Pennsylvania Long-Term Disability (ERISA) Lawyers

Serving Philadelphia, Bucks, Montgomery, Delaware, Chester, Lehigh, Northampton & Dauphin Counties, PA, and Burlington, Mercer & Middlesex Counties, NJ

When an injury or illness keeps you from working, your long-term disability policy may be the one thing standing between your family and serious financial strain. You paid for that protection, either directly or through your job, and you should be able to count on it. Instead, many Pennsylvania workers find themselves fighting an insurance company that delays, demands more paperwork, or denies the claim outright, all while they are trying to recover and keep up with medical bills.

You do not have to deal with that alone. A long-term disability lawyer at Young, Marr, Mallis & Associates can take the claim off your shoulders so you can focus on your health. We help Pennsylvania workers apply for benefits, appeal denials, and fight wrongful terminations of benefits under both employer-sponsored ERISA plans and individual disability policies.

Our attorneys have more than 25 years of experience with disability claims and an 80% success rate on long-term disability cases, well above the industry standard. If your claim is pending, has been denied, or has been cut off, call us at 215-639-5297 for a free evaluation.

About Young, Marr, Mallis & Associates

Young, Marr, Mallis & Associates is a Pennsylvania and New Jersey law firm that represents individuals in disability, bankruptcy, and criminal defense matters. Our disability practice covers long-term disability claims under ERISA and private policies as well as Social Security Disability, which gives us a full view of how the different benefit systems interact for someone who can no longer work. We take on insurance companies on behalf of injured and ill workers, and we build every claim with the expectation that it may one day be reviewed by a federal judge.

What Is Long-Term Disability Insurance?

Long-term disability insurance replaces part of your income if an illness or injury keeps you from working for an extended period. Most policies pay roughly 50% to 70% of your pre-disability earnings, and coverage usually begins after a waiting period or after short-term disability benefits run out, often around 26 weeks.

Long-term disability coverage matters because other programs leave gaps. Workers’ compensation only applies to injuries and illnesses that happen on the job, so a cancer diagnosis, heart condition, or off-the-job accident will not be covered there. Social Security Disability has its own strict standards and a long wait. For many people, a long-term disability policy is the fastest and most substantial source of income replacement available.

Coverage generally comes in one of two forms:

• Employer-sponsored group coverage, offered as part of a benefits package, with premiums paid by the employer, the employee, or both.
• Individual policies, purchased directly from an insurance carrier or through an agent.

One of the first questions we ask is which type you have, because it controls which laws apply and how your case will proceed.

ERISA Long-Term Disability Plans

If your coverage came through your employer, your plan is most likely governed by the Employee Retirement Income Security Act of 1974 (ERISA), a federal law. That means your claim is not treated like an ordinary contract dispute between you and an insurer. It follows a specific set of federal rules, and those rules tend to favor the insurance company unless the claim is handled carefully from the start.

Several features of ERISA make these cases different:

• You must appeal internally first. Before you can file a lawsuit, you generally have to complete the plan’s own appeal process. For disability claims, federal regulations give you at least 180 days from a denial to submit that appeal, and missing the deadline can end the claim.
• The record usually closes at the appeal. In most ERISA cases, a court reviews only the evidence that was in the claim file when the insurer made its final decision. Medical records, physician opinions, and other proof that are not submitted during the claim or appeal may never be considered.
• Courts may defer to the insurer. When a plan gives the insurer discretion to decide claims, a court will often uphold a denial unless it was unreasonable. That makes it far harder to overturn a denial after the fact.
• There is no jury. ERISA disability cases are decided by a federal judge, and the remedies available are generally limited to the benefits owed.

Because of these rules, even small mistakes during the claims process can permanently derail benefits. The appeal is often your best and last real chance to build the record that wins your case.

Individual Disability Policies

If you bought your policy on your own, it is usually not governed by ERISA. Instead, your claim is handled under Pennsylvania contract and insurance law, which can allow additional remedies, including claims for bad faith when an insurer unreasonably denies benefits. Knowing which framework applies shapes the entire strategy, which is why we review your policy documents before anything else.

How Insurance Companies Deny Disability Claims

Insurance carriers save money every time they avoid paying a claim, and many have well-developed methods for finding reasons to deny or terminate benefits. Common tactics include:

• Digging into your medical history to argue that your condition was preexisting;
• Hiring investigators to gather surveillance video or photos, or reviewing your social media, to suggest you are more capable than you claim;
• Sending you to physicians they select, whose reports tend to favor the carrier;
• Relying on file reviews by doctors who never examined you;
• Claiming there is not enough “objective” medical evidence, especially for conditions like chronic pain, fatigue, or mental health disorders; and
• Terminating benefits when the policy’s definition of disability changes, often from being unable to perform your own occupation to being unable to perform any occupation, which commonly happens after 24 months.

Insurers are only required to give modest justification for a decision, so a denial letter may seem final even when the claim is strong. An experienced attorney can spot the weaknesses in the carrier’s reasoning and respond with the right evidence.

How Our Long-Term Disability Attorneys Help

We get involved at whatever stage you need us, and the earlier we start, the more we can do to protect the claim.

Building a Strong Initial Claim

A well-prepared application can prevent the need for an appeal altogether. We review your policy and plan documents, track every deadline, gather and organize your medical records, work with your treating physicians to document your restrictions, and present a claim that clearly shows why you cannot work. The U.S. Department of Labor offers an overview of the benefit claims process under ERISA plans, but the details of your plan and your medical evidence are where claims are won or lost.

Appealing a Denial

Even carefully assembled claims are sometimes denied. If that happens, we request the complete claim file, identify exactly why the insurer denied benefits, and build an appeal that answers each reason with medical evidence, expert opinions, vocational evidence, and written argument. Because the appeal record is often the only record a court will see, we treat the appeal as if it were the trial.

Litigation in Federal Court

If the insurer upholds its denial, we can take your case to federal court. Pennsylvania ERISA cases are heard in the Eastern, Middle, and Western Districts of Pennsylvania, with appeals to the Third Circuit. We know how judges in these courts review disability denials and what it takes to show that an insurer got it wrong.

Wrongfully Terminated Benefits

Insurers sometimes approve a claim and later cut it off, often after a periodic review or a change in the policy’s definition of disability. If your benefits were stopped even though your condition has not improved, we can challenge the termination and work to restore your monthly payments and any back benefits owed.

When to Call Us

• You have been injured or ill for an extended period and are preparing to apply for long-term disability benefits
• Your claim for long-term disability benefits was denied
• Your long-term disability benefits were reduced or terminated
• The insurer is requesting an independent medical exam, a recorded statement, or more records and you are unsure how to respond
• You have questions about your coverage or your rights under your employer’s plan

Frequently Asked Questions About Pennsylvania Long-Term Disability Claims

Is my long-term disability policy governed by ERISA?

If you received your coverage through a private employer’s benefits package, it is very likely governed by ERISA. Plans offered by government employers and churches are usually exempt, and policies you purchased on your own are generally governed by Pennsylvania law instead. We can review your documents and tell you which rules apply.

How long do I have to appeal a long-term disability denial?

For ERISA disability claims, you generally have at least 180 days from the date you receive the denial letter to file an internal appeal. Your denial letter should state the exact deadline. Because the appeal is often your only chance to add evidence to the record, it is best to contact an attorney well before that deadline.

Can I sue my insurance company right away after a denial?

Usually not under an ERISA plan. You generally must complete the plan’s internal appeal process before filing a lawsuit in federal court. Skipping that step can result in your case being dismissed.

What is the difference between “own occupation” and “any occupation”?

Many policies first define disability as being unable to perform the duties of your own job. After a set period, often 24 months, the definition changes to being unable to perform any job you are reasonably suited for based on your education, training, and experience. Insurers frequently terminate benefits at this transition, so it is important to prepare for it in advance.

Will Social Security Disability benefits reduce my long-term disability payments?

Many long-term disability policies allow the insurer to offset your monthly benefit by the amount you receive from Social Security Disability, and some require you to apply for Social Security. Because our firm handles both types of claims, we can help you coordinate them so you understand how each one affects the other.

How much does it cost to hire a long-term disability lawyer?

We offer a free evaluation of your claim. During that consultation, we will review your situation and explain how our fees work before you make any decision.

Talk to a Pennsylvania Long-Term Disability Lawyer Today

The months after a disabling injury or a serious diagnosis can be filled with uncertainty, and an insurance company’s denial can make an already difficult time feel overwhelming. Whether you are just starting a claim, facing a denial, or dealing with benefits that were cut off, Young, Marr, Mallis & Associates is ready to help you pursue the benefits you are owed. Contact a long-term disability lawyer at our firm at 215-639-5297 for a free evaluation of your claim.