​​​​Social Security Disability and Veterans Compensation Attorneys

​Understanding Long-Term Disability Insurance Benefits and the ERISA Appeals Process

If you’re unable to work due to a serious illness or injury, long-term disability (LTD) insurance benefits can provide crucial financial support. But for many people, obtaining those benefits—especially after a denial—can be frustrating, time-consuming, and legally complex. Most LTD policies provided through an employer are governed by a federal law called ERISA (the Employee Retirement Income Security Act of 1974), which imposes strict rules on the claims and appeals process.

Here’s what you need to know about LTD benefits and how an experienced attorney can help you navigate the ERISA appeals process.

What Are Long-Term Disability Benefits?

Long-term disability insurance provides monthly income replacement if you’re unable to work due to a qualifying medical condition. LTD benefits usually cover a percentage (typically 50–70%) of your pre-disability salary and may continue for several years—or even until retirement age—depending on the policy.

Common Reasons LTD Claims Are Denied

Insurance companies often deny LTD claims for reasons including:
Lack of sufficient medical evidence
Disagreements about the severity of your condition
Allegations of non-compliance with treatment
Assertions that you can still perform “sedentary” work
Surveillance or social media evidence contradicting your claim

Even strong claims may be denied if paperwork is incomplete or deadlines are missed.

ERISA and Why It Matters

If your LTD policy is provided through your employer, your claim is likely governed by ERISA. Unlike private, non-ERISA policies, ERISA severely limits your legal options if your claim is denied.

Key points about ERISA:

Strict Deadlines: You typically have 180 days to file an administrative appeal after a denial.
No Jury Trial: If your case proceeds to federal court, there’s no jury—only a judge.
Limited Evidence: You usually cannot submit new evidence in court. The judge reviews only what was in the claim file at the time of the final denial.
Complex Procedures: ERISA regulations are procedural and unforgiving. Even small missteps can harm your chances of success.

The Importance of the Administrative Appeal

The administrative appeal is your last opportunity to build and strengthen your claim before litigation. It’s critical to:

Submit updated medical records and expert opinions
Address the insurance company’s specific reasons for denial
Provide statements from treating physicians and vocational experts
Correct any misrepresentations in the insurer’s file

Because no new evidence can typically be added after this stage, getting it right is essential—and it’s why having an experienced ERISA attorney is so important.

How an LTD Appeals Attorney Can Help

An attorney familiar with ERISA and disability law can:

Analyze your policy and the insurer’s denial letter
Collect and submit strong medical and vocational evidence
Prepare a compelling written appeal
Communicate directly with the insurance company on your behalf
File a federal lawsuit if the appeal is denied

At our firm, we help disabled individuals fight back against wrongful denials of long-term disability benefits. We understand the tactics insurers use—and we know how to counter them.

Don’t Fight the Insurance Company Alone

If your LTD claim has been denied or terminated, don’t wait. The ERISA appeals process is deadline-driven and document-heavy. Let us help you protect your rights and recover the benefits you’ve earned.

Contact our office today for a free case evaluation.

SSA Lawyers PA
4925 Independence Parkway, Suite 195
Tampa, FL 33634
📞 1-813-221-1300​

SSA Lawyers P.A.