Before You Appeal an ERISA Long-Term Disability Denial: A Complete Guide

Receiving an ERISA LTD denial can be overwhelming, especially when you’re already struggling with your health and finances. But a denial doesn’t mean the end of your benefits prospects — it means the beginning of the administrative appeal process.

This guide will walk you through the steps to take after a denial but before you file an appeal, including how ERISA’s closed record works, what evidence you can still submit, how the standard of review affects your case, and why preparation matters now more than ever.

Understanding Your ERISA LTD Denial

Before diving into the appeal process, it’s crucial to understand what a denial really means under ERISA.

• Your claim file has been reviewed, and a decision has been made based on the information submitted.
• ERISA generally limits what evidence can be considered after the denial.
• You now have a finite window to challenge the decision within the plan.

This denial is not a verdict — it’s a starting point for the next phase.

The ERISA Closed Administrative Record Explained

One of the most important concepts in any ERISA LTD appeal is the closed administrative record.

Under ERISA, when you file an appeal:

• The plan administrator reviews only the evidence that was in the record at the time the denial was made, plus any additional evidence you submit before the deadline.
• Evidence submitted after the appeal deadline is usually excluded from the review and may not be considered if your case goes to court.
• The appeal review is confined to what exists in the record, not what you wish had been included.

Because of this, the time between denial and appeal is your last chance to strengthen the record.

The Standard of Review: How Courts Look at ERISA Decisions

If you must take your case to federal court after an internal appeal, the standard of review matters tremendously.

De Novo vs. Abuse of Discretion

• Some plans are reviewed de novo — meaning the court looks at the case as though the denial never happened and makes its own determination.
• Most ERISA LTD plans give the administrator discretionary authority to interpret plan terms and review claims, triggering the abuse of discretion standard.

Under abuse of discretion review:

• A court will not overturn a denial unless the administrator’s decision was unreasonable, arbitrary, or not supported by substantial evidence.
• Courts give significant weight to the plan administrator’s interpretation of policy language and evidence.

This makes it critical for your appeal to create a record that leaves no reasonable doubt about your disability under the policy.

Before You Appeal — What You Can Still Submit

Even after a denial, you have a window of opportunity to submit additional evidence before your appeal deadline.

This is your last chance to supplement the administrative record through:

1. New Medical Records

• Updated treatment notes that reflect worsening or persistent limitations.
• Specialist evaluations completed after your initial submission.
• Diagnostic tests or imaging not previously in the record.

2. Clarifying Evidence

• Attending physician statements that explicitly tie your impairments to functional limitations.
• Statements from therapists or other providers that explain day-to-day barriers.
• Vocational assessments showing how your symptoms affect your job tasks.

3. Correcting Inconsistencies

If your initial claim was denied for inconsistency among records:

• Submit statements reconciling those apparent contradictions.
• Provide explanations from providers to clarify treatment gaps or changes.

Common Reasons ERISA Appeals Fail — And How to Avoid Them

Understanding why appeals are denied can help you avoid those same pitfalls.

• Lack of Objective Evidence

Appeals often fail when medical records do not clearly show objective findings that match your policy’s definition of disability.

• Failure to Link Limitations to Work Tasks

You must show how your medical conditions prevent you from performing your job duties. Without direct linkage, denials frequently stand.

• Incomplete or Outdated Records

Appeals with only old or partial records don’t address what the plan administrator deemed insufficient the first time.

• Ignoring Plan Language

Every ERISA plan has its own definitions. Appeals that don’t speak directly to those language requirements often come up short.

How to Organize Your Appeal Effectively

Preparation now improves your appeal more than waiting until after the denial hits.

1. Analyze the Denial Letter

• Identify the specific reasons for denial.
• Highlight the policy language the administrator relied on.
• Identify any missing evidence or gaps mentioned.

2. Develop a Strategy With Our Attorneys

Working with experienced counsel before filing your appeal helps you:

• Target evidence gaps efficiently.
• Frame your argument to align with plan definitions.
• Anticipate common insurer defenses.

3. Prepare a Persuasive Appeal Letter

Your appeal letter should:

• Address each denial reason point-by-point.
• Cite supporting evidence in the record.
• Explain why your condition meets the policy’s definition of disability.

Our attorneys can help draft a persuasive appeal letter that makes it hard for the administrator to ignore clear evidence and logic.

Deadlines Matter — And They Are Strict

In ERISA cases, missing a deadline can cost you the right to appeal or pursue relief in court later.

• Appeal deadlines are often found in your denial letter and policy.
• Extensions may be possible in rare circumstances, but should not be relied upon.
• Start preparing your appeal immediately after denial.

What Happens After You File Your Appeal

Once you file:

• The plan administrator will review all evidence in the closed administrative record.
• They may seek additional information (though they are not required to).
• A decision is issued, typically with written findings.

If your appeal is denied again, your next step would be to consider federal court — but that is outside the scope of this guide.

Contact Our Nationwide ERISA LTD Appeals Attorneys for Help Today

An ERISA LTD denial is not a final refusal — it’s a turning point where preparation and strategy matter most. This stage offers your last chance to strengthen the administrative record, clarify gaps in evidence, and present a compelling case that meets the plan’s requirements.

Knowing how the closed administrative record works, what evidence you can still submit, and how the applicable standard of review affects your case gives you a much better chance of success.

When you’re ready to organize your appeal or need professional guidance tailored to your unique situation, our nationwide attorneys at Disability Insurance Law Group are ready to help.

Call 954-989-9000 or reach out online today for a free consultation.