February 4, 2025

The insurance claims process, in all situations, can be overwhelming. That said, managing ERISA claims can be particularly challenging. Because of the federal regulations governing them, there are strict legal requirements that must be closely followed. The combination of the volume of detailed documentation required and the non-negotiable filing deadlines are only the start. Those who have fallen ill or become injured must provide specific criteria to prove their disability. Adding insult to injury, insurers tend to fight these claims vigorously.

When it comes to getting the ERISA settlement you so desperately need, you, the injured party, become responsible for proving your disability.

Undertaking this task on your own is not advisable. The process is intentionally complicated, and even the smallest mistake can invalidate your claim.

Working with a seasoned insurance attorney, one who has a breadth of experience handling ERISA claims, is a wise decision. This professional can leverage their knowledge on your behalf and alleviate a great deal of the stress that accompanies the process.

What is ERISA?

ERISA is the acronym for the Employee Retirement Income Security Act of 1974. This federal law established minimum standards for health and retirement plans in private industry.  The law offers protection for covered individuals, such as:

  • Ensures plans are fairly maintained and financially sound
  • Requires plans to share details regarding their features and funding
  • Mandates that plans behave in a responsible fiduciary manner
  • Provides a clear appeal and grievance process.

While the majority of employer-sponsored plans are governed by ERISA, those run by government or religious organizations are exempt.

Because of  government oversight, it is not surprising that filing an ERISA disability claim is a multi-step, often complicated process.

Types of ERISA Disability Claims

ERISA governs a broad base of employee benefits, so filed claims cover a broad range of situations, like the following:

  • Requesting benefits for Long Term Disability(LTD)
  • Appealing wrongfully denied LTD claims
  • Accusing breach of fiduciary responsibility
  • Situations where claims are underpaid
  • Lawsuits for wrongful decisions to not overturn denials
  • Issues regarding retirement benefits and their recipients
  • Common law claims.

The type of claim you file reflects the specifics of your appeal or your lawsuit.

Challenges of ERISA Disability Claims

It is surprising how many individuals are told that their medical conditions do not qualify as disabling.  In fact, the terms used in insurance policies can be misleading. Some terms that are most often misunderstood are “disability,” “pre-existing condition,” “injury,” and “regular occupation.”  Other terms, like “income” and “employee” can also be ambiguous, even though they seem straightforward. A seasoned ERISA lawyer can explain the specifics of these definitions as well as the intricacies of your policy.

A second frequently seen challenge refers to the limitations of your policy; some are simply more restrictive than others. Your insurance attorney can review your situation, including the scope of your job responsibilities and the specifics of your policy.

It is important to understand that ERISA denials are commonplace and overcoming them can be especially difficult.  You will need to file an administrative appeal (which is best done with the assistance of an attorney). Proving your claim requires both providing very specific evidence and adhering to an intricate and multifaceted process.  Mistakes will result in an appeal denial, placing the financial burden of your care on your shoulders.

Steps to Take If Your Claim Is Denied

The actions you take after a denial of an ERISA claim will impact the success of your appeal.  First and foremost, you should engage the assistance of an experienced ERISA disability attorney.  Once you have identified a professional with whom you are comfortable, you can work with them to:

  • Gather your medical records
  • Obtain documentation from your physician that provides a detailed description of your condition and its impact on your ability to complete your professional responsibilities
  • Identify and reference medical research that supports the necessity of your treatment
  • Amass employment information, including performance reviews and job descriptions
  • Locate and complete all insurance and employer-related claims forms
  • Compose a statement that describes your illness/injury, its related symptoms, and its impact on your work and life
  • Submit your claim as soon as possible (via certified mail so you receive a return receipt, or online if requested), always adhering to posted deadlines.

All paperwork must be completed correctly and supporting documentation labeled.  Additionally, if you are submitting via certified mail, keep a copy of the full set of papers that you send. Any time you speak with anyone from your insurance company, be sure to document the conversation; a record of all communication can be extremely valuable. Finally, if a representative from the insurance company reaches out to you, redirect them to your attorney.  This professional knows how to communicate to best protect you and not negatively impact any potential settlement.

How Can an ERISA Attorney Help?

ERISA disability claims are more complex than general long-term disability claims. Because of government oversight, filing, appealing and litigating ERISA claims is particularly challenging. Working with an experienced ERISA attorney, an individual who specializes in the procedures and regulations of these claims, can have a positive impact on your life.

These professionals will leverage their knowledge, so your claim is submitted appropriately.  If you have submitted it yourself and have been denied, they can help identify the reason for the denial and assist in submitting a clear and complete appeal letter. Finally, if you need to take your case to court, they can represent you and help to identify issues like when a long-term disability insurance company takes evidence out of context.

Doug Terry Law Knows How to Handle ERISA Disability Claims

The team at Doug Terry Law has a long history of successfully handling ERISA disability claims and is well regarded for the compassionate manner in which they guide their clients through the complex road to settlement. ERISA disability attorneys play a vital role in helping their clients manage this process.

For decades, Doug Terry Law has been helping clients with all facets of ERISA disability claims — from initial filings to appeals to federal litigation.

They understand the tactics insurance companies take to avoid paying claims, and they know how to counteract them.  In all cases they leverage their knowledge and experience to help minimize the stress associated with the process while maximizing their clients’ settlements.

Their commitment to quality service begins right away. Every prospective client is offered a free consultation during which their ERISA attorney will actively listen to their story in order to gain a better understanding of the situation at hand.  At this meeting the attorney can explain how they would approach the case. This interaction provides future clients with a window into what they can expect as the process progresses. Compassionate, responsive communication combined with technically excellent service is a hallmark of the Doug Terry Law Firm approach. Their goal is to exceed their clients’ expectations.

It is important to recognize the value of time when it comes to ERISA claims and appeals — the clock is ticking. Doug Terry Law is ready to go to work for you immediately.  Contact them today at 405-463-6362 to schedule your no-cost consultation.

Attorney Doug Terry

Attorney Doug TerryAfter 25 years practicing in a larger firm, Doug chose to open his own practice in Oklahoma City. He brings his wealth of knowledge and his skills as a litigator to bear for his clients in matters of insurance bad faith, personal injury cases and class actions. He won $200 million and $25 million verdicts for clients in cases in which an insurer denied a health insurance claim. Doug has the distinction of being awarded a Martindale-Hubbell “AV Preeminent” rating from his peers in the legal community. He has also been selected as an Oklahoma Super Lawyer. [Attorney Bio]