When the Administrative Process Fails, Federal Court Is the Next Step.
ERISA Litigation Is Unlike Any Other Disability Case
When an employer-sponsored LTD claim is denied and the administrative appeal is exhausted, the claim moves to federal court under 29 U.S.C. §1132(a)(1)(B). There is no jury. There is generally no discovery beyond the administrative record. The case is decided on cross-motions for summary judgment — paper submissions reviewed by a federal judge. The standard of review is the most consequential variable. Under Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101 (1989), if the plan grants the insurer discretionary authority, the court reviews the decision for abuse of discretion rather than de novo. That is a hard standard to beat — which is why building an airtight administrative record during the appeal is the predicate for every successful federal case.
What you need to know
Plain-English answers to the questions that come up most often on these cases.
De Novo vs. Abuse-of-Discretion Review
De novo review — where the court decides the issue fresh — applies when the plan does not grant the insurer clear discretionary authority. Abuse-of-discretion review applies when it does. Most employer-sponsored group plans include discretionary authority clauses. The Second Circuit applies Firestone and its progeny carefully — but the baseline remains deferential to the plan administrator.
Read moreThe Closed Administrative Record
In most ERISA cases, the federal court reviews only the evidence that was before the plan administrator during the administrative process. New expert reports, new medical records, and new arguments generally cannot be introduced in federal court. This is why the appeal must be treated as the trial — not as a preliminary step.
Read moreCross-Motions for Summary Judgment
ERISA LTD cases are typically resolved on cross-motions for summary judgment. Both sides submit briefs and supporting documents from the administrative record. The judge decides as a matter of law — reviewing the insurer’s decision against the record evidence and the applicable standard of review.
Read moreConflict of Interest Under Glenn
When the insurer both funds benefits and decides claims, Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105 (2008) requires the conflict to be weighed as one factor in the abuse-of-discretion analysis. Documenting the structural conflict — through claim file analysis, IME history, and internal communications obtained during litigation — remains an important litigation tool.
Read moreStatute of Limitations
ERISA does not specify a statute of limitations for benefit claims. Courts apply the most analogous state law limitations period, but many plan documents contain contractual limitations clauses that shorten the window — sometimes to as little as one year after the final denial. Missing that deadline bars the claim entirely.
Read moreAttorney Fees Under ERISA
29 U.S.C. §1132(g) permits courts to award reasonable attorney fees and costs to either party. Prevailing claimants often recover fees — a meaningful consideration in case valuation and settlement negotiations.
Read moreHow we handle these cases
Step 1
Analyze the plan document for the standard of review before accepting any federal court case.
File the complaint within the plan’s contractual limitations period
never the state limitations period alone.
Step 3
Submit a comprehensive summary judgment brief that highlights every failure in the insurer’s administrative process.
Step 4
Argue Glenn conflicts of interest using documented patterns of biased IME selection and file-review practices.
Step 5
Evaluate settlement throughout the litigation with an accurate assessment of attorney fee recovery.
Real cases. Real results.
Three recent Long-Term Disability outcomes — case context and result. No client identifying information.
After an insurer denied benefits to a technology executive with a debilitating autoimmune condition, we litigated in the Southern District of New York. The court found the insurer’s reliance on a paper-review physician — over years of treating specialist documentation — to be an abuse of discretion. Benefits were reinstated with prejudgment interest.
Filing in federal court prompted a rapid settlement in a case involving a benefits termination at the 24-month transition. The insurer agreed to a lump-sum settlement that included past benefits, future benefits through maximum benefit age, and attorneys fees.
We successfully argued that the plan document did not contain a valid discretionary authority clause. The court applied de novo review and found in our client’s favor, awarding benefits and fees under 29 U.S.C. §1132(g).
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.
Related questions
Quick answers from our FAQ library.
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
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Car accident. Construction site. Scaffold Law.
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Retaliation, wage theft, harassment. Plaintiff-side only.
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The attorneys who work your case
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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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