Long-Term Disability (ERISA) Lawyers

Helping Disabled Workers Across the Country Recover the Benefits They Paid For

A long-term disability policy is supposed to protect you if a serious illness or injury ends your ability to work. Too often, the insurance company sees it differently. Claims sit in review for months, adjusters ask for the same records again and again, and denial letters arrive with explanations that are hard to follow and harder to challenge. Meanwhile, the paychecks have stopped and the bills keep coming.

Young, Marr, Mallis & Associates represents workers nationwide in long-term disability claims under employer-sponsored ERISA plans and individually purchased policies. We help with initial applications, internal appeals after a denial, terminations of approved benefits, and federal court litigation when an insurer refuses to correct its decision. Our attorneys bring more than 25 years of disability claims experience and an 80% success rate on long-term disability cases.

If your claim has been denied, delayed, or cut off, call 215-639-5297 for a free evaluation.

About Young, Marr, Mallis & Associates

Young, Marr, Mallis & Associates is a disability benefits law firm that represents people who can no longer work because of illness or injury. Our practice includes long-term disability claims under ERISA and private policies as well as Social Security Disability, so we understand how private insurance benefits and federal benefits fit together and where they overlap. We prepare every claim with the assumption that a federal judge may eventually read the file, because under ERISA, the file is often the entire case.

Why Long-Term Disability Claims Are So Often Denied

Disability insurers are businesses, and every claim they pay reduces their bottom line. Most carriers have dedicated claims units, in-house medical reviewers, and vocational consultants whose work frequently supports a denial. Some of the most common reasons insurers give include:

• Not enough objective evidence. Insurers often discount conditions that do not show up clearly on imaging or lab work, such as fibromyalgia, chronic fatigue, migraines, long COVID, and many mental health conditions.
• Paper reviews by doctors who never met you. A carrier may rely on a physician who reviewed your records for an hour over the opinion of a treating doctor who has seen you for years.
• Preexisting condition exclusions. Many policies exclude conditions you were treated for shortly before coverage began, and insurers search medical histories closely for anything that fits.
• Surveillance and social media. A few minutes of video or a vacation photo can be presented as proof you are more capable than your records show.
• The change from “own occupation” to “any occupation.” Many policies switch definitions after 24 months, and insurers often use that moment to end benefits even though nothing about your health has improved.
• Self-reported symptom limitations. Some policies cap benefits for mental health or self-reported conditions at 24 months, and insurers sometimes apply those limits to claims that should not fall under them.

A denial is not the final word. Many denials rest on selective reading of the records, an incomplete vocational analysis, or a reviewer who ignored key evidence. Those weaknesses can be exposed with the right response.

How ERISA Changes the Rules

Most disability coverage provided through a private employer is governed by the Employee Retirement Income Security Act of 1974, a federal law that applies the same way in every state. ERISA sets out the procedures insurers must follow, and it also places real limits on what a claimant can do if the process goes wrong.

Here is what makes ERISA disability claims different from almost any other kind of legal dispute:

• The internal appeal comes first. You generally must complete the plan’s appeal process before filing suit, and federal regulations give disability claimants at least 180 days after a denial to submit that appeal.
• The appeal builds the record. In most cases, a court only looks at the evidence that was in the claim file when the insurer made its final decision. Records submitted after that point are usually not considered.
• You have the right to your claim file. The insurer must provide, free of charge, the documents and reports it relied on, including the opinions of its own medical reviewers.
• You can respond to new evidence. If the insurer develops new evidence or a new rationale during the appeal, it must give you a chance to respond before it decides.
• Courts may defer to the insurer. When a plan grants the insurer discretionary authority, a court will often uphold the decision unless it was unreasonable. Some states restrict these discretionary clauses in insured policies, which can change the standard of review.
• No jury and limited remedies. A federal judge decides the case, and recovery is generally limited to the benefits owed, though courts may also award attorney’s fees.

Put simply, an ERISA appeal is not a formality. It is usually the only real opportunity to put the evidence that wins the case in front of the decision maker.

Policies Not Governed by ERISA

Not every disability policy falls under ERISA. Policies you purchased yourself, and many plans offered by government employers and churches, are generally governed by state contract and insurance law instead. Depending on the state, that can open the door to a jury trial and to bad faith claims when an insurer unreasonably denies benefits. Identifying which rules apply is the first step we take in every case.

How We Handle Your Long-Term Disability Claim

Filing the Initial Claim

The strongest claims are built before the insurer ever makes a decision. We review your policy language and definitions of disability, calendar every deadline, collect your medical records, and work with your treating providers to document specific functional restrictions rather than diagnoses alone. The U.S. Department of Labor provides a general guide to filing a benefits claim under an employer plan, but success usually depends on how well the medical and vocational evidence fits the exact terms of your policy.

Appealing a Denied Claim

When a claim is denied, we obtain the full claim file and review every reason the insurer gave. We then build an appeal that answers each one, using updated treatment records, narrative reports from your doctors, functional capacity evaluations, vocational analysis, and a detailed legal argument. Because the appeal record is usually the record a judge will review, we prepare it as carefully as we would prepare for trial.

Restoring Terminated Benefits

Benefits that were approved can still be taken away, often after a periodic review, an insurer-arranged medical exam, or the switch to an “any occupation” standard. If your condition has not improved, we challenge the termination and pursue reinstatement of your monthly benefit along with any back benefits owed.

Federal Court Litigation

If the insurer upholds its denial on appeal, the next step is a lawsuit in federal district court. We evaluate the record, the plan terms, and the standard of review to decide how to present the case for the strongest possible result, whether that is a judgment in your favor or a negotiated resolution.

Signs You Should Speak With a Disability Attorney

• You are preparing to file a long-term disability claim and want it done right the first time
• Your claim was denied, or you were told it is “under review” with no end in sight
• Your approved benefits were reduced, suspended, or terminated
• The insurer wants you to attend a medical exam, give a recorded statement, or sign broad authorizations
• Your policy is about to switch from “own occupation” to “any occupation”
• The insurer is demanding repayment because of a Social Security Disability award

Frequently Asked Questions About Long-Term Disability Claims

How do I know if my disability policy is covered by ERISA?

If your coverage came through a private employer as part of a benefits package, it is most likely governed by ERISA. Coverage you bought on your own, and many government and church employer plans, usually are not. Your summary plan description often answers the question, and we can review your documents to confirm.

What is the deadline to appeal a long-term disability denial?

Under ERISA, you generally have at least 180 days from receiving the denial letter to file your internal appeal, and the letter should list the exact deadline. Starting early matters, because gathering medical opinions and responding to the insurer’s reviewers takes time.

How long does the insurer have to decide my appeal?

For ERISA disability claims, the insurer generally has 45 days to decide an appeal and may take one 45-day extension if it notifies you and explains why. If the insurer fails to follow the required procedures, you may be able to move forward without waiting further.

Can I file a lawsuit right after my claim is denied?

Usually not if your plan is governed by ERISA. You typically must complete the plan’s internal appeal before going to federal court, and a lawsuit filed too early may be dismissed. Many plans also set their own deadline to sue after the final appeal decision, so it is important to know that date.

Do I need a diagnosis that shows up on tests to get benefits?

Not necessarily. Many policies do not require objective proof of the diagnosis itself, and courts have recognized that some conditions cannot be measured that way. What matters most is documenting how your condition limits what you can do, through treating physician opinions, functional testing, and consistent treatment records.

Will my long-term disability benefit be reduced if I receive Social Security Disability?

Most group policies allow the insurer to offset your monthly benefit by your Social Security Disability award, and many require you to apply. If SSDI back pay is awarded, the insurer may claim a portion of it. Because we handle both kinds of claims, we can help you coordinate them and avoid surprises.

Can you help me if I live outside your local area?

Yes. Long-term disability claims and ERISA appeals are handled through written submissions to the insurer, so we can work with clients wherever they live. If litigation becomes necessary, we will explain how your case would proceed in the federal court where it would be filed.

What does it cost to hire your firm?

Your initial evaluation is free. We will review your claim, explain your options, and walk you through our fee arrangement before you decide anything.

Speak With a Long-Term Disability Lawyer

You should not have to fight an insurance company while you are fighting for your health. Whether you are getting ready to apply, responding to a denial, or trying to restore benefits that were cut off, Young, Marr, Mallis & Associates can step in and handle the claim from here. Call 215-639-5297 today for a free evaluation of your long-term disability claim.