ERISA Appeals & Denials for Disability Benefits
ERISA Disability Appeals, Explained
Why The Administrative Record Decides Your Case
Employer disability plans are governed by ERISA, which requires a
formal appeal before any lawsuit. Everything you submit during the appeal becomes your administrative record. Wooster Law builds that record with medical, vocational, and policy proof designed to win benefits or set up litigation.
Deadlines That Matter
Your Clock Is Already Ticking
Most LTD denials allow 180 days to appeal in writing. Insurers then have defined timelines to decide the appeal, with limited extensions. Miss a deadline and strong claims can fail on procedure alone.
What To Include In A Strong Appeal
Medical Proof, Vocational Evidence, And Policy Terms
Request your complete
claim file and analyze what the insurer relied on. Add treating physician opinions, objective testing, and vocational reports addressing your duties and realistic job market. Cite the policy's definitions, limits, and any own-occupation to any-occupation transition that undercuts the denial.
Common Reasons Insurers Deny
We Tackle The Usual Tactics
Carriers point to "insufficient evidence," cherry-pick
file reviews, or rely on surveillance. They downplay fatigue, pain, and cognitive limits that do not show neatly on scans. Our appeals fill the gaps with longitudinal records, third-party statements, and specialist opinions.
Standard Of Review And Why It Matters
De Novo Or Abuse Of Discretion
Your policy language can change how a judge reviews the insurer's decision. If discretion applies, you must win by showing the decision lacked a reasonable basis. That is why the administrative record must be complete before suit is filed.
Local Help Across Florida
Broward, Palm Beach, And Lake County Coverage
From our Fort Lauderdale and Boca Raton offices to Mount Dora, we serve clients across South Florida and Central Florida. We understand local providers, court procedures, and the expectations of busy professionals in Las Olas, Palm Beach Island, and the Harris Chain of Lakes communities. Discreet, responsive service is standard at Wooster Law.
From Appeal To Federal Court
If The Plan Still Says No
If the insurer upholds the denial, we prepare a lawsuit based on the closed record. We coordinate updated medical support and expert declarations consistent with ERISA rules. Our boutique approach keeps you informed while we press for benefits and, when available,
attorney fees.
ERISA Appeals FAQ
Clear Guidance For Complex Rules
How long do I have to appeal an ERISA denial?
Most plans give you 180 days from the date on the denial letter to file an appeal. Use this time to gather medical, vocational, and policy evidence. We organize, build, and file your appeal to ensure every requirement is met.
What is a claim file and how do I get it?
The claim file is the complete record the insurer used to make its decision. You have the right to request it in writing and to submit additional evidence during the appeal. We review the file for gaps, biased reviews, and missing records.
Do I need a lawyer for my ERISA appeal?
You’re not required to hire one, but the process is technical and strict. After the appeal window closes, you typically cannot add new evidence in court. An experienced ERISA team can strengthen your appeal and preserve issues for litigation.
What evidence helps most in an LTD appeal?
Strong evidence includes:
- Treating physician opinions supported by objective testing
- Functional capacity evaluations
- Vocational reports linking your limitations to your job demands
- Consistent treatment notes and third-party statements
These help establish credibility and show how your condition impacts your ability to work.
Will I have to go to court?
Many ERISA disputes resolve during the appeal stage. If not, the case is usually decided by a federal judge based solely on the written record. We build appeals as if trial were inevitable, often leading to better outcomes earlier.
Related Services
Insurance Disputes And Work-Related Injuries
If an
auto,
workplace, or premises injury triggered your disability claim, we can coordinate all related cases. That includes liability claims, uninsured motorist disputes, and
bad-faith issues when insurers stonewall. One strategy, one team, start to finish.