When You Can’t Work, Your Income Shouldn’t Disappear.
A serious illness, injury, or medical condition can change your life in an instant. Long-Term Disability benefits are designed to help protect your income when you’re unable to work, but obtaining those benefits isn’t always easy. For more than 93 years, The Disability Guys have helped workers understand their rights, navigate complex disability claims, and move forward with confidence.
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Your policy made a promise. We make sure they keep it.
You paid for these benefits. You should understand your rights.
Many people are surprised to learn how difficult it can be to obtain Long-Term Disability benefits — even when a claim is medically sound. Claims are often delayed. Insurers request additional documentation. Benefits are reduced or denied outright.
You may have a claim if a medical condition — a neurological disorder, cancer, a heart condition, a musculoskeletal injury, chronic pain, a mental health condition, or an autoimmune disorder — prevents you from performing the duties of your job. Every situation is different, but the best way to understand your options is to speak with someone who understands how these policies actually work.
Many valid claims are denied for reasons that have little to do with the severity of the condition: insufficient documentation, missed deadlines, disputes over your ability to work, administrative errors, or a routine insurer review timed to the point your policy shifts from “own occupation” to “any occupation.” If your coverage came through an employer, the federal ERISA law governs your claim and strictly limits your options — understanding that framework early changes what is possible later.
Many people come to us simply because they want to understand their rights, their options, and what to do next. If you’re struggling to obtain the benefits you’ve earned, we’re here to help.
Answers on the issues that decide LTD claims
Long-Term Disability and ERISA cases turn on specific, often technical issues. Here is where to start.
Understanding Your LTD Policy
ERISA vs. non-ERISA, own-occ vs. any-occ, exclusions, and offsets — know what your policy actually promises before you file.
Read moreLTD Denials and Appeals
You have 180 days under ERISA to appeal a denial. What you submit becomes your entire case — get it right the first time.
Read moreThe 24-Month Cliff
Most policies shift from “own occupation” to “any occupation” at month 24. Prepare before the cliff, not after.
Read moreIndependent Medical Exams
Insurer-ordered medical exams are not neutral. Know what to expect and how to prepare before you walk in.
Read moreSurveillance and Social Media
Assume you’re being watched. A photo taken on a good day can become the centerpiece of a termination letter.
Read moreERISA Federal Court
When the appeal fails, ERISA litigation moves to federal court — no jury, a closed record, and a deferential standard.
Read moreConditions Covered Under LTD
Cardiac, autoimmune, neurological, cancer, orthopedic, and mental health conditions can all support an LTD claim — if documented correctly.
Read moreWhat to do next
Read the denial letter and calendar your deadline
Under ERISA, you typically have 180 days from the denial date to file a written appeal. That clock starts on the date of the letter — not when you retain an attorney. Mark the date immediately.
Request your complete claim file
You are entitled to the full plan document, the Summary Plan Description, and everything the insurer relied on — including any IME report or surveillance footage — before your appeal is due.
Get your treating physicians on record
A detailed, function-specific statement from your treating doctor carries far more weight than a note that simply says you’re “unable to work.” Insurers respond to specifics: lifting limits, sitting tolerance, cognitive stamina.
Build the record like it’s your only chance — because it is
In most ERISA cases, a federal judge can only review what was submitted during your administrative appeal. New evidence introduced later is generally excluded. Treat the appeal as the trial.
Talk to an ERISA-experienced attorney before you file
The appeal is not simply a letter disagreeing with the insurer — it is a legal submission that determines what a court can later consider. We review your policy, denial letter, and medical record before your response is due.
Questions we hear every day
Plain-English answers to the questions clients ask most about long-term disability and ERISA appeals.
What is ERISA and how does it affect my LTD claim?
ERISA — the Employee Retirement Income Security Act — governs most employer-sponsored LTD plans. Under 29 U.S.C. §1132, it is your exclusive legal remedy if your plan denies benefits. 29 CFR 2560.503-1 sets the minimum claims and appeals procedures every plan must follow.
What is the 180-day appeal deadline in ERISA LTD cases?
Under 29 CFR 2560.503-1, you have at least 180 days from receipt of a benefits denial to submit a written administrative appeal. Missing this deadline is almost always fatal to your ERISA claim under 29 U.S.C. §1132 — courts routinely hold that failure to exhaust administrative remedies bars federal litigation.
What is the difference between own-occupation and any-occupation disability?
“Own occupation” means you are disabled if you cannot perform the material duties of your specific job. “Any occupation” means you must be unable to work in any job for which you are reasonably suited by education, training, or experience. Most ERISA plans shift from own-occ to any-occ after 24 months — a critical threshold under 29 U.S.C. §1132.
What is the elimination period in a long-term disability policy?
The elimination period is the waiting period between the onset of disability and the first day you are eligible to receive LTD benefits — typically 90 or 180 days. It functions like a deductible in time. Under ERISA plans governed by 29 U.S.C. §1132, 29 CFR 2560.503-1 claim procedures begin once you file, not when benefits start.
Does SSDI reduce my long-term disability benefit?
Yes. Most ERISA LTD plans contain an offset provision that reduces your monthly benefit dollar-for-dollar by the amount you receive from Social Security Disability Insurance. The insurer, not you, captures the financial benefit of your SSDI award — a feature permitted under 29 U.S.C. §1132 and routinely enforced in federal court.
Can my LTD insurer use surveillance or social media against me?
Yes. ERISA LTD insurers routinely conduct physical surveillance and review social media as part of their investigation process. Evidence collected this way becomes part of the administrative record under 29 CFR 2560.503-1 and can be cited in a denial upheld under the Firestone abuse-of-discretion standard in federal court under 29 U.S.C. §1132.
What are mental and nervous policy limits in an LTD plan?
Most ERISA group LTD plans cap benefits for mental health and nervous system conditions — typically depression, anxiety, and PTSD — at 24 months. After that cliff, benefits terminate even if you remain disabled. These limits are governed by plan terms enforceable under 29 U.S.C. §1132 and reviewed deferentially under Firestone v. Bruch if the plan grants administrator discretion.
What is the difference between group and individual long-term disability insurance?
Group LTD is employer-sponsored and governed by ERISA, limiting your remedies under 29 U.S.C. §1132 and stripping state bad-faith claims. Individual LTD is a private contract outside ERISA, governed by state insurance law, and allows breach of contract and bad-faith damages. The distinction is critical — it determines your entire legal strategy.
What might an LTD benefit look like?
Every policy is different, and this is a simplified illustration — not a calculation of your benefit, not legal advice, and not a promise of any outcome. Most group LTD plans replace a percentage of your pre-disability monthly income, often reduced further by any SSDI you receive. An attorney can review your actual policy and explain what applies to your situation.
Real cases. Real results.
Illustrative, representative examples of LTD and ERISA matters we have handled. Details have been altered to protect client confidentiality.
A claimant was denied after the insurer misapplied the own-occupation definition in her policy. After obtaining the full plan document and submitting a detailed vocational analysis, the claim was approved at the administrative appeal stage — before federal court was ever necessary.
As a claimant approached the own-to-any-occupation transition, we commissioned an independent functional capacity evaluation and a vocational rebuttal in advance of the insurer’s review. Benefits continued without interruption through the transition.
After an insurer denied benefits based on a paper-review physician who never examined the claimant, we litigated in federal court. The court found the insurer’s reliance on that review over years of treating-physician records to be an abuse of discretion, and benefits were reinstated with interest.
Prior results do not guarantee a similar outcome. Each case is evaluated on its own facts. The case outcomes shown are representative examples; details have been altered or generalized to protect client confidentiality.
Other ways we help
Same firm, same approach — different practice areas under one roof.
Workers’ Compensation
Injured at work. Lost wages. Denied benefits.
Learn more →Social Security Disability
Can’t work due to a disability. SSDI & SSI claims, denials, appeals.
Learn more →Personal Injury
Car accident. Construction site. Scaffold Law.
Learn more →Workers’ Rights
Retaliation, wage theft, harassment. Plaintiff-side only.
Learn more →Find a lawyer near you
Seven offices in the towns working New Yorkers actually live.
The attorneys who work your case
Not a call centre. The lawyer who signs you is the lawyer who shows up.
Brian M. Mittman, Esq.
Managing Partner · Markhoff & Mittman, P.C.
Call 866-205-2415 Schedule with Brian- Admitted in New York
- 30+ years in practice
- Attends Board hearings personally
Brian has personally handled New York workers' compensation, SSDI, and personal-injury cases for over three decades. Your case is never handed off to a paralegal.
- Admitted in New York and New Jersey
- Pace University School of Law, J.D.
- Litigates before the Workers' Compensation Board
Randy has litigated every type of claim before the Workers' Compensation Board on behalf of hundreds of claimants.
- Admitted in New York, 2008
- New York Law School, J.D. 2007
- With The Disability Guys since 2013
Benai has spent more than a decade fighting for injured workers before the Workers' Compensation Board and the New York State Employees' Retirement Board.
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