When you’re unable to work due to illness or injury, long-term disability (LTD) insurance benefits are supposed to provide financial stability. But many claimants are shocked when their LTD claim is denied, sometimes unfairly, without full consideration of their medical evidence, or based on biased insurance company reviews.
If your long-term disability benefits were denied, you still have legal options. The appeal process is strict, deadline-driven, and often confusing, especially under ERISA, the federal law that governs most employer-provided disability insurance plans.
At Martin J. Sperry, P.A., we help individuals throughout Fort Lauderdale appeal long-term disability denials and fight for the benefits they deserve.
Why Long-Term Disability Claims Are Frequently Denied
Insurance companies often deny LTD claims for reasons such as:
- “Insufficient medical evidence”
- Conflicting medical records
- Lack of “objective findings”
- Surveillance claiming you can work
- Opinions from insurance-hired doctors
- Failure to meet a strict policy definition of disability
- Missed deadlines or incomplete paperwork
Many of these reasons are disputable, and often not based on the full picture of your condition.
Understanding ERISA and Why It Matters
Most employer-sponsored LTD plans fall under ERISA (Employee Retirement Income Security Act). ERISA gives insurance companies tremendous power, but also establishes strict rules for appeals.
Under ERISA:
- You must go through the insurer’s internal appeal process before filing a lawsuit.
- You generally have 180 days to file an appeal.
- You cannot add new evidence after the appeal stage.
This means your administrative appeal is your final chance to build the strongest possible record.
An experienced LTD attorney can help ensure your appeal includes every medical record, expert opinion, and legal argument necessary.
How the Appeal Process Works in Florida
1. Review the Denial Letter
The insurer must explain why they denied your claim and what evidence they relied upon. This letter determines how your attorney will structure your appeal.
2. Request Your Entire Claim File
You have a legal right to obtain all documents the insurer used—medical reviews, internal notes, vocational assessments, and more.
3. Build a Comprehensive Administrative Appeal
This may include:
- Detailed physician statements
- Functional capacity evaluations
- Vocational expert reports
- Medical literature supporting your diagnosis
- Witness statements from family or coworkers
- Evidence of medication side effects
- Rebuttals to insurer-hired doctors
Because ERISA limits what can be added later, this stage is critical.
4. Submit the Appeal Before the Deadline
Most appeals must be filed within 180 days, missing this deadline can permanently bar you from receiving benefits.
5. Insurance Company Review
The insurer must review your appeal in good faith. If they still deny your claim…
6. File a Lawsuit in Federal Court (If Necessary)
Under ERISA, the case is decided by a judge, not a jury, and the court generally reviews only what is in the administrative record. This is why your appeal must be airtight.
Can You Fight a Long-Term Disability Denial Without a Lawyer?
Technically, yes. But it is risky.
Insurance companies have teams of lawyers, in-house doctors, and claim analysts. ERISA rules are complex, and mistakes can permanently damage your claim.
A skilled LTD attorney can:
- Identify weaknesses in the denial
- Gather the right medical evidence
- Ensure deadlines are met
- Prepare a legally sound appeal
- Fight biased disability reviews
- Represent you in federal court if the insurer refuses to pay
Hiring an attorney often dramatically increases your chances of approval.
Common Medical Conditions That Lead to LTD Disputes
We represent clients with a wide range of physical and mental impairments, including:
- Chronic pain disorders
- Degenerative spine conditions
- Cancer treatment complications
- Autoimmune diseases
- Heart and circulatory conditions
- Neurological disorders
- Traumatic injuries
- Severe depression, anxiety, or cognitive impairment
Insurance companies often overlook how these conditions affect real-world functioning.
Don’t Give Up After a Denial — Get the Legal Help You Deserve
A long-term disability denial is not the end of your claim. With the right legal strategy, many denials can be overturned on appeal.
Attorney Martin J. Sperry fights aggressively for individuals in Fort Lauderdale who rely on LTD benefits to support themselves and their families.
Call (954) 324-2340 today to discuss your long-term disability denial.