If your long-term disability claim was denied, your next question is probably:
“How do I appeal an ERISA denial?”
Most people think the answer is simple:
- Submit your medical records
- Write a short letter
- Ask the insurance company to reconsider
But in ERISA cases, that approach is exactly why so many appeals fail.
I’m Brandon Osterbind, a disability lawyer here in Virginia, and I help people appeal denied long-term disability claims. And if you’re dealing with an ERISA denial, this may be your only real opportunity to prove your case.
Why an ERISA Appeal Is So Important
Most employer-provided long-term disability policies are governed by ERISA (the Employee Retirement Income Security Act).
Under ERISA:
- Your appeal is not just a second chance
- It is your best—and often only—chance to submit evidence
- The appeal becomes the official record of your case
If something isn’t included during the appeal, a court may never see it later.
That’s why understanding how to appeal properly is critical.
Step 1: Understand Why Your Claim Was Denied
Before you do anything, carefully review the denial letter.
The insurance company is required to explain:
- Why your claim was denied
- What evidence they relied on
- What information they believe is missing
Your appeal must directly respond to those reasons.
If you ignore them, the denial will likely be upheld.
Step 2: Answer the Three Questions Every ERISA Appeal Requires
A successful ERISA appeal must clearly answer three questions:
1. What is your condition?
Provide clear medical documentation of your diagnosis.
2. What symptoms does it cause?
Explain your symptoms in real-world terms:
- Pain
- Fatigue
- Brain fog
- Limited mobility
3. How do those symptoms prevent you from working?
This is the most important part.
You must show how your condition affects your ability to perform the material duties of your occupation.
This is where most appeals fail.
Step 3: Don’t Rely on Medical Records Alone
One of the biggest mistakes people make is submitting stacks of medical records and assuming that’s enough. It’s not.
Medical records are written for treatment, not for disability claims.
They often do not explain:
- How long you can sit or stand
- Whether you can maintain focus
- Whether you can work consistently
- Whether you can perform your job duties
And the insurance company is not required to connect those dots for you.
Step 4: Build the Missing “Bridge”
To win your appeal, you need to connect your condition to your inability to work.
That usually requires:
A Detailed Personal Statement
Explaining:
- Your daily limitations
- How your symptoms affect your job
- What you can no longer do
A Doctor’s Narrative Report
Not just notes, but a clear opinion on:
- Functional limitations
- Work restrictions
- Why you cannot perform your job
A Clear Job Description
Not just your job title, but your actual duties:
- Physical demands
- Cognitive demands
- Schedule requirements
Because the key issue is always:
👉 Can you perform the essential duties of your occupation?
Step 5: Address “Functional Limitations,” Not Just Diagnosis
In ERISA cases, a diagnosis alone is not enough.
The insurance company is asking:
- Can you sit for a full workday?
- Can you concentrate consistently?
- Can you maintain pace and reliability?
- Can you work 8 hours a day, 5 days a week?
If your appeal doesn’t clearly answer those questions, the insurer will fill in the blanks, and not in your favor.
Step 6: Submit Everything Before the Deadline
Timing is critical.
Most ERISA appeals must be filed within 180 days of the denial.
But more importantly:
👉 You must submit all supporting evidence during the appeal
Because under ERISA:
- You usually cannot add new evidence later
- Courts rely on the administrative record
- Missing evidence can permanently weaken your case
Step 7: Treat the Appeal Like a Trial File
An ERISA appeal is not just a form.
It should be treated like a case being prepared for court. I know . . . easy for a lawyer to say.
A strong appeal will:
- Address every reason for denial
- Include new, targeted evidence
- Clearly explain why the policy definition of disability is met
A weak appeal often looks like:
- “I disagree with your decision”
- A stack of records with no explanation
That’s not enough.
Why Most ERISA Appeals Fail
Most appeals fail for three simple reasons:
- They don’t respond to the denial reasons
- They rely on medical records without explanation
- They fail to connect symptoms to job duties
It’s not that the person isn’t disabled.
It’s that the case wasn’t properly presented.
The Bottom Line
If you’re wondering how to appeal an ERISA denial, here’s the truth:
This isn’t just paperwork.
This is your case.
And once the appeal is over, you usually don’t get another chance to fix it.
What You Should Do Next
If your long-term disability claim has been denied:
- Don’t rely on medical records alone
- Don’t assume the insurance company will “figure it out”
- Don’t rush your appeal (Though you should understand the time constraint)
Take the time to build a complete, well-documented case. Sadly, this is very difficult for people to formalize on their own; that is why we do what we do. We fully review disability denials before taking on a case to see if it has valid potential. From there, we can help draft an appeal with dozens of pages of context to make sure that you have a fighting chance. Want to know the best part? It’s all under contingency. You don’t pay us a fee unless you get benefits. Contact us for your FREE CASE REVIEW!
In ERISA claims, how you appeal often determines whether you win or lose.
