Understanding ERISA: What is ERISA?

What Is Long-Term Disability?

Long-term disability (LTD) insurance provides income replacement when you can’t work due to a serious illness, injury, or chronic condition. Most policies pay between 50% and 70% of your income after a waiting period—usually 90 to 180 days.

There are two types of LTD insurance:

• Group LTD Policies (ERISA plans)
  Provided through your employer and governed by a federal law called ERISA.
• Individual or Private LTD Policies
  Purchased on your own. These are not governed by ERISA.

Most of the long-term disability cases we handle in Virginia involve ERISA group policies.

Common Conditions That Qualify for Long-Term Disability

Not every health condition qualifies—but many do, including:

Why Long-Term Disability Claims Are Denied

Insurance companies deny valid LTD claims for all kinds of reasons. Here are the most common ones we see in Virginia:

• “Lack of objective medical evidence”
  They claim your condition can’t be proven, especially for pain or fatigue disorders.
• “You can still work”
  Insurers often argue you can perform sedentary work, even if that’s unrealistic.
• Missed deadlines
  If you miss even one critical deadline, they may use it to deny your claim.
• Pre-existing conditions
  Some policies exclude disabilities tied to a condition that existed before coverage.
• Video surveillance
  A brief video of you doing daily tasks may be twisted to show you’re “not disabled.”

If any of these sound familiar, you’re not alone—and we can help.

Understanding ERISA: The Law That Governs Most LTD Claims

If your long-term disability in Virginia is covered by a group policy through your employer, it is most likely governed by ERISA.

ERISA makes these claims more complex:

• You must go through the appeal process before filing a lawsuit.
• There is no jury trial or punitive damages in ERISA cases.
• You cannot testify in court.
• You cannot present new evidence in court.
• The judge will rule based only on the administrative record.

That means your appeal is your trial. It must be perfect the first time.

That’s why hiring an experienced long-term disability attorney is critical. We know how to build the strongest possible record for appeal—and how to hold insurers accountable.

How We Handle Long-Term Disability Appeals in Virginia

At Osterbind Law, we’ve handled dozens of ERISA disability appeals. Here’s what our process looks like:

1. Review Your Policy and Denial Letter

We break down every line of the insurance policy and your denial letter. We mark it up, outline the insurer’s arguments, and start planning how to counter them.

2. Request and Review the Claim File

We obtain the internal file the insurance company used to make their decision. This often reveals what they relied on—and what they ignored.

3. Gather New Medical and Vocational Evidence

We work closely with your doctors to obtain updated records, narrative reports, and functional assessments that directly respond to the denial.

4. Rebut the Insurance Company’s Flawed Reasoning

We often bring in vocational experts or consult with specialists. We address every point made by the insurer and show why it’s wrong or misleading.

5. Submit the Administrative Appeal

Your appeal is submitted with a comprehensive legal brief, full exhibits, and a timeline showing your medical decline. This is your strongest chance to win benefits without litigation.

What Happens If the Appeal Is Denied?

If the insurance company upholds the denial, we file a lawsuit in U.S. District Court.

Here’s what happens next:

• The court reviews the administrative record.
• Both sides submit legal briefs (summary judgment).
• In most cases, there is no live testimony or trial.
• A federal judge will issue a written opinion.

Because there’s no new evidence allowed, your appeal has to be airtight from the beginning. That’s why we go all in during the appeal stage.

Long-Term Disability for Mental Health Conditions

One of the most difficult areas of long-term disability in Virginia involves mental health claims, like:

• Major depressive disorder
• Generalized anxiety disorder
• PTSD
• Bipolar disorder
• OCD
• Trauma-induced conditions

Insurers are notorious for minimizing these claims. They argue that:

• “You’re not seeing a psychiatrist.”
• “You’re not taking enough medication.”
• “Your notes show some improvement.”

They may also limit benefits to 24 months under “mental health caps” in your policy—even if your condition is lifelong.

We work with mental health professionals who understand how to document psychiatric disability the right way, with functional assessments and longitudinal records that support your claim.

Why Hire Osterbind Law for Your Long-Term Disability Case?

Most law firms dabble in disability. We live it.

At Osterbind Law, we bring a combination of legal experience, trial preparation, and human understanding to every disability case we handle.

Here’s what sets us apart:

• We focus on long-term disability in Virginia.
  We know the laws, the courts, and the insurers.
• We understand ERISA.
  This isn’t Social Security or workers’ comp. It’s a different ballgame—and we know how to play it.
• We’re trial lawyers.
  If your case needs to go to federal court, we’re ready.
• We care.
  You’re not a file number. You’re a person. And you deserve to be treated like one.

Frequently Asked Questions

How long do LTD benefits last in Virginia?

It depends on your policy. Some end at age 65. Others continue for life. Some have two-year caps for mental health conditions.

Can I get both Social Security Disability and LTD?

Yes. But your LTD insurer may offset your monthly benefit based on what you receive from SSDI.

Will my benefits be taxed?

If your employer paid the premiums, your benefits are taxable. If you paid the premiums with after-tax dollars, they’re tax-free.

What if I’m still working part-time?

Some policies allow for partial disability benefits. Others do not. It depends on your specific plan language.

Take Action Now: Don’t Miss Your Deadline

If your long-term disability in Virginia has been denied, you have 180 days to appeal. After that, you may lose your right to challenge the denial forever.

Let us help.

What is an ERISA Disability Policy?

ERISA stands for the Employee Retirement Income Security Act. It is a series of federal statutes that govern benefit plans that Employers offer to their employees. These statutes control health insurance, dental insurance, vision insurance, 401k’s, and short-term/long-term disability insurance. A disability insurance company must adhere to these statutes when managing and providing benefits under these policies.

The rules are strict and federal courts are unforgiving.

They do not give the claimant the benefit of the doubt; instead, the courts treat both sides the same.

Often to the claimant loses out because you did not have an ERISA lawyer helping you through the process.

📞 Call Osterbind Law today or fill out our secure contact form. We’ll review your denial and give you a clear path forward—at no cost and with no pressure.

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At this point, you can do three things:

The choice is yours. There is no wrong choice, but there are consequences to our choices.

DO NOTHING

If you are defeated, you could stay down. You could lose the right to pursue your claim at all in the future. By not doing anything or waiting too long, it will be too late to accomplish any degree of success.

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HANDLE THE APPEAL ON YOUR OWN

You can work up your appeal on your own by filling out the insurance companies limited forms. And, hope for the best knowing that the insurance company has more resources and knowledge about how these claims are resolved. At the end of the day, this may cost you.

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HIRE AN ERISA ATTORNEY

An Osterbind Law attorney can review your denial letter and records—for free—to tell you what your chances of success may be. Our attorneys have the specialized knowledge of the law and the practical aspect of these claim. They can tell you whether you can win or lose. Then, they will create a plan to win.

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Why hiring Osterbind Law is the best option

When federal judges look at long-term disability claims in Virginia, they see inequality. Especially for people compared to the vast experience of the insurance companies. One federal judge said: 

“The Court also recognizes that ERISA claimants may not have the advantage of legal advice or favorable referrals before the administrative process is complete, placing such claimants at a distinct disadvantage if discovery is not permitted on judicial review. For ERISA claimants not able or aware enough to hire legal counsel before the administrative process is complete, they likely enter into judicial review facing a loaded deck–a deck loaded with the expert opinions of those hired by the plan administrator and, with the possible exception of a treating physician or two, lacking the opinions of vocational or medical experts hired by the claimant. Further, if the plan vests discretion with the plan administrator, as almost all do, such claimants also face the hurdle of a discretionary standard of review.”  

Abromitis v. CNA, Reporter, 261 F. Supp. 2d 388 (F. Dist. Ct. W.D.N.C 2003).

Facing billion dollar insurance companies without legal representation can put claimants at a significant disadvantage.

This isn’t just lawyers saying it, this is a federal judge.

If you don’t want to face a loaded deck, you need to start looking for an ERISA attorney. 

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1. The best time to consult a long term disability lawyer is right away.

What Judge Cogburn is saying here is that ERISA long-term disability claims in Virginia are different than almost every other case. In a personal injury case, you can file your lawsuit, send written questions to the other side that they are required to answer, order a deposition of the opposing party and any important witnesses, find new witnesses and present new evidence, and eventually, present your evidence to a judge or a jury. Unfortunately, with ERISA long-term disability cases, that is not true. 

Presenting Evidence

Your opportunity to present evidence is limited to the appeal process with the insurance company. That means the same company that is responsible for paying your claim is responsible for fully and fairly considering whether your disability meets the eligibility requirements under the plan. This structural conflict of interest sometimes weighs in your favor, if you know how to develop the case.

What a Lawyer Does

Ideally, you want an ERISA lawyer filing the notice of your disability and drafting the initial disability claim application. A lawyer can help you identify the areas where the insurance company is likely to object to your disability claim. Insurance companies will nitpick through your medical records and find statements like, “she is doing well” and take those statements out of context. Addressing some of those statements is essential for winning your claim early. Your lawyer should prepare to preemptively address these problems.

Also, there are pretty strict deadlines to filing your long-term disability claim within and if you don’t meet these deadlines, they can be treated like a statute of limitations. Having an ERISA lawyer helping you from the very beginning will eliminate many of these problems. 

2. The second best time to consult an ERISA long term disability lawyer is after your long-term disability claim has been denied.

After you have submitted your long-term disability claim and the insurance company has denied it, you should consult an ERISA lawyer immediately.

At this point, your timeline is very limited and there is significant work to be done to overturn that initial decision. If you hire an ERISA lawyer to help you, he or she should start by gathering all of the relevant information necessary for your claim. That includes all of your medical records, all of your vocational records, and the entire claim file. This is typically your last chance to prove your claim by presenting new evidence. 

Addressing Issues on Appeal

Your ERISA lawyer should be able to discover exactly why the insurance company denied your claim. Many times, insurance companies give vague explanations for your denial that make no sense. If that is the case, a lawyer will be able to force them to be more specific so you can address every issue raised by the insurance company.  

Additional Evidence

Your ERISA lawyer should also be able to get additional evidence to submit in support of your long-term disability claim. Often, the insurance company will deny your claim for lack of objective evidence. Your lawyer should know the types of tests, exams, or images that would provide the necessary objective evidence to prevail and work with your healthcare providers to get that information. Then, your lawyer should present that information in a compelling way to the insurance company. 

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Hiring an ERISA lawyer should make your life easier, not harder.

Call us at 434-515-2807.

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Our ERISA attorneys offer free strategy sessions for all who ask us to review their claim. Whether you are thinking about applying for long-term disability benefits, or if you’ve already been denied and you need to appeal, we’ll sit down with you to discuss the merits of your claim and provide a strategy for going forward. We call these free strategy sessions. I don’t pressure you to do something that you don’t want to, but rather, we’ll present you with all of your options and set out a strategy going forward. Give us a call or send us an email and we’ll be happy to talk with you.

We also have several videos with answers to the most frequently asked questions that people have after their long-term disability claim was denied. 

We represent claimants for long-term insurance disability claims against insurance companies who don’t want to pay. 

Your employer pays for a long-term disability insurance policy as an employment benefit. These insurance companies gladly accept the premium payment from your employer but rarely do they want to pay a claim like this. If your benefit is $6,000 per month, that is $72,000 per year that the insurance company has to pay. You can see why they don’t want to pay. We always quip that insurance companies are in the business of making profits not paying claims.  

But your plan administrator owes a fiduciary duty to all plan beneficiaries, including you. That means that she has to act with your best interests in mind. However, when faced with your best interest versus paying a substantial claim, you can see why the insurance company would deny it. 

They are required to give your claim full and fair consideration. If they don’t, then your only recourse is to file a complaint in the federal district court. This stage becomes even more complicated and a lawyer’s ability to communicate in writing is essential.

Insurance Company Responsibilities

Insurance companies have a fiduciary duty to act in the best interests of their policyholders, especially when it comes to long-term disability claims. This fiduciary duty means that insurance companies must:

• Provide clear and accurate information about policy terms and conditions.
• Process claims in a timely and fair manner.
• Make decisions based on objective criteria, rather than arbitrary or biased factors.
• Provide adequate explanations for denying claims or terminating benefits.
• Allow policyholders to appeal denied claims or terminated benefits.

When insurance companies fail to meet these responsibilities, they may be acting in bad faith, which can lead to legal action. A long-term disability attorney can help policyholders hold insurance companies accountable for their actions and ensure that they receive the disability benefits they are entitled to.

In the context of long-term disability claims, insurance companies often face a conflict of interest. They are responsible for both paying out claims and making decisions about those claims, which can lead them to prioritize their own financial interests over the needs of their policyholders. This conflict can result in unfair denials or terminations of benefits, causing significant hardship for individuals who rely on these benefits to support themselves and their families. A long-term disability attorney can help level the playing field, ensuring that policyholders receive the fair treatment and disability benefits they deserve.