Long-term disability benefits can be a financial lifeline when illness or injury prevents you from working. So what are your options when your employer denies your claim? You might be surprised to learn that you have legal grounds to fight back.
Our friends at The Law Office of Bennett M. Cohen help people through these situations regularly. An ERISA disability lawyer can review your case and explain what rights you have.
Understanding ERISA and Employer-Sponsored Disability Plans
Most employer-provided long-term disability plans fall under the Employee Retirement Income Security Act of 1974, or ERISA. This federal law sets the rules for how employers manage benefit plans and handle disputes when they arise. ERISA requires you to follow specific procedures before filing a lawsuit. You can’t just sue your employer the moment they deny your claim. The law makes you exhaust your administrative remedies first. That means going through your plan’s internal appeals process.
When You Can Sue for Denied Benefits
Legal action becomes an option under certain circumstances. You may have grounds to sue your employer or the insurance company handling the plan if:
- They denied your claim without properly reviewing your medical evidence
- The denial contradicts what your treating physicians documented
- The plan administrator didn’t follow ERISA procedures
- You’ve finished all required internal appeals
- The denial seems based on a conflict of interest
Plan administrators must provide clear reasons for denials and let claimants appeal their decisions, according to the U.S. Department of Labor. When they don’t follow these rules, you have recourse.
The Administrative Appeals Process
ERISA won’t let you skip straight to court. You need to complete your plan’s appeals process first. This usually involves several steps:
- Filing a written appeal within the timeframe your plan documents specify (typically 180 days)
- Submitting additional medical evidence that supports your disability
- Requesting full access to review your claim file
- Waiting for a final decision from the plan administrator
The process can drag on for months. But finishing it properly strengthens your position if litigation becomes necessary.
Time Limits for Filing a Lawsuit
ERISA doesn’t set a specific statute of limitations for disability benefit lawsuits. Courts instead apply whatever contractual limitations period appears in your plan documents. Most plans set these periods somewhere between one and three years from the date of final denial. Missing this deadline can permanently destroy your claim. It won’t matter how strong your case is.
What Damages You Can Recover
ERISA puts strict limits on what you can recover in a disability benefits lawsuit. The available damages typically include:
- Past-due benefits starting from your disability date
- Future benefits if your disability continues
- Attorney’s fees and court costs (though courts decide this at their discretion)
Don’t expect punitive damages or money for emotional distress. ERISA generally doesn’t allow those. The focus stays on getting you the benefits your plan promised.
Building a Strong Case
Solid medical documentation forms the backbone of any successful disability benefits lawsuit. You’ll need detailed records from your treating physicians that clearly explain how your condition prevents you from working. Your case gets stronger when multiple healthcare providers agree on your limitations. The insurance company might arrange independent medical examinations that contradict your doctors. But consistent evidence from your treatment team carries real weight in these disputes.
Getting Legal Help
Dealing with a disability benefit denial is tough enough when you’re already managing health problems. ERISA regulations are complex. Understanding your rights and the procedures for challenging denials takes experience. Don’t assume you’re out of options if your employer denied your long-term disability claim. Reach out to an attorney who handles ERISA disability cases. They can review what happened and talk through your potential next steps.