo](https://support.avvo.com/hc/en-us/articles/208478156-What-is-the-Avvo-Rating?_gl=1*1s1mvq8*_ga*MTMwNjQ1OTQzOC4xNzc2MTk4MjM0*_ga_19ND86TN6P*czE3NzYxOTgyMzQkbzEkZzEkdDE3NzYxOTgzMzckajM3JGwwJGgw) [Expertise.com](https://www.expertise.com/about/our-selection-process) [Super LawyersⓇ](https://www.superlawyers.com/about/selection-process/) --- ### [Employment Law Resources](https://www.garnerltd.com/resources/) **Published:** November 4, 2022 **Author:** Kevin Sparkman **Content:** ## ERISA, Disability & Employment Law Resources ### Official federal and state resources to help professionals understand benefit denials, appeal rights, and pay protection. This page provides official federal and state resources related to ERISA, disability insurance benefits, and wage and hour laws. Many employer-sponsored long-term disability and life insurance plans are governed by the Employee Retirement Income Security Act (ERISA), a federal law that controls how claims, appeals, and lawsuits proceed. Because ERISA disputes often depend on strict deadlines and administrative procedures, understanding the governing framework is critical before taking action. The links below connect you directly to government agencies and primary legal sources. While these materials explain the governing rules, they do not provide case-specific guidance. If you are facing a benefit denial, termination, or wage dispute, we are here to interpret the law, evaluate your options, and guide you through the next steps. Call us at (215) 645-5955 or [contact us online](https://www.garnerltd.com/contact/) to discuss your situation and any deadlines that may apply. ## U.S. Department of Labor – Employee Benefits Security Administration **These are the federal government’s core ERISA resources.** They are helpful for confirming whether ERISA applies and understanding basic rights, plan duties, and complaint channels. - [Information for Workers and Families](https://www.dol.gov/agencies/ebsa/workers-and-families): Start here for plain-English explanations of employee benefit protections. - [ERISA Fact Sheet – Employee Retirement Income Security Act](https://www.dol.gov/node/64128 "ERISA Fact Sheet – Employee Retirement Income Security Act"): Quick overview of what ERISA covers (and what it doesn’t). - [ERISA – Laws and Regulations](https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/erisa): The official source for statutes and regulations. ## Helpful Wage & Hour Law Links **These agencies may be involved when your issue involves pay practices** (unpaid overtime, minimum wage issues, breaks, final pay, or misclassification). Each state has its own rules and enforcement process. - [U.S. Dept. of Labor Wage & Hour Division](https://www.dol.gov/whd/): Federal wage and hour rules and complaint information. - [Pennsylvania Dept. of Labor & Industry](http://www.dli.pa.gov/Individuals/Labor-Management-Relations/llc/Pages/Wage-FAQs.aspx): PA state wage protections and enforcement resources. - [New Jersey Dept. of Labor & Workforce Development](https://www.nj.gov/labor/wageandhour/): NJ wage laws, claims, and guidance. - [Maryland Dept. of Labor, Division of Labor & Industry](http://www.dllr.state.md.us/labor/wages/): MD wage law information and agency contact paths. If your long-term disability benefits have been denied or terminated, more information is available on our [ERISA Claims](https://www.garnerltd.com/practice-areas/erisa-litigation/) and [Long-Term Disability Claims](https://www.garnerltd.com/practice-areas/erisa-short-term-long-term-disability-attorneys/) pages. If you are dealing with unpaid wages, overtime violations, or employee misclassification, visit our [Labor & Employment](https://www.garnerltd.com/practice-areas/labor-and-employment/) page for information about your rights under federal and state law. --- ### [Attorney Profiles](https://www.garnerltd.com/attorney-profiles/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** Jake Day Jake Day is an accomplished attorney specializing in ERISA and employment law matters. With extensive experience in long-term disability claims, Jake provides dedicated representation to clients navigating complex benefit disputes. View Jake’s full profile: https://www.garnerltd.com/attorney-profiles/jake-day/ --- ### [Privacy Policy](https://www.garnerltd.com/privacy-policy/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** We value your privacy and want you to make an informed decision about using our website. Thus, the purpose of this Privacy Policy is to explains how we collect, use, and safeguard the personal information you choose to share with us. By using our website, you are providing your consent for The Garner Firm, Ltd. to use your personal information in the ways specified by this Privacy Policy. This Privacy Policy applies to information collected by any of the websites, internet IP addresses, and other domains The Garner Firm, Ltd. owns and operates. **What Information Is Collected** Two types of information may be collected when you visit our website. The first is personal information you knowingly chose to disclose. Such information includes your name, address, telephone number and email address, which is collected on an individual basis. The second type of information we collect is site usage data. That information is collected on an aggregate basis when you and others browse our website. The Garner Firm, Ltd. does not collect any personally identifiable information from you unless you voluntarily choose to submit or otherwise disclose such information to us, including information submitted or disclosed by mail, telephone, fax or electronically. **Our Policy regarding Cookies** “Cookies” are a standard form of internet technology. We may use cookies to obtain information about your usage of our website. Cookies may record information such as the date and time of visits, the pages reviewed, and the time spent on our website. This information is collected on an aggregate basis and is not associated with you individually. A cookie is a text-only string of information that a website transfers to the cookie file of the browser on your computer’s hard disk so that the website can remember who you are. When you visit our website we send you a cookie. Cookies may be used in the following ways: - To enable the personalization features on our website. - To compile anonymous, aggregated statistics that allow us to understand how visitors use our site and to help us improve the structure of our Website. There are two types of cookies that may be used on this website. The first are session cookies. Session cookies expire when you close your browser. The second are persistent cookies. These persistent cookies remain in the cookie file of your browser for a longer period of time that depends on the lifetime of the specific cookie. **Disabling/Enabling Cookies** You may accept or decline cookies by modifying the settings in your browser on your computer or smartphone. If you disable cookies, you may not be able to use all the interactive features of our site. **How Information Is Collected** If you sign up on our website to receive news from us, we will use the information you provide to provide the information requested and may use it to communicate with you about other topics and events we believe may be of interest to you. If you choose to write to us by email, we may retain the content of your email messages along with your email address and our responses. You can always ask to change any information submitted to The Garner Firm, Ltd., and you can always opt out of our mailing lists. Simply do so by emailing us at adam@old-garner-wp-engine.local We automatically collect certain non-personally identifiable information when you visit our site – such as the browser type, operating system, and the domain name of your Internet service provider. **How We Use the Information Collected** We use information collected for our business purposes and to improve the service we provide. We may also use information collected to notify you about legal developments, services, and special events. We also use aggregate data to analyze site usage (e.g., information about the pages our users visit) to improve the design and content of our site. **Sharing and Transfer of Personal Information** We will not sell, trade, or rent your personal information to third-parties. That having been said, we may share your information about you with service providers we have retained to perform services for us. Our service providers are not authorized to use or disclose the information about you except as necessary to perform services on our behalf or comply with applicable law. If we are required to do so by law or legal process, we may share personal information about you in response to a request from the government authorities, in response to a lawful subpoena, or if we believe disclosure is necessary to prevent personal harm or financial loss. If all or part of The Garner Firm, Ltd. is sold or, we reserve the right to transfer your personal information to the purchaser. We will require, however, that the purchaser use personal information you have provided through this website in a manner consistent with our privacy policy and applicable law. **Transmission Errors or Unauthorized Acts** No data transmission is 100% secure, despite our efforts to protect your privacy. The Garner Firm, Ltd. cannot ensure or guarantee the security of any information you transmit to us or any information provided online. Any use of this website and any data you transmit is at your own risk. The Garner Firm, Ltd. will not be liable for disclosures of your personal information due to errors in transmission or unauthorized acts of third-parties. Once we receive your transmission, however, we will act to ensure its security on our systems by making reasonable efforts to protect the information. **SMS Terms of Service** By opting into SMS from a web form or other medium, you are agreeing to receive SMS messages from The Garner Firm, Ltd. This includes SMS messages for conversations (external). Message frequency varies. Message and data rates may apply. Message HELP for help. Reply STOP to any message to opt out. **How to Contact Us** If you have any questions about our information practices, please [contact us](https://www.garnerltd.com/contact/ "Contact The Garner Firm Today"). --- ### [Wage and Hour Lawyer](https://www.garnerltd.com/practice-areas/wage-hour-law/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** ## Your Employer Is Required to Pay the Wages You Have Earned Congress passed the [Fair Labor Standards Act in 1938](https://www.dol.gov/general/aboutdol/history/flsa1938) (“FLSA”) to provide for a federal minimum wage and ensure overtime is paid at least at time and a half for all non-exempt employees who work more than 40 hours in a given work week. Although there are several exemptions to the FLSA, such as those for so-called Executive, Administrative, and Professional employees, they may be (and frequently are) abused or incorrectly applied. Individuals who have wrongfully been denied the wages they are entitled to under the FLSA may recover the wages owed, an amount equal to the wages owed as liquidated damages, as well as their costs and reasonable attorneys’ fees. Although the FLSA remains the law of the land to this day, many states have added additional protections regarding the payment of wages. These include wage payment collection laws that provide an alternate means of recovery when an individual’s wages have been wrongfully withheld. Although the laws vary from state to state, in some cases an individual may recover double or triple the amount owed to him or her, as well as his or her costs and attorneys’ fees. If you believe your employer has wrongfully withheld the wages owed to you, it is important that you consult with experienced legal counsel regarding these issues. The Garner Firm represents employees who have been denied the wages they have earned in violation of state and federal laws. [Contact us](/contact/) today for your free consultation. **Related Links and Resources:** - [U.S. Dept. of Labor Wage & Hour Division](https://www.dol.gov/whd/) - [Pennsylvania Dept. of Labor & Industry](http://www.dli.pa.gov/Individuals/Labor-Management-Relations/llc/Pages/Wage-FAQs.aspx) - [New Jersey Dept. of Labor & Workforce Development](https://www.nj.gov/labor/wageandhour/) - [Maryland Dept. of Labor, Licensing & Regulation, Division of Labor & Industry](http://www.dllr.state.md.us/labor/wages/) --- ### [ERISA Frequently Asked Questions](https://www.garnerltd.com/erisa-faqs/) **Published:** November 4, 2022 **Author:** Kevin Sparkman **Content:** ### What is ERISA? ERISA stands for the Employee Retirement Income Security Act of 1974. It is a federal law passed in 1974 that went into effect on January 1, 1976. It governs nearly all private sector employer-provided benefit plans, including retirement plans, medical plans, life insurance plans, disability benefits, and some severance plans. It does not apply to governmental plans, and so-called “church plans” that are sponsored by certain religious employers. [Link to ERISA related video.](/blog/?_categories=erisa-litigation&_story_type=videos) ### If my ERISA claim is denied, do I have to appeal the denial? If your ERISA claim is denied, and if you want to continue to pursue your claim, you are generally required to appeal the denial of your claim. If you choose not to appeal the denial of your benefits claim, the decision will become final. ### Do I need a lawyer for my ERISA or long-term disability claims appeal? You are not required to have an attorney assist you with your ERISA appeal, but it is generally a good idea. An experienced ERISA lawyer will know: **(i)** what information you need to submit to the plan or insurer; **(ii)** the right arguments to make; and **(iii)** how to spot the issues with your claim or the fiduciary’s handling of it. An [experienced ERISA attorney](https://www.garnerltd.com/attorney-profiles/adam-garner/ "Adam H. Garner") cannot guarantee your appeal will be successful, but he or she can put you in the best position to prevail on your appeal. Moreover (and more importantly), if your ERISA appeal is denied, and you file a lawsuit in court, the Court may not allow you add additional documents or facts to the record created during the appeal when you go to court. Instead, the court may limit its review of the case to the facts contained in the claim file record (often inaccurately described as the “administrative record”). Thus, the appeal stage is your best and the most important opportunity to demonstrate the facts the support your claim. ### How much time do I have to appeal a long-term disability claim denial? The answer depends on the type of benefit claim at issue. For example, by law, you are entitled to a minimum of 180 days from the date of the adverse claim determination to appeal a denial of a claim for benefits under a disability benefits or medical benefits plan. Similarly, you have a minimum of 60 days to appeal the denial of a claim for retirement benefits or life insurance benefits. The actual deadline will be set forth in your “plan document.” Please note that the denial letter you receive from your plan’s claim administrator, which is often an insurance company such as Cigna, SunLife, MetLife, Standard, The Harford, Prudential, or Unum Life Insurance Company, is required to state how long you have to appeal, and it must also include instructions for submitting an appeal. [Link to related long-term disability video.](/how-much-time-do-i-have-to-appeal-a-long-term-disability-claim/) ### What is an ERISA plan document? ERISA benefits plans are required to be administered subject to a written instrument – the plan document. The plan document is required to set forth all of the terms of the plan. ### What is a summary plan description or SPD under ERISA? An SPD is a summary of the benefit plan and is required to set forth the material terms of the plan in a way that can be understood by the average benefit plan participant. Every participant is required to be furnished with a copy of the SPD. Sometimes the SPD is also the plan document, but not always. ### Does state law apply to ERISA claims? Generally, ERISA preempts any and all state laws insofar as they relate to an employee benefit plan. This means state law generally does not apply to ERISA plans. There are some exceptions, however, such as certain laws regulating insurance. State insurance bad faith law is generally preempted by ERISA. ### What is an ERISA discretionary clause and why do they matter? An ERISA discretionary clause is a provision that provides that the plan’s administrator or claim fiduciary has the discretionary authority to interpret the terms of the plan and determine eligibility for plan benefits. In 1989, the Supreme Court of the United States issued a decision in a case called Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), that held that claim fiduciaries receive a very deferential review of their claim determinations when a plan contain a discretionary claim. This deferential review, which is known as either the “abuse of discretion” or “arbitrary and capricious” standard of review, means that a court will not overturn an adverse claim determination if it thinks the decision is wrong. Rather, the court will only overturn the decision if it is unreasonable and unsupported by substantial evidence. ### What do the terms “Plan Sponsor” and “Plan Administrator” mean? An ERISA Plan Sponsor is most often the employer who sponsors the benefit plan at issue. Thus, for example, the ABC Company is the plan sponsor of the ABC Company medical plan. With multiemployer benefit plans for union employees, the sponsor is generally the Board of Trustees of the multiemployer plan. A plan sponsor is not a fiduciary. An [ERISA Plan Administrator](https://www.garnerltd.com/understanding-your-retirement-plan-information/ "Understanding Your Retirement Plan Information") is a fiduciary charged with administering the plan. By default, the Plan Sponsor is also the Plan Administrator, but the sponsor can designate someone or something (like a committee) else to serve as the Plan Administrator. ### What is a fiduciary and why does it matter to my ERISA claim? A [fiduciary](https://www.garnerltd.com/understanding-erisa-fiduciary-insurance/ "Understanding ERISA Fiduciary Insurance") is someone who is legally required to act in the best interests of another on all matters within the scope of the fiduciary relationship. Under ERISA, certain people or groups of people are fiduciaries by statute. They include: **(i)** those people who exercise any discretionary authority or control over the plan, **(ii)** those who render investment advice to a plan for a fee or other compensation; or **(iii)** those people who have any discretionary authority or discretionary responsibility in the administration of a plan. An ERISA fiduciary has many responsibilities, and is required to act solely in the interest of the participants and beneficiaries and for the exclusive purpose of: **(i)** providing benefits to participants and their beneficiaries; and **(ii)** defraying reasonable expenses of administering the plan. An ERISA fiduciary must further exercise its duties as a reasonably prudent person would under the same or similar circumstances. --- ### [Retirement Plan Benefit Claims Attorneys](https://www.garnerltd.com/practice-areas/retirement-plan-benefit-claims/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** To be fully secure in your retirement, you will likely need to rely on income and savings from several different sources. Social Security benefits or personal savings are rarely enough. For many people, a significant portion of their anticipated retirement income will come from their employer-sponsored retirement plan. When the day comes to draw from this plan, you need to know that you will be able to get the full financial compensation that you are owed. > Far too frequently, retirement plan claims are wrongly denied or significantly underpaid by the retirement plan or its fiduciaries. Far too frequently, retirement plan claims are wrongly denied or significantly underpaid by the retirement plan or its fiduciaries. At The Garner Firm, our aggressive [Philadelphia retirement plan claims attorney](/attorney-profile/), Adam H. Garner, has extensive experience handling these types of cases. In fact, he spent several years of his career administering large retirement plans. If your retirement plan claim was denied, please do not hesitate to contact our office today for legal assistance. ### Retirement Plan Claims and ERISA The majority of employer-based retirement plans are regulated by the [Employee Retirement Income Security Act of 1974 (ERISA). ](https://www.dol.gov/general/topic/retirement/erisa)This federal law requires retirement plans to conform to certain legal standards regarding their funding, structure and administration. ERISA also regulates the process for claims and appeals against these retirement plans. There are, broadly speaking, two types of ERISA-regulated retirement plans: defined benefit plans and defined contribution plans. Defined benefit plans are typically traditional pension plans that provide retirees with a set monthly retirement benefit for the retiree’s life (and sometimes for the life of the retiree’s spouse if he or she survives the retiree). In the past, defined benefit pension plans were common for nearly all large employers. Today, many older workers still have access to a defined benefit pension plan benefit. In addition, many union workers, as well as government employees, still have the opportunity to participate in a traditional defined benefit pension plan. > Claims requiring legal counsel could arise related to a retiree’s entitlement to retirement benefit, the calculation of the retiree’s benefit, or whether the retiree has engaged in conduct that caused his or her benefit to be suspended. Defined contribution plans are most often 401(k) or 403(b) plans, which provide the retiree with a tax advantaged savings account during their working life. After retiring, a defined contribution plan participant typically has access to the full balance of his or her retirement savings and is responsible for managing that savings by him- or herself. In today’s work environment, participation in a defined contribution plan is more common than participation in a defined benefit plan. Claims requiring legal counsel could arise related to a retiree’s entitlement to retirement benefit, the calculation of the retiree’s benefit, or whether the retiree has engaged in conduct that caused his or her benefit to be suspended. In addition, sometimes the retirement plan will make a mistake and overpay a claim. Retirement plans will attempt to make the retiree pay for their mistake by demanding repayment or reducing the retiree’s benefit going forward. If you are having a problem with receiving your retirement benefits, then you should contact an experienced employee benefits lawyer today. ### Contact Our Philadelphia Retirement Plan Claims Attorneys At [The Garner Firm](/about-us/), we have helped many people recover the full and fair retirement benefits that they deserve. If your retirement plan claim was denied, our ERISA attorney Adam H. Garner is standing by, ready to help. To set up your free case evaluation, please call us our Philadelphia office today at (215) 645-5955 or contact us through our website. **Related Resources** [Understanding Your Retirement Plan Information](https://www.garnerltd.com/understanding-your-retirement-plan-information/ "Understanding Your Retirement Plan Information") [What to Do If Your Retirement Benefits Were Denied](https://www.garnerltd.com/what-to-do-if-your-retirement-benefits-were-denied/ "What to Do If Your Retirement Benefits Were Denied") --- ### [Severance Benefits Attorneys](https://www.garnerltd.com/practice-areas/severance-benefits/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** Typically, employees are not entitled to a severance package by law. A severance package is usually negotiated between you and your employer. When crafted properly, a severance package provides important benefits to both parties: the employee gets financial compensation and the employer gets certain legal protections. At The Garner Firm, [Philadelphia severance benefits attorney](/attorney-profiles/) Adam H. Garner has extensive experience drafting, negotiating and litigating severance agreements. If you have any questions or concerns about your severance benefits or your severance agreement, please contact Mr. Garner today to schedule a free consultation. ## **What You Need to Know About Severance Benefits** Employees do not generally have an automatic right to receive severance benefits. Neither federal laws, nor most state laws require employers to offer severance pay to any class of worker. Instead, severance [benefits](/services/retirement-plan-benefit-claims/) are offered by employers as part of a voluntary agreement with a departing worker. Sometimes severance benefits are part of an established severance benefits plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), while other times severance benefits are offered to individual employees on a case-by-case basis. Of course, this raises an important question: ***what is in it for the company?*** If your intuition says that your employer would not give severance benefits away for nothing, you are generally correct. > It is imperative that employees know exactly what they are worth so that they are able to get a fair deal. Most employers offer severance benefits to get something in return from the soon-to-be former employee. Most frequently, employers will look to receive release of claims that essentially requires the departing employee to agree that they will not file a [lawsuit](/services/) against the company. In other cases, the employer may want to offer severance pay in exchange for confidentiality or for an agreement not to disparage the company. ### **Know Your Worth, Know Your Agreement** You should remember that the term “severance *benefits”* works in both directions. The benefits are not just for the worker. All parties to the agreement are obtaining a benefit. As severance benefits are also offered for the benefit of the employer, it is imperative that employees know exactly what they are worth so that they are able to get a fair deal. Before agreeing to accept severance benefits in exchange for something, you should know: - **The exact type and amount of benefits that are being paid to you; and** - **Your obligations under the agreement.** Should any type of dispute over your severance benefits arise, you should contact an experienced employment law attorney as soon as possible. ### **Contact Our Philadelphia Severance Benefits Lawyers** If you are having any trouble getting the full severance benefits that are owed to you, or negotiating a severance agreement, our employment law attorney can help. At [The Garner Firm](/), we have extensive experience handling severance benefits cases. To get immediate assistance, please call us today at (215) 645-5955 to request your free legal consultation. --- ### [Blog & News](https://www.garnerltd.com/blog/) **Published:** November 4, 2022 **Author:** Kevin Sparkman --- ### [Reviews by Clients of The Garner Firm](https://www.garnerltd.com/reviews/) **Published:** January 9, 2023 **Author:** Kevin Sparkman --- ### [SERP and Other Executive Deferred Compensation Claims](https://www.garnerltd.com/practice-areas/serp-and-other-executive-deferred-compensation-claims/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** Retirement benefits are an important part of most employee compensation packages. To comprehend the value of the position being offered to you, it is imperative that you have a full understanding of the retirement benefits being provided, as well. For executives and other high-level managers, this can be challenging. In the modern business world, retirement benefits are often structured in complex ways. Increasingly, companies are relying on deferred compensation packages to hire and retain top executives. > You have legal options if your SERP or executive deferred compensation claim is denied. Unfortunately, when it comes time to make a claim for your deferred compensation, some employers are not always willing to pay up. At The Garner Firm, our [Philadelphia SERP attorney Adam H. Garner](/attorney-profile/) can help. Mr. Garner provides skilled, aggressive legal representation to employees making SERP and other executive deferred compensation claims. ### **What is a Supplemental Executive Retirement Plan (SERP)?** A supplemental executive retirement plan (SERP) is a type of nonqualified retirement plan that can be offered by companies to executive-level employees. This type of plan provides benefits beyond a standard defined benefit pension, IRA, or 401(k). For example, through SERP, executives might be offered: - A plan tailored specifically to fit their unique individual needs; - The ability to maximize tax-deferred compensation; and - Key benefits for their beneficiaries. Notably, however, these types of plans are exempt from many of the regulations included within the [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa). This can sometimes lead to problems when it comes time to make a claim. Unlike other [ERISA](/erisa-litigation/)-regulated plans, the proceeds to pay out a SERP claim do not have to be kept in a trust. If a company becomes insolvent or is sold to another party before executive deferred compensation benefits are claimed, the company’s new operators may try to find an excuse not to pay the claim. In the unfortunate event that your SERP or other executive deferred compensation claim is denied, you have legal options available. You should contact a qualified attorney immediately who can review your case and take action to protect your rights. ### **Contact Our Philadelphia Executive Benefits Attorneys Today** At [The Garner Firm](/), we handle SERP and other executive deferred compensation claims. If your claim was denied, for any reason, please do not hesitate to contact us today. Initial consultations are always confidential and free of charge. From our office in the heart of Philadelphia, we represent clients throughout Pennsylvania, New Jersey, and Maryland. --- ### [Employment Contract Reviews](https://www.garnerltd.com/practice-areas/employment-contract-reviews/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** ## Attorneys for Employment Contract Reviews Employees, especially those who work as managers or executives, are sometimes asked to sign contracts. These employment contracts set up certain rights and responsibilities that both parties will need to follow as the employer-employee relationship moves forward. As an employment contract can dramatically affect employee rights, it is imperative that employees have their contract negotiated and reviewed by an experienced attorney. > You have the right to negotiate the terms of your employment contract, and you are not required to sign a deal that you do not feel is in your best interests. At The Garner Firm, [Philadelphia employment contract attorney](/attorney-profile/) Adam H. Garner has extensive experience negotiating and reviewing a wide variety of different types of employment contracts. To schedule an appointment to get your contract reviewed, please contact our office today. ### Common Employment Contract Terms One of the many things that make drafting and reviewing employment contracts so complex is that these agreements address a wide array of different issues. Every single term matters. In fact, one sentence tucked deep within the agreement could dramatically transform your employee rights. Some of the key terms that you should look out for include: - The base compensation being offered; - Your ability to earn bonus pay; - Additional benefits being offered, including sick leave and disability insurance; - Job title and general responsibilities; - The performance standards and expectations; - Whether or not [severance benefits](/employment-contracts-severance-agreements/) are available; - The company’s authority to terminate you; - Any non-compete or non-solicitation provisions; - Confidentiality requirements; - Mandatory arbitration clauses; and - The relevant law that will control any legal disputes. ### Can You Negotiate the Terms of an Employment Contract? Similar to the terms of any other contract, you have the right to negotiate the terms of your [employment](/employment-contracts-severance-agreements/) contract. At the end of the day, you are not required to sign a deal that you do not feel is in your best interests. Ultimately, you need to have a full understanding of your bargaining position and exactly what is being asked of you by the employer. This is why employment contract review is so important; your lawyer will be able to give you clear and concise information that helps you understand exactly what you are signing so that you have the power to assess the agreement and negotiate to the extent that you feel it is necessary. ### Get Your Employment Contract Reviewed Today At The Garner Firm, [Philadelphia labor law attorney Adam H. Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/ "Adam H. Garner") has extensive experience reviewing employment contracts. To get your employment agreement reviewed today, please call our legal team now at (215) 645-5955 or contact us through our website. We offer free, fully confidential legal consultations. --- ### [Long-Term Care Claims](https://www.garnerltd.com/practice-areas/long-term-care-claims/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** ## Long-Term Care Claims Attorneys If you or a family member requires long term care, you need immediate access to your benefits. Unfortunately, the big insurance companies do not always cooperate. Sadly, many people find out that recovering long term care benefits can be immensely frustrating and incredibly challenging. At The Garner Firm, our dedicated [Philadelphia long term care claims lawyer](/attorney-profile/) represents policyholders in long term care insurance claims. If you made a long term care claim, only to have your benefits denied, please contact our law firm today for immediate assistance with[ your case](/services/). ### **Know Why Your Long-Term Care Claim Was Denied** To recover the full long-term care compensation that is owed to you, it is imperative that you have a complete understanding of exactly why your claim was rejected in the first place. Under applicable law, insurance companies are generally required to send you a written denial letter that explicitly states why the denial was issued. > Long-term care claims are denied for a wide variety of reasons. In far too many cases, insurance companies reject these claims for reasons that are unfair or wholly illegitimate. When you get this denial letter, please get it into the hands of a qualified Philadelphia [long term](/disability-benefits-lawyer/) care lawyer as soon as possible. Your lawyer will be able to review the insurer’s stated reasoning, along with the facts of your case, and determine what action must be taken to get you the benefits that you and your family need. ### **What Our Long-Term Care Attorneys Can Do For You** Long term care claims are denied for a wide variety of reasons. In far too many cases, insurance companies reject these claims for reasons that are unfair or wholly illegitimate. If you or a family member has a claim denied, our Philadelphia long term care lawyer is standing by, ready to take action to help protect your rights. Some of the actions our legal team may take include: - Reviewing your denial letter; - Investigating the facts of your case; - Gathering additional evidence to support your claim; - Assembling evidence in a manner to directly address the insurance company’s stated reasoning for denial; - Helping you with all documents and applications; - Filing an appeal with the insurance company; and - If necessary, filing a long-term care lawsuit on behalf of you or your family member. ### **Get Help With Your Long-Term Care Claim Today** At [The Garner Firm](/about-us/), we represent clients in long term care claims. Our founder, Adam H. Garner, is an experienced benefits attorney who has helped many people recover their benefits. If you believe that your long-term case claim was wrongly denied, please do not hesitate to contact our Philadelphia office today to schedule your free consultation. --- ### [Labor and Employment](https://www.garnerltd.com/practice-areas/labor-and-employment/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** ## Labor and Employment Employees, regardless of their position, are legally entitled to a workplace free of unlawful harassment and unlawful retaliation. Likewise, all employees are entitled to the wages they have earned. Work is hard enough without being mistreated or taken advantage of by your employer. The good news is that there are many different federal, state and local laws that provide valuable legal protections for [employees](/employment-discrimination/). Unfortunately, however, many employers still violate their employees’ rights. At The Garner Firm, we know employees may find the labor and employment laws governing the workplace to be complex. That is why it is critical to consult with an experienced employment lawyer when you think your employment rights have been violated. The Garner Firm was founded to help employees understand their rights, and to fight for fair workplace treatment. We want to make sure that all workers are able to obtain the [wages](/wage-and-hour/) and benefits that they have rightfully earned. > We represents employees, managers, and executives in a wide range of different labor and employment claims. Our experienced [Philadelphia employment law attorney](/attorney-profile/) Adam H. Garner is a zealous advocate for employee rights. He represents employees, managers, and executives in a wide variety of different labor and employment claims. If you need employment law assistance, please do not hesitate to contact our firm today to schedule your free legal consultation. ### **We are a Full-Service Labor and Employment Law Firm** At The Garner Firm, we are proud to offer our clients a full array of labor and employment law services. Our breadth of experience is important because labor and employment issues often overlap with each other. In fact, employees frequently have multiple different legal claims at the same time. With our deep understanding of labor and employment law, we always work to find the best available solutions for our clients. No matter your specific issue, our legal team is ready to help. Specifically, we handle the following types of labor and employment cases: - Wage and hour claims; - Employee benefits litigation; - ERISA benefits claims; - ERISA fiduciary litigation; - Short-term disability (STD) claims; - Long term disability (LTD) claims; - Retirement benefits claims; - SERP and other executive deferred compensation claims; - Health insurance and life insurance disputes; - Severance agreement review and negotiation; - Employment contract review and negotiation; - Employment contract litigation; ### **Contact Our Dedicated Philadelphia Employment Law Attorneys Today** At [The Garner Firm](/about-us/), we are proud to represent employees in the City of Philadelphia and throughout Southeastern Pennsylvania, the Delaware Valley and Maryland. No one should have their rights taken advantage of while they are trying to earn a living. If your workplace rights were violated, our employment law attorney Adam H. Garner is standing by, ready to assist you with your case. To get your free, fully confidential [legal consultation, ](/services/)please call us today at (215) 645-5955 or email us directly online. --- ### [Accessibility Notifications](https://www.garnerltd.com/accessibility-notifications/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** ## ADA Accessibility Modifications We are continually improving our online services to better meet the needs of all individuals. Providing a barrier-free environment on our website which is accessible to all users is important to us. To this end, we have updated and tested this website and its elements to be compliant with the Web Content Accessibility Guidelines (WCAG) 2.0 as accepted and published by the World Wide Web Consortium (W3C). This website has been designed to be viewable and navigable by non-graphical text-only browsers. The coding implemented in the site and its elements are compliant with W3C standards for CSS and HTML. All current web browsers should be capable of displaying the site correctly and our developers strive to use code that will also support future browser requirements as the web continues to evolve. In certain situations, due usually to changes to technology, changes to standards, practical limitations or third-party code, complete accessibility, usability and compatibility may not be immediately available. To address such potential situations and provide a better user experience, this website is periodically audited for compatibility issues and compliance with current standards and guidelines. When issues are reported and remain outstanding, they will be documented in a changelog for visitors to review. This changelog will include a brief description of the issue, the date it was reported as well as an anticipated resolution timeframe. Minor deficiencies that do not impact navigation or site use but cannot be immediately resolved will be included as a courtesy to users. Issues that have been resolved will be removed from the changelog. If you discover a usability issue on this website, please use the form below to report it. We will investigate the issue, explore solutions and if necessary, add it to the changelog. You may also report issues by sending an email to . Please limit your email to issues related to website usability. CURRENT CHANGELOG: No outstanding issues as of 10/2019 --- ### [Disclaimer](https://www.garnerltd.com/disclaimer/) **Published:** January 9, 2023 **Author:** Kevin Sparkman **Content:** This web site does not offer legal advice. All material on this web site has been prepared by THE GARNER FIRM, LTD., for general informational purposes. The information on this site does not necessarily reflect all current legal developments. No warranties or guarantees are made as to the accuracy or adequacy of the information provided on this site. No two legal issues are the same and each must be evaluated on its own. The description anywhere on this web site of the results of any specific matter does not guarantee similar results can or will be obtained in the future. Again, no two legal issues are the same, and each matter must be evaluated on its own. Thus, the outcome of similar matters can differ significantly. The decision to hire an attorney is an important one. When an an attorney-client relationship is formed, it is THE GARNER FIRM’S practice to do so in writing through a written engagement letter. No attorney-client or other professional relationship of any nature is created by your visiting this website, or reading the information on it. Do not act on or rely on any information on this site, but instead, consult with a licensed attorney because this site is not a substitute for obtaining appropriate legal advice from legal counsel in your relevant jurisdiction. If you wish to discuss potential legal representation with us, please contact us. Please note, however, that sending us an email or calling us does not create an attorney-client relationship by itself. --- ## City State ### [Philadelphia ERISA Lawyer](https://www.garnerltd.com/citystate/philadelphia-erisa-lawyer/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** The [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) is a federal law that governs the majority of employer-sponsored group benefits plans that are offered in the United States. ERISA is notoriously complex. It contains a number of confusing, even counterintuitive rules and provisions. Sadly, many employees and plan participants have trouble getting access to their full and fair benefits they are owed through their ERISA plan. At The Garner Firm, our **Philadelphia ERISA lawyer** is committed to providing reliable, responsive, effective legal representation to employees and beneficiaries in Southeastern Pennsylvania. We know how to hold large insurance companies and other plan administrators and fiduciaries accountable. To get immediate assistance with your case, please contact our law firm for a free, strictly confidential initial consultation. ### Handling Employee Benefits (ERISA) Cases in Philadelphia, Pennsylvania ERISA requires plan administrators and/or insurance providers to conduct a comprehensive, full, and fair review of every claim for benefits. Sadly, in reality, this process does not always occur as it should, including because the administrator or insurer allows its financial self-interest to improperly affect its decision-making process. In far too many cases, ERISA claims are unfairly denied or substantially underpaid. Our Philadelphia ERISA lawyer has experience representing employees and other beneficiaries in wide array of different ERISA cases, including: - Short term disability denials - [Long term disability denials](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/); - [Life insurance disputes](https://www.garnerltd.com/practice-areas/life-insurance/); - [Long term care benefits](https://www.garnerltd.com/practice-areas/long-term-care-claims/); - [Retirement plans](https://www.garnerltd.com/practice-areas/retirement-plan-benefit-claims/); and - [Executive deferred compensation](https://www.garnerltd.com/practice-areas/serp-and-other-executive-deferred-compensation-claims/). We also handle breach of fiduciary duty cases and other claims where benefits or participant rights were impaired. As ERISA has a number of different quirks and complicated features, the claims and appeals process challenging for individuals. As a starting point, you should be aware that these claims are subject to tight deadlines. If your claim was denied, you typically may only have between 60 and 180 days, depending on the type of benefit at issue, to put together and submit your appeal. Furthermore, it is crucial that you file a comprehensive, well-prepared appeal. Should your claim go to litigation, the court may be restricted in the evidence that can be reviewed. If you failed to submit relevant evidence during the “administrative” appeal stage of the claims process, you may lose the right to use that evidence in your lawsuit. Our Philadelphia ERISA lawyer will work to ensure that your claim is properly handled and presented at every stage of the legal process. ### Speak to a Philadelphia ERISA Attorney Today At The Garner Firm, our Philadelphia ERISA lawyer represents executives, employees, former employees, and other beneficiaries in a broad range of employee benefits cases. To get help from an experienced Philadelphia ERISA attorney today, please do not hesitate to [contact our law office](https://www.garnerltd.com/contact/) for a free, no-obligation initial consultation. --- ### [Disability Insurance Attorneys Philadelphia](https://www.garnerltd.com/citystate/disability-insurance-attorneys-philadelphia/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** The ability to work is critical for most people to support themselves and their households. If you develop a medical condition that prevents you from working, it is important to know your options for financial support. Many employees have insurance coverage from their employers for short-term disability (STD) or long term disability benefits (LTD) that is supposed to provide benefits to help disabled employees cover their bills. However, getting these benefits can be much more challenging than you might imagine. If you need assistance filing a disability claim or if your claim has been denied, you should not wait to call [disability insurance attorneys in Philadelphia](https://www.garnerltd.com/attorney-profiles/). The Garner Firm helps clients in your situation, and we are ready to assess your options. Contact our office directly today. ### Disability Insurance Complications Most employer-sponsored disability insurance policies are governed by the Employee Retirement Income Security Act of 1974 ([ERISA](https://www.garnerltd.com/erisa-litigation)). This is a federal statute that claims to protect the rights of employees, but in reality, it largely favors disability insurance companies and employers. You would think that if you and your employer contributed to premiums for disability coverage, benefits should be available should you need them. Unfortunately, many people encounter serious roadblocks when seeking disability benefits, including delays and outright denials of valid claims. There are many reasons why a disability claim might be denied upfront, including: - The insurance company denies that you have a disability as covered by your policy - You did not provide the (often extensive) supporting documentation required to support you claim - The insurance company claims that you should be able to work – either at your previous job or another position with different job duties In some cases, people who are already receiving benefits will learn that their benefits have been suddenly and prematurely reduced or terminated. This can also be a difficult decision to challenge and prove you still need benefits. If this happens, it is time to contact a law firm that handles disability insurance cases. ### The Right Disability Insurance Lawyer There are many different ways that a Philadelphia disability insurance attorney can help claimants who are struggling to receive the benefits they deserve. At The Garner Firm, we assist with ERISA disability claims at all stages of the process, including the following; - Helping clients prepare and file persuasive claims, which can often increase the chances of an initial approval - Appealing claims that have been denied, both by negotiating with the insurer and by filing claims in court - Appealing benefit termination or reduction that was premature Disability claims and appeals are highly complicated, and your benefits are too important to try to handle the process on your own. You should never hesitate to contact our office to learn how we can help. ### Contact Our Experienced Disability Insurance Attorneys in Philadelphia The Garner Firm is dedicated to helping disabled clients obtain and keep the disability benefits they deserve and need to support themselves. If you have concerns regarding a disability insurance claim, [contact us](https://www.garnerltd.com/contact/) to speak with disability insurance attorneys in Philadelphia. --- ### [Haverford Township Long Term Disability Lawyer](https://www.garnerltd.com/citystate/haverford-township-long-term-disability-lawyer/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** When you become disabled and are unable to continue working as rigorously as you had before your injury – or unable to work at all – you may be able to file a claim to seek short-term or long term disability benefits if your employer offers its employees a long term disability plan. Many employers offer long-term and short-term disability benefits to provide disabled employees with the income they need to continue supporting themselves and their families. Although you may have the right to receive these benefits, it is not uncommon for a disability insurance provider to look for reasons to deny a claimant the compensation he or she seeks. This is because replacing a disabled individual’s income can be quite expensive. When you are disabled and in pursuit of long term disability benefits, work with an experienced [long term disability benefits lawyer](https://www.garnerltd.com/practice-areas/labor-and-employment/) who can be your advocate and help you pursue the benefits you deserve. ### ERISA Disability Benefits In the United States, most private sector long term disability insurance plans are governed by the[Employee Retirement Income Security Act of 1974 (ERISA)](https://www.dol.gov/general/topic/health-plans/erisa). Under ERISA, your employer must provide you with comprehensive information about your policy, how to file a claim for benefits, and how to appeal the insurance provider’s decision if your claim is denied. When you file a claim, the provider must make a decision about it within 45 days. This can be extended for up to an additional 60 days in some circumstances. ERISA does not regulate how a long term disability insurance provider defines “disabled.” Some have a more specific definition of the term than others, and some exclude certain conditions from their policies or limit the duration for which benefits may be able for certain conditions. ### Your Rights Regarding Long Term Disability Benefits You also have the right to have a lawyer represent your case and work with you to pursue your long term disability benefits. Your long term disability insurance provider may hire an investigator to watch you at doctor appointments and even outside your home. He or she may even utilize video surveillance in an attempt to “catch” you moving in ways that you claim you are unable to move because of the disability. Your lawyer can help you handle interactions with an investigator, with the insurance provider and if necessary, with the court. If your [ERISA long term disability claim is denied](https://www.garnerltd.com/category/long-term-disability/), you have the right to appeal it. Under ERISA, the deadline for filing your internal appeal can never be less than 180 days. If this does not result in a favorable ruling and you still feel your claim should have been approved, you may bring a civil action against the insurer or the disability plan pursuant to Section 502(a) of ERISA. 29 U.S.C. § 1132(a). ### Work with an Experienced Haverford Township Long Term Disability Lawyer When you are disabled and unable to work, it is in your best interest to pursue long term disability benefits with the aid of an experienced[long term disability lawyer](https://www.garnerltd.com/contact/). Contact The Garner Firm, Ltd. today to set up your legal consultation with us. --- ### [Long Term Disability Attorney in Lower Merion Township](https://www.garnerltd.com/citystate/long-term-disability-attorney-in-lower-merion-township/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** There are many situations where you can find yourself unable to continue working due to a physical or mental disability. When this happens your immediate concern–aside from tending your disabling condition–is figuring out how you will continue to earn a living for you and your family. There are certain government disability and social safety net programs you may be able to take advantage of, but your employer may also provide short-term and long term disability benefits as part of your group insurance plan. Of course, just because you are eligible for disability benefits, that is no guarantee the insurer will actually give them to you. After all, insurance companies are not in the business of generosity. They exist to maximize profits by paying out as little as possible. And while there are certain laws in place to regulate disability benefit plans–notably the [Employee Retirement Income Security Act (ERISA) of 1974](https://www.garnerltd.com/practice-areas/erisa-litigation/)–the complexity of this legislation often serves to only further frustrate disabled employees. At The Garner Firm, we can help you obtain the disability benefits you are entitled to under your employer-sponsored ERISA plan.[Lower Merion Township disability attorney Adam H. Garner](https://www.garnerltd.com/attorney-profile/) has extensive prior experience representing and administering ERISA plans. He now puts that substantial knowledge to work for employees who find themselves unable to work or deal with the complex ERISA claims and appeals process. ### Why ERISA Disability Claims Often Fail What makes it so difficult to get disability benefits that the employee has earned through his or her service to their employer? As is usually the case when insurance companies are involved, there are mountains of rules and regulations that must be followed to the letter. Many employees make the mistake of assuming that simply showing up with a doctor’s note stating they are disabled and unable to work is enough. But that is not how the process works. The most important thing to understand is that when it comes to disability benefits, it is the insurance company–not your employer–that makes the final decision. Even if your supervisors, or the company’s human resources department, agree that you qualify for short-term or long term disability benefits, the insurance company is in no way bound by such opinions. Since it is ultimately the insurance company’s call, it is critical that you build as strong a case as possible for receiving benefits. This means not only fully documenting your medical treatment history, but also carefully following your doctor’s advice. Too many disability claims fail because an employee engaged in certain activities against medical advice–and the insurance company was watching. ### Call Disability Attorney Adam H. Garner Today The other key mistake that many employees make is failing to hire their own disability lawyer. If you are disabled, you need an attorney who understands the ERISA system and will aggressively represent your interests–and only your interests. So if you are in the process of seeking long term disability benefits and need assistance, [contact The Garner Firm today](https://www.garnerltd.com/contact) to schedule a free initial consultation today. --- ### [Long Term Disability Attorney in Philadelphia](https://www.garnerltd.com/citystate/long-term-disability-attorney-in-philadelphia/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** If you are no longer able to work on a full-time basis, you may be eligible for long term disability benefits. Many Philadelphia area workers are covered by long term disability insurance policies. If the policy was obtained through an employer, it is likely regulated by [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa). While ERISA provides certain key protections to plan participants and beneficiaries, obtaining full and fair long term disability benefits can still prove to be challenging. At The Garner Firm, our **Philadelphia long term disability attorney** knows how to hold the big insurance companies accountable. We fight to protect the rights and interests of our clients. If your long term disability claim was denied in Southeastern Pennsylvania, we can help. For a free, no-obligation initial legal consultation, please do not hesitate to contact our legal team today. ### Was Your LTD Claim Denied in Philadelphia? If your long term disability claim was denied in Philadelphia, you need to take immediate action to protect your rights. Most LTD claims are filed against ERISA-governed employee benefits plans. [ERISA ](https://www.garnerltd.com/practice-areas/erisa-litigation/)[has strict deadlines](https://www.garnerltd.com/practice-areas/erisa-litigation/) for filing an LTD appeal. Even if you are filing an LTD claim against a non-ERISA insurance policy, you will still only have limited time to take action. It is crucial that you understand why your claim was rejected. You should have received a denial letter from the insurer; it is recommended that you get this letter to an experienced long term disability attorney for guidance on how to proceed. ### How Our Philadelphia Long Term Disability Lawyer Can Help Unfortunately, ERISA stacks the deck in favor of the insurance companies. The good news is that a skilled Philadelphia long term disability attorney can help you fight back. Our law firm is prepared to protect your rights. If your long term disability claim was denied, we will: - Carefully review the denial; - Request a copy of the insurance file to better understand your claim; - Explain your legal rights and legal options; - Investigate your case and work to obtain supplemental evidence; - Work with doctors to better document your medical condition; - Prepare a strong administrative appeal; and - Negotiate with the insurance company for a fair settlement. Our legal team works tirelessly to help our clients get access to their benefits without unreasonable delay. In many cases, this means reaching a full and fair settlement with the insurance company. Though, if the insurance company refuses to pay you or your family the full amount that is owed, we are always prepared for litigation. ### Contact Our Philadelphia Long Term Disability Lawyer Today At [The Garner Firm](https://www.garnerltd.com/about-us/), our Philadelphia long term disability lawyer represents applicants who have had their disability claims denied. If your disability claim was denied or underpaid in Southeastern Pennsylvania, please contact our Philadelphia law office at (215) 645-5955. Initial consultations are always free of charge. --- ### [Long Term Disability Attorney Near Me](https://www.garnerltd.com/citystate/long-term-disability-attorney-near-me/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** ***Get Help From a Long Term Disability Lawyer Near Me*** If you can no longer work due to an illness, an injury, or a medical condition, you may be entitled to receive long term disability benefits for yourself and your family. Many people are covered by employer-backed long term disability plans which are regulated under the [Employee Retirement Income Security Act of 1974 (ERISA)](https://www.dol.gov/general/topic/retirement/erisa). Others are covered by individual disability policies that were obtained on the private insurance market. At [The Garner Firm](https://www.garnerltd.com/practice-areas/), our long term disability attorney is dedicated to fighting for the rights of those who have had their disability benefits wrongfully denied. We have a deep understanding of these complex legal cases. If your long term disability claim was rejected, please do not hesitate to contact our legal team for a free, fully confidential consultation. ### How can a Long Term Disability Lawyer Near Me Help? The big insurance companies know how to work the disability claims process to their own benefit. Unfortunately, claimants often have a difficult time getting access to the full disability benefits that they deserve under the terms of their plan. There are many obstacles within the claims process that can undermine a disability application— a small error could lead to your long term disability claim being delayed, underpaid, or even denied outright. At The Garner Firm, our dedicated local long term[disability lawyer](https://www.garnerltd.com/attorney-profile/) has the skills and experience to help you maximize your benefits. Our law firm is prepared to: - Help you prepare your initial long term disability claim; - Conduct a comprehensive review of your denial letter; - Explain your options to you; - Investigate your claim, gathering all relevant supplemental evidence; - Put together a strong long term disability appeal; - Negotiate for a full and fair settlement offer; and - File a long term disability lawsuit. Many long term disability claims can be resolved prior to litigation. Ideally, you will be able to get access to the maximum available long term disability compensation without unreasonable delay. To do so, it is crucial that you speak to an experienced long term disability lawyer close by as soon as possible after receiving an official denial letter. ERISA claims have specialized legal rules. Not only are there tight deadlines, but you need to be sure that you have submitted all supporting evidence with your initial claim or during your administrative appeal. If you fail to do so, it could make it difficult to get your full benefits. ### Contact a Long Term Disability Lawyer Near Me Today At [The Garner Firm](https://www.garnerltd.com/about-us/), our long term disability lawyer represents employees, former employees, plan participants, and their beneficiaries in long term disability claims. If your long term disability claim was denied, we can help. For a free, no obligation review of your case, please call our law office today at (215) 645-5955. --- ### [Long Term Disability Denial Attorneys Near Me](https://www.garnerltd.com/citystate/long-term-disability-denial-attorneys-near-me/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** When you have a disabling condition and have private disability insurance coverage through your employer or a personal plan, you are entitled to benefits to cover lost wages and future earnings associated with the disability. While in an ideal world, you would receive your benefits automatically following your disability, this is not the case. Disability benefits must be applied for, and if you have an employer, they also have a portion that must be filled out before the insurance companies review your claim. As we’ll discuss below, the goal of the insurance company is not to pay out on as many claims as possible for the greatest amount allowed, but rather just the opposite. This can lead to improper denials, which can entitle you to damages. If your disability claim has been denied, one of the experienced long-term disability denial attorneys from [The Garner Firm](https://www.garnerltd.com/practice-areas/) can provide you guidance on how to best appeal the denial. Should you have a diagnosis of a disability and not yet applied for your disability benefits, an attorney can help you through the application process to support a faster and more complete payout than the insurance companies might otherwise offer you without the assistance of an attorney. ### Common Reasons Why Your Disability Claim Could be Denied Disability claims are denied for a number of reasons, with the most common being a lack of information or inaccurate information, challenging the severity of the disability or its impact on your ability to work, claiming that the disability is outside your coverage, and other attempts at dodging the obligation to pay you benefits for your disability. Your disability insurance attorney can effectively [appeal your disability claim denial](https://www.garnerltd.com/how-to-appeal-a-long-term-disability-denial/) by collecting the evidence you need to not only have your claim accepted but also accurately assessed so that you receive full compensation and coverage for your disability. The impact of your disability can be felt throughout your working life in terms of lost future earnings, and treatments could be required in the long term. An experienced disability insurance attorney knows how to assess your situation and negotiate the fullest possible benefits from the insurance company. ### Contacting an Attorney as Soon as Possible After Your Disability Supports Your Benefits The insurance companies are often quick to offer a lowball offer quickly after your disability. This is advantageous to the insurance company, as the amount is generally lower than your damages might require, and less time invested into the payment saves on human resources costs. Having an attorney on your side before you accept any offer will support the fullest compensation possible for your disability. ### Reach Out to a Philadelphia Disability Attorney Today Connect with one of the experienced Philadelphia disability attorneys from The Garner Firm now to [schedule a consultation](https://www.garnerltd.com/contact/) to discuss your claim now. --- ### [LTD Insurance Attorneys Philadelphia](https://www.garnerltd.com/citystate/ltd-insurance-attorneys-philadelphia/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** When your disability insurance comes through your job, ERISA gives you certain legal rights. Unfortunately, in their zeal to protect their bottom line, insurance companies often try to violate those rights. When that happens, you need an LTD insurance attorney in Philadelphia to help ensure that you get what you legally deserve. ### Why Insurance Companies Will Deny Your Benefits Claim Insurance companies do not make it easy for you to get your ERISA long-term disability benefits. They may even conduct surveillance on you and approach your friends and family to try to get them to unwittingly give statements that can undercut your claim. They may deny benefits for some of the following reasons: - The claimant has not shown medically that they are sufficiently injured and [disabled](https://www.garnerltd.com/insurance-companies-define-disability/); - The claim is incomplete; - The injury was a preexisting condition and; and - The claim was excluded by the policy The disability insurance companies try to put every obstacle that they can in front of you when you are trying to appeal your denial of benefits. They have many lawyers at their disposal who specialize in trying to keep you from getting the disability benefits that you need. However, the insurance company is not the judge and jury, nor do they get the final say on your claim. Otherwise, they would be able to wrongly deny a claim and not be subject to any scrutiny. This is why you need to come to the table with an LTD insurance attorney of your own. This will help level the playing field between you and the insurance company. ### How You Can Appeal Your Benefits Denial The first thing that you need to do is file an appeal of the denial. You must take this process very seriously because the record for the appeal may be the only factual record a court considers in a lawsuit. You should include the following in your appeal: - Your claim file; - Extensive medical records that show your injuries; - Personal statements about your condition; - Witness statements from people you know; and - Support from your employer if they will give it If your appeal is not successful, you will need to file a lawsuit in court to receive your benefits. A judge will review the evidence in your appeal file and listen to your attorney’s arguments about why you are entitled to long-term disability insurance. At all points in the litigation process, your claim is subject to strict deadlines. The timeframes in these cases tend to be short, making it vital to get started on your claim early. When you have earned the right to [ERISA disability benefits](https://www.garnerltd.com/factors-that-can-influence-your-ltd-payment/), you need to be vigilant about fighting back when the insurance company is trying to take them away from you. ### Contact an LTD Insurance Attorney in Philadelphia The Garner Firm represents individuals who are fighting to receive ERISA long-term disability benefits.[Contact us](https://www.garnerltd.com/contact/) today for help with your claim. We understand the appeals process and can help you navigate this complicated process. Your initial consultation is free. --- ### [Mt. Holly Long Term Disability Attorneys](https://www.garnerltd.com/citystate/mt-holly-long-term-disability-attorneys/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** ERISA long-term disability benefits are not as easy to be approved for as you think. Even though these benefits are governed by federal law, the insurance company has quite a bit of room to operate. This means that they can deny claims and force you to fight for your disability. These are the rules of the game that you must play by when you want benefits, and you should have the help of a Mt. Holly long-term disability attorney. ### Filing Your Claim for ERISA Long-Term Disability Benefits Your process begins when you file your [initial application for benefits.](https://www.garnerltd.com/practice-areas/long-term-care-claims/) Presumably, you would include all the documentation that supports your claim, including: - Medical diagnosis and prognosis - Vocational reports - Physician’s statement - Your statement - Other documentation that supports your claim One of the common reasons for denial is that the insurance company does not believe that you are disabled. They may even resort to sneaky tactics such as hiring someone to follow you to get evidence that could dispute your claim. All of this is to say that they can deny your claim for the slightest of reasons. ### The Administrative Appeals Process You have rights when your claim is denied. While you cannot sue the information company for wrongfully denying your claim, you can file an administrative appeal. In fact, ERISA expects you to fully go through this process before you could even go to court. Some people may hesitate to file an appeal with the same company that turned down their initial claim. However, you have no choice. This is the process that the law requires. ERISA does not really do claimants any favors. If you did not already have a lawyer, the appeals process is [when you need to hire one](https://www.garnerltd.com/attorney-profiles/). The key is to put together a file with extensive documentation that supports your claim. Even if the insurance company still will not approve your benefits, this will help you at the next step of the process. Insurance companies actually fully consider the record at appeal. Many claimants are successful during this process, perhaps because the extensive appeal file clears up misunderstandings or provides something that was missing. If your appeal is unsuccessful, you still have the ability to take your case to court. The insurance company does not have the final say. However, you will not get a trial or hearing where you get to introduce evidence. The judge will take the file from your administrative appeal and review it to see if the insurance company made a mistake. Of course, your attorney will get a chance to explain in writing why you are entitled to benefits, but you are not able to add new evidence to your file. This is another reason why you need an experienced attorney who is intimately familiar with the appeals process. ### Consult with a Long-Term Disability Attorneys in Mt. Holly The attorneys at The Garner Firm fight for their clients when they are up against the difficulties that insurance companies cause them. We do not let them off easy when they deny you benefits. [Contact us](https://www.garnerltd.com/contact/) today to find out how we can help you in your case. --- ### [Newtown Square Long Term Disability Lawyer](https://www.garnerltd.com/citystate/newtown-square-long-term-disability-lawyer/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** The [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) is a federal law that regulates most employer-provided employee benefits plans, including the vast majority of disability insurance policies. Sadly, in many ways, ERISA is designed to favor insurance companies. Far too many employees and plan beneficiaries struggle to get the full long term disability benefits that are owed to them. At The Garner Firm, our **Newtown Square long term disability lawyer** handles every client’s case with professionalism, expertise, and diligence. We know how to hold employers and insurance companies accountable. If your long term disability claim was rejected or underpaid in Newtown Square, please contact our law firm for a free, fully confidential consultation. ### How Our Newtown Square, PA Long Term Disability Attorney can Help You and Your Family If you have received a long term disability denial letter, it is critically important that you take immediate action to protect your rights and to preserve your ability to seek your benefits. Under ERISA regulations, you only have six months (180 days) to prepare and submit an internal appeal for a disability claim. You must submit this appeal to the insurance company before you take your case to court. Claimants should consult with an experienced professional before submitting their “administrative” appeal. Even a small misstep within the long term disability appeals process could severely impair your rights. Our law firm will ensure that your claim is properly handled. Among other things, our[Newtown Square long term disability attorney](https://www.garnerltd.com/attorney-profile/) is prepared to: - Request your full disability file for review from the insurance company; - Conduct a comprehensive assessment of your disability denial letter; - Take action to obtain additional vocational and medical evidence; - Carefully put together a strong and thorough appeal; and - Initiate settlement negotiations with the other side, if warranted. In many cases, long term disability denials can be resolved during the so-called “administrative” appeals process. Our law firm works tirelessly to get our clients the full disability benefit that they deserve under the law. If the disability plan administrator or disability insurance company refuses to pay your benefits or offer an acceptable settlement, we are prepared to take your disability claim to court pursuant to Section 502(a) of ERISA, 29 U.S.C. § 1132(a). Pennsylvania long term disability attorney Adam H. Garner has extensive experience in[ERISA litigation](https://www.garnerltd.com/practice-areas/erisa-litigation/). You deserve full disability benefits. ### Was Your Disability Claim Denied in Newtown Square? Our legal team is prepared to help. At The Garner Firm, our Newtown Square long term disability attorney has more than a decade of experience litigating complex disability and ERISA claims. To set up a free, no obligation review of your long term disability case, please do not hesitate to[contact our legal team](https://www.garnerltd.com/about-us/) today. We represent clients in Newtown Square and throughout Delaware County. --- ### [Philadelphia ERISA Disability Appeals Lawyer](https://www.garnerltd.com/citystate/philadelphia-erisa-disability-appeals-lawyer/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** The Employee Retirement Income Security Act (ERISA) of 1974 protects disabled employees. If you have been disabled, it is important to hire an experienced [Philadelphia ERISA disability appeals lawyer](https://www.garnerltd.com/attorney-profiles/) who knows how to protect your legal rights. Errors in filing, documenting, or appealing your claim can cost you huge amounts of disability benefits. You have the right to get legal advice in order to get the full benefits to which you are entitled. ### What is ERISA? ERISA is a federal law that created minimum standards for private employer-sponsored retirement and other benefit plans. The law also created other important protections for plan participants and their beneficiaries. Participants must be notified about plan features and funding, as well as other important information. Those who manage plan assets have fiduciary responsibilities to protect these assets for the participants and their beneficiaries. And perhaps most importantly, plan administrators must have clear processes for grievances and appeals. This allows participants and their beneficiaries to get the benefits to which they are entitled under their plan. ### How Do I File an ERISA Disability Claim? The first step in [filing a disability claim](https://www.garnerltd.com/understanding-the-erisa-claim-process/) is to contact your plan’s claim administrator. The administrator that applies to your situation may depend on whether your plan is insured or self-funded by the employer. A disability lawyer can help you how to properly file a claim. An attorney will also be able to document your disability properly to reduce the chances of having your claim denied. ### What Do I Do if My Claim is Denied? Even with an attorney’s help, your disability claim might be denied. This is why ERISA is so important. ERISA requires insurance companies to set a clear process for grievance and appeals. Your attorney can follow this process in order to move your claim forward. If the insurance company has unnecessary delays or does not follow its own appeals procedures, your attorney can advise you on other legal options. It is important to understand that insurance companies are not on your side. Even if you are a subscriber, the insurance company is still working to pay as little as possible on as few claims as possible. These companies spend huge sums of money to train their claims adjusters on how to deny claims and reduce payments. They also have armies of lawyers to defend these actions. This is why it is so important for disability victims to have their own lawyers who can advocate for them throughout the claims process. ### An Experienced Philadelphia Disability Lawyer Near You A disability can change your life. Without the ERISA compensation to which you are legally entitled, it could be difficult to simply pay your medical bills. No disability victim should be denied their legal rights. The experienced disability attorneys at The Garner Firm have helped many clients throughout the Philadelphia area. [Contact us](https://www.garnerltd.com/contact/) today to schedule your free consultation. The sooner you have an attorney fighting on your side, the better protected your legal rights will be. --- ### [Philadelphia Long Term Disability Insurance Lawyer](https://www.garnerltd.com/citystate/philadelphia-long-term-disability-insurance-lawyer/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** ### Handling Long Term Disability Claims for Clients in the Philadelphia Area Disabilities are not only limiting physically or mentally, but they can also result in extensive financial losses if your disability prevents you from working. Numerous employers provide employees with long term disability insurance coverage that should provide benefits if disability restricts their ability to work. However, most of these long term disability plans are regulated by the Employee Retirement Income Security Act of 1974 ([ERISA](https://www.garnerltd.com/erisa-litigation)), which can make it difficult for employees to obtain the benefits they need and deserve. If you need to file a claim, you received a claim denial, or your benefits were terminated too soon, you need the help of an experienced Philadelphia long term disability insurance lawyer. [The Garner Firm, Ltd](https://www.garnerltd.com/attorney-profile/)., represents the rights of clients with disabilities when it comes to insurance benefits. Contact our office to discuss your situation and how we can help today. ### Fighting for Long Term Disability Benefits There are different reasons why complications might arise with long term disability claims. Some issues might include: - The insurer acted unreasonably in denying your claim - You did not follow proper claim procedures - Your claim did not include adequate supporting documentation - Your insurer challenged that you had a disability or that your condition prevents you from working - You missed a deadline to appeal a claim denial - You did not follow proper appeal procedures Disability claims need to be detailed and provide the right information to prove you deserve benefits. These are difficult to prepare, and even the slightest error can result in a denial. It is important to recognize that a denial is not the final word regarding your claim, as it is possible to appeal denials. You should have the help of a skilled long term disability attorney to do so. If your appeal is denied, you can then bring a lawsuit under Section 502(a)(1)(B) of ERISA in federal court. In addition, many people have their benefits prematurely reduced or terminated. It is important to seek legal representation to appeal these changes to your benefits. ### Experience You Can Trust Attorney Adam Garner has over a decade of experience successfully representing clients in ERISA long term disability claims and appeals. ERISA is a complex law, and ERISA appeals and litigation can be challenging endeavors. Adam and his team bring leverage, their past experience and knowledge of the industry exclusively to protect the rights of disabled individuals. Adam Garner is highly respected in this area of law practice, and he publishes and edits material and speaks about ERISA and long term disability benefits on a regular basis. If you have an issue regarding your disability insurance claim, you want a nationally recognized attorney on your side. ### Contact a Philadelphia Long Term Disability Insurance Lawyer about Your Claim Whether you have not yet filed a claim or have received a denial, the help of the right Philadelphia long term disability insurance attorney can be invaluable. Do not put the benefits you need at risk. Instead, fight to prove your disability and eligibility for a claim approval. The Garner Firm, Ltd., is ready to help, so please [contact us](https://www.garnerltd.com/contact/) today. --- ### [Radnor Life Insurance Lawyer](https://www.garnerltd.com/citystate/radnor-life-insurance-lawyer/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Life insurance is the type of insurance that compensates spouses, families, and other beneficiaries of deceased individuals for their loss of the deceased’s financial support. For many people, having a life insurance policy gives them peace of mind knowing that if they were to die prematurely, their loved ones would not face financial hardship. Working with an experienced [life insurance lawyer](https://www.garnerltd.com/) can save you the stress and headaches that often accompany filing and managing this type of claim. If your life insurance claim is denied, your lawyer can work on your behalf to [appeal the denial](https://www.garnerltd.com/practice-areas/erisa-litigation/) and pursue the compensation you are seeking. ### Filing a Life Insurance Claim In order to file a life insurance claim, you must provide a copy of the deceased individual’s death certificate because you must prove that he or she is no longer living. With some policies, claimants are also required to provide additional documentation. Sometimes, the claimant is able to choose how he or she wants to receive his or her benefits from the claim. Options generally include: - A lump sum payment; - Lifetime income. With this option, the claimant receives benefits in regular installments for the rest of his or her life; - A specific income schedule. By choosing this, the claimant chooses to receive benefits in installments according to a specific schedule; and - Income interest. A claimant may also have the option to allow the insurance provider to keep ownership of the policy and simply pay him or her the interest it accrues. Upon the claimant’s death, it is transferred to a new beneficiary. ### Appealing a Denied Life Insurance Claim If the life insurance policy with which you file your claim is one governed by the[Employee Retirement Income Security Act of 1974 (ERISA),](https://www.dol.gov/general/topic/health-plans/erisa) there is a higher chance it will be denied than if it were a consumer life insurance policy. This does not mean you cannot recover compensation from an employer-sponsored life insurance policy, but that it can be quite challenging to do so. If your life insurance claim is denied, your lawyer can help you understand your recourse options, keep track of the deadlines that apply to your case, and ERISA’s appeals process. If your policy is not governed by ERISA, your attorney can also help you determine whether the[life insurance provider acted in bad faith](http://www.badfaithinsurance.org/reference/General/0122a.htm) by denying your claim and work to overrule the decision. If you do end up litigating the case, your lawyer can help you navigate this process. ### Work with an Experienced Radnor Life Insurance Lawyer Life insurance claims, like all other types of insurance claims, can be complicated. Working with an experienced[life insurance lawyer](https://www.garnerltd.com/contact/) can ensure that you are fully aware of your rights and all of your legal options when you are working through this process. To get started with a member of our team, contact The Garner Firm, Ltd. today to set up your legal consultation in our office. --- ### [A Radnor Disability Benefits Attorney Can Get Your Claim Paid](https://www.garnerltd.com/citystate/a-radnor-disability-benefits-attorney-can-get-your-claim-paid/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** If you have lost the ability to work, you and your family may be facing a considerable financial burden. The good news is that you may be entitled to disability benefits under an employer sponsored disability insurance plan or another type of individual disability benefits policy. The overwhelming majority of employer sponsored plans are regulated by a federal law known as the [Employee Retirement Income Security Act of 1974 (ERISA)](https://www.dol.gov/general/topic/retirement/erisa). While this law provides some protections for beneficiaries, the big insurance companies have developed a wide array of tactics and strategies to work the process towards their own benefit. At The Garner Firm, [Radnor long term disability lawyer Adam H. Garner](https://www.garnerltd.com/attorney-profile/) is committed to supporting the legal rights and financial interests of disabled employees. Mr. Garner has more than a decade of experience handling, resolving, and winning long term disability cases in Pennsylvania and elsewhere. ### What Our Radnor Long Term Disability Lawyer Can Do For You Under ERISA, the long term disability [claims](https://www.garnerltd.com/practice-areas/serp-and-other-executive-deferred-compensation-claims/) process is subject to certain deadlines, standards, and procedures. To best protect your ability to get the full and fair long term disability benefits that you deserve, it is highly recommended that you consult with an experienced Radnor, PA long term disability attorney as early on in the claims process as possible. Radnor ERISA attorney Adam H. Garner will handle all aspects of your claim. This includes: - Assisting you in preparing your initial application; - Reviewing and analyze a long term disability denial letter; - Helping you gather additional supporting evidence; - Submitting a strong internal appeal on your behalf; - Negotiating with representatives of the insurance company; and - Filing a lawsuit to get you your full long term disability compensation. Our law firm is dedicated to getting you your full disability benefits as quickly as possible. There are many cases in which we are able to obtain compensation for our clients a full settlement offer without actually going through the entire litigation process. Of course, if your insurer will not cooperate, our legal team is always ready to take your long term disability claim to court. You deserve fair compensation. ### Contact Our Long Term Disability Attorney Today At [The Garner Firm](https://www.garnerltd.com/about-us/), Radnor long term disability lawyer Adam H. Garner has helped many people get the full and fair of their claim for disability benefits that they deserve. If your long term disability claim was denied in Delaware County, Pennsylvania, we can help. To schedule a free, no obligation case evaluation, please call our law firm today at (215) 645-5955. --- ### [Wage and Hour Attorneys in Blue Bell](https://www.garnerltd.com/citystate/wage-and-hour-attorneys-in-blue-bell/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** All employers across the United States must comply with the Fair Labor Standards Act (FLSA), which is a federal law that sets minimum requirements for employee wages. In addition, some states enacted their own labor laws, including the [Pennsylvania Wage Payment and Collection Law](https://www.legis.state.pa.us/CFDOCS/LEGIS/LI/uconsCheck.cfm?txtType=HTM&yr=1961&sessInd=0&smthLwInd=0&act=0329.&CFID=341800948&CFTOKEN=51581063) and the Pennsylvania Minimum Wage Act. Some states choose to set stricter standards than federal law, but Pennsylvania’s wage laws are generally in line with FLSA. When employers violate wage laws, they owe penalties and back pay to affected employees. However, employees must take action to protect their rights, and it is important to have the help of trusted [wage and hour attorneys in Blue Bell](https://www.garnerltd.com/attorney-profiles/) to do so. Let The Garner Firm, Ltd. protect your rights. ### How Employers Deny You Compensation There are different ways that employers can violate FLSA and state wage laws, and all of them deprive employees of their rightful compensation. The following are only some complaints that employees in Blue Bell might have. - **Misclassification of employees – Many** wage requirements only apply to employees classified as “nonexempt.” There are strict requirements to meet for an exempt classification, though some people might be misclassified as exempt because employers want to avoid wage compliance. In addition, some employers might misclassify employees as independent contractors, as wage laws do not apply to independent contractors either. Misclassified employees can lose significant wages as a result. - **Minimum wage –** Pennsylvania’s minimum wage is in line with FLSA and is currently $7.25 per hour. Nonexempt employees must receive this minimum wage for every hour they work, including partial hours. There are specific rules for tipped employees, as well, to ensure their compensation meets minimum wage requirements. Many employers might miscalculate hours or take unlawful deductions that cause employees to fall below minimum wage. - **Overtime –** For hours worked in excess of 40 hours per week, non-exempt employees should receive 1.5 times their usual hourly wage for overtime rates. There are many ways that employers try to get out of paying overtime, and this violates wage laws. - **Employment contracts –** When employers have employees sign employment contracts, the agreement should set out terms for compensation, including regular salary, bonuses, commissions, and other benefits. When employers breach employment contracts by not providing the agreed-upon compensation. ### Protect Your Rights to Compensation If you believe that your employer did not provide you proper compensation for the work you performed or according to an employment contract, you should not wait to have a wage lawyer review your situation. If we identify compensation issues or violations, we can advise you of your legal options to protect your rights. We can handle the legal process, seeking back pay and other legal relief available to you. We represent individual employees, as well as groups of employees who experienced the same compensation violations. ### Consult with Our Compensation Attorneys in Blue Bell The Garner Firm, Ltd., is proud to stand up for the [rights of employees](https://www.garnerltd.com/practice-areas/) in Blue Bell and the surrounding areas. [Contact us](https://www.garnerltd.com/contact/) to set up an initial consultation so we can assess your rights. --- ### [West Chester ERISA Attorney](https://www.garnerltd.com/citystate/west-chester-erisa-attorney/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Have you had a claim denied by an employer-sponsored insurance plan? Appealing the denial and fighting for the benefits you deserve can be a challenging task. This is because such claims are governed by the [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa#:~:text=The%20Employee%20Retirement%20Income%20Security,for%20individuals%20in%20these%20plans.), a federal law that can favor insurance companies and employers over the rights of employees and claimants. ERISA also governs employer-provided retirement plans. If you have any issues regarding ERISA-governed insurance claims or retirement plans, it is always best to contact a [West Chester ERISA attorney](https://www.garnerltd.com/attorney-profiles/) for help as soon as possible. The Garner Firm, Ltd. is a premier ERISA law firm in West Chester and throughout the Philadelphia area. Do not hesitate to contact us directly for more information about how we might help. ### Handling Complex ERISA Benefit Claims There are several different types of benefit claims and retirement plans that fall under ERISA, and we handle cases involving the following and more: - [Long-term disability](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) (LTD) benefits - Short-term disability (STD) benefits - Accidental death and dismemberment (AD&D) benefits - Life insurance benefits - 401(k) benefits - Pension benefits When it comes to ERISA-related issues, we represent employees, former employees, executives, retirement plan participants, and plan beneficiaries in cases asserting a wide range of claims. This can include wrongful denial of insurance benefits, mismanagement of pension plans, refusal to pay retirement benefits, breach of fiduciary duty, and more. ### The ERISA Litigation Process When you receive a denial of benefits, your first move is not to rush into court. Instead, let our legal team follow the legal process with which we have extensive experience. This begins with appealing directly with the insurer, employer, or plan administrator. You are entitled to a full and fair review of any ERISA benefit claims, and we can request this happens, which might change the result. If you need to request a formal appeal of your claim denial, there are specific steps you must take as required by law. There is no doubt that ERISA is a confusing and complex statute, so you want to have the right attorney navigating this process to ensure you do not inadvertently lose your right to appeal your claim. If the insurance company or plan administrator still refuses to grant the benefits you deserve under the law, we can escalate the matter by filing a lawsuit in federal court. ERISA litigation can be complicated, and you want a highly skilled litigator representing your rights in court. We handle every step of the litigation process, seeking to obtain a favorable settlement agreement from the insurance company every step of the way. If no settlement is possible, we will aggressively fight for the benefits you deserve in court. ### Contact a West Chester ERISA Attorney Who Can Evaluate Your Rights When you believe that you have been deprived of benefits you deserve under your employer-sponsored insurance or retirement plan, you want a West Chester ERISA attorney from The Garner Firm, Ltd. on your side. [Contact us](https://www.garnerltd.com/contact/) as soon as possible so we can evaluate your case. --- ### [Malvern Long Term Disability Attorneys](https://www.garnerltd.com/citystate/malvern-long-term-disability-attorneys/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Injured employees are initially encouraged when they learn that they have long-term disability coverage through their jobs that is governed by federal law. However, the difficulties of the situation become apparent when they learn that the process generally favors the insurance companies that provide the coverage. This means that getting the benefits that you need is not always easy. When you realize that you are unable to work, you will need to go through the insurance company. ERISA gives very strict deadlines and requirements for the process, and these often make life more difficult for you as a claimant. Oftentimes, that emboldens the insurance company to deny your initial claim. Unlike a regular insurance policy, you cannot sue a company for a bad faith denial under ERISA. This means that you could end up having to fight for your benefits after the insurance company has denied your claim. You want the help of [Malvern long term disability attorneys.](https://www.garnerltd.com/attorney-profiles/) ### How You Qualify for Long-Term Disability Benefits You qualify for long-term disability benefits when you have a debilitating disease that keeps you from working. This could include conditions such as: - Arthritis - Bipolar disorder - Depression - Multiple sclerosis When you first submit your claim for long-term disability, you must present documentation of your medical condition that shows why you cannot work. It is important that your claim is thorough and spells the condition out in detail for the insurance company. They may deny your claim with the slightest of excuses. All they have to do is tell why they turned down your claim. ### Appealing an ERISA Long-Term Benefits Claim Denial You have the right to file an administrative appeal of a coverage denial, and you must take this process seriously. Your first step of appeal is with the insurance company itself. They are the ones who will decide your appeal. While you may be suspicious of appealing your denial to the company that turned down your claim in the first place, you have to fully participate in this process. The insurance company will consider your arguments and will issue a decision on your appeal. If they continue to maintain that you cannot receive benefits, you have the ability to file a lawsuit for benefits. This lawsuit does not allow you to introduce new evidence. Instead, the court can only consider the evidence that was introduced. This is why you must present the best possible case to the insurance company first since that will be the record for your lawsuit. The stakes are high for your [ERISA](https://www.garnerltd.com/practice-areas/erisa-litigation/) long-term disability claim since it is your only way to receive benefits when you cannot work because of a health condition that is not a work-related injury. However, it is not always an easy process, so you must take it seriously from the outset. ### Experienced Malvern Long-Term Disability Lawyers The attorneys at The Garner Firm, Ltd. are experienced at helping clients through all parts of the long-term disability process. [Contact us](https://www.garnerltd.com/contact/) today to learn how we could help you file your claim or appeal a denial of your application for benefits. --- ### [Malvern Long Term Disability Lawyer](https://www.garnerltd.com/citystate/malvern-long-term-disability-lawyer/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** If an injury or illness causes a disability that prevents you from working, it can be a devastating situation. If you cannot earn a living, how will you cover your bills and expenses? If you had long term disability (LTD) insurance coverage through your employer, you can file a claim for disability benefits now that you cannot work. Long term disability benefit claims are notorious for being challenging and complicated, and insurance companies regularly find reasons to deny these claims. If you need assistance with a claim or need to appeal a denial, contact a [Malvern long term disability lawyer](https://www.garnerltd.com/attorney-profiles/) for help. The Garner Firm, Ltd. is ready to fight for the benefits you deserve. ### ERISA and Long Term Disability Coverage Almost all disability insurance plans offered through private employers are subject to the Employee Retirement Income Security Act of 1974 ([ERISA](https://www.garnerltd.com/erisa-litigation)). This is a federal statute that seems as if it is protecting employees when, in reality, its provisions can be favorable to employers and insurance companies over claimants. For this reason, it is common for disabled individuals to receive denials of disability or to have their benefits terminated inappropriately. If you need to file a claim for long term disability benefits, you should never hesitate to seek help from an experienced LTD lawyer. The more comprehensive and persuasive your initial claim is, the greater chance you have of getting approved for benefits from the start. We know the type of documentation and proof disability insurers want, and we can prepare and file your claim, as well as negotiate with the insurance company on your behalf. We know the tactics insurers use to deny LTD claims, and we can build the strongest case in favor of benefits for you. If you already received a claim denial, you should contact our office as soon as possible. You must take the proper steps to appeal the denial within a certain timeframe. If you fail to do so, you can lose your rights. We know the procedures for appealing LTD claims, and we can handle this process for you. In the event that an appeal is unsuccessful, we can file a lawsuit against your insurance company. We know how to handle [ERISA litigation](https://www.garnerltd.com/practice-areas/erisa-litigation/), which can be complex. ### Learn How a Malvern Long Term Disability Lawyer Can Help You If you need to file a claim for long term disability benefits under an employer-sponsored plan, you must meet every deadline and requirement for your initial claim, as well as an appeal of a denied claim. Many people are not familiar with all the necessary procedures, which can jeopardize the benefits they need and are entitled to. For professional assistance with this complicated process, contact a Malvern long term disability lawyer from The Garner Firm, Ltd. We can handle the claims process and take your insurer to court if needed to protect your rights. [Contact us](https://www.garnerltd.com/contact/) today for more information and a free initial consultation. --- ### [Malvern Long Term Disability Insurance Attorney](https://www.garnerltd.com/citystate/malvern-long-term-disability-insurance-attorney/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** There are many different medical conditions that can prevent people from being able to work and earn a living. Without the ability to work, you will need financial assistance to cover your bills and basic expenses, as well as provide for your household. Many people feel comfort knowing they have disability insurance coverage from their employer in case they become disabled. However, once you need benefits, it can be surprisingly challenging to obtain them from an insurer. If you are having difficulty with a long term disability insurance claim, or you would like assistance with an initial claim, you should not hesitate to consult with a [Malvern long term disability insurance attorney](https://www.garnerltd.com/attorney-profiles/). The Garner Firm understands the challenges that come with disability claims, and we help clients get the benefits they deserve. Contact us today. ### Denied Disability Claims If you have long term disability coverage through your employer, the coverage is most likely governed by the Employee Retirement Income Security Act of 1974 ([ERISA](https://www.garnerltd.com/erisa-litigation)). Most employees believe this law is in place to protect their rights to benefits, though, in practical matters, the law tends not to favor claimants. Many claimants find they do not have the protections to benefits they expect under the law, and insurance companies can more easily justify denying long term disability claims. Insurance companies will search for any possible reason to deny a benefits claim. Some reasons for denials include: - The insurer believes you should be able to work - The insurer states that your medical condition does not fit into the definition of “disability” under your policy - The insurer claims you made a procedural error or did not provide all the necessary documentation There is a lot of preparation that goes into a successful long term disability claim, and many people do not realize the time and energy it takes. Even if you do everything right, you can still end up facing a denial of benefits. While you focus on your medical condition and any necessary medical treatment you need, let our long term disability lawyers handle the claim process for you. ### Long Term Disability Claim Appeals Some people are denied disability benefits from the start. Others might receive benefits for some time, then learn that their benefits have been terminated or reduced when they still cannot work. In either situation, it is important to have the right attorney appealing the insurance company’s decision. Our lawyers understand the evidence and documentation needed to prove a disability to an ERISA insurance company. If the insurer still will not give you the rightful benefits, we can file a lawsuit in court to fight for what you are entitled to. ### Contact Our Experienced Disability Insurance Attorneys in Philadelphia If you have a potential fight with a disability insurer, you want an experienced Malvern long term disability insurance attorney on your side. The Garner Firm is committed to representing disabled clients, so please [contact us](https://www.garnerltd.com/contact/) for more information today. --- ### [Get Help From a Skilled Lower Merion Township Severance Benefits Attorney Today](https://www.garnerltd.com/citystate/get-help-from-a-skilled-lower-merion-township-severance-benefits-attorney-today/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Severance benefits are typically negotiated between employers and employees who are leaving the company. If you sign a severance agreement, you will undoubtedly be asked to give up some of your rights in return. In too many cases, employees simply sign severance agreements without seeking professional guidance. You should not sign a severance agreement until you consult with an experienced attorney. At The Garner Firm, [Lower Merion Township severance agreement lawyer Adam H. Garner](https://www.garnerltd.com/attorney-profile/) has extensive experience negotiating, drafting, reviewing, and litigating severance agreements. Our legal team is committed to ensuring that employees get fair value in their agreement. To get legal advice regarding your severance package, please do not hesitate to contact our law firm today. ### Severance Pay is Generally Not Guaranteed As a general rule, severance benefits are not guaranteed as a matter of state or federal law. For example, there are no provisions within the [Fair Labor Standards Act (FLSA)](https://www.dol.gov/whd/flsa/) that guarantee employees will be offered severance benefits. Though, in some limited cases, these benefits are established by an agreement that is governed by the [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa)**.** As severance benefits are typically not guaranteed by the law, it is critically important that all Lower Merion Township employees recognize that their employer will want something in return for offering severance pay. Before finalizing an agreement, you need be sure that you are getting full value for what you are giving up. You do not have to sign your employer’s initial offer. ### You Have the Right to Negotiate Severance Benefits[](https://www.garnerltd.com/practice-areas/severance-benefits/) [Severance benefits](https://www.garnerltd.com/practice-areas/severance-benefits/) work in both directions. In general, employers will ask employees to sign a deal that contains some combination of the following four provisions: 1. A full release of all future claims against the company, meaning the employee agrees not to sue the company regarding their termination or employment. 2. Agree to confidentiality regarding certain issues. 3. Agree not to ‘disparage’ the company or its management in the future. 4. Sign a non-compete clause. Lower Merion Township employees must be sure that they have a full understanding of their obligations under their severance agreement. Our Pennsylvania severance benefits lawyer is standing by, ready to help you negotiate the best possible deal. We will ensure that you can maximum your benefits. . ### Contact Our Pennsylvania Severance Agreement Attorney Today At [The Garner Firm](https://www.garnerltd.com/about-us/), our Lower Merion Township employee benefits attorney has extensive experience handling issues related to severance benefits. We will make sure that you get the best possible deal. To find out more about what we can do for you, please call us today at (215) 645-5955 to set up a free, fully confidential case evaluation. --- ### [Choose a Skilled Long Term Disability Attorney in Mt. Holly Who Can Help Get Your Claim Paid](https://www.garnerltd.com/citystate/choose-a-skilled-long-term-disability-attorney-in-mt-holly-who-can-help-get-your-claim-paid/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Long term disability plans through private employers are typically governed by the[Employee Retirement Income Security Act](https://www.garnerltd.com/practice-areas/erisa-litigation/), known as ERISA. This is a complex federal statute and is supposed to provide various protections to claimants, but large insurance providers are well-versed in manipulating the law and system to work entirely in their favor. This means that many employees are on the losing end because they suddenly discover their valid long-term disability claims are significantly underpaid, or even denied altogether. At The Garner Firm, our [Mt. Holly long term disability attorney](https://www.garnerltd.com/attorney-profile/) has devoted his practice to be an advocate for ERISA beneficiaries who have been unfairly treated by the system. If you or a loved one has had your long-term disability claim denied in the Mt. Holly area, we are here to help. ### Reasons Some Long Term Disability Claims Are Denied Your long-term disability benefits can be rejected for a variety of reasons. You have a right to know why your application for benefits was not accepted. Once you have this information, you can look to address why the insurance company denied your claim. Some of the common examples of why long-term disability claims are denied can include: - You made a mistake on your initial disability application; - There is a dispute over the definition of disability in the policy; - You failed to provide enough supporting evidence on your application; - There is a dispute over your medical evidence presented; or - There was bad faith or errors by the insurance provider. In the event your claim was denied, it is crucial to hire a Mt. Holly long term disability attorney to find out how we can help. At The Garner Firm, we will do a thorough review of your disability benefits denial. After that, we will take the appropriate course of action in order to protect your rights and help you prepare the strongest appeal possible. ### How a Mt. Holly Long Term Disability Attorney Can Assist Once you retain an attorney, we will immediately start on your appeal. We will request your entire case file from the insurance company and then start gathering all your medical and vocational records. This helps us build a strong appeal, and we can start negotiations with the insurer. We will not give up just because the insurance company denied your benefits. We are relentless when it comes to fighting for our clients’ rights. There are some situations where the claim can be settled without the need for litigation, but we are not afraid to take a case to judgment if needed. ### Contact a Mt. Holly Long Term Disability Attorney Today If your long-term disability benefits have been denied, let The Garner Firm help.[Contact our office today](https://www.garnerltd.com/contact/) to schedule an initial consultation. --- ### [Long Term Care Lawyers Near Malvern](https://www.garnerltd.com/citystate/long-term-care-lawyers-near-malvern/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Many people need long term care as they age due to a decline in physical health or mental cognition. If you or someone you love needs to move into a long term care facility, you want them to be as comfortable and well-cared for as possible. However, these facilities and services are [costly](https://www.marketwatch.com/story/this-is-how-much-long-term-care-could-cost-you-and-dont-expect-medicare-to-help-2019-07-19), and you want to be sure you have the benefits you need to cover the costs without depleting all of your or your family member’s assets and property. When it comes time to access long term care benefits, many people come up against obstacles, delays, and other frustrations. You should not hesitate to speak with [long term care lawyers near Malvern](https://www.garnerltd.com/attorney-profiles/) about your benefit needs. The Garner Firm, Ltd. is committed to representing policyholders during the long term care benefits claim process, and we are ready to assess your situation. ### Was Your Long Term Care Claim Denied? When you file a claim for the benefits you or a loved one needs, you might be shocked to learn the claim was denied. Even though premiums are covered for years, insurance companies can still find many reasons to deny your claim. You should receive a written letter stating specifically why your claim was denied. Once you receive a denial letter, it is generally not a good idea to try to decipher the denial reasons and address the matter yourself. Time is of the essence when you need to cover the costs of a long term care facility, so you should take your denial letter to a skilled claim attorney as soon as you can. We will review the circumstances of your situation and the reasoning given for a denial, and we can assess the best course of action to take to get you or your family member’s rightful benefits as quickly as possible, so there is no interruption in care or unnecessary bills. ### How Our Malvern Long Term Care Claim Lawyer Can Help Many denials are unfair or completely wrongful. When we review your denial letter, we can evaluate the strongest manner of appeal. This can involve gathering information to present to the insurance company in the most persuasive manner possible to challenge their denial reasons. We directly address reasons for the denial and know how to argue that neither your policy nor the facts of your situation support that denial. We handle all communications with the insurer and ensure that all appeal deadlines are met. In some cases, if the insurance company will not budge and refuses to grant benefits, we can file a lawsuit against the insurer on your behalf. Lawsuits can claim insurance bad faith and other causes of action and seek the full benefits you deserve under your policy. ### Consult with Long Term Care Lawyers Near Malvern Today[](https://www.garnerltd.com/practice-areas/) [The Garner Firm, Ltd](https://www.garnerltd.com/practice-areas/)., represents clients and their loved ones who rely on their long term care benefits but are pushed around by insurance companies. If you need assistance with a long-term care claim or appeal, [contact us](https://www.garnerltd.com/contact/) to speak with our long term care lawyers near Malvern today. --- ### [Life Insurance Attorneys in Lower Merion Township](https://www.garnerltd.com/citystate/life-insurance-attorneys-in-lower-merion-township/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Many employees in Lower Merion Township have life insurance through an employer-sponsored benefit plan. These policies are governed by the [Employment Retirement Income Security Act (ERISA) of 1974](https://www.garnerltd.com/practice-areas/erisa-litigation/), a federal law that sets minimum standards for a variety of employee programs, including life insurance and long term disability benefits. ERISA requires life insurance plan administrators to follow certain procedures when reviewing or denying claims. If you have lost a family member covered by an ERISA life insurance plan, you may be unsure as to how the claims process works. This can lead to problems, especially if the insurer denies the claim and the beneficiary does not fully understand their right to appeal. This is where a hiring a qualified Lower Merion Township life insurance attorney can make the difference between receiving benefits and walking away with nothing. Attorney Adam H. Garner has litigated numerous claims involving both ERISA and non-ERISA life insurance policies issued in Pennsylvania, and he can help you fight for the benefits you legally deserve. ### Fighting the Insurance Company’s Delay Tactics A life insurance policy sounds simple enough on its face: When the insured person dies, the insurer pays benefits to a designated beneficiary. But in practice, life insurance policies are complex legal documents that involve numerous caveats, conditions, and exceptions. One problem that often arises with life insurance is competing claims from different family members or potential beneficiaries. For example, say an employee initially designated their spouse as beneficiary but the couple later divorced. Since employer-sponsored life insurance plans are governed by the ERISA, rather than state divorce law, that beneficiary is still legally entitled to benefits unless the employee changed their designation prior to death. This can lead to litigation between competing claimants, which in turn prompts the insurance company to declare it will not pay out any benefits until the matter is resolved. In fact, life insurance companies often employ delaying tactics, even when there is no dispute as to the beneficiary. The insurer may demand excessive and unnecessary “proof” of the beneficiary’s identity. Or perhaps the insurer will claim it needs to conduct a more detailed investigation into the circumstances surrounding the insured employee’s death. Hiring a qualified [Lower Merion Township life insurance attorney](https://www.garnerltd.com/attorney-profile/) sends a clear message to the insurer that you will not accept these kinds of delay tactics. At The Garner Firm, we know how to deal with insurance companies. We will explain your rights under the ERISA and how to enforce them should it become necessary. Even if your loved one had a private life insurance policy not governed by the ERISA, we can still advise and assist you in dealing with an insurer. ### Have a Life Insurance Problem? Contact The Garner Firm Today to Schedule a Free, No-Obligation Consultation Keep in mind, at least with respect to ERISA-controlled policies, there is a strict regulatory process that must be observed. If your claim is denied, you must exhaust certain administrative remedies first before attempting to file a lawsuit. The Garner Firm can provide you with more specific advice as to how this process works. Call us today or [contact us online](https://www.garnerltd.com/contact/) to schedule a free consultation. --- ### [Life Insurance Attorney Haverford Township](https://www.garnerltd.com/citystate/life-insurance-attorney-haverford-township/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Life insurance provides peace of mind. It provides the sense of security that comes with knowing that if you were to die prematurely, your dependents will be taken care of financially. That is, if the life insurance claim is approved. Like other types of insurance claims, life insurance claims are regularly denied. If your life insurance policy is one provided by your private sector employer, it is likely governed by the[Employee Retirement Income Security Act of 1974 (ERISA)](https://www.dol.gov/general/topic/health-plans/erisa). The deck is often stacked against claimants with ERISA regulated life insurance policies as compared to claims made against life insurance policies purchased directly by individuals. If you plan to file a life insurance claim, work with an experienced[life insurance lawyer](https://www.garnerltd.com/attorney-profile/) who can improve your claim’s chance of being approved. ### What Does Life Insurance Cover?[](https://www.iii.org/article/how-do-i-file-life-insurance-claim) [Life insurance](https://www.iii.org/article/how-do-i-file-life-insurance-claim) benefits provide an individual’s loved ones with compensation for their loss of the policyholder’s financial support. ### Filing a Life Insurance Claim When you file a life insurance claim, you must provide a copy of the policyholder’s death certificate to prove he or she has passed away. Depending on the policy, you may be required to provide additional documentation. Often, you have a few options for how you would like to receive your benefits. These include: - Lump sum: You receive the entire policy amount in one transaction; - Life income: When this is an option, you can use it to receive the benefits in regular payments for the rest of your life; - Specific income provision: With this option, you receive the benefits according to a specific payment schedule; and - Income interest: The company retains ownership of the policy and pays you interest on it, then transfers the policy to a new beneficiary after your death. ### Appealing a Denied Life Insurance Claim If your life insurance policy is governed by ERISA, you must comply with [ERISA’s appeals process](https://www.garnerltd.com/practice-areas/erisa-litigation/) if you plan to appeal the insurance provider’s decision on your claim. The deadlines for life insurance claims can be confusing. Your lawyer can help you navigate this process. You must file an appeal with your life insurance provider before you can sue the insurance carrier under ERISA. If your appeal does not result in a favorable decision, you may litigate your case pursuant to Section 502(a) of ERISA, 29 U.S.C. § 1132(a), in an effort to reach one. Your lawyer can coach you through this process and help you make the best decisions for your case. ### Work with an Experienced Haverford Township Life Insurance Attorney If you are in a position to file a life insurance claim, work with an experienced[life insurance attorney](https://www.garnerltd.com/contact/). Your attorney is your advocate and if your claim is denied, he or she can help you determine whether appealing the decision is the best course of action and if so, work with you to file and pursue your appeal. Contact The Garner Firm, Ltd. today to set up your legal consultation in our office to get started with us. --- ### [ERISA Lawyer Philadelphia](https://www.garnerltd.com/citystate/erisa-lawyer-philadelphia/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** If you have an employer-sponsored benefit plan, it is likely governed by ERISA. ERISA stands for the Employee Retirement Income Security Act of 1974, which sets forth the requirements these plans must follow. However, the claims process is anything but fair in most cases. The larger insurance companies and other plan administrators have been working for years to develop strategies that help them deny benefit claims. If your claim was denied, you may be confused and frustrated as you are unsure of what to do next. It is important to contact an[ERISA lawyer in Philadelphia](https://www.garnerltd.com/attorney-profile/) as soon as possible. With the help of The Garner Firm, you may get the full benefits to which you are entitled. ### How Pennsylvania ERISA Claims Work Under an employer-sponsored benefit plan, participants and their beneficiaries are entitled to a full and fair review of their claim for benefits. Because this does not always happen, you need to retain a Philadelphia ERISA lawyer who can make sure it will occur. Since the people who are reviewing employee benefits claims are often also the ones paying the claims, this creates a conflict of interest. This situation also creates the temptation for them to deny your claim outright since it will ultimately benefit their bottom line. If you received a denial of benefits, there are specific steps you must take in order to start the appeals process. Failure to handle things exactly as required could result in your appeal being denied outright. This means you could be facing a difficult time challenging the denial, or you could even be barred from challenging it at all. When you retain an ERISA lawyer in Philadelphia, you will get the benefit of an ERISA attorney who has over a decade of experience in handling appeals. You deserve someone on your side who is looking out for your best interests. You may not realize that the person who is reviewing your claim works for the entity who ultimately pays it. You only have 60-180 days, depending on the type of claim, to file your appeal, which is why it is so important that you contact an attorney as soon as possible. Failure to take any sort of action within the allotted time means your claim may be permanently denied. ### ERISA Benefit Claims Under ERISA, examples of some valid claims may include: - Short-term disability (STD) benefits - [Long-term disability (LTD) benefits](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) - Accidental death and dismemberment (AD&D) benefits - 401(k) benefits - Health insurance benefits - Pension benefits - [Life insurance benefits](https://www.garnerltd.com/practice-areas/life-insurance/) - Other employee benefits At The Garner Firm, we routinely represent clients who are employees, former employees, plan participants, beneficiaries, or executives in all aspects of ERISA law and the types of claims mentioned above. ### Contact an ERISA Lawyer in Philadelphia Today If you need assistance with an ERISA benefits claim, contact The Garner Firm today to schedule an initial consultation. --- ### [ERISA Claims Lawyer Near Me](https://www.garnerltd.com/citystate/erisa-claims-lawyer-near-me/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** The [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) sets minimum standards for most employer-backed retirement plans and group welfare plans. Over the last few decades, large insurance companies and other claim fiduciaries have developed many complex strategies that they use to tilt the ERISA claims process in their own favor or in favor of the plan. As a result, unfortunately, many claimants struggle to get the full benefits that they are owed. At The Garner Firm, we represent employees and other plan beneficiaries in the full range of ERISA claims. If you are looking for an ‘**ERISA claims lawyer near me’**, our experienced, local attorney is standing by, ready to fight for your rights. To set up a free, no-obligation review of your ERISA claim, please give our legal team a call today. ### ERISA Claims We Handle in Pennsylvania and New Jersey Adam H. Garner is a knowledgeable ERISA lawyer with more than 10 years of experience representing a broad range of clients. From your initial phone call to the resolution of your case, Mr. Garner will work tirelessly to protect your interests. We handle all types of ERISA claims and ERISA appeals. Some examples of ERISA appeals and ERISA litigation cases we handle in Pennsylvania and New Jersey include: - [Disability benefit denials](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/); - [Life insurance claims](https://www.garnerltd.com/practice-areas/life-insurance/); - [Long term care benefits](https://www.garnerltd.com/practice-areas/long-term-care-claims/); - [Retirement plan benefits claims](https://www.garnerltd.com/practice-areas/retirement-plan-benefit-claims/); and - [Executive deferred compensation benefits](https://www.garnerltd.com/practice-areas/serp-and-other-executive-deferred-compensation-claims/). ### Understanding ERISA Appeals and ERISA Litigation Unfortunately, you cannot rely on your employer or on your insurance company to offer you reliable guidance with your ERISA claim or your ERISA appeal. This is a complicated federal law: there are many potential pitfalls in the claims and appeals process. As an example, you only have a limited amount of time — often 60 to180 days, depending on the type of claim — to file an ERISA appeal. If you fail to take action before the deadline expires, your claim may be extinguished. Notably, you must submit an ERISA appeal directly with your insurer or other claim fiduciary before you can file a lawsuit in federal court. Additionally, should you be required to seek ERISA litigation to get your benefits, the court may be restricted to reviewing certain documents and records. It is imperative that you submit all relevant evidence to your insurance company or other claim fiduciary in your initial application for benefits or in your administrative appeal. Whether you are in Pennsylvania or New Jersey, our experienced ERISA lawyer will make sure that case is handled properly. ### Get Help From a Local ERISA Attorney Today At The Garner Firm, we are here to enforce and protect your employee rights. If you are struggling to obtain full ERISA benefits, our local attorney is prepared to help. To arrange a free, no obligation review of your ERISA claim, please [contact our law firm](https://www.garnerltd.com/contact/) right away. With an office in Philadelphia, we represent clients in Pennsylvania and New Jersey. --- ### [Doylestown ERISA Attorney](https://www.garnerltd.com/citystate/doylestown-erisa-attorney/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** [ERISA](https://www.dol.gov/general/topic/retirement/erisa) is an important law that sets standards for most group welfare benefit plans from private employers. While ERISA provides some much-needed protections, it also tilts many aspects of the claims process and the appeals process in favor of insurance companies and other claims administrators. Unfortunately, many beneficiaries struggle to access their rightful benefits. At The Garner Firm, our **Doylestown ERISA attorney** advocates for the rights and interests of employees and other plan participants. We know what needs to be done to ensure insurance carriers and other claim fiduciaries are held responsible for paying out benefits. If your application was denied, it is essential that you take quick action. For a free consultation with an experienced Bucks County, PA ERISA lawyer, please call our law firm today. ### ERISA Claims We Handle in Doylestown, PA Adam H. Garner is an ERISA claims lawyer with over a decade of experience handling ERISA benefits claims. Our law firm handles the complete range of ERISA appeals and ERISA litigation. No matter the nature of your case, we will conduct a careful assessment, explain your rights and options to you, and help you pursue the fair benefits that you rightfully deserve. Specifically, some ERISA claims our attorney frequently handles in Doylestown, PA include: - [Long term disability benefits](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/); - [Life insurance appeals](https://www.garnerltd.com/practice-areas/life-insurance/); - [Long term care benefits](https://www.garnerltd.com/practice-areas/long-term-care-claims/); - [Retirement plan issues](https://www.garnerltd.com/practice-areas/retirement-plan-benefit-claims/); and - [Executive deferred compensation benefits](https://www.garnerltd.com/practice-areas/serp-and-other-executive-deferred-compensation-claims/). ### ERISA Claims and ERISA Appeals: The Basics Under ERISA, every plan participant is entitled to a full and fair review of their claim. Of course, the initial review is conducted by the insurance company or other claim fiduciary — that is supposed to be acting as a fiduciary in the interests of plan participants. Unfortunately, many of these insurers and other claim fiduciaries work under an inherent financial conflict of interest and may not have your best interests in mind. Should your claim be denied, which unfortunately could happen even if you are owed benefits, you need to be ready to bring a strong and well-supported appeal. ERISA appeals always begin with an internal or so-called “administrative” review. Before you can file a lawsuit to get your benefits, you must give the insurance company or other claim fiduciary an opportunity to hear your appeal and reassess your claim. It is imperative that you submit a persuasive appeal. As soon as you receive a denial letter, the next step you should take is to reach out to an experienced Doylestown, PA ERISA attorney. Your attorney can conduct a review of your case and determine what action needs to be taken to best protect your rights. ### Contact Our Doylestown, PA ERISA Attorney Today At The Garner Firm, we will fight for your employee benefits and your employee rights. If your ERISA claim was denied in Southeastern Pennsylvania, you need an experienced lawyer on your side. To schedule your no-cost, no-obligation ERISA consultation, please [contact our law firm](https://www.garnerltd.com/contact/) right away. We represent clients in Doylestown, PA and throughout the surrounding communities in Bucks County. --- ### [Long Term Disability Appeals Lawyer Near Me](https://www.garnerltd.com/citystate/long-term-disability-appeals-lawyer-near-me/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Long term disability insurance provides benefits to policyholders in the event a physical or mental disability prevents them from earning a living. While each policy has different language, each policy should include specific requirements for what a claimant must demonstrate to qualify as disabled and entitled to benefits. In many cases, you might believe that you meet the criteria, though you might still receive a claim denial from your long term disability insurer. For people with disabilities, insurance benefits can be crucial to cover their basic expenses and bills. A claim denial can be devastating, though it is important to remember that a denial is not always the final say in the matter. There are options to appeal, and you should speak with a[long term disability appeals lawyer](https://www.garnerltd.com/attorney-profile/) as soon as possible. The Garner Firm, Ltd., handles all types of[long term disability](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) cases and is ready to help disability claimants like you. ### Common Reasons for a Long Term Disability Insurance Claim Denial Denials are all too common when it comes to long term disability insurance claims, as insurers will often seek any possible reason to limit payouts. That being said, there are some reasons for denials that are more common than others, which include: - The medical condition claimed does not qualify as a disability as defined by the insurance policy - The claimant provided insufficient documentation to support the extent of their medical condition - The insurer claims that the medical condition should not prevent the claimant from working (whether from working at their previous position or at all, depending on the policy) When you receive notice of a claim denial, our law firm will first identify the specific reason for your denial to begin exploring options for your appeal. ### The Appeal Process In many cases, our firm can gather and present any missing documentation that can prove your claim for the insurance company to consider. The claim processor can review the supplemental documentation and records and determine whether it is adequate to overturn the denial and grant benefits. If the claim remains denied, it will depend on your policy and insurer whether another round of internal appeals is available. If your “administrative” appeal attempts are unsuccessful, our firm can determine whether it is an option to litigate the case in state or federal court, depending on the type of policy. We have filed lawsuits against insurance companies to fight for the benefits our clients deserve, and we can handle this complex process. It is always in your best interests to have the right legal representation from the start to finish of the appeal process. ### Do Not Wait to Consult with a Long Term Disability Appeals Lawyer Near You As soon as you learn of a claim denial, you should discuss your next steps with a long term disability appeals lawyer near you. A successful appeal can be essential to your financial well-being moving forward, and The Garner Firm, Ltd., represents clients fighting against claim denials.[Contact us](https://www.garnerltd.com/contact/) to discuss your situation right away. --- ### [Bryn Mawr ERISA Attorney](https://www.garnerltd.com/citystate/bryn-mawr-erisa-attorney/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** The[Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) is a federal law that was designed to help protect the rights and interests of the participants and beneficiaries of employer-sponsored group benefit plans. Unfortunately, in practice, the big insurance companies have tipped the claim process in their own favor. Many employees and beneficiaries struggle to get the full and fair benefits that they deserve. At The Garner Firm, our dedicated **Bryn Mawr ERISA attorney** has more than a decade of experience representing current and former employees, their family members, and other plan participants and stakeholders in the full range of ERISA cases. To set up a free, no-obligation initial legal consultation, please do not hesitate to contact our law firm right away. ### Full-Service ERISA Law Firm Representing Clients in Bryn Mawr, PA Adam H. Garner is an experienced Bryn Mawr ERISA attorney. He represents clients in all aspects of the ERISA claims process. Whether you are preparing your initial claim for employee benefits, responding to a denial letter for the insurance company, or considering ERISA litigation, our law firm is available to assist you and guide you through the process. We frequently handle the following types of ERISA claims: - [Long term disability claims](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/); - [Life insurance appeals and litigation](https://www.garnerltd.com/practice-areas/life-insurance/); - [Long-term care claims](https://www.garnerltd.com/practice-areas/long-term-care-claims/); - [Retirement plan benefits](https://www.garnerltd.com/practice-areas/retirement-plan-benefit-claims/); - Fiduciary breach claims; and - [SERP and executive deferred compensation claims](https://www.garnerltd.com/practice-areas/serp-and-other-executive-deferred-compensation-claims/). ### Understanding ERISA Appeals and ERISA Litigation If your ERISA claim was denied, it is essential that you seek legal guidance as soon as possible. There are many unique rules and regulations that govern your appeal, and, if one is needed, your lawsuit. The insurance company has a comprehensive understanding of these rules — they know exactly what to do to work the claims procedure to their own financial benefit. You need a Bryn Mawr ERISA litigation attorney who can level the playing field. Some of the key things you need to know about ERISA appeals include the following: - You must file an internal appeal before filing a lawsuit for a denial of benefits; - You must include all relevant supplemental evidence with your internal appeal; and - You only have a limited amount of time, sometimes as little as 60 days, to file an appeal. Plan participants and beneficiaries deserve a legal advocate who will give their ERISA appeal the fully personalized attention that it deserves. Adam H. Garner is an experienced Pennsylvania ERISA lawyer. He is committed to holding insurers and plan fiduciaries accountable and helping his clients obtain their full benefits. ### Contact Our Bryn Mawr ERISA Lawyer Today At The Garner Firm, we are proud to be a well recognized ERISA law firm and employee benefits law firm serving Southeastern Pennsylvania. To get a free, strictly private review of your ERISA case, please[contact our legal team](https://www.garnerltd.com/contact/) right away. We represent clients in Bryn Mawr, PA and throughout Montgomery County and Delaware County. --- ### [Bryn Mawr Long Term Disability Lawyer](https://www.garnerltd.com/citystate/bryn-mawr-long-term-disability-lawyer/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Suffering an injury or illness that results in the inability to work is frustrating. It can become an absolute nightmare if you are unable to work for a long period of time and need to pursue long-term disability payments. In most cases, employee disability benefit plans that are issued by private employers are governed by the Employee Retirement Income Security Act of 1974, or ERISA. The Garner Firm, Ltd. is highly experienced in handling ERISA cases and may be able to help with your claim in Pennsylvania, New Jersey or Maryland. ERISA is a federal law that was designed to protect employees and their benefits. Unfortunately, given the way the law has developed, most of these plans end up benefiting the insurance companies that provide the benefits rather than the employee. For this reason, many employees who should be receiving benefits find that their claims are terminated early or are denied altogether. It is important that you do not let the insurance companies take advantage of you and unfairly deny your benefits. Retaining a [Bryn Mawr](https://www.garnerltd.com/practice-areas/) [long-term disability lawyer](https://www.garnerltd.com/practice-areas/) is a key step in protecting your rights. At The Garner Firm, Ltd., our experienced attorneys are ready and willing to help fight to get you the benefits you deserve. ### Reasons Long Term Disability Claims are Often Denied There are numerous reasons the carrier may deny your long-term disability benefits. You have a right to know why your claim was denied. With that information, you can move forward with trying to address the reasons the insurance company wrongfully denied your claim in your appeals paperwork. Some of the common reasons cited for denying a long-term disability claim include: - Failure to provide supporting evidence; - You made a mistake on your initial application for disability; - The insurance provider made errors or acted in bad faith; - Dispute regarding the medical evidence you submitted; or - Dispute over the policy’s definition of disability. In the event your long-term disability claim is denied, it is important to reach out to a skilled and experienced attorney who can help. Our [long-term disability attorney](https://www.garnerltd.com/attorney-profile/) at The Garner Firm, Ltd. will start by carefully reviewing your disability denial letter, and then develop a strategy for a compelling appeal. ### How a Long Term Disability Attorney Near Bryn Mawr can Help One of the most important ways an attorney can help is to prepare the best appeal for your benefits. Your attorney will speak with the insurance company and obtain your entire case file. He or she will also gather all evidence, medical records, and vocational evaluations in order to build a persuasive argument for your appeal and handle negotiations with the insurance company. While some attorneys might give up, we are relentless in our pursuit of long-term disability benefits for our clients. While some claims can be resolved out of court, there are scenarios in which litigation is necessary. Our attorneys have experience in the courtroom, so we are ready to take your claim to court if it becomes necessary. ### Contact a Bryn Mawr Long Term Disability Attorney If long-term disability benefits were prematurely terminated or denied outright, [contact The Garner Firm, Ltd.](https://www.garnerltd.com/contact/) today to schedule a free initial consultation. --- ### [Villanova Long Term Disability Lawyer](https://www.garnerltd.com/citystate/villanova-long-term-disability-lawyer/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** The [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) is a complex federal statute that governs most company-backed group welfare plans, including long term disability plans. Although ERISA provides certain key protections to claimants, large insurers are extremely adept at navigating this law and working the process in their favor. Unfortunately, many long term disability claims are unfairly denied or substantially underpaid. At The Garner Firm, our **Villanova long term disability lawyer** is a committed and aggressive advocate for ERISA beneficiaries. If you or your loved one has had your long term disability claim denied in Southeastern Pennsylvania, we are here to help. For a free, fully confidential initial consultation, please do not hesitate to contact us today. ### Why Was My Disability Claim Denied? Long term disability benefits are rejected for many reasons. Claimants should know why their application was not accepted. With this information, you will be able to effectively address the insurance company’s stated reasoning in your disability appeal. Some common examples of why disability claims are denied in Pennsylvania include: - Mistakes on the initial disability application; - Lack of adequate supporting evidence; - Disputes regarding medical evidence; - Disputes over the policy’s definition of ‘disability’; and - Errors or bad faith by the insurance provider. If your claim was rejected, you should not hesitate to reach out to an experienced[long term disability attorney in Villanova, PA](https://www.garnerltd.com/attorney-profile/). Our attorney will carefully review your disability denial letter. From there, we will take the appropriate steps to protect your rights and help you build a strong and compelling appeal. ### How Our Villanova Disability Lawyer can Help After reviewing your disability denial letter, our law firm will take immediate action to help you bring an effective appeal. Among other things, this includes obtaining your complete case file from the insurance company, gathering all relevant additional medical and vocational evidence, building a persuasive administrative appeal, and negotiating with the insurer. We are relentless in seeking full and fair long term disability benefits for our clients. While many disability appeals can be settled outside of litigation, there are certainly plenty of exceptions to that general rule. Our Villanova disability lawyer, Adam. H. Garner, has extensive experience with[ERISA litigation](https://www.garnerltd.com/practice-areas/erisa-litigation/). We are prepared to take your claim to court when necessary. ### Contact Our Villanova Long Term Disability Attorney Today At The Garner Firm, our Pennsylvania long term disability lawyer is standing by, ready to fight to protect your rights. If your disability claim was turned down, you need professional support. For a free initial consultation, please[contact our law firm](https://www.garnerltd.com/contact/) right away. We represent clients in Villanova, PA and throughout Delaware County and Montgomery County. --- ### [West Chester Long Term Disability Lawyers](https://www.garnerltd.com/citystate/west-chester-long-term-disability-lawyers/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** When you are applying for ERISA disability benefits, the insurance company that would pay out the claim has the initial say about whether you are entitled to benefits. This creates a situation where many initial benefit claims are denied, often wrongfully. This is why you need a West Chester long term disability lawyer for your case. After your claim is denied, the first thing to do is take a deep breath and focus on the appeals process ahead of you. If you do not already have long-term disability lawyers on your side, now is the time to hire one. The appeals process is complicated, and the insurance company brings its own legal firepower to the table. ### You Need to File an Administrative Appeal of a Benefit Denial The initial step of the process is appealing your denial to the insurance company itself. If they rejected your claim because there was a misunderstanding or incomplete information, now is the time when you can clear up the issue and show that you qualify for[benefits](https://www.garnerltd.com/factors-that-can-influence-your-ltd-payment/). Sometimes, you can qualify for benefits by better explaining your side of the story to the insurance company. However, the insurance company is far from on your side. They are paying attention to their own bottom line, and the more claims they pay, the less money they make. They are required to give you a reason for the denial. Beyond that, they tend to be sticklers for details. Insurance companies might even hire people to observe you and talk to your friends so that they can have further ammunition to deny your claim. ### How to Appeal a Benefit Denial When you are filing an long-term disability appeal, you should treat it very carefully. In many cases, after the internal appeal stage, you will be unable to add much if any information to your file if your case ends up in front of a judge. You should submit all relevant information, including: - Your complete medical records and diagnosis, along with explanatory statements from your physicians; - Your own personal statements; - Statements from your family and friends who have observed your condition; - Reports from vocational experts; and - Information about the duties of the occupation(s) that you cannot perform If your internal appeal to the insurance company is not successful, you still have legal options. [ERISA](https://www.garnerltd.com/practice-areas/erisa-litigation/) gives you the right to file a lawsuit against the insurer after you have exhausted all administrative appeals. A judge will consider the record of your appeal to the insurance company and decide whether the insurance company wrongfully denied your benefits. Generally, your attorney will need to work with the exact record that the insurance company considered to persuade the judge. ### Contact a West Chester Long Term Disability Attorney If the insurance company does not approve your claim, you need legal help to contest their denial. The Garner Firm has experienced attorneys with a track record of assisting benefit applicants who have been unfairly denied benefits. [Contact us](https://www.garnerltd.com/contact/) today to schedule your free consultation so that we can discuss a legal strategy for getting you disability benefits. --- ### [Radnor Township ERISA lawyer](https://www.garnerltd.com/citystate/radnor-township-erisa-lawyer/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** The [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) governs most employer-backed benefits claims. Unfortunately, this federal law stacks the deck in favor of employers and insurance companies. Too many employees and plan participants struggle to recover their benefits. If your ERISA claim was denied in Southeastern Pennsylvania, you should consult with an experienced employee benefits lawyer. At The Garner Firm, our **Radnor Township ERISA lawyer** will fight to help you and your family obtain the full employee benefits that you are owed. Adam H. Garner has more than a decade of experience handling the full range of ERISA claims in Pennsylvania and New Jersey. To set up a free, fully private case evaluation with a [Radnor Township ERISA attorney](https://www.garnerltd.com/attorney-profile/), please contact our law firm today. ### Full-Service Employee Benefits Law Firm Our legal team represents employees and beneficiaries in all types of ERISA claims. Whether you are preparing your initial application for benefits, filing an administrative appeal, or considering ERISA litigation, we can help. Some examples of cases that our Radnor Township ERISA lawyer frequently handles include: - long term disability claims; - Life insurance claims; - Retirement plan cases; - Executive compensation claims; and - Breach of fiduciary duty lawsuits. ### How Our Pennsylvania ERISA Attorney Will Help You Even a seemingly minor error on your initial application could lead to your employee benefits being denied. If you need help filing an ERISA claim, our legal team can help to guide you through the application process. If your claim was underpaid or denied, you should take immediate action to protect your rights. ERISA grants all plan beneficiaries the right to appeal. However, there are strict deadlines that you must follow when appealing your claim. For instance, in long term disability claims, you typically only have 180 days to file an appeal. However, in life insurance claims, the deadline to appeal may only be 60 days. Immediate action is a must. ERISA requires claimants to submit an administrative appeal directly to the insurance company before filing a lawsuit. If you are preparing an administrative appeal, you should seek help from an experienced ERISA lawyer. Your attorney will ensure that you include all supplemental evidence and that you present the strongest possible appeal. In many cases, our law firm is able to settle ERISA claims during the appeals process — prior to litigation. At the same time, we are trial-tested. Our legal team is always prepared to take your case as far as it needs to go to get you and your family full employee benefits. ### Get Help From a Radnor Township ERISA Attorney At [The Garner Firm](https://www.garnerltd.com/about-us/), we represent employees and beneficiaries in all aspects of ERISA appeals and ERISA litigation. If your ERISA claim was denied in Delaware County, PA, we are here to help. To set up a[free consultation](https://www.garnerltd.com/contact/) with an experienced Radnor Township ERISA lawyer, please call us today at (215) 645-5955. --- ### [A Radnor Severance Agreement Lawyer Can Protect Your Legal Rights ](https://www.garnerltd.com/citystate/a-radnor-severance-agreement-lawyer-can-protect-your-legal-rights/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** A severance agreement, also sometimes referred to as a ‘termination agreement’ or a ‘separation agreement’, governs the terms under which an employee leaves their position with an employer. As a general matter, employees are not automatically guaranteed severance benefits as a matter of state law or federal law. Instead, a severance agreement is negotiated between an employee and the employer.. At The Garner Firm, [Radnor severance agreement attorney Adam H. Garner](https://www.garnerltd.com/attorney-profile/) has considerable experience drafting, negotiating, and reviewing a wide range of severance packages. If you have any questions about your severance agreement or severance benefits, please call our legal team today to set up a free and fully confidential review of your case. ### Negotiating a Fair Severance Agreement in Radnor, Pennsylvania Far too often, employees quickly sign severance agreements in order to get their compensation and move forward with their lives. Unfortunately, this can sometimes prove to be a big mistake. While it is understandable to want to move on, it is imperative that you take care to protect your best interests. Employers offer workers severance packages in order to get something in return. If you sign a severance agreement, please remember that you will be giving up something of value to your former company. Most notably, severance agreements typically: - Address COBRA, unused vacation time, and other employee benefits; - Require employees to sign a full release of all claims against the employer; - Contain confidentiality agreements or non-disparagement provisions; and - May include a non-compete clause or similar type of restrictive covenant. By their nature, the terms of your [severance](https://www.garnerltd.com/practice-areas/retirement-plan-benefit-claims/) agreement are negotiable. If your former employer is getting a benefit from you, whether because you are agreeing to release all potential claims or because are signing a non-compete agreement, you need to be certain that you are getting full and fair value for what you are giving up. This is why it is so important to work with an experienced employment law professional. Radnor severance benefits attorney Adam H. Garner can help to draft, negotiate, and review the terms of your agreement. Mr. Garner will ensure that your rights and interests are fully protected. ### Contact Our Severance Agreement Lawyer Today At [The Garner Firm](https://www.garnerltd.com/about-us/), our Radnor severance benefits attorney has extensive experience representing employees throughout Delaware County, Pennsylvania. If you have any questions about severance, please do not hesitate to call us today at (215) 645-5955 to request a free, no strings attached review of your case. --- ### [Radnor Accidental Death Attorney](https://www.garnerltd.com/citystate/radnor-accidental-death-attorney/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Many employers offer life insurance as an employee benefit. When they do, the life insurance policies they offer are often governed by the[Employee Retirement Income Security Act of 1974 (ERISA).](https://www.dol.gov/general/topic/health-plans/erisa) ERISA governs all aspects of covered life insurance policies, including secondary and supplemental insurance benefit plans like Accidental Death and Dismemberment (AD&D) benefits. [AD&D benefits](https://www.investopedia.com/terms/a/accidental-death-dismemberment-insurance.asp) are insurance benefits that provide benefits to victims who lose limbs or the use of specific body parts in accidents and benefits to their dependents in the event of accidental death. Your lawyer can help you fully understand your policy and your rights regarding it. ### What do Accidental Death Benefits Cover? Accidental death benefits provide monetary compensation to a policyholder’s beneficiaries in the event he or she dies in an accident. An accidental death can include a car accident, a fall, death from exposure to the elements, drowning, construction accidents, and in some cases, even homicide. Accidental death benefits often mirror the face value of the policyholder’s life insurance policy. When a beneficiary files an AD&D claim, he or she may receive benefits from both policies, essentially doubling the amount of money he or she receives after losing a loved one in an accident. However, there are often limits on policy values and insurance providers may cap the amount payable to a beneficiary when certain circumstances apply. ### Appealing a Denied Accidental Death Claim Accidental death claims are regularly [denied](https://www.garnerltd.com/practice-areas/erisa-litigation/). Sometimes, they are denied because the insurance provider believes the policyholder’s death was not actually accidental and in other cases, insurance adjusters apply policy exceptions to justify a denial. When an accidental death claim is denied, the claimant may appeal the decision in an effort to recover benefits. Under ERISA, any claimant whose accidental death claim is denied must appeal the decision with the life insurance provider before filing a lawsuit. There are specific limits on this process that vary from policy to policy, but which must be at least sixty (60) days, and it is important to know that your policy could have a very short time window for the appeals process. Talk to your lawyer about the specific limits on your case and how to make sure you do not violate them. Your lawyer can also go over your rights as the claimant and work on your behalf to pursue the benefits you are entitled to receive, which can mean ultimately heading to court to litigate the case. ### Work with an Experienced Radnor Accidental Death Attorney When you are seeking accidental death benefits, it is in your best interest to work with an experienced [accidental death attorney](https://www.garnerltd.com/contact/) who can be your advocate. Contact our team at The Garner Firm, Ltd. today to set up your initial legal consultation in our office. During your consultation, we will go over your policy, your rights, and your legal options as you work to secure compensation for your accidental death-related damages. --- ### [Philadelphia Severance Agreements](https://www.garnerltd.com/citystate/philadelphia-severance-agreements/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** If you were recently terminated or laid off by your employer, you may be offered severance pay or a severance package in exchange for signing an agreement. Severance packages can come in many different forms. For example, you may be offered a lump-sum payout, a temporary continuation of paychecks, or another type of financial benefit. Before signing a severance agreement, you need to carefully consider your options. If you take a close look at your severance offer it will likely advise you to consult with an attorney or indicate that you have been informed that you should consult with an attorney. Do not ignore this advice. Severance agreements are mutually beneficial contracts. Your employer is offering you severance in exchange for something, and you need to be sure that you are receiving a fair offer. At The Garner Firm, our [Philadelphia severance agreements attorney](https://www.garnerltd.com/attorney-profile/) Adam H. Garner has extensive experience reviewing severance agreements. If you were offered severance benefits, let us review your agreement to ensure that your legal rights and best interests are fully protected. ### Four Things You Should Know About Severance Agreements ***What are the Exact Terms of Your Severance Pay*** First and foremost, you need to carefully consider the terms of your severance benefits. You should know exactly how much is being offered and what you have to do to receive that compensation. ***How Your Earned, but Unpaid, Compensation is Affected*** Your employer may still owe you sick time or other paid leave, as well as regular wages. You should inquire as to how those benefits will be affected by your severance agreement. As a general rule, signing a severance package does not eliminate your right to recover compensation you are already owed, but you should know the specific terms of the deal. ***Are You Being Asked to Sign a Release of Claims*** Generally, signing a release of claims means that you are agreeing not file a lawsuit against your employer. Before signing, please be sure that you find such an arrangement acceptable. If you have another employment law claim against the company, you need to speak to a qualified lawyer immediately. ***What Non-Disparagement and Confidentiality Obligations Do You Have*** Many severance agreements contain provisions that compel employees to keep certain information confidential and to refrain from disparaging the company. These terms may be included in your contract. You need to be sure that you fully understand your obligations under your severance agreement. ### Speak to an Experienced Severance Agreement Lawyer Today At [The Garner Firm](https://www.garnerltd.com/about-us/), we have extensive experience negotiating and reviewing severance agreements. To get legal assistance with your severance agreement, or if you believe your severance benefits were wrongly denied, please call our Philadelphia office today at (215) 645-5955. We offer initial legal consultations that are fully confidential and free of any charge. --- ### [Philadelphia Severance Agreement Attorneys](https://www.garnerltd.com/citystate/philadelphia-severance-agreement-attorneys/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Most individuals do not have an employment contract or a severance agreement, but for those who do, they can be confusing or intimidating. [Adam H. Garner](http://www.garnerltd.com/attorney-profile) and The Garner Firm, Ltd. has significant experience reviewing, drafting, and negotiating [employment](http://www.garnerltd.com/wage-and-hour/) and severance agreements, including those containing agreements not compete with your employer or solicit its employees or customers. If you have questions, or need assistance with, your employment or severance agreement, please do not hesitate to [contact The Garner Firm, Ltd. today.](http://www.garnerltd.com/contact) --- ### [Short-Term Disability and Long Term Disability Claims](https://www.garnerltd.com/citystate/short-term-disability-and-long-term-disability-claims/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** The [Employee Retirement Income Security Act of 1974 (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) is a notoriously complex federal law that governs the short and long term disability claims process for most employer-sponsored group disability plans. If you or a loved one has a short-term disability or a long term disability, and you are covered by an ERISA plan, you may be entitled to benefits. The insurance companies that fund and/or administer disability benefits claims can make obtaining your benefits a real challenge. In far too many cases, valid short-term disability claims and/or long term disability claims are wrongly rejected. At The Garner Firm, compassionate [Philadelphia long term disability attorney](http://www.garnerltd.com/attorney-profile/) Adam H. Garner is an experienced disability benefits attorney and advocate for employee benefits and employee rights. If your short-term disability or long term disability claim was denied, Mr. Garner is ready to help you recover the compensation that you are owed. ### Understanding the Basics of the Short-Term Disability and Long Term Disability Claims Process ***What Does ERISA Do?*** If you are filing a short-term disability or a long term disability claim for an ERISA-regulated group benefits plan, there are several important things that you need to know about the claims process. First and foremost, you should be aware of the fact that ERISA is designed to do two important things: 1. Establish minimum requirements for employer-sponsored plans; and 2. Standardize the claims and appeals processes. ***Insurance Companies Know How to Work ERISA to Their Benefit*** While ERISA was originally crafted to protect beneficiaries (employees), employers and their disability insurance companies have found ways to tilt the process in their favor. As such, you need to be ready to fight for your short-term disability and long term disability benefits. ***Three Things You Need to Know*** As a short-term disability or long term disability claimant, there are three extremely important things that you need to know about claims process. 1. If your short-term disability or long term disability claim is rejected, you only have 180 days to appeal the decision; 2. You will be required to go through the entire internal appeals process before you can file a short-term disability or long term disability lawsuit; and 3. If you do file a short-term disability or long term disability lawsuit, the court may, depending on the terms of the disability plan document and jurisdiction, be restricted to examining the evidence that you submitted to the insurance company during your appeal. ### Get Help With Your Short-Term Disability or Long Term Disability Claim Today If your short-term disability claim or long term disability claim was denied, our experienced ERISA lawyer Adam H. Garner will fight to protect your [rights](http://www.garnerltd.com/services/) and financial interests. [The Garner Firm](http://www.garnerltd.com/about-us/), is Philadelphia’s employee benefits firm. We fight aggressively to hold employers and big insurance companies accountable, so that our clients can obtain every dollar that they rightfully deserve. For a free review of your case, please call us today at (215) 645-5955 or contact us through our website. --- ### [Philadelphia Long Term Disability Attorney](https://www.garnerltd.com/citystate/philadelphia-long-term-disability-attorney/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Have you been denied your rightful long-term disability benefits? Many times, a denial was based on misrepresentation, error, or even bad faith on the part of the insurance company, and it is important to know your options to appeal the decision. The Garner Firm, Ltd., has some of the top [Philadelphia long-term disability attorneys](https://www.garnerltd.com/practice-areas/) and has helped many people get their rightful benefits. If you are wondering how to file a claim or what your options are following a denial, reach out today to schedule an appointment with one of our talented lawyers. ### What is the Employee Retirement Income Security Act (ERISA)?[](https://www.dol.gov/general/topic/retirement/erisa#:~:text=The%20Employee%20Retirement%20Income%20Security,for%20individuals%20in%20these%20plans.) [ERISA](https://www.dol.gov/general/topic/retirement/erisa#:~:text=The%20Employee%20Retirement%20Income%20Security,for%20individuals%20in%20these%20plans.) is a federal law passed in 1974 that regulates employee benefit plans. The purpose of ERISA is to make sure the benefits promised by an employer are provided to employees through insurance coverage or when they retire or leave the company. When you qualify for long-term disability insurance coverage, your claim will be handled according to what’s stated in your group policy. Long-term disability claims under ERISA can be complicated, however. Our firm can help answer any questions about this process and work on getting you back into financial stability as quickly as possible. ### How to Know if Your Disability Benefits Have Been Wrongfully Denied? If you have been denied your long-term disability benefits, it is important to know why. Typically, claims are denied because: - The insurer claims you do not have a qualified disability - You did not provide sufficient information regarding your disability - The insurer states that even with your condition, you can still work - The insurance company is acting in bad faith We can review your denial reasons and advise you of your best chances of appeal. ### Why You Should Hire a Long-Term Disability Lawyer If you are considering hiring a lawyer to handle your appeal, it is important to know that the sooner you take action on an [ERISA long-term disability denial of benefits case,](https://www.garnerltd.com/practice-areas/erisa-litigation/) the better. Here at The Garner Firm, we understand how difficult this process can be and will make sure all steps in the appeals process are taken care of for the best possible outcome. We offer free consultations and will make sure you receive the benefits that are rightfully yours under ERISA law. With years of experience handling long-term disability cases, we can be the powerful partner you need in a battle against your employer and their insurance company. We have helped many people get their rightful benefits and can help you with your case. ### Work with the Right Philadelphia Long-Term Disability Attorney The Garner Firm, Ltd., is qualified to handle this complicated process for you, even if your case requires ERISA litigation. Understanding ERISA claims can be challenging, especially if you don’t have an experienced attorney at your side. This is where we can come in and help. To learn more about our services, [contact us](https://www.garnerltd.com/contact/) today to schedule a free consultation. We can help your disability claim get back on the right track. --- ### [Moorestown Township Life Insurance Denial Lawyer](https://www.garnerltd.com/citystate/moorestown-township-life-insurance-denial-lawyer/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** ### Helping Clients Obtain the Life Insurance Benefits They Deserve Many people have life insurance policies, hoping they will be able to provide for and protect their loved ones when they pass away. Many families rely on life insurance benefits to cover costs and expenses following the death of a loved one. Unfortunately, many families have their situation become even more stressful when they learn their life insurance claim has been denied. If you received a denial of your claim, you should consult with a Moorestown Township life insurance denial lawyer as soon as possible. Some life insurance policies are purchased privately, while others are provided by employers and governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). While ERISA plans might lead to more claim denials, any type of life insurance claim can be denied for a variety of reasons. [The Garner Firm](https://www.garnerltd.com/attorney-profiles/) helps clients appeal wrongful claim denials and fight for the life insurance benefits they deserve. Contact our office directly for more information about how we might help in your situation. ### Common Reasons for life Insurance Denials Like any insurance company, life insurers aim to limit benefits and payouts to claimants as much as possible. They have many reasons why they might [deny a claim](https://www.garnerltd.com/possible-reasons-for-life-insurance-claim-denials/) that you believe to be valid, including the following: - The insured passed away within a short timeframe, leading to an investigation of the claim - No beneficiary was named, or there is a dispute over who the designated beneficiary should be - The beneficiary did not follow the right procedures to file the claim or failed to provide the proper information - The insured’s cause of death was excluded from coverage by the policy For example, some life insurance policies will not cover death by suicide or a death to which the deceased somehow contributed. ### Appealing Your Denial Fortunately, an initial denial is not the final word on whether you will receive benefits or not. There are different ways to appeal a denied claim, depending on the details of the specific policy. You should always have an experienced attorney review the denial to determine the best course of action in your case. Some claims can be appealed to the company itself, and you only have a short period of time to file this type of administrative appeal. If your administrative appeal is unsuccessful, you might be able to file a lawsuit against the insurance company. If the policy is governed by ERISA, this lawsuit will likely be filed in federal court. You want to have the right ERISA life insurance litigation attorney handling your case. ### Contact a Moorestown Township Life Insurance Denial Lawyer as Soon as Possible Ar The Garner Firm, we know that many life insurance denials are wrongful, and we fight to obtain the benefits our clients deserve under the law. When you are grieving a tragic loss, the last thing you need is to deal with life insurance complications. Instead, [contact us](https://www.garnerltd.com/contact/) to speak with a Moorestown Township life insurance denial lawyer today. --- ### [Dedicated Employee Benefits Lawyer Serving Clients in Lower Merion Township, PA](https://www.garnerltd.com/citystate/dedicated-employee-benefits-lawyer-serving-clients-in-lower-merion-township-pa/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Employee benefits are a key part of any employee’s compensation package. Pennsylvania employees rely on their benefits. Unfortunately, in far too many cases, employees have a difficult time recovering the full benefits owed to them. Often, benefits are wrongly denied when employees need them most, such as in cases of disability or retirement. At The Garner Firm, [Lower Merion Township employee benefits attorney Adam H. Garner](https://www.garnerltd.com/attorney-profile/) represents executives, employees, and plan beneficiaries in a wide range of employee benefits claims. We have deep experience handling all aspects of [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) claims. If your employee benefits claim was denied, please contact our law firm today. ### ERISA Employee Benefits Claims ### *Short-Term Disability Benefits* If you have developed a medical condition that will temporarily keep you off the job, you may be entitled to short-term disability benefits under your company’s ERISA plan. Our law firm is committed to helping Lower Merion Township employees obtain their full short-term disability compensation, as soon as possible. ### *Long Term Disability Benefits* Losing the ability to return to work is a tremendous burden on Pennsylvania employees and their families. This is especially true if your disability is long-term or permanent. In these cases, employees need to be able to access their full long term disability benefits. Our Lower Merion Township employee benefits lawyer can help. ### *Retirement Plan Claims* There are many different types of [retirement plan claims](https://www.garnerltd.com/practice-areas/retirement-plan-benefit-claims/). Our Lower Merion Township employee benefits lawyer is committed to ensuring that employees get their full benefits. We have extensive experience handling a wide range of retirement plan claims, including pension plans, 401(k) plans, profit sharing plans, and Supplemental Executive Retirement Plan (SERP) claims. ### *Health Insurance Benefits* Our Lower Merion Township employee benefits lawyer also handles ERISA health insurance claims. If you or a family member is having trouble getting the full medical coverage that should be available to you under your employer-sponsored health plan, our law firm is here for you. ### *Other Employee Benefits* Employee benefits lawyer Adam H. Garner also handles many other employee benefits issues. Our legal team is committed to helping Pennsylvania employees get the full benefits owed to them, no matter the circumstance. Among other things, our law firm handles: - Severance agreements/severance benefits; - Employee contract negotiation and review; - Wage & hour claims. ### Contact Our Pennsylvania Employee Benefits Lawyer Today At [The Garner Firm](https://www.garnerltd.com/about-us/), we are committed to advocating for the rights and interests of employees in Lower Merion Township. To schedule a free, no obligation initial consultation with employee benefits attorney Adam H. Garner, please do not hesitate to call our office today at (215) 645-5955. --- ### [Long Term Disability Lawyers Philadelphia](https://www.garnerltd.com/citystate/long-term-disability-lawyers-philadelphia/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** ### Working to Get the Long Term Disability Benefits You Need Millions of people in the United States rely on disability benefits to cover their basic expenses. Not being able to work due to a disabling condition can be devastating and stressful, as you might not know how you are going to support yourself. Many companies provide employees with long term disability coverage that should provide important benefits should you become disabled. However, many disabled individuals have an uphill battle ahead to obtain the benefits they deserve. Most private-sector employer-sponsored disability plans are governed by the Employee Retirement Income Security Act of 1974 ([ERISA](https://www.garnerltd.com/erisa-litigation)). While this law was intended to protect covered employees, in reality, it very much favors insurance companies who are trying to keep benefits and payouts low. Unfortunately, this means that many people who have valid claims for disability benefits have their claims denied. If your disability claim was denied despite you having a legitimate disability under your policy, or if your benefits were terminated without a valid reason, you should immediately seek the help of a long term disability lawyer in Philadelphia. [The Garner Firm](https://www.garnerltd.com/attorney-profiles/) is dedicated to fighting insurance companies that use abusive practices against claimants, and we work to get you the benefits that were wrongfully withheld. Contact us directly today for more information. ### The Right Help for Your Long Term Disability Claim Many people believe that they can file a successful disability claim without the help of a skilled attorney. While this is sometimes the case, preparing a thorough claim that is likely to be granted is a difficult task. While you are focusing on your health, let our disability lawyers prepare a claim that has the best chance of a successful outcome. If you already filed a claim and received a denial, all hope is not lost. There are options to appeal a denial, but you need to take swift action to do so. The appeal process is complicated, so you want to seek help from a long term disability lawyer as soon as you learn about your initial claim denial. We can review why your claim was denied and prepare the strongest possible appeal. ### Why Choose The Garner Firm for Help With Your Claim? Dealing with ERISA long term disability insurers is no easy task. It is important to choose an experienced ERISA lawyer to protect your rights under your insurance policy and under the law, so you can get your rightful benefits as soon as possible. Attorney Adam Garner has extensive experience handling ERISA disability claims and winning appeals for our clients. His past experience representing employee benefit plans gives him the insight needed to understand how to successfully advocate on behalf of his clients. Now that he has committed his practice to representing individuals, he has become a respected advocate for disabled claimants in both initial claims and appeals. ### Contact Our Long Term Disability Lawyers in Philadelphia for Assistance Today If you need help filing or appealing a claim, please contact our long term disability lawyers in Philadelphia right away. The Garner Firm is on your side, so please [contact us](https://www.garnerltd.com/contact/) for more information. --- ### [Long-Term Disability Lawyers in West Chester ](https://www.garnerltd.com/citystate/long-term-disability-lawyers-in-west-chester/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** The experience of an illness or injury that results in a long-term disability can be life-altering and also incredibly stressful. Dealing with a serious medical condition is difficult, requires a great deal of effort and attention, and can keep you out of work for years – or permanently. It is easy to worry about how you are going to support yourself on top of all your other stresses. Having [long-term disability lawyers in West Chester](https://www.garnerltd.com/practice-areas/) by your side to guide you through the disability claim process can relieve some of your stress. We ensure that everything with your claim is completed correctly to fight for the full amount of disability benefits you need. ### ERISA Long-Term Disability Claims If you have long-term disability insurance through your employer, you might have peace of mind that you will be covered if you suffer a lasting injury or illness that prevents you from working. However, once a disability strikes, you might find that receiving the benefits you need is a greater challenge than you imagined. Disability insurance companies have complicated policy language that aims to limit benefit eligibility as much as possible. It can take a significant amount of evidence to prove your disability, and you might have to appeal a claim denial. [ERISA](https://www.dol.gov/general/topic/retirement/erisa) has complex rules overseeing this entire process, so you want to have a disability lawyer assisting with your claim or denial. Appealing a denial of an [ERISA long-term disability claim](https://www.garnerltd.com/practice-areas/erisa-litigation/) requires first exhausting all administrative options, which are often unsuccessful. The final step is to file a lawsuit in federal court, which is a highly technical legal process. You want an attorney to help with your appeal, and we can also help with your initial claim to increase your chances of success from the start. ### An Attorney Can Help Prove Your Disability Insurance companies will not issue benefits unless you can prove that you have a qualifying disability that prevents you from working. You might know that you cannot work, but providing evidence to an insurer to prove this can be a challenging task. You might think you can simply submit medical records, but often, the insurance company will require occupational exams, independent medical exams, and additional evidence. Dealing with a long-term disability is stressful enough without having to worry about maximizing your compensation and settlements. The role of a disability lawyer is to step in on your behalf, handle all insurance communications, and present sufficient evidence to prove that you are eligible for benefits. If your claim was already denied, do not wait to seek assistance with your appeal, as your benefits are on the line. ### Connect with a West Chester Long-Term Disability Lawyer Now Long-term disability benefits are an important part of your financial security, and a long-term disability attorney in West Chester can help you make the most of them by supporting you through the application process. Visit The Garner Firm, Ltd. to [schedule an appointment](https://www.garnerltd.com/contact/) to chat about the options on your case today. --- ### [Long Term Disability Lawyers Doylestown](https://www.garnerltd.com/citystate/long-term-disability-lawyers-doylestown/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** When your health reaches the point where you cannot work, financial help is the key to survival. However, you must first go through the insurance company that is the gatekeeper for your claim. Your hope is that your initial claim is strong enough to be approved. When you first file, you would include evidence of your disability and why you are unable to work. It helps to have the help of [long term disability lawyers in Doylestown](https://www.garnerltd.com/attorney-profiles/). ### Fight Back When the Insurance Company Denies Your Claim The insurance company may deny your claim, saying that your disability is not serious enough for long-term benefits or finding some other problem with your paperwork. There is really no risk for them in denying your initial claim because [ERISA](https://www.garnerltd.com/practice-areas/erisa-litigation/) does not allow you to sue them for bad faith. At this point, you should hire an attorney if you do not already have one. ERISA does allow you to file an administrative appeal when your claim is denied. The first level of appeal is to the insurance company itself. They will have already given you a reason why they denied your claim, and you must present evidence that shows that you deserve benefits. This could include: - Medical evidence - Statements from vocational experts - Witness affidavits and statements - Medical expert testimony You should err on the side of submitting everything possible that could bolster your claim. This will be the only chance that you have to introduce evidence for your appeal. If your administrative appeal is denied and you must file a lawsuit against the insurance company, you will not get another chance to add evidence to your file. Instead, ERISA locks down the record after the first administrative appeal, so you must put your best foot forward. ### You Can Sue the Insurance Company While the law generally skews the process in favor of the insurance company, they are not the judge and jury when it comes to your long-term disability claim. You have the ability to appeal the denial in federal court. There, the judge would review the record that was in front of the insurance company and make their own decision about whether you could receive benefits. You do not need to prove a mistake on the part of the insurance company. You just need to demonstrate that you are entitled to benefits. When dealing with claimants, insurance companies have a disproportionate amount of power. They act in the interests of their own bottom line, which can make your life harder. Hiring a long-term disability attorney is one way to level the playing field, especially when the insurance company is making things difficult. We stand up for you when the insurance company denies your claim or terminates your benefits. The law gives you the right to fight back, but you must come to the table with an experienced attorney to put your best case forward in the appeals process. ### Contact a Doylestown Long-Term Disability Attorney At [The Garner Firm, Ltd](https://www.garnerltd.com/)., we help clients who are getting pushed around by the insurance company in the claims process. If you find yourself with a denial, [contact us](https://www.garnerltd.com/contact/) so we can help you file an appeal. --- ### [Long Term Disability Lawyer Near Villanova](https://www.garnerltd.com/citystate/long-term-disability-lawyer-near-villanova/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Federal law provides for long-term disability benefits for injured workers. However, just because the law says that you may be eligible for these benefits does not mean that they are easy to get. You may need to file an appeal after your initial claim is rejected. One important step is to fully understand your long-term disability policy before you apply for benefits. While these must comply with federal law, not every policy is the same. They may have different procedures and terms. For example, the term “disability” can vary from policy to policy, and that can decide whether you are eligible for benefits. You should also closely review the policy to see what the timelines are and how you should submit information. Never hesitate to seek help from a[long-term disability lawyer near Villanova. ](https://www.garnerltd.com/attorney-profiles/) ### Make Sure Your Claim Is Documented In addition, you should fully document your claim with medical evidence before you submit your appeal. This is what will form the basis for the insurance company’s decision to grant benefits. They don’t need an extra reason to make your life more difficult, so you should try not to give them reasons. The insurance company often does not grant these benefits easily. They may do things like hire investigators to follow you to see if you are really disabled. The law does not punish them for rejecting claims, so they may do so to force you to appeal. This is when you will go through the appeals process. You should have a lawyer to help you[because the appeal is critically important](https://www.garnerltd.com/reviews/). ### Prepare for an Appeals Process First, you should understand why the insurance company rejected your claim. They will give you a reason. Some cases may be easily cleared up by providing missing information. Other cases require a fight because the insurance company does not think that you meet the policy requirements. Common reasons for rejecting benefit claims include: - Insufficient medical evidence to back the claim - You do not meet the policy definition of disabled - You missed a deadline - The insurance company has discovered evidence that undermines your claim You must put your strongest foot forward during the appeals process. Unlike other types of insurance claims, the ERISA appeals process has a direct bearing on your legal rights going forward. You must fully present evidence and develop the record at the appeals stage because you will not get another chance in the future. If you lose your appeal, you can file a lawsuit in federal court. However, the judge can only consider evidence that was introduced to support your appeal. You cannot add anything new to the record, and the judge will only determine whether the appeals board made the wrong decision based on the evidence that they saw. ### Contact Long-Term Disability Lawyers Near Villanova The Garner Law Firm fights for injured workers to receive a fair shake from the insurance companies and courts when they apply for benefits. [Contact us ](https://www.garnerltd.com/contact/)today to schedule your free initial consultation, so we can discuss your case. --- ### [Long Term Disability Lawyer Near Me](https://www.garnerltd.com/citystate/long-term-disability-lawyer-near-me/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Do you have a disability and need legal help? If so, please contact The Garner Firm, Ltd. to learn more about how we can help. We provide representation for those who need to file a disability claim in Philadelphia and New Jersey, and our legal team has experience in helping people with disabilities receive the benefits they deserve from insurance companies. Often, hard-working people are denied long-term disability benefits by their employer-sponsored insurance for a wide variety of reasons. If you have been denied, it is not the end of the road. Contact a [long-term disability lawyer near you](https://www.garnerltd.com/attorney-profiles/) to level the playing field and receive the benefits you deserve. ### Highly-Experienced Disability Attorney With several years of experience, we have successfully helped people with disabilities receive the benefits they deserve. We know that it can be a difficult road to receive [long-term disability insurance benefits](https://www.garnerltd.com/5-things-to-know-about-disability-insurance-claims/), and these claims often end up denied for a variety of reasons. Insurance companies might have undermined the severity of your condition or find another reason to avoid paying you the money you deserve. If you have been denied your rightful benefits, do not simply accept this denial. Instead, speak with our legal team about your denial and possible options to negotiate with the insurance company or take further legal action. First, we can assess the reasons for your claim denial and whether they might be valid or not. Sometimes, we need to submit additional evidence of your disability and the impact on your life, and the insurer might reverse its decision. However, some insurance companies fight to avoid paying valid claims, and we might need to escalate your appeal. Because employer disability policies are governed by ERISA, there are rules to appeal if negotiating with the insurance company does not work. We know how to exhaust all administrative appeals before taking the case to federal court if needed. ### Nationally Recognized Long-Term Disability Attorney Don’t wait another second to get help from a nationally recognized long-term disability attorney near you. Our legal team can investigate your case, provide legal advice, or just answer any questions you have about getting back on track after being denied benefits. We have been recognized as one of the top long-term disability attorneys in America by The American Bar Association Journal and Best Lawyers® for years – take advantage of this experience today. ### Speak With a Trusted Long-Term Disability Lawyer Near You At The Garner Firm, Ltd., we have successfully prevailed in many claims for our clients that had been wrongly denied. We know the long-term disability benefits system and will make sure you are taken care of in your time of need for both medical coverage and financial assistance with living expenses. Don’t delay another second to speak with a disability attorney about how we can help you receive the benefits you deserve and need. We would love to speak to you if you believe you’ve been wrongly denied long-term disability benefits. [Contact us](https://www.garnerltd.com/contact/) today to schedule a free consultation with our legal team. --- ### [Our Radnor Township Long Term Disability Attorneys are Here for You When Your Disability Benefits are Denied](https://www.garnerltd.com/citystate/our-radnor-township-long-term-disability-attorneys-are-here-for-you-when-your-disability-benefits-are-denied/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** When you lose the ability to work because of a disability, it can be an overwhelming financial and emotional burden. Numerous employers offer their employees short-term disability or long-term disability benefits to help them support themselves and take care of their families. Almost all of these private disability benefit plans are governed by ERISA, which is the Employee Retirement Income Security Act of 1974. [ERISA](https://www.garnerltd.com/practice-areas/erisa-litigation/) is a federal law that unfortunately is far more favorable to the employers’ insurance companies than it is to the employees for whom it is supposed to provide benefits. The result is that many employees who have valid disability claims find themselves receiving denials or having their benefits suddenly terminated. If you find yourself in this situation, it is important to find a Radnor Township [long-term disability attorney ](https://www.garnerltd.com/attorney-profile/)who can help you appeal the denial and fight for your right to benefits. ### We are an Experienced ERISA Disability Benefit Firm At The Garner Firm, Adam H. Garner specializes in helping employees pursue the disability benefits they are owed. He has over a decade of experience assisting clients in New Jersey, Pennsylvania, Maryland, and elsewhere in ERISA disability claims, and has exclusively represented individuals who have been victims of ERISA’s unfair practices for several years. When you are looking for a long-term disability attorney near you, it is best to find someone who has experience handling both sides of these claims. Adam Garner has experience representing disability plans and administering them. Today, Adam Garner exclusively represents clients who have been wrongfully denied benefits by their employer’s plan. He understands very well how the arduous appeals process works and is up to date on all applicable laws that govern the disability benefits denial process. Not only does he represent clients who deserve to have competent representation in an appeals process, but he is also recognized on a national level, publishing works and speaking on the topic. ### How The Garner Firm can Help with Your Radnor Township Long Term Disability Claim Denial If your claim was denied, it is important to take action quickly, as there are strict deadlines for filing an appeal in an ERISA-governed employee benefits plan. Some of the ways our firm can assist is by: - Carefully reviewing your long-term disability benefits denial; - Requesting a copy of your insurance file; - Discussing your legal options and rights; - Opening an investigation into your case and collecting any supplemental evidence needed; - Speaking with doctors to ensure your condition is clearly documented; - Drafting a strong claims appeal; and - Negotiating with the insurance provider. ### Contact a Radnor Township Long Term Disability Attorney At The Garner Firm, our attorneys will work tirelessly to help you get access to the benefits you deserve. This is why it is important to reach out right away, so we have plenty of time to work on your appeal.[Contact our office](https://www.garnerltd.com/contact/) today to schedule an initial consultation. --- ### [Life Insurance Lawyer Near Me](https://www.garnerltd.com/citystate/life-insurance-lawyer-near-me/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** ***Get Help From a Top Life Insurance Attorney Near Me*** The loss of a family member can be emotionally traumatic. If your family relied on the person to bring in income, losing a family member also creates major financial challenges. Life insurance is designed to provide some much-needed support during this difficult time. Unfortunately, when it comes time to collect, many life insurance plan beneficiaries have trouble getting access to the full and fair benefits that they are owed. At [The Garner Firm](https://www.garnerltd.com/about-us/), you’ll receive assistance from a life insurance lawyer near me with extensive experience handling the full range of life insurance claims. Whether you are bringing a claim against an ERISA-covered life insurance policy or a private, non-ERISA plan, we are prepared to help. To set up a free, fully confidential initial consultation, please do not hesitate to contact our legal team today. ### Filing a Life Insurance Claim Near Me When you file a life insurance claim, you must be sure that you carefully follow all of the claims procedures that are required by your specific plan. If you obtained life insurance through an employer, then your plan is likely covered under the [Employee Retirement Income Security Act of 1974 (ERISA)](https://www.dol.gov/general/topic/retirement/erisa). This federal law has specialized rules with which you must comply. If you are covered by an individual plan, other regulations may apply. In either case, you must provide a copy of the policyholder’s death certificate when filing a claim *and* you must meet all filing deadlines. ### What to do if Your Life Insurance Claim is Denied If your l[ife insurance claim was denied](https://www.garnerltd.com/practice-areas/), it is imperative that you take immediate action to protect your legal rights and financial interests. Under ERISA, claimants should receive a written denial letter that explains the insurance company’s reasons for rejecting the life insurance claim. While these denial letters are supposed to be clear and provide a comprehensive assessment, they often contain confusing, industry-specific language. Your life insurance claims attorney near me will be able to review your denial letter and explain to you exactly what it means. From there, your life insurance claims lawyer will be able to help you gather all of the supplemental evidence and records you need to bring the strongest possible appeal. It is crucial that you include all additional supporting evidence with your administrative appeal. The failure to do so could lead to your benefits being delayed, underpaid, or denied. ### Contact a Life Insurance Attorney Near Me Today At [The Garner Firm](https://www.garnerltd.com/contact/), our life insurance lawyer represents clients in ERISA life insurance claims and non-ERISA life insurance claims. If you need help obtaining life insurance benefits, we are here to help. To arrange a free, no obligation review of your life insurance claim, please call us today at (215) 645-5955. --- ### [Hartford Disability Lawsuit in Philadelphia](https://www.garnerltd.com/citystate/hartford-disability-lawsuit-in-philadelphia/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** ### Handling Complex Disability Litigation in and around Philadelphia Disability insurance claims are always complicated. However, when all attempts at the process fail and litigation is necessary, the situation becomes significantly more complex and challenging. If you need to file a Hartford disability lawsuit in Philadelphia, it is imperative that you have a highly experienced disability litigator fighting for your interests. Contact The Garner Firm, Ltd., to speak with a [disability litigation attorney](https://www.garnerltd.com/attorney-profile/) right away. ### Disability Denials When a physical or mental disability prevents you from working, you rely on your disability insurance coverage to provide the benefits you need to cover your basic living expenses. Your company might provide you with insurance governed by[ERISA](https://www.garnerltd.com/practice-areas/erisa-litigation/), or you might have private coverage. In any event, there is a good chance your claim will be denied – especially if you handle it yourself – since disability claims are notoriously difficult. When you receive a claim denial from Hartford, you should immediately contact a knowledgeable disability attorney. There are appeal procedures that vary from company to company, and the appeal process is never simple. When appeals and negotiating attempts are unsuccessful, your attorney might advise that a lawsuit is necessary. ### Disability Litigation There are two different types of disability lawsuits, and your case might involve: - **Lawsuits involving ERISA-governed plans –** These require that you first exhaust all internal appeals prior to turning to litigation, and these cases are overseen by federal law and pursued in federal court. - **Lawsuits involving private individuals disability coverage –** If you had your own coverage, not through an employer, state law will apply, and the case will be initiated in state court. Our firm knows how to handle either type of lawsuit, so please do not hesitate to contact us to discuss possible litigation seeking the disability benefits you deserve. ### Fighting for Your Benefits Disability insurance companies will fight against paying claims whenever possible, and it is no different when you bring your claim into court. You can bet the insurance company’s legal team will be ready to challenge your disability and inability to work. You should always have an attorney who is ready to fight for your interests just as aggressively as the insurance company fights against them. We handle every step of your Hartford disability lawsuit, including: - Filing the initial complaint - Responding to the insurer’s answer if needed - Discovery - Settlement negotiations - Filing motions with the court - Representing your interests at trial if your case does not settle We are confident negotiators who bring all our experience and resources to the table when trying to obtain a favorable settlement agreement. If the insurance company still will not cooperate, we are also experienced litigators who do not hesitate to stand up for you in court. ### Contact Our Legal Team about a Possible Hartford Disability Lawsuit in Philadelphia When you need to file a Hartford disability lawsuit in Philadelphia, you want The Garner Firm, Ltd., on your side. [Contact us](https://www.garnerltd.com/contact/) right away if you receive a claim denial and need assistance fighting for disability benefits. --- ### [ERISA Claims Attorney Cherry Hill Township](https://www.garnerltd.com/citystate/erisa-claims-attorney-cherry-hill-township/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Many employer-sponsored retirement plans and group welfare plans are subject to the rules and regulations set forth under the Employee Retirement Income Security Act (ERISA). Large insurance companies and other plan administrators have been working hard during recent years to sway the ERISA claims process in their favor. They have complex strategies that they use, which have resulted in many employees not getting the full benefits they are owed. If you need assistance, it is important to speak with an[ERISA claims attorney in Cherry Hill Township](https://www.garnerltd.com/practice-areas/) who can help protect your rights. At The Garner Firm, we routinely represent employees and plan beneficiaries who are presenting ERISA claims. Our team of skilled lawyers is available and ready to help you fight for your rights. Please contact us to set up a free, no-obligation review of your legal claim today. ### Cherry Hill Township ERISA Claims We Handle Adam H. Garner has over a decade of experience helping Cherry Hill Township clients with their ERISA claims. From your first phone call to the completion of your case, we will work tirelessly to help protect your interests and get you the benefits you deserve. We handle a wide variety of ERISA claims, as well as ERISA appeals. Examples of ERISA appeals and litigation cases we’ve handled in Cherry Hill Township have included: - [Life insurance claims](https://www.garnerltd.com/practice-areas/life-insurance/); - Disability benefits denials ; - Executive deferred compensation benefits claims; and - Retirement plan benefits claims. ### Understanding how ERISA Appeals and ERISA Litigation Work Sadly, even though they may owe you a fiduciary duty, you often cannot rely on your employer or the insurance company to provide any helpful information or guidance in regard to your ERISA claim or appeal. The law is complicated, and there are loopholes that can cause potential problems with the claims process as well as the appeals process. One example is that you only have a limited amount of time to file a claim, like 180 days for disability benefits denials. However, there are some circumstances where you may have even less time to file an appeal. Failure to meet the deadlines could mean your case is automatically dismissed after that. Before filing a lawsuit in court, you are required to submit an appeal to the insurance company or other plan fiduciary responsible for deciding appeals. It is crucial that you submit all relevant documentation to your claim administrator in your initial application for benefits or in the appeal. In the event your claim goes to litigation, the court may limit its review to the documents that were submitted with the claim and appeal. ### Contact a Cherry Hill Township ERISA Attorney Today If you are struggling to get ERISA benefits that are owed to you, it is important to speak with an ERISA lawyer right away.[Contact The Garner Firm](https://www.garnerltd.com/contact/) today to schedule an initial consultation. Let us help you get the benefits you deserve. --- ### [Your Employee Benefits, Employment, and Wages are Valuable.](https://www.garnerltd.com/citystate/your-employee-benefits-employment-and-wages-are-valuable/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** ### We Fight to Protect Them. We Fight for You. We do it Every Day. No one should have his or her employee benefits claim wrongfully denied. No one should be discriminated or retaliated against in the workplace. No one should have their wages wrongfully withheld or underpaid. Sadly, individuals are wrongfully denied the benefits of their employment and treated unlawfully every day. They need [someone](http://www.garnerltd.com/attorney-profile/) to fight for them, fight for the benefits they earned, and hold their employers and benefit plan providers accountable for their wrongful conduct. The Garner Firm was founded to do just that. The Garner Firm pursues its clients’ claims with experience, tenacity, and a deep understanding of the issues. If a client’s short or long term disability benefits, retirement benefits, life insurance benefits, or health benefits have been denied or cut, we aggressively pursue claims to have them reinstated. If a client has been discriminated or retaliated against in the workplace, we pursue justice and fair compensation on the client’s behalf. If a client has been wrongfully denied the wages he or she has earned, we work to ensure that those wages are paid, that the employer is held accountable for its misconduct, and that the employee is made whole. ### Employee Benefits and Employment Law are Complex.[](http://www.garnerltd.com/attorney-profile/) [Adam H. Garner](http://www.garnerltd.com/attorney-profile/) is an experienced, nationally recognized, Radnor ERISA employee benefits lawyer and employment lawyer with over a decade of experience litigating ERISA employee benefits and employment law claims and counseling his clients on the laws governing the workplace and employee benefits. Adam regularly speaks at conferences and seminars regarding ERISA employee benefits and employment law in Radnor, and he is an editor and contributing author of one of the leading treatises on employee benefits law. He has appeared in state and federal courts, as well as before state and federal agencies, throughout the United States, but he serves clients primarily in Pennsylvania, Maryland, and New Jersey. If you reside or work outside of Pennsylvania, New Jersey, or Maryland, The Garner Firm maintains relationships with law firms throughout the United States in order to serve your needs. ### The Garner Firm, Ltd. Our firm is Philadelphia’s ERISA employee benefits and employment law firm. We represent employees, former employees, and employee benefits plan participants on an individual, collective, and class basis in employee benefits (ERISA) litigation and all types of employment disputes. Our focus is on vindicating our clients’ rights and securing the employee benefits and compensation to which they are entitled. In addition we provide legal counsel to our clients on other matters and are available to assist, or find someone who can assist, our clients in any way possible. If you have had an employee benefits claim denied in Radnor, such as a long term disability (LTD), [short-term disability](http://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) (STD), or a pension claim, we may be able to help. If your employer has violated your rights in the workplace, we may be able to help. Learn more about our firm, read our blog, or get in touch with us. --- ### [Doylestown Long Term Disability Attorney](https://www.garnerltd.com/citystate/doylestown-long-term-disability-attorney/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Having a disability can limit your ability to not only resume your former habits and activities, but it can also negatively influence your capacity to work, which can impact your ability to support your family. This is where disability coverage comes into play – to provide you compensation for your lost wages and earnings. One of the experienced Doylestown long-term disability attorneys from [The Garner Firm](https://www.garnerltd.com/practice-areas/) can provide you information on what your disability claim or denial might entitle you to. If your case fits with our firm, we can collect the best possible benefits on your case. Learn more about how a disability attorney can help you ensure that your disability and the costs related to it are covered by your private disability insurance or that which was provided by your employer. ### Your Disability Attorney Advocates for Your Interests Against the Insurance Company When you are injured and covered through a private disability insurance company, whether provided by your employer or purchased yourself, you are entitled to coverage for your lost wages. Coverage depends upon your disability qualifying for benefits, and also on the accuracy of your application and making sure that it meets the requirements to be accepted. It is important to remember that the insurance company does not work for you – they work for profits. Profit is what is left after costs are subtracted from income. Insurance companies generate income by collecting insurance premiums from customers and maximize profits by denying whichever claims they can and paying as little as possible out on the claims that are approved. Insurance companies have teams of claim specialists and attorneys working to carefully scrutinize each and every disability application that comes in, looking for ways to disqualify them. If your claim meets the requirements for coverage, insurance companies might offer you a quick offer. The offer might seem attractive, but generally, these quick offers are meant to save the insurance company money by getting you to take a lower amount of benefits in exchange for less effort in receiving them. Speaking to a disability attorney as soon as possible after your disability takes the negotiations out of your life, so you can focus on recovering from your disability (when possible) while your attorney focuses on maximizing your compensation. ### Reach Out to a Local Philadelphia Disability Attorney Now Ensuring that your future is protected and your ability to cover the costs associated with your disability depends upon your disability benefits. If you have had difficulty collecting on your benefits, or you have received compensation that is less than what is needed to meet your needs, you could be entitled to damages. Having an experienced attorney on your side to work towards the best possible outcome for your claim is essential to counter the interests of the for-profit insurance company and its team of claim specialists working to deny or reduce your claim. Connect with one of the experienced [Philadelphia disability attorneys](https://www.garnerltd.com/attorney-profiles/) from The Garner Firm now to [schedule a consultation](https://www.garnerltd.com/contact/) to discuss your claim now. --- ### [Cherry Hill Township Life Insurance Appeals Attorney](https://www.garnerltd.com/citystate/cherry-hill-township-life-insurance-appeals-attorney/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** Life insurance policies are generally meant to protect and provide for loved ones in the event of a death. If a policyholder pays their premiums as required during their life, surviving family members or other beneficiaries should expect to receive the agreed-upon payment should the policyholder pass away. Unfortunately, many people have learned the hard way that life insurance companies do not always provide benefits as they should. If you are the designated beneficiary of a life insurance policy, receiving a denial letter of your claim can be devastating. You are already facing a difficult time, and now you are denied the payment you expected. It can be difficult to know what to do next, but know that a Cherry Hill Township[life insurance appeals attorney](https://www.garnerltd.com/attorney-profile/) is here to assist you. Contact The Garner Firm, Ltd., for more information about your appeal today. ### Why was Your Life Insurance Claim Denied? Life insurance claims are similar to any other type of insurance company – they will often deny claims whenever they can to maximize profits. There are several different reasons why life insurance claims are denied, such as the following: **Misrepresentations on applications –** Some people might provide inaccurate information when they apply for life insurance coverage. This can often include information about illnesses, existing health conditions, lifestyle choices, and more. If the life insurance company believes there was a material misrepresentation on the application, it can render the policy invalid, and the company can refuse to provide coverage. **The policyholder allowed the policy to lapse –** In order to keep a life insurance policy active, the policyholder must ensure they make payments as required by the policy. If they fail to make payments, the policy can lapse, and coverage will not be provided. In some situations, policyholders can reinstate lapsed policies, and the company might wrongfully treat the policy as lapsed when it is time to pay benefits. **The cause of death was excluded by the life insurance policy –** Life insurance policies do not automatically cover [every death,](https://www.garnerltd.com/practice-areas/accidental-death-dismemberment-benefits/) as each policy will specifically exclude certain causes of death from coverage. These causes often include: - Suicide - Participation in risky or hazardous activities - Criminal activity - Driving under the influence of alcohol or drugs - Pre-existing health conditions - Pregnancy or childbirth - Natural disasters ### Appealing Your Denial Though a denial letter can be disheartening in an already emotional time, know that many life insurance companies wrongfully deny claims. It is always worth it to discuss the possibility of an appeal with an experienced attorney who handles life insurance claims. The appeal process will differ depending on your specific situation, but it can involve appealing directly with the insurer, filing a lawsuit, and more. ### Seek Help from a Cherry Hill Township Life Insurance Appeals Attorney Right Away If your claim for life insurance benefits is denied, you should not hesitate to consult with a Cherry Hill Township life insurance appeals attorney at The Garner Firm.[Contact us](https://www.garnerltd.com/contact/) directly so we can evaluate your options for seeking the benefits you deserve. --- ### [Cherry Hill Long Term Disability Attorney](https://www.garnerltd.com/citystate/cherry-hill-long-term-disability-attorney/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** *Top Long Term Disability Lawyer Serving Claimants Throughout Southern New Jersey* If you or your loved one is no longer able to work on a full-time basis, the loss of income can put a tremendous financial burden on your family. Long term disability insurance can help to relieve some of this burden. However, if your claim is denied you may need the assistance of a Cherry Hill long term disability attorney. Many people are covered by long term disability policies that were obtained through their employer. These policies are generally covered [Employee Retirement Income Security Act of 1974 (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) — a federal law that insurance companies know how to use to their own benefit. Sadly, the result is that it can be difficult for qualified applicants to get their full long term disability benefits. At [The Garner Firm](https://www.garnerltd.com/contact/), our dedicated **Cherry Hill long term disability attorney** helps people fight back. Adam H. Garner has extensive experience handling, negotiating, litigating, and resolving long term disability disputes. If your long term disability claim was denied in Camden County, New Jersey, we can help. ### How Our Cherry Hill, NJ Long Term Disability Attorney Can Help You It is an unfortunate reality, but the long term disability claims process is stacked in favor of the insurance company. There are many complex legal procedures that you must follow in order to get a [fair hearing](https://www.garnerltd.com/practice-areas/erisa-litigation/) in your case. Relatively minor mistakes could cost you big in the end. Our Cherry Hill long term disability lawyer is prepared to help you with all aspects of the claims process. Among other things, we will: - Guide you through preparing your initial claims package; - Carefully review your long term disability denial letter; - Explain your legal rights and your legal options to you; - Take action to obtain supporting evidence, including additional medical evidence; - Put together a strong, persuasive administrative appeal; - Negotiate directly with the insurance company, working toward a full settlement; and - Prepare for long term disability litigation. Every long term disability claim is different. In some cases, a settlement is a possibility. With additional supporting evidence and a well-presented claim, the insurance company may be willing to offer you a complete settlement without a lawsuit. In other cases, litigation may prove to be necessary to hold the insurer accountable. Our Cherry Hill, NJ long term disability lawyer is ready to take whatever action is needed to protect your rights. ### Contact Our Cherry Hill Long Term Disability Lawyer Today At [The Garner Firm](https://www.garnerltd.com/about-us/), our Cherry Hill long term disability attorneys are committed to fighting for full disability benefits for those who have been wrongfully withheld. If your long term disability claim was denied in Camden County, New Jersey, we can help. For a free, fully confidential review of your case, please do not hesitate to [contact](https://www.garnerltd.com/contact/) our law office at (215) 645-5955. --- ### [Cherry Hill Life Insurance Lawyer](https://www.garnerltd.com/citystate/cherry-hill-life-insurance-lawyer/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** *Experienced Life Insurance Attorney Serving Clients in Cherry Hill and Throughout Southern New Jersey* Losing a loved one is devastating. The emotional and financial toll that the loss takes on your family can be a substantial burden. Life insurance is there to provide some much needed financial support during this difficult time. Unfortunately, in far too many cases, beneficiaries struggle to get access to the full life insurance benefits they are owed. At [The Garner Firm](https://www.garnerltd.com/attorney-profile/), our top-rated **Cherry Hill life insurance lawyer** fights for the legal rights and financial interests of people in their time of need. We know how to hold life insurance companies accountable. If your life insurance claim was denied in Southern New Jersey, please do not hesitate to contact our legal team to get a free, comprehensive review of your case. ### What to do if Your Life Insurance Claim is Denied - ***Understand Why the Insurance Company Denied the Claim*** The first step to getting your benefits is understanding why your life insurance claim was denied. Federal and state regulations require insurers to share some basic information about the denial. For example, if you obtained a life insurance plan through an employer, then it is likely regulated by the [Employee Retirement Income Security Act of 1974 (ERISA)](https://www.dol.gov/general/topic/retirement/erisa). Under this federal law, insurance companies must provide written denial letters to beneficiaries that lay out the precise reasoning behind the rejection. Of course, in reality, insurance company explanations can be convoluted and confusing. You should get your life insurance denial letter to an experienced attorney who can help you understand the true meaning of the letter and who can explain what actions you need to take next. - ***Carefully Gather and Organize All Relevant Documents and Records*** If you are considering appealing the life insurance denial, you will need supporting evidence. One of the keys to getting successful results is keeping your claim well-organized. At this time, it is crucial that you carefully gather and assemble all of the information that you have that is related to your life insurance claim. Get this evidence into the hands of an experienced Cherry Hill life insurance lawyer. - ***Speak to a Life Insurance Lawyer: Get Ready to File an Appeal*** Most life insurance claims must be appealed internally (administrative review) before any type of [lawsuit](https://www.garnerltd.com/practice-areas/erisa-litigation/) can be filed. The actual appeal process will depend on the terms of your specific life insurance policy. ERISA life insurance plans and non-ERISA life insurance plans may have different appeal procedures. Your Cherry Hill life insurance lawyer will analyze the terms of your policy and determine exactly what needs to be done to submit the strongest possible appeal in your case. ### Contact Our Cherry Hill Life Insurance Attorney Today At [The Garner Firm](https://www.garnerltd.com/about-us/), our Cherry Hill life insurance claims lawyer has extensive experience litigating both ERISA and non-ERISA life insurance claims. If your life insurance claim was denied in Southern New Jersey, we can help. To arrange a free, no obligation review of your case, please call our legal team today at (215) 645-5955 or [contact us](https://www.garnerltd.com/contact/) directly through our website. --- ### [Cherry Hill ERISA Attorney](https://www.garnerltd.com/citystate/cherry-hill-erisa-attorney/) **Published:** February 14, 2023 **Author:** Kevin Sparkman **Content:** The [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) is a complex federal law that regulates most employee benefit plans and employer-sponsored insurance plans offered in the United States. ERISA standardized much of the claims process and it was enacted to help ensure that all participants and beneficiaries get a fair review of their application. Sadly, in reality, obtaining benefits can be challenging. At The Garner Firm, our **Cherry Hill ERISA attorney** is committed to fighting for the legal rights and financial interests of our employees and other plan participants. If your employee benefits were wrongly denied, our law firm is here to help. To get a free, fully confidential review of your Cherry Hill, NJ ERISA claim, please contact us today. ### Employee Benefits Law Firm Representing Claimants in Cherry Hill, New Jersey We represent employees, executives, and other plan beneficiaries in the full range of ERISA cases. Our legal team has a deep understanding of the claims process and how insurance companies operate. We know what needs to be done to protect your rights. Among types of cases, our Cherry Hill ERISA attorneys have experience handling: - Short term disability claims; - [Long term disability claims](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/); - [Life insurance denials](https://www.garnerltd.com/practice-areas/life-insurance/); - [Retirement plan benefits claims](https://www.garnerltd.com/practice-areas/retirement-plan-benefit-claims/); - [Accidental death and dismemberment insurance (AD&D)](https://www.garnerltd.com/practice-areas/accidental-death-dismemberment-benefits/); and - Breach of fiduciary duty litigation. We are prepared to work with you through every step of the ERISA claims process — from preparing your initial application for benefits to putting together a strong administrative appeal or filing an ERISA lawsuit. No two ERISA claims are identical; every client deserves attentive, fully individualized legal guidance. From completing forms to obtaining additional evidence for an appeal, we will walk your case through every step of the process. If your ERISA claim has been denied in Southern New Jersey, it is crucial that you [consult with a qualified Cherry Hill employee benefits lawyer](https://www.garnerltd.com/contact/) as soon as possible. ERISA has strict deadlines, and there are specific steps that you must take to ensure that your administrative appeal is properly prepared and well presented. No matter the circumstances of your ERISA case, our law firm is here to help. ### Contact Our Cherry Hill ERISA Lawyer Today At [The Garner Firm](https://www.garnerltd.com/about-us/), our Cherry Hill ERISA attorney has extensive experience protecting the rights of employees and helping them secure the full and fair benefits that they deserve. We handle the full range of ERISA claims. To get immediate assistance with your case, please do not hesitate to call us at (215) 645-5955 to schedule a free, no-obligation initial legal consultation. --- ### [Cherry Hill Township ERISA Lawyer](https://www.garnerltd.com/citystate/cherry-hill-township-erisa-lawyer/) **Published:** February 13, 2023 **Author:** Kevin Sparkman **Content:** The [Employee Retirement Income Security Act (ERISA)](https://www.dol.gov/general/topic/retirement/erisa) is a federal law that regulates that the overwhelming majority of employee benefits claims. While ERISA standardizes the claims and appeals processes, it is a complicated law that often works in favor of insurance companies. If you or your loved one is struggling to obtain employee benefits in Southern New Jersey, you should speak to an experienced ERISA lawyer immediately. At The Garner Firm, our **Cherry Hill Township ERISA lawyer** represents employees, executives, and plan beneficiaries in the full range of employee benefits claims. Our practice is focused on helping our clients protect their rights and recover their full benefits. For a free, fully confidential consultation with New Jersey ERISA attorney, please do not hesitate to contact our legal team today. ### ERISA Employee Benefits Claim We Handle in Cherry Hill Township Under federal regulations, all employees and plan participants are entitled to a full and fair review of their ERISA file. At The Garner Firm, our Cherry Hill Township ERISA lawyer represents clients in ERISA appeals and ERISA litigation. Among other types of cases, we have experience handling: - Short term and [long term disability](https://www.garnerltd.com/practice-areas/disability-benefits-lawyer/) appeals; - Life insurance disputes; - Retirement plan benefit claims; - long-term care cases; and - SERP and other executive deferred compensation claims. ### ERISA Claim Denied in New Jersey? How Our Attorney Can Help If you ERISA claim was denied, you should have received written notification. ERISA regulations require insurers to explain a denial. In theory, this rule helps to ensure that employees and other plan beneficiaries understand why their benefits were denied and what steps they need to take to bring a successful appeal. In practice, ERISA denial letters are often vague. They tend to be filled with confusing, industry-specific language. Our Cherry Hill Township ERISA attorney can help. When you reach out to our law firm, we will: - Review your ERISA denial letter; - Explain to you the insurer’s decision; - Help you understand your rights and options; - Take action to pull together all relevant evidence; - Craft a strong, compelling administrative appeal; - Negotiate with the insurance company; - Prepare for ERISA litigation. Not all ERISA denials go to court. In many cases, ERISA claims are resolved during an administrative appeal or during settlement negotiations, though litigation is always a possibility. No matter the circumstances, our law firm is committed to helping our clients recover the full and fair employee benefits that they are owed. ### Contact Our Cherry Hill Township ERISA Attorney At [The Garner Firm](https://www.garnerltd.com/about-us/), we represent employees and beneficiaries throughout Southern New Jersey. If you or your loved one is having trouble obtaining ERISA benefits in Camden County, please do not hesitate to reach out to us at (215) 645-5955. [Initial consultations](https://www.garnerltd.com/contact/) are fully private and free of charge. --- ### [Blue Bell Long Term Disability Lawyer](https://www.garnerltd.com/citystate/blue-bell-long-term-disability-lawyer/) **Published:** February 12, 2023 **Author:** Kevin Sparkman **Content:** If you have been disabled, you could be entitled to several different types of disability compensation. It is important to consult with a [Blue Bell long term disability lawyer](https://www.garnerltd.com/attorney-profiles/) to be sure you are protecting your legal rights to compensation. Long term disabilities can drastically affect your financial future for the rest of your life. It is important to plan for this by defending your legal right to compensation. ### Long Term Disability Insurance Many insurance companies offer long term disability (LTD) insurance. This is an optional coverage that entitled you to compensation in the event that you suffer a disability lasting longer than a specified length of time. LTD benefits usually do not apply until after you have satisfied a waiting period commonly referred to as an “elimination period.” At that point, LTD will cover a set portion of your salary for a specified time. Some LTD policies limit this to five years, while others will cover you until 65 years of age (or another set retirement time). It is important to understand that LTD is often an optional coverage. Employers might sponsor a portion of the premium, but an employee will usually have to opt in to LTD insurance and pay for this coverage. ### Seek Help with Your Long Term Disability Claim Insurance companies are businesses, and they will not simply pay benefits based on a claimant’s word. Even if you cannot work and present evidence to support your claim, you might learn that the [claim has been denied](https://www.garnerltd.com/reasons-jersey-long-term-disability-claim-denied/). It is important to remember that a denial is not the final decision, as you can appeal the denial in specific ways. You always want to contact an attorney following a claim denial. ### The Right Disability Lawyers For Blue Bell Cases If you have suffered a long term disability, you may have the right to compensation from several different sources. It is important to be sure that your legal rights are protected. You have the right to dispute unfair awards or improper denials of your claim. The experienced Blue Bell disability attorneys at The Garner Firm have helped many clients throughout the Philadelphia area. We will fight hard for your rights, too. [Contact us](https://www.garnerltd.com/contact/) today to schedule your free consultation. --- ### [Blue Bell ERISA Attorneys ](https://www.garnerltd.com/citystate/blue-bell-erisa-attorneys/) **Published:** February 12, 2023 **Author:** Kevin Sparkman **Content:** The decision to retire is one not to be taken lightly, as it will impact your day-to-life potentially more than any decision you have made thus far in your life. In addition, some people need to stop working earlier than planned due to an unexpected disability, and if this happens, you will need proper disability benefits from your employer-sponsored plan. Contact [The Garner Firm, Ltd.](https://www.garnerltd.com/practice-areas/) to discuss your disability or retirement benefits and gain a better understanding of the process and how it will impact your life. Read on to learn about ERISA and how an attorney can help you in the process. ### What is ERISA? ERISA is the Employee Retirement Income Security Act of 1974, a federal law that sets the minimum standards for the majority of voluntarily established retirement and insurance plans within private industry. The purpose of [ERISA](https://www.dol.gov/general/topic/health-plans/erisa) is supposed to be to provide protection for the persons who participate in these plans. However, ERISA is a complicated law, and it often makes receiving disability or retirement benefits more challenging for employees. If you encounter any issues with your benefits under an ERISA plan, you need a [Blue Bell ERISA attorney](https://www.garnerltd.com/attorney-profiles/) assisting you and protecting your rights to benefits under the law. ### Disability Claims Under ERISA Every disability policy will have different terms, but these insurance companies all have one thing in common – they will make it difficult for you to qualify for and start receiving benefits. Insurers regularly deny or delay valid disability claims, and you cannot simply appeal the decision like you would any other type of insurance claim. This is because ERISA sets out complicated procedures and strict deadlines to claim appeals. If you have a disability claim and run into challenges, speak with an ERISA attorney about the best course of action right away. ### An Important Function of ERISA: Fiduciary Responsibility Fiduciary responsibility is the requirement that resources be managed intelligently – in such a way as to reduce the risk of loss while increasing the return on an investment. Stability is an important factor in terms of retirement plans, as they must be around for a while, and a risky financial manager without a sense of fiduciary duty might gamble away retirement plans in a volatile market, as with the Great Recession. ERISA’s requirement of fiduciary duty requires diversification of your investments to minimize risk, and the investment into stable funds with stable returns, to ensure the stability of your future. ### What If My Retirement or Healthcare Benefits Have Been Wrongfully Denied? Your retirement plan is an investment you have made and an asset you own. If you have experienced difficulty accessing your retirement plan or are not being paid what was agreed, you may have a case, and an ERISA attorney can help. ### Connect with a Blue Bell ERISA Attorney Now Are you facing a roadblock to your rightful disability or retirement benefits under an ERISA plan? You should discuss your concerns and legal rights with an experienced attorney who can seek the benefits you deserve. Reach out to The Garner Firm, Ltd. to [schedule an appointment](https://www.garnerltd.com/contact/) to discuss your situation today. --- ## Profiles ### [Melanie Garner](https://www.garnerltd.com/attorney-profiles/melanie-garner/) **Published:** January 13, 2023 **Author:** Lauren Forbes **Content:** Melanie J. Garner is an ERISA attorney and partner at the firm, with over 20 years of experience forcefully advocating on behalf of her clients in state and federal courts throughout the country. She has significant experience litigating employee benefits claims, mass tort and personal injury matters, as well as handling “qui tam” whistleblower cases. Since 2008, Melanie has primarily represented plaintiffs and their family members, helping them to recover millions of dollars in ERISA/employee benefits, asbestos, mass tort, personal injury, and other cases in Philadelphia, Pennsylvania, New Jersey, Maryland, and elsewhere. ### Employee Benefits, Insurance, and Employment Litigation ![Melanie Garner, ERISA Attorney at The Garner Firm in Philadelphia](https://www.garnerltd.com/wp-content/uploads/2023/01/melanie-garner-erisa-attorney-phila-portrait-694x1024.webp "melanie-garner-erisa-attorney-phila-portrait - The Garner Firm") Since joining The Garner Firm, Ltd. in 2020, a large portion of Melanie’s practice has involved representing employees in ERISA claims and litigation. This typically involves appealing the decisions of plan administrators, insurers, and other claim fiduciaries denying or terminating benefits made available to employees through their jobs, such as short-term disability (STD) benefits, long-term disability (LTD) benefits, life insurance, pensions, and other retirement benefits, and litigating these claims against insurance companies, employers, and plan fiduciaries. These claims often involve individual employees, but they may also involve class actions brought on behalf of a number of employees and plan participants who have been similarly harmed by a defendant’s breaches of fiduciary duty and other wrongdoing. Melanie has also represented plaintiffs in disputes and litigation against insurance companies involving claims of bad faith and breach of contract for denying or terminating benefits under individual disability insurance (IDI) policies, often purchased by doctors, lawyers, and other professionals with specialized training in the event they become disabled and unable to perform the duties of their own occupation during their career. In addition, Melanie has represented employees in employment discrimination and FLSA wage and hour cases brought against their employers. ![Preloader image](https://www.garnerltd.com/wp-content/plugins/wp-carousel-pro/src/Frontend/css/spinner.svg) ![Untitled design - 2026-06-02T103610719](https://www.garnerltd.com/wp-content/uploads/2023/02/Untitled-design-2026-06-02T103610719.png) [![logo link to AVVO Top attorney rating for melanie garner philadelphia ERISA and long term disability attorney](https://www.garnerltd.com/wp-content/uploads/2023/02/AVVAO-Top-attorney-rating-melanie-garner-philadelphia-philadelphia-ERISA-lawyer.png)](https://www.avvo.com/attorneys/19102-pa-melanie-garner-1228817.html) ![american-bar-foundation-fellow-melanie-garner-philadelphia-ERISA-lawyer](https://www.garnerltd.com/wp-content/uploads/2023/02/american-bar-foundation-fellow-melanie-garner-philadelphia-ERISA-lawyer-e1676664675910.jpg) ![american-association-justice-melanie-garner-philadelphia-ERISA-lawyer](https://www.garnerltd.com/wp-content/uploads/2023/02/american-association-justice-melanie-garner-philadelphia-ERISA-lawyer.jpg) ![Expertise.com logo for melanie garner philadelphia long term disability and erisa lawyer](https://www.garnerltd.com/wp-content/uploads/2023/08/best-employment-lawyers-in-philadelphia-expertise-badge-2-copy.webp) No aspect of this advertisement has been approved by the Supreme Court of New Jersey. [View Award Methodologies](https://www.garnerltd.com/award-methodologies/ "Award Methodologies"). ### Asbestos, Mass Tort, and Personal Injury Litigation Throughout her career, a large portion of Melanie’s practice has included representing mesothelioma victims, including those with occupational and other exposures to asbestos. In addition, she has litigated cases involving products liability and exposures to other toxic chemicals, including benzene and lead paint; class actions; and other mass tort claims, including those involving defective medical devices. Melanie has also litigated various other types of personal injury actions on behalf of those injured through the negligence or intentional conduct of others, including premises liability, motor vehicle accidents, medical malpractice, and nursing home abuse cases. In addition to recovering millions of dollars on behalf of her clients, her work has held defendants, including many large corporations and employers, accountable for their wrongful conduct. ### Football Concussion Claims and Litigation Melanie has also represented former professional and college football players suffering from catastrophic injuries, disabilities, latent brain disease, and other cognitive impairments, including chronic traumatic encephalopathy (“CTE”). She has pursued these claims as a part of the NFL Concussion Litigation Settlement and has also litigated individual lawsuits against the NCAA and private universities on behalf of former professional and student athletes and their family members. ### Qui Tam Whistleblower Litigation Melanie also has experience representing workers who “blew the whistle” and reported Medicare and other fraud conducted by their employers, including pharmaceutical companies and government contractors, against federal and state governments. These cases, called “qui tam” cases, permit an employee who has not participated in the fraud to bring a lawsuit on behalf of the government in order to recover on its behalf. Individuals who bring these suits are referred to as “relators,” and, in certain situations, they are entitled to a share of the government’s recovery. ### Recognitions Melanie was selected by her peers for inclusion on the Pennsylvania Super Lawyers Rising Stars list in 2018 and 2019 and on the Pennsylvania Super Lawyers list each year from 2020 through 2026. She has also been recognized in The Best Lawyers in America® since 2024. ### Outside of the Office Melanie has been actively involved in the Pennsylvania Association for Justice (PAJ) for over a decade and currently serves as chair of its Employment Law Section. She is a past chair of PAJ’s Women Lawyers Section and a former member of its Board of Governors. She is also a member of PAJ’s Civil Rights Section, Diversity, Equity, and Inclusion Section, and Insurance Bad Faith Section. Additionally, Melanie currently serves as chair of the American Association for Justice’s (AAJ) ERISA Benefits Litigation Group and is a member of AAJ’s Women Trial Lawyers Caucus, Employment Rights Section, Insurance Law Section, and Bad Faith Litigation Group. She is also a member of the Philadelphia Bar Association’s Employee Benefits Committee and Women in the Profession Committee, the American Bar Foundation, and the American Bar Association’s Labor and Employment Section’s Employee Benefits Committee and Tort Trial & Insurance Practice Section. She is an active member of the Eastern Pennsylvania regional chapter of the National Employment Lawyers Association and serves as a senior editor for *Employee Benefits Law*, the treatise published by Bloomberg Law. ### Video: Winning Cases for Clients is Personal For Me ### Professional Associations **Fellow of the American Bar Foundation** **Pennsylvania Association for Justice** - Member, Board of Governors - Civil Rights Section, Diversity Equity & Inclusion Section, Employment Law Section, and Insurance and Bad Faith Section - Immediate Past Chair, Women Leaders Section **American Association for Justice** - ERISA Benefits Litigation Group, Treasurer - Women Trial Lawyers’ Caucus, Publications Committee Co-Chair **Philadelphia Trial Lawyers Association** **Philadelphia Bar Association** - Employee Benefits Committee - Women in the Profession Committee **American Bar Association** - Labor and Employment Section, Employee Benefits Committee - Section of Litigation, The Woman Advocate Committee - Tort Trial & Insurance Practice Section, Employee Benefits Committee ### Speaking Engagements - **“Lunch & Learn: Family Leave,”** American Association for Justice Women Trial Lawyers Caucus, January 2023 - **“The Sonny Banks Health and Wellness Hour”** Radio Show, Guest Speaker Discussing ERISA benefits claims, May 2022 - **“Mass Torts: What’s Hot and What’s Not in 2020,”** Pennsylvania Association for Justice, Winter Member Meeting, Bethelehem, Pennsylvania, January 2020 - **“Jurisdictional Updates,”** Perrin Mid-Atlantic Asbestos Conference, Wilmington, Delaware, June 2019 - **“Finding and Retaining Women Lawyers,”** Women’s Breakfast, Perrin Mid-Atlantic Asbestos Conference, Wilmington, Delaware, June 2019 - **“The ABCs of Complex Litigation: Asbestos, Benzene CRPS and More,”** Legal Intelligencer CLE, Philadelphia, Pennsylvania, October 2016 - **“Social Media Evidence: Finding It, Getting It and Using It,”** Pennsylvania Association for Justice 34th Annual Auto Law Conference, Harrisburg, Pennsylvania and Philadelphia, Pennsylvania, May 2016 - **“Off the Beaten Path – The Rules of Successful Qui Tam Litigation,”** New Jersey Association for Justice Mass Tort – Boardwalk Seminar 2016, Atlantic City, New Jersey, April 2016 --- ### [Zachary Lipschutz](https://www.garnerltd.com/attorney-profiles/zachary-lipschutz/) **Published:** May 1, 2026 **Author:** Lauren Forbes **Content:** ## ERISA and Long-Term Disability Attorney ![Head-and-shoulders portrait of a smiling man in a dark gray suit and orange patterned tie, office background](https://www.garnerltd.com/wp-content/uploads/2026/06/Untitled-design-2026-06-10T101312200-203x300.png "Lipschutz Headshot - The Garner Firm") Zachary Lipschutz represents individuals in ERISA and long-term disability disputes, fighting for clients whose benefits have been wrongfully denied or terminated. He approaches every case with a litigator’s mindset, ensuring clients are positioned to win from day one. ### A Strategic Approach to Every ERISA and LTD Dispute No two disability disputes are alike. Zach is as comfortable advocating for his client in a federal court as he is negotiating a successful settlement without ever entering a courtroom. His experience spans administrative appeals, high-level settlement negotiation, state and federal litigation, and appellate advocacy, and his broader background in workers’ compensation and Social Security disability law gives him a practical understanding of how disability disrupts his clients’ lives and livelihoods. He draws on all of it to pursue the best outcome for each individual client. ### Detail-Driven ERISA and LTD Representation In ERISA and long-term disability cases, the so-called administrative record can determine the outcome before a case ever reaches a judge. Zach’s robust research background and detail-oriented approach is built for exactly that reality — ensuring that the record is developed carefully, the legal arguments are fully supported, and nothing is left to chance at any stage of the process. ### Recognized ERISA and Long-Term Disability Counsel Zach has been recognized in *Best Lawyers: Ones to Watch®* and named to the list of [Super Lawyers Rising Stars](https://profiles.superlawyers.com/pennsylvania/philadelphia/lawyer/zachary-lipschutz/474f2710-2e47-4489-9a4e-eeba047b6f25.html). He is an active member of the Pennsylvania Bar Association, Philadelphia Bar Association, and Philadelphia Trial Lawyers Association. ![Rising Stars badge from Super Lawyers for Zachary Lipschutz, 2026.](https://www.garnerltd.com/wp-content/uploads/2026/05/Screenshot-2026-06-02-at-23333-PM.png "Screenshot 2026-06-02 at 23333 PM - The Garner Firm")No aspect of this advertisement has been approved by the Supreme Court of New Jersey. [View Award Methodologies](https://www.garnerltd.com/award-methodologies/). --- ### [Jake Day](https://www.garnerltd.com/attorney-profiles/jake-day/) **Published:** September 26, 2025 **Author:** Lauren Forbes **Content:** ![Jake Day, ERISA Attorney at The Garner Firm](https://www.garnerltd.com/wp-content/uploads/2025/09/Jake-Website-Headshot-1.png "Jake Website Headshot 1 - The Garner Firm") Associate Jake Day is an ERISA attorney at The Garner Firm. Prior to joining The Garner Firm, Jake worked as an attorney in the U.S. Department of Education, Office for Civil rights and clerked in the Philadelphia County Court of Common Pleas. Jake earned his law degree from Temple University Beasley School of Law. Prior to law school, Jake earned a B.A. in English and Creative Writing from the College of William & Mary, lived and worked in Australia, and spent years in the restaurant industry. During law school, Jake interned at the U.S. Department of Labor Regional Solicitor’s Office, provided legal services through Temple University’s Small Business Development Center, and mediated landlord-tenant disputes, small claims cases, and private criminal complaints. As a law clerk, Jake drafted judicial opinions and gained valuable experience with local politics, municipal corporations and development non-profits while assisting with the administration of petitions for conservatorship filed pursuant to Pennsylvania’s Act 135. Jake’s experience in the restaurant industry in the United States and abroad have instilled in him a strong desire to help working people. Jake was a member of the American Federation of Government Employees, ALF-CIO prior to working at the firm. Throughout his career, including at the Office for Civil Rights where he investigated civil rights complaints filed against federally funded schools, Jake has demonstrated an enduring commitment to upholding and restoring the dignity of vulnerable individuals, including working people facing challenges with their employee benefits or in their workplace. --- ### [Adam H. Garner](https://www.garnerltd.com/attorney-profiles/adam-garner/) **Published:** January 3, 2023 **Author:** Lauren Forbes **Content:** ## Philadelphia ERISA and Bad Faith Insurance Attorney for Long-Term Disability, Life Insurance, and Retirement Plan Claims ![Adam H. Garner, ERISA Attorney at The Garner Firm in Philadelphia](https://www.garnerltd.com/wp-content/uploads/2023/01/adam-garner-erisa-attorney-phila-portrait-203x300.webp "adam-garner-erisa-attorney-phila-portrait - The Garner Firm") Adam H. Garner, Esquire, is an ERISA attorney and the Founder and Managing Member of The Garner Firm, Ltd., located in Philadelphia, Pennsylvania. He concentrates his practice on **[ERISA litigation](https://www.garnerltd.com/practice-areas/erisa-litigation/)**, bad faith insurance disputes, **[long-term disability appeals](https://www.garnerltd.com/practice-areas/long-term-disability/)**, **[life insurance benefit claims](https://www.garnerltd.com/practice-areas/life-insurance/)**, and **[retirement plan cases](https://www.garnerltd.com/practice-areas/retirement-plan-benefit-claims/)**. With over two decades of experience as a skilled ERISA, insurance and employment attorney, he has built a reputation as a dedicated advocate for employee benefit plan participants, beneficiaries, and insured individuals who need aggressive representation against insurance carriers and other employee benefit plan fiduciaries. ### Extensive Experience in ERISA and Employee Benefits Mr. Garner has handled **[ERISA lawsuits](https://www.garnerltd.com/practice-areas/erisa-litigation/)** in state and federal courts nationwide, including claims for benefits and equitable relief actions under Section 502(a) of ERISA and fiduciary breach litigation. His thorough knowledge of the Employee Retirement Income Security Act of 1974 spans from administrative appeals to complex multi-party litigation. As a former administrator of multi-million and billion-dollar multiemployer benefit plans, he has firsthand insight into the policies, procedures, and fiduciary obligations that govern retirement plans, health benefits, and long-term disability programs. ### Skilled Advocate in Bad Faith Insurance and Disability Claims Mr. Garner devotes a significant portion of his practice to first-party bad faith insurance litigation, and **[ERISA benefits claims](https://www.garnerltd.com/practice-areas/erisa-litigation/)** holding insurance companies accountable when they fail to honor valid claims or engage in unfair practices. His in-depth understanding of long-term disability policies, life insurance contracts, and bad faith insurance laws allows him to prepare compelling cases for clients who have been unjustly denied benefits. By combining careful review of policy language with strategic advocacy, he works tirelessly to obtain the full scope of benefits owed to his clients. ### Additional Experience in Employment Law In addition to his ERISA and insurance litigation work, Mr. Garner regularly assists clients with employment law matters, including **[negotiating and drafting employment contracts](https://www.garnerltd.com/practice-areas/employment-contract-reviews/)** and **[severance agreements](https://www.garnerltd.com/practice-areas/severance-benefits/)**. His Philadelphia-based practice includes counseling employees regarding wage and hour issues and litigating **[wage and hour cases](https://www.garnerltd.com/practice-areas/wage-hour-law/)** and select employment discrimination claims. Leveraging years of hands-on experience in both litigation and contract review, Mr. Garner develops tailored strategies to protect his clients’ interests—whether they are seeking fair compensation, clear terms in an offer letter, or a strong position in severance negotiations. ### Bar Admissions and Recognitions Licensed to practice in Pennsylvania, New Jersey, and Maryland, as well as several federal district courts and U.S. Courts of Appeals, Mr. Garner is positioned to assist clients in various jurisdictions. He regularly writes and speaks on ERISA litigation, employee benefits law, insurance bad faith, and employment law topics for legal conferences, bar associations, and professional publications. His contributions as a chapter editor and senior editor for multiple editions of *Employee Benefits Law* (published by the American Bar Association in conjunction with Bloomberg) demonstrate his commitment to shaping the field. Mr. Garner has been selected to the [Pennsylvania Super Lawyers](https://profiles.superlawyers.com/pennsylvania/philadelphia/lawyer/adam-h-garner/40c84be5-e0a0-47a1-a0c6-d5e3e4e0bd82.html) or Rising Star list every year since 2018. ### Client-Centered Approach Throughout every phase of representation, Mr. Garner prioritizes transparency and open communication, offering clients a clear path forward whether they are facing long-term disability denials, life insurance claim disputes, retirement plan challenges, or employment-related concerns. His approach involves both negotiation and litigation, ensuring that each case strategy is fully customized to the client’s unique circumstances. ![Preloader image](https://www.garnerltd.com/wp-content/plugins/wp-carousel-pro/src/Frontend/css/spinner.svg) [![Untitled design - 2026-06-02T103610719](https://www.garnerltd.com/wp-content/uploads/2023/02/Untitled-design-2026-06-02T103610719.png)](https://www.garnerltd.com/wp-content/uploads/2023/02/Untitled-design-2026-06-02T103610719.png) [![avvo rating logo for adam garner long term disability and erisa attorney in philadelphia](https://www.garnerltd.com/wp-content/uploads/2023/08/AVVO-Rating-Superb-adam-garner-philadelphia-ERISA-attorney-copy.webp)](https://www.garnerltd.com/wp-content/uploads/2023/08/AVVO-Rating-Superb-adam-garner-philadelphia-ERISA-attorney-copy.webp) [![american association of justice rating logo for adam garner long term disability and erisa attorney in philadelphia](https://www.garnerltd.com/wp-content/uploads/2023/08/american-assoc-justice-adam-garner-philadelphia-copy.webp)](https://www.garnerltd.com/wp-content/uploads/2023/08/american-assoc-justice-adam-garner-philadelphia-copy.webp) [![Expertise.com rating logo for adam garner long term disability and erisa attorney in philadelphia](https://www.garnerltd.com/wp-content/uploads/2023/08/expertise-badge-adam-garner-philadelphia-long-term-disability-attorney.webp)](https://www.garnerltd.com/wp-content/uploads/2023/08/expertise-badge-adam-garner-philadelphia-long-term-disability-attorney.webp) [![avvo rating logo for adam garner long term disability and erisa attorney in philadelphia](https://www.garnerltd.com/wp-content/uploads/2023/08/AVVO-five-star-lawyer-adam-garner-philadelphia-ERISA-attorney-copy.webp)](https://www.garnerltd.com/wp-content/uploads/2023/08/AVVO-five-star-lawyer-adam-garner-philadelphia-ERISA-attorney-copy.webp) No aspect of this advertisement has been approved by the Supreme Court of New Jersey. [View Award Methodologies](https://www.garnerltd.com/award-methodologies/ "Award Methodologies"). ### Video: Questions To Ask Before Hiring an ERISA Attorney ### Nationally Recognized Long-Term Disability Lawyer and Speaker In addition to representing clients, Adam is a regular speaker and author on topics related to employment law and employee benefits law. For the last several years, Adam has served as a Contributing Author, Chapter Editor, and Senior Editor of the highly regarded treatise Employee Benefits Law, which is published by Bloomberg BNA. He is also a Subcommittee Co-Chair of the American Bar Association Section of Labor and Employment Law, Employee Benefits Committee and the Chair-Elect of the ABA’s Torts, Trial, Insurance Practice Section (TIPS) Health and Disability Insurance Committee. ### Speaking Engagements - **“Civil Procedure Update,”** ABA Section of Labor & Employment Law, Employee Benefits Committee, Mid-Winter Meeting, February 2025 - **“ERISA Issues Arising for Labor and Employment Lawyers,”** ABA Section of Labor and Employment Law 18th Annual Labor and Employment Law Conference, November 2024 - **“ERISA Litigation Remedies,”** Pennsylvania Bar Institute, Employment Law Institute, April 2024 - **“Benefits Claim Litigation,”** Pennsylvania Bar Institute, Employment Law Institute, April 2023 - **“Benefit Claims Administration and Litigation,”** ABA Section of Labor & Employment Law, Employee Benefits Committee, Mid-Winter Meeting, February 2023 - **“Benefit Claims – Part I: Administrative Procedures,”** ABA Joint Committee on Employee Benefits Plans ERISA Basics National Institute, November 2022 - **“Benefit Claims – Part II: Litigation Overview,”** AABA Joint Committee on Employee Benefits Plans ERISA Basics National Institute, November 2022 - **“The Ever-Evolving Standard of Review in ERISA Health and Disability Litigation,”** ABA Joint Committee on Employee Benefits webinar, October 2022 - **“From Long-COVID to Compliance with Regulations: Trends in Health and Welfare Administration and Disability Litigation,”** ABA Joint Committee on Employee Benefits Plans Employee Benefits Law Update: A Year in Review Webinar Series, March 2022 - **“Pension and Welfare Plan Overpayments – What Plans and Participants Need to Know,”** ABA Joint Committee on Employee Benefits Plans Webinar, February 2022 - **“ERISA Litigation and Attorneys’ Fees,”** ABA Torts, Trial, Insurance Practice Section (TIPS) Health and Disability Committee Webinar, August 2020 - **“Multiemployer Pension Plans: Selected Topics,”** ABA Section of Labor & Employment Law, Employee Benefits Committee, Mid-Winter Meeting, February 2020 - “**Attorneys’ Fees in ERISA Litigation,”** ABA Torts, Trial, Insurance Practice Section (TIPS), 46th Annual Midwinter Symposium on Insurance and Employee Benefits, January 2020 - **“Life Happens: Impact of Divorce, Disinheritance, and Murder on Life Insurance Claims,”** ABA Torts, Trial, Insurance Practice Section (TIPS), 45th Annual Midwinter Symposium on Insurance and Employee Benefits, January 2019 - **“Remedies,”** ABA Joint Committee on Employee Benefits ERISA Basics National Institute, October 2018 - **“Spousal Rights Under ERISA Plans: QDROs, and QMCSOs,”** ABA Joint Committee on Employee Benefits ERISA Basics National Institute, October 2018 - **“Subrogation and Reimbursement Claims,”** ABA Joint Committee on Employee Benefits ERISA Basics National Institute, October 2018 - **“Benefit Claims Litigation: Discovery, Experts, Standard of Review and Discovery and Dispositive Motions,”** ABA Joint Committee on Employee Benefits Advanced ERISA Benefits Claims Litigation Seminar, May 2018 - **“Administrative Appeals Review – Health Claims,”** ABA Joint Committee on Employee Benefits Advanced ERISA Benefits Claims Litigation Seminar, May 2018 - **“Recent Developments in Life Insurance Litigation: Contestable Claims, Misrepresentations, Rescissions, STOLI, and Class Actions,”** ABA Torts, Trial, Insurance Practice Section (TIPS), 44th Annual Midwinter Symposium on Insurance and Employee Benefits, January 2018 - **“Spousal Rights Under ERISA Plans: QDROs, and QMCSOs,”** ABA Joint Committee on Employee Benefits ERISA Basics National Institute, October 2017 - **“Subrogation and Reimbursement Claims,”** ABA Joint Committee on Employee Benefits ERISA Basics National Institute, October 2017 - “**External Review Pros & Cons: Perspectives of the Plan and Claimant,”** ABA Section of Labor & Employment Law, Employee Benefits Committee, Mid-Winter Meeting, February 2016 - **“Sweet (ERISA) Mystery of Life (Insurance),”** ABA Section of Labor & Employment Law, Employee Benefits Committee, Mid-Winter Meeting, February 2014 - **“Multiemployer Health Plans and the Affordable Care Act,”** BNA webinar, November 14, 2013 - **“Employment Laws Made Simple,”** NBI Seminars, March 21, 2012 - **“Multi-Employer Pension Plans: Withdrawal Liability,”** IOMA (BNA) webinar, 2011 - **“The HIRE Act: Benefits and Possible Pitfalls for Employers,”** HRHero.com teleconference, 2010 - **“Changes to COBRA After ARRA,”** Labor and Employment Law Developments in Uncertain Times, 2009 - **“Employment Records Retention Requirements Under Federal and Maryland Law,”** Records Retention and Destruction, Lorman Education Series, 2007 and 2008 ### Recent Reported Decisions **Campbell v. Royal Bank** **Supplemental Exec. Ret. Plan**, 646 F. Supp. 3d 629 (E.D. Pa. 2022) **Campbell v. Royal Bank** **Supplemental Exec. Ret. Plan**, 625 F. Supp. 3d 387 (E.D. Pa. 2022) **Bansept v. G&M Auto.**, 557 F. Supp. 3d 584 (E.D. Pa. 2021) **Dwyer v. Unum Life Ins. Co. of Am.**, 548 F. Supp. 3d 468 (E.D. Pa. 2021) **Edwards v. Albert Einstein Med. Ctr.**, 533 F. Supp. 3d 215 (E.D. Pa. 2021) **Dwyer v. Unum Life Ins. Co. of Am.**, 470 F. Supp. 3d 434 (E.D. Pa. 2020) **Bansept v. G & M Auto.**, 434 F. Supp. 3d 253 (E.D. Pa. 2020) **Solkoff v. Pennsylvania State Univ.**, 435 F. Supp. 3d 646 (E.D. Pa. 2020) **Sadowski v. Tuckpointers Local 52 Health & Welfare Tr.**, 281 F. Supp. 3d 710 (N.D. Ill. 2017) --- ## Reviews ### [Highly Recommend!](https://www.garnerltd.com/reviews/highly-recommend-3/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [Adam and his team are great.](https://www.garnerltd.com/reviews/669/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [Excellent Service](https://www.garnerltd.com/reviews/excellent-service-2/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [Best ERISA Attorney in Philadelphia](https://www.garnerltd.com/reviews/best-erisa-attorney-in-philadelphia/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [Outstanding Service](https://www.garnerltd.com/reviews/outstanding-service/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [Excellent Disability Lawyer](https://www.garnerltd.com/reviews/excellent-disability-lawyer/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [Excellent Service](https://www.garnerltd.com/reviews/excellent-service/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [What a great attorney,](https://www.garnerltd.com/reviews/what-a-great-attorney/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [Highly Recommend](https://www.garnerltd.com/reviews/highly-recommend/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [Exceptional Job](https://www.garnerltd.com/reviews/exceptional-job/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [Adam Garner is a Terrific Attorney](https://www.garnerltd.com/reviews/adam-garner-is-a-terrific-attorney/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [The Absolute Best](https://www.garnerltd.com/reviews/the-absolute-best/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [Highly Recommend](https://www.garnerltd.com/reviews/highly-recommend-2/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [Best possible lawyer anyone could ask for!](https://www.garnerltd.com/reviews/best-possible-lawyer-anyone-could-ask-for/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [SUPERIOR SERVICE!](https://www.garnerltd.com/reviews/superior-service/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [Top flight attorney](https://www.garnerltd.com/reviews/top-flight-attorney/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [Exceptional Service](https://www.garnerltd.com/reviews/exceptional-service/) **Published:** January 26, 2023 **Author:** Kevin Sparkman --- ### [Lawyer](https://www.garnerltd.com/reviews/lawyer/) **Published:** January 26, 2023 **Author:** Kevin Sparkman ---