What is ERISA and how does it affect my LTD claim?

If your long-term disability coverage came through a job, it almost certainly falls under ERISA. Congress passed ERISA in 1974 to create uniform rules for employee benefit plans, but the law contains a critical trade-off: it pre-empts state insurance law, which means you cannot sue your insurer for bad faith or punitive damages the way you could with a private policy. Your remedies are limited to the benefits owed, attorney fees at the court’s discretion, and injunctive relief under 29 U.S.C. §1132(a).

The regulation at 29 CFR 2560.503-1 is where the procedural rights live. It requires your plan administrator to provide a written denial with specific reasons, reference the plan provisions relied upon, and tell you exactly what additional information is needed. Critically, it gives you 180 days from receipt of an adverse decision to file a written administrative appeal — a deadline most claimants miss because they spend too long waiting for a phone call that never leads anywhere.

The other defining feature of ERISA litigation is the standard of judicial review. Under Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), if the plan document grants the administrator discretionary authority to interpret the plan and determine eligibility, federal courts review the denial only for “abuse of discretion” — a highly deferential standard that makes overturning a denial difficult without a well-built administrative record.

This is why representation matters from day one. The evidence you submit during the administrative appeal is almost always the only evidence a federal court will consider. Our firm handles LTD and ERISA appeals on a contingency basis — no fee unless we win.