ERISA Short-Term & Long-Term Disability Attorneys

When Your Disability Benefits Are Denied, We Fight Back.

Experienced ERISA 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 disability attorneys understand the complex web of regulations, deadlines, and procedures that govern disability claims. We’ve 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 have a clear conflict of interest 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, 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”
• Pre-existing condition exclusions
• 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

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 intenral 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 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 timeframe (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 signficantly 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 The Garner Firm for ERISA STD/LTD Appeals

At The Garner Firm, we focus exclusively on ERISA and employment law, giving us deep expertise 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 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 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 millions of dollars recovered for clients.

Melanie Garner brings a unique perspective to disability cases, combining her background in mass torts with expertise 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 review the administrative record and determine whether the insurance company’s decision was reasonable. 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 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 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 to discuss your case with our legal team.