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How Do Individual Disability Claims Differ from ERISA Group Plans?

There are a couple of differences between a private claim and an ERISA claim.

No.1 and probably the biggest problem with ERISA is that you are not entitled to a jury trial when a claim is governed by ERISA. So, which essentially means if you don’t have the right to a jury trial that means that a judge is going to make the decision for you and it gets even more complicated than that. When the judge is asked to make a decision after a person has exhausted all his appeals, the judge has to decide as to whether the insurance company acted in an arbitrary or capricious manner. Basically, the judge is asked if the insurance company acted reasonably. For an insurance company to go ahead and act reasonably, they basically just have to have a person’s medical records reviewed, possibly speak to their doctor, it is a very low threshold for the insurance company which makes it an easy threshold for them to overcome, so that when it gets to the court and the judge is asked if the insurance company acted unreasonably, usually 8 out of 10 times the judge has to find that they acted reasonably even if he thinks that the person is disabled.

The second biggest problem with an ERISA claim is that, there are no penalties against the company. For example, if a person comes and to me who bought a policy on his own and was denied benefits, we could immediately go ahead and file a lawsuit. With the ERISA claim we have to exhaust the administrative remedies and then file a lawsuit. If the company is proved to have wrongfully and intentionally or recklessly denied their benefits, there are extra contractual penalties that can be had against this disability company. With ERISA, there are no penalties against the company. So essentially at the end of the day if you prove that the insurance company was wrong at the end of the day, you get your money and you get a sorry saying “we were wrong” but there are no remedies whatsoever. And that process, going through all the appeals, filing a lawsuit can take several years and at the end of the day the only responsibility an insurance company has is to pay you your benefits, some interest on a judgment and possibly pay your attorney’s fees.

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Mutual of Omaha

90 days and still waiting

Reviewed by Cheryl on July 26th 2025 Verified Policyholder | July 2024 date of disability

I filed for benefits in July, 2024 with an effective date of 7/30 (after the 14 day wait) and today is October 18th and my claim is still pending. They either don't want t... read more >

New York Life

NY Life Short Term Disability Team is Terrible

Reviewed by Dr. T on July 22nd 2025 Verified Policyholder | August 2024 date of disability

I am a physician and was in a high velocity rear impact car accident. The person slammed into my stopped car going almost 50mph. Was not physically or cognitively able to ... read more >

Sedgwick

Sedgwick will use the false need for discovery to deny your claim

Reviewed by Calvin on July 20th 2025 Verified Policyholder | August 2021 date of disability

Sedgwick will use the false need for discovery to deny your claim for as long as possible to wear you down because you are out of work and need the money.Lie, cheat and ... read more >

Unum

Unum does not act as a fiduciary

Reviewed by Unum is horrible on July 15th 2025 Verified Policyholder | October 2025 date of disability

I received paycheck from 2 sources at work. I was approved for LTD by Metlife within 40 days, no questions asked. I was approved by NWM which was my private own occupation... read more >

Unum

UNUM denied my LTD claim after 6 months although my health continues to decline

Reviewed by Michael B on July 12th 2025 Verified Policyholder | July 2023 date of disability

An attorney is needed to monitor an open, ongoing claim. I naively thought payments would continue. Review of medical records by a disability attorney before submission to... read more >

MetLife

Horrible STD Service. Run !!!!

Reviewed by Scott F. on July 8th 2025 Verified Policyholder | June 2025 date of disability

For the first time since I can remember my employer did not offer STD as one of my paid benefits so I’m paying for this policy. Had to file a claim on 6-14-25. Went thro... read more >

Reliance Standard

Reliance Standard cut off LTD suddenly claiming I could do sedentary work after 10 plus years… no paperwork sent to appeal

Reviewed by Autumn on July 1st 2025 Verified Policyholder | January 2015 date of disability

I’ve been on STD then LTD with Reliance since 1/2015. They sent a medical review in December 2024 to my old address which of course I never got the paperwork for. I emai... read more >

Sedgwick

Denial for benefits, Sedgwick is the worst

Reviewed by Andrea on May 22nd 2025 Verified Policyholder | June 2024 date of disability

I was not paid for 7 months on STD. My appeal was finally approved, but in the meantime I lost company match on my 401k, and then they canceled my company insurance. Out o... read more >

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Keith G.

They were very professional with their responds and on time with keeping you inform about everything with your case. I would recommend My lawyer Stephen Jessup, he was on point with everything, thank you. You guys are awesome people to work with. God bless you guys.

Keith L.

I was not able to work as a physician for about 14 months due to neck/back issues. Even though I had 3 medical doctors explicitly state that I was not to work AT ALL as a physician at that time, New York Life (NYL) Disability Insurance denied my long term disability claim (which apparently they deny a high percentage of people similar to me- only they know why they do this to so many- I have my own suspicions). I was in pain from my medical issues and so frustrated with NYL considering I had many bills coming due. I then decided to call Dell Disability Lawyers. One of their attorneys, Alex Palamara, spoke to me on the phone right then to hear and understand my story and then offer ways he could help. Long story short, within a few months of me returning back to work, he was able to persuade NYL to pay me my long term disability claim. He (and his kind assistant, Tabitha) were always very helpful, informative, and available to me. I feel quite certain that NYL would NEVER have paid me what was appropriate based on my insurance agreement/ contract with them without the help of Alex. I highly recommend him/Dell Disability Lawyers. If you find yourself in a similar situation of disability insurance denial of your own personal/group policy, especially if you are a medical provider/physician like me, then consider contacting them for advice/direction PRIOR to appealing your claim on your own.

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Jay Symonds and his assistant, Sonia helped me tremendously. The insurance company that worked for my former employer did everything they could to make my life literally miserable. That all changed when I hired Jay. He and Sonia fought for my rights and forced the insurance company to pay what they should have.

If you have a disability claim hire Jay as if you go it alone the insurance company will screw you. Jay and Sonia will fight for everything you are entitled for. I couldn’t recommend them more highly.

Frank R.

I cannot say enough positive things about my experience with Dell Disability Lawyers. Attorney Stephen Jessup and Amanda offered an opportunity to provide clarity on a complex issue regarding my disability claim. Mr. Jessup offered advice on an offset to my claim after my insurance company asked for additional information from Social Security. With counsel from Mr. Jessup, I was able to address the outstanding issue with the Social Security office and provide my insurance company with the required documentation to address their concerns. Mr. Jessup always responded in a timely manner with expert advice and offered the opportunity for follow up. I strongly recommend Dell Disability Lawyers to those seeking legal counsel for disability matters.

Wesley D.

I have been able to help others as a soldier, a police officer, and a pharmacist. I needed help forcing the insurance company to keep their commitment to take care of me and my family. I called Dell. Alex, Tabitha, and their entire team were very compassionate, extremely patient, and extraordinarily knowledgeable. Many thanks Dell!

Samar A.

My husband had applied for Long Term Disability and was denied. We sought out Rachel Alters at Dell Disability Lawyers to help us with our appeal. Rachel and her team were so diligent and meticulous in every aspect of the process. The process was seamless, and we never had any doubts that she would get it done and that she did! We are forever grateful to Rachel and Catherine for all of their determination and tenacity to get us the outcome we needed and deserved.

We could not recommend better representation and are indebted to them for making us whole again. Thank you so much Rachel and team!

Jam

Alex Palamara is one of The Best lawyers in the world and Dell Disability Lawyers are the Best by Far. Alex and his Assistant Tabitha helped me get the compensation I needed for a Horrific Disabling heath condition I’ve been dealing with for over a year. Alex and his team were so professional and caring. They treated me like I was there own family. Alex Knowledge, Expertise and skills as a Lawyer is among the Best of the Best in his field and I would HIGHLY recommend that if you ever have any issues with any Insurance Company over your Disability issues, please don’t hesitate to seek out Dell Disability and Alex Palamara. They truly are Amazing and caring. Thank God for them. Outstanding Job Alex and Tabitha

G.T.

9 years ago when I had to apply for disability benefits from my private disability policy the insurance company ignored my inquiries until Dell and Schaefer represented me and I have received the benefits without interruption til my policy expired at age 65. I have appreciated not having to deal directly with the insurance company and having attorney Greg Dell and assistant Danielle Lauria handle all communications which included monthly progress reports. I thank them for their efforts on my behalf and highly recommend them to all those in need of disability benefits.

Misty A.

I’m so thankful I chose to reach out to the attorneys at Dell. They have always been quick to respond to any and all questions I have had. The anxiety I had while dealing with Lincoln Financial on my own has decreased immensely since Alex and Danielle took my case. They were able to get my LTD denial reversed and I am so very grateful!

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