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SSA Lawyers P.A.

Private Long-Term Disability Insurance Claims: What You Need to Know When ERISA Doesn’t Apply

If you’ve purchased a long-term disability (LTD) insurance policy on your own—outside of your employment—you’re likely dealing with a private, non-ERISA disability claim. While the basics of qualifying for benefits are similar, the legal rights and appeals process differ significantly from ERISA-governed claims.

At SSA Lawyers PA, we help individuals navigate both ERISA and private LTD claims. In this article, we explain the unique aspects of non-ERISA disability claims and how they can impact your path to receiving benefits.

What Is a Non-ERISA LTD Claim?

Most LTD policies are provided through employers and are governed by the federal law known as ERISA (Employee Retirement Income Security Act). However, ERISA does not apply to:

Privately purchased disability insurance (bought directly from an insurer)
Disability policies through certain government or church employers
Self-employed individuals who buy their own LTD coverage

These are considered non-ERISA policies, and the claims process is handled very differently.

Key Differences Between Non-ERISA and ERISA LTD Claims

1. Right to a Jury Trial

One of the biggest differences: in a non-ERISA claim, you have the right to a jury trial if your claim ends up in court. In contrast, ERISA claims are decided by a judge and are limited to the administrative record.

2. Opportunity for Bad Faith Claims

If the insurance company acts unfairly or unreasonably denies your claim, you may be able to sue for insurance bad faith under state law. This opens the door to additional damages—including punitive damages and attorney’s fees—something not allowed in ERISA claims.

3. Discovery Rights

In non-ERISA lawsuits, you are generally allowed to conduct full discovery, including depositions of claims personnel, internal insurer communications, and more. This can be crucial in uncovering unfair practices or bias.

4. More Favorable Legal Standards

Non-ERISA LTD claims are typically reviewed under state contract and insurance laws. This can often be more favorable to the claimant than the highly deferential “abuse of discretion” standard applied in many ERISA cases.

What’s Involved in a Private LTD Claim?

While non-ERISA claims allow more legal tools to challenge a denial, insurance companies still use many of the same tactics to avoid paying. These may include:

laiming your condition isn’t severe enough
Arguing you can still perform “other work”
Sending you to biased medical examiners
Misinterpreting policy terms to exclude coverage

The process generally involves:

Filing the initial claim with supporting medical and occupational evidence
Responding to any requests for additional information or independent medical exams
Appealing the denial (if required by the policy)
Filing a lawsuit in state court, if the insurer continues to wrongfully deny your benefits

How Our Firm Helps With Non-ERISA Disability Claims

At SSA Lawyers PA, we understand the unique protections available in non-ERISA cases and use them to our clients’ advantage. Whether you’re preparing your initial claim or fighting a wrongful denial, we can:

Review your insurance policy to identify all coverage and exclusions
Work with your doctors to document your disability effectively
Represent you in negotiations, appeals, or litigation
Pursue bad faith damages when appropriate

You Have Rights. We’ll Help You Protect Them.

If your privately purchased long-term disability claim has been delayed, denied, or terminated, don’t try to face the insurance company alone. You may be entitled to far more than the insurer is offering.

Contact SSA Lawyers PA today to schedule a free consultation and get the experienced legal representation you deserve.

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