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What Must I Do If My ERISA Disability Claim Is Denied?

If your ERISA governed long-term disability claim has been denied following your initial application for disability benefits, ERISA regulations require the insurance company to establish and maintain a procedure by which a claimant shall have a reasonable opportunity to appeal an adverse benefit determination to an appropriate named fiduciary of the plan, and under which there will be a full and fair review of the claim and the adverse benefit determination.

Your disability plan will provide language as to whether or not you must file one or two appeals, before you can file a lawsuit. The insurance company is required to maintain an internal appeal review process so that the insurance company employee reviewing each appeal is completely independent of the employee that originally denied your claim. The idea is that a claimant is supposed to receive a full and fair review by the insurance company when an appeal is filed.

The terms of your long-term disability plan will specify the number of Appeals that are required and the total number of Appeals that a claimant may file. An insurance company can not require the filing of more than two appeals. The information submitted in an ERISA disability Appeal is extremely important, as all of the documents submitted become part of what is known as the “administrative record”. In the event that your ERISA appeal(s) are denied and a lawsuit is filed, the court in most cases will be limited to their review of the administrative record. ERISA does not allow for a jury trial, therefore if a lawsuit is filed it will be decided by a Judge.

A non-jury ERISA trial is usually a disadvantage for a claimant, because the Judge does not get to hear live testimony and the Judge is basically just reviewing documents. When submitting an Appeal it is essential that a claimant submits every piece of information in support of a claim for disability benefits that the claimant would want a Judge to consider. Attorneys Dell & Schaefer prepare all of our client’s appeals in anticipation that a lawsuit may be filed if the Appeal is denied.

In order to present our client’s appeal in a light most favorable to the insured, Attorney’s Dell & Schaefer work very closely with our clients and their treating physicians, to ensure that the appeals are submitted with an overwhelming amount of information and detail. In most disability appeals, Attorney’s Dell & Schaefer will retain a vocational expert in order to determine what vocational skills a claimant can perform in light of the claimant’s medical restrictions and limitations. The vocational expert will also perform a labor market study in order to determine the availability of specific jobs in a particular market. In some cases, Attorneys Dell & Schaefer will retain a medical doctor to review all of our client’s medical records and make recommendations regarding additional evidence that would strengthen our client’s claim.

ERISA provides extremely strict guidelines and deadlines for disabled claimants seeking disability insurance benefits under their group policies. If sufficient information is not submitted within these timelines, a claimant may be forever barred from introducing the documentation to prove their disability. The disability insurance company is required to give a claimant 180 days from the date of initial denial to submit a first appeal. While 180 days seems like a long time to prepare a disability appeal, most of this time is required to submit an appropriate appeal. The appeal process is timely because it often takes time to receive all of the claimant’s medical records and to review the entire claim file provided by the disability insurance company.

Additionally, if a claimant undergoes additional medical treatment or diagnostic testing during the 180 days, it will generally improve the claimant’s chances of winning an Appeal by providing this new medical information. The disability insurance company has 45 days to respond to a claimant’s Appeal, however they may request an extension for good cause. Attorneys Dell & Schaefer understand the importance of trying to obtain benefits for our clients in an expedient and efficient manner.

Frustrating as it may seem, the disability carrier will not tell you what is necessary to perfect your claim. Moreover, group disability income policies are drafted with ambiguous and confusing contractual terms. These ambiguities provide insurance companies with multiple reasons for delaying and denying disability income benefits. Furthermore, most policies provide the insurance company with full discretion in deciding whether sufficient information has been provided by claimants prior to approving a claim. Given the complexity of the legal issues involved and the tendency of insurance companies to vigorously defend claim denials, evaluation of any potential legal claim on behalf of an insured should be handled by a law firm experienced in ERISA disability insurance claims.

Attorneys Dell & Schaefer are available to provide you with a free consultation and review of your long-term disability policy. Please keep in mind that there are time deadlines with ERISA disability claims and we must have sufficient time to evaluate your claim and take the appropriate legal actions on your behalf.

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Disability Company Reviews

(650)

Showing 8 of 650 Reviews

MetLife

MetLife for disability? Avoid the surgery unless it's life-threatening

Reviewed by Jeff on August 22nd 2024 Verified Policyholder | August 2024 date of disability

The worst company I ever dealt with, never received a call from my claim manager.

Reliance Standard

Short Term Disability Claim/Inconsistent to NO Communication

Reviewed by GaKRN on August 22nd 2024 Verified Policyholder | June 2024 date of disability

When I did call & reach a live person they were kind & helpful. The person assigned to my claim left one phone message & I have not spoken to her since. Information she re... read more >

Unum

Unum Closed My Case Today

Reviewed by Scott C. on July 5th 2024 Verified Policyholder | March 2023 date of disability

Unum will keep you around, if they pay you 100 a month. But as soon as have to pay more than 2700 a month, they will drop you. We will be going to the attorneys office fir... read more >

Hartford

Ran me Around for Months

Reviewed by David on July 5th 2024 Verified Policyholder | January 2024 date of disability

Scammers. Immoral horrible people.

Reply

Sent on July 5th 2024 by Attorney Gregory Dell

David:

It’s horrible that Hartford did that to you.

Prudential

Denied but Not Denied but I am Denied

Reviewed by KDDK on July 5th 2024 Verified Policyholder | August 2022 date of disability

I went out in Aug. 2022 for neck pain. After seeing a neurologist I had to get an ACDF C5-7, it was also determined I had carpal tunnel in my right hand and bulging disk i... read more >

New York Life

Claiming They Are Not Receiving Paperwork

Reviewed by Macey on June 26th 2024 Verified Policyholder | February 2024 date of disability

After suffering from medical issues from my delivery in February, I had to have a colostomy bag placed. Now New York Life is trying to claim my condition was pre-existing ... read more >

Hartford

Truly Horrible and Immoral Company with No Customer Service

Reviewed by William M. on June 26th 2024 Verified Policyholder | June 2020 date of disability

My experiences with Hartford have been nothing short of cruel. They started off by claiming that having Glioblastoma, which has an expected life span of about fifteen mont... read more >

Hartford

Sent my Direct Deposit to a Strangers Bank Acct

Reviewed by Brad on May 2nd 2024 Verified Policyholder | February 2024 date of disability

I went on short term disability and The Hartford put my direct deposit into someone else’s bank account. Somehow they messed up a number or two and they are refusing to ... read more >

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Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak

If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >

Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company

When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >

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How Do You Fight a Long-Term Disability Denial?

Getting a denial letter from your disability insurance company is one of the ultimate insults. You are sick and not able to work, yet your disability insurance company is telling you to return to work. The disability insurance company has denied your disability benefit claim and is basically calling you a liar. When receiving a disability denial letter or a ph... Read More >

Disability Denial Reason #2 - Change of Disability Definition & Vocational Review

One of the top reasons for terminating a claimant's long term disability benefits involves the change in the disability insurance policy's definition of "disability." This definition change often happens in conjunction with a vocational review, or an analysis of a claimant's medical records that tells the insurance company which jobs the claimant should be able ... Read More >

Disability Denial Reason #1 – Paper Review & IME

At Dell Disability Lawyers, we've seen insurance companies give countless reasons to deny long term disability benefits. However, most disability benefit denials tend to fall into one of a few categories - and one of the biggest ones is the paper review and independent medical exam (IME). Learn more about what this review process entails and what your claim file... Read More >

How to Apply for Reliance Standard Disability Benefits & Top 5 Reasons for a Claim Denial

At Dell & Schaefer we’ve handled hundreds of long term disability insurance claims against Reliance Standard, and have learned a few things in the process. When you’re experiencing an injury or illness that makes it difficult (or impossible) to work, it can be tempting to file a claim as quickly as possible – but unless a claimant has all their ducks in a row, this could actually delay the ultimate r... Read More >

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Showing 8 of 375 Dell Disability Cases

Seven Surgeries and The Standard Still Denies Disability Insurance Benefits

Our client was employed with the State of Oregon as a Technical Support Representative. She sought disability through her employer provider LTD Policy with Standard due to low back, hip, and lower extremity pain. She had two hip, two knee and three back surgeries.After paying her for 1.5 years Standard hired a board-certified neurologist to perform a review ... Read More >

Sun Life Wrongfully Denies Disability After Paying For 23 Months

We represent a 57 year-old claimant who’s occupation was selling commercial vehicles for many years. Her job was very physical as it required her to climb in and out of semi-trucks multiple times a day as well as operate them which was very strenuous. She went out of work in due to ongoing and severe debilitating right hip, low back, and bilateral knee pain... Read More >

Nurse Denied Long-term Disability Benefits by Lincoln After the Definition of Disability Changed

Our client, a registered nurse for Dignity Health, found herself in a difficult situation after being diagnosed with lumbar spondylosis and left knee arthritis. She continued to work, however, struggled while attempting to work through chronic lower back pain and left lower extremity radicular symptoms on a daily basis. Sadly, her condition failed to improve and... Read More >

Lincoln Reverses Decision to Terminate LTD Benefits of Corporate Attorney after Dell Disability Lawyers Appeals the Decision

The claimant is an 64 year old former Corporate Attorney and at a prominent Florida business law firm who was forced to cease working in his highly successful and rewarding profession, job, and career on January 27, 2021, and to seek disability compensation under his policies with Lincoln due to severe symptomatology stemming from or following a viral COVID-19 i... Read More >

Transportation Manager with Brain Injury Wins Unum Disability Benefit Appeal

Unum unjustly terminated our client’s disability insurance claim after it had approved and accepted liability for six months. Unum unreasonably concluded, without any evidence of improvement, that the claimant had resumed the sustained work capacity to perform the material and substantial duties of her high level occupation as a Transportation Division Manage... Read More >

Prudential reverses decision to terminate LTD benefits of MRI Tech with Primary Progressive Multiple Sclerosis and degenerative Disc Disease

The claimant is a 58-year-old former MRI Technologist for Fairview Health Services who has long suffered from the debilitating effects of her chronic medical conditions. She has a history of neck pain as well as right arm pain and numbness dating back to 2005 with a reoccurrence of severe symptomatology in 2013. MRI of her cervical spine performed in August of ... Read More >

Engineer With Depression Wins Prudential LTD Appeal

The claimant is a former Senior Technology Services Engineer for Accolade, Inc. who was forced to cease working on May 25, 2021 and to apply for disability insurance benefits under his policy with Prudential because of severe symptomatology related to depression and anxiety. Prudential initially approved his claim for LTD benefits as his symptoms were demonstrat... Read More >

New York Life Approves Disability Benefits for School Teacher With Multiple Sclerosis

Our client, a former elementary school teacher suffering from Multiple Sclerosis, contacted our office after New York Life terminated her claim for short term disability benefits and spoke with Attorney Stephen Jessup. New York Life had initially approved her claim for short term disability benefits, but in doing so awarded benefits only on account of a mental health condition, even though our client had filed... Read More >

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Reliance Standard Disability Denial Upheld Due to Claimant's Lack of Strong Medical Record Support

In the case of Amy Wright v. Reliance Standard Life Insurance Company (Reliance), Plaintiff was the vice-president of health information services at Integrity Health Care when she stopped working on August 7, 2017. She brought claims for benefits under an LTD insurance policy and a waiver of premiums under a life insurance policy.In order to be approved for LTD benefits, Plaintiff ... Read More >

Unum Wrongfully Terminated Disabled Lawyer’s Disability Claim of Depression and Anxiety Despite Improvement in His Condition

This Unum lawsuit and appeal in federal court is a great victory for all Unum disability claimants. This case supports all claimants that are disabled and claim that they cannot return to work as the requirements of their job will aggravate their symptoms and make them unable to work.Mark was a personal injury litigation attorney, when he began struggling with symptoms of... Read More >

Federal Court Overturns Aetna Denial Of Disability Benefits

In the recent case of Ferrin v. Aetna Life Ins. Co. a federal judge from the Northern District of Illinois determined that Aetna improperly terminated Ferrin’s claim for long term disability benefits and ordered Aetna to reinstate Ferrin’s claim and pay all past due benefits with interest. Prior to filing for long term disability Ferrin was an employee of Southwest Airlines. In 2008, while at work, she suf... Read More >

Court Finds Irregularities in Procter & Gamble Disability Insurance Benefit Denial

In ERISA cases filed in a district court asking for judicial review of a plan administrator's denial of benefits, the court is generally limited to considering only the administrative record that was before the plan administrator. The case of Robert Stallings v. The Proctor & Gamble Disability, Committee, et al., is an example of how plaintiffs with cases filed in a District Court that is under the jurisdi... Read More >

Federal Judge Makes Companion Life Insurance Pay Disability Benefits

Companion Life tried to play games and deny disability insurance benefits, but thankfully a New Mexico Federal Judge made them pay disability benefits and attorney fees. The Plaintiff, Mr. Paul Chandhok, was recently awarded disability benefits in a decision by The United States District Court for the District of New Mexico, in a case decided on August 13, 2021. What makes this decision important for plaintif... Read More >

NFL Disability Review Board Ignores Evidence of Disability and Appeal Court Reverses Lower Court Decision

In Darren Mickell v. Bert Bell/Pete Rozelle NFL Players Retirement Plan (Plan), Mickell spent nine years in the NFL as a defensive end. He was repeatedly subjected to high speed contact hits which caused multiple orthopedic injuries to his “back, ribs, shoulders, arms, hands, knees, hips, legs, and feet." He had multiple orthopedic surgeries. Mickell also sustained multiple blows to his head t... Read More >

Judge Agrees that MetLife's Denial of Long Term Disability Benefits was Reasonable

In Anne Ehlert v. Metropolitan Life Insurance Company (MetLife), Ehlert was a consulting pension actuary for pension plans at Towers Watson. Her first day of work with Towers was September 8, 2003. Her last day of work was December 23, 2015. In August 2016, she applied for long-term disability (LTD) benefits under her employer’s disability insurance benefit plan which was administered by MetLife.In thi... Read More >

Can Standard Insurance Company’s Failure to Raise an Issue be Considered a Waiver?

The case of Jose Chavez v. Standard Insurance Company has quite a history with the United States District Court for the Northern District of Texas, Dallas Division. It began in September 2016 when Standard first began paying long-term disability benefits to Chavez. He had several operations on his wrist and was no longer able to perform the duties of his own occupation.Standard terminated his ben... Read More >

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Reviews from Our Clients

S.S.

I am a physician in my 30s who was practicing in my hospital based medical specialty until my Multiple Sclerosis diagnosis began to severely limit my physical ability to work.

My husband and I were obviously in distress at these very unwanted life changes and frankly overwhelmed with the possibility of a long and traumatizing legal battle ahead of us. We knew we were legally entitled to benefits through the separate private individual and employer based ERISA disability insurance policies we had, but even cursory research and discussion with colleagues made it clear that insurance companies will strategize with their own legal teams to find ways to not pay out benefits. We found many before us who had fallen unwittingly into legal pitfalls that prevented them from ultimately obtaining benefits. We realized we needed to seek legal counseling.

We found Dell Disability Firm through their youtube channel where their associates have videos discussing the legal intricacies and latest developments in private disability law. I was impressed by their dedication to the field and reached out through their website to request a free consultation.

We were delighted to hear that Mr. Steven Dell himself would be willing to take our case and felt assured that we would be represented by the best of the best.

We have not been disappointed in our expectation and have, in fact, been consistently very impressed. Steven Dell is clearly both knowledgeable and wise about dealing with these issues but more importantly, has shown kindness and impeccable honesty at each step of the way.

Merlin has demonstrated a very high capacity for organizing and handling the endless myriad of documents and communications between us and the insurance companies. She has also been very compassionate, accessible and forthcoming in dealing with our many anxiety fueled emails and telephone calls to her and we are very grateful for her involvement.

For over 7 months, we have been working closely with Steven Dell and Merlin Bryan from Dell Disability Lawyers as they have guided us through the process of review and initial application for benefits from our two insurance policies (Hartford and Ameritas).

We are happy to announce we just received approval of claim from the Hartford insurance company.

At this time we are still working with this firm as we await the final decisions from Ameritas policy that we are hopeful will have a similar outcome.

As anyone with a chronic and progressive illness can tell you, time becomes a very precious commodity. Through their representation, Dell Disability Associates has allowed us to focus the majority of our time enjoying the time and function I have left while resting assured that our disability case laid in competent and caring hands.

The truth is that no amount of money can make up for what we have lost, but it is a huge comfort to have a team like Dell Disability Lawyers at our sides to help us ensure we will be able to continue to care for ourselves and our families.

We highly recommend Dell Disability Lawyers, Mr. Steven Dell and Ms. Merlin Bryan to handle your disability insurance claim.

Thank you Steven, thank you Merlin!

We will certainly plan on leaving another review for completeness once we have our final decision from Ameritas.

Paula B.

I have been working with Dell Disability Lawyers for the past 5 years concerning my disability as it pertained to my employer. I have been more than pleased with them the entire time. They have always kept me informed of any paperwork needing completed or any changes coming ahead. Nothing has been a surprise. I would recommend them to you to help with your disability case if you’re trying to dip into the policy you’ve been paying for.

Michael M.

I am a physician who has been disabled for over 10 years. During this time I have been represented by Cesar Gavidia and his assistant Danielle Lauria. Their representation on my behalf has allowed me to concentrate on dealing with my disability/disease process and all associated complications and not having to deal with all the things that are necessary in a disability claim. Based on my personal experience from many years of practicing medicine I would consider their work product, insight and effort in the disability claim procedures to be superior. I would recommnend them, which I have done, with my highest level of confidence. In short, you well served with this practice.

Dan P.

I had to retire from my career due to a bad back that restricted me from performing my duties. I had LTD insurance and after a few years of receiving monthly benefits from this insurance company, they notified me that my benefits were terminated stating that I don’t qualify due to my duties not fitting into some “national job description” and a nurse had deemed me eligible to go back to work. Its a crushing feeling to have this told to you over the phone with hardly any information given. Luckily, I came across Dell Disability Lawyers and spoke with Attorney Palamara who calmed me down and stated they would take my case. Within a couple of months my benefits were restored, and I had piece of mind. I cannot thank Attorney Palamara and the staff enough at Dell Disability for their professionalism, no nonsense approach, personal and timely communication and quick ability to litigate my case.

Jen S.

I wanted to thank Mr. Symonds and his legal assistant Sonia for their professionalism, guidance and dedication towards my LTD claim. Going through the denial process on my own was going to get me sicker and knew it was time for help right away. I reached out to Dell Disability Lawyers for assistance and not too long after my call, I was connected with Sonia – Soon after that, I was talking about my case with Mr. Symonds. After a long and tedious process with the LTD insurer, we won the case. The wait can absolutely be lengthy, but in the end, it was all very much worth the fight. Thank you both so much for all that you have done for me! I also want to thank those who assisted in keeping me updated, as needed. Highly recommended for anyone who is going through the brutal process of an LTD denial.

Carl G.

I would like to thank Dell Disability Lawyers for taking care of my case and help me get the insurance coverage that I was rightfully in need of. Specially, I would like to thank Lawyer Alexander Palamara and RIGHT-HAND legal assistant, Sonia Nogueira, who made this process less stressful. They answered all my questions and kept me informed every step of the way.

Don’t get me wrong. They never promised or told me that I was going to win my case, as no one can guarantee that for you. What they did do, was letting me know that they were working hard for me and to keep positive. Something that I recommend everyone to do is to subscribe to their YouTube channel. That will give you an idea on how they operate and why they (for most of their cases) win their cases.

Since I was awarded disability, I am still having surgeries and thanks to Dell Lawyers, I’ve been able to cover all those expenses.

Warm regards to everyone at Dell.

Clarisa B.

I’m so very Grateful and Thankful for the team at Dell. They worked tirelessly to get the best outcome for me. I’m so glad that I found them!!

Carole S.

Exceptional efficient and professional service from Jay Symonds and Sonia Nogueira. They were both so helpful and knowledgeable and navigated me through a very stressful and difficult situation with New York Life.

K. S.

Awesome team. Jay and his team, Sonia and Francesca, truly care. This team is very Professional and quick to respond. Jay always provided answers in detail to my questions. I strongly recommend Jay Symonds.

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