Your Doctors Say You Can't Work. Your Insurance Company Disagrees. We Know Who's Wrong.

Long-term disability denials are rarely about the facts of your condition — they're about the record the insurance company built against you. We build a better one.

A Denied LTD Claim Is a Document Problem — Not a Medical One

When a long-term disability claim gets denied, most people assume the insurance company reviewed the evidence and reached a fair conclusion. That's almost never what happened. Insurers deny claims because they can — because the policy language gives them discretion, the medical file has gaps they can point to, or the definition of "disability" in your plan doesn't match the way your doctors described your condition.

A long-term disability denial attorney doesn't just appeal the decision. We identify exactly what the insurer said was missing, gather the evidence to fill those gaps, and submit a record that is far harder to deny a second time.

We represent clients across Florida whose LTD claims have been denied, delayed, or terminated — whether the plan was provided through an employer, a union, or a professional association.

ERISA Controls Most Employer LTD Plans — and That Changes Everything

If your long-term disability coverage came through your job, it is almost certainly governed by the Employee Retirement Income Security Act (ERISA). ERISA is a federal law that sets strict procedural rules for how insurance companies must handle LTD claims and appeals — and it creates a specific problem that most claimants don't know about until it's too late.

Under ERISA, the administrative record closes at the end of the appeal process. That means any medical evidence, vocational reports, or expert opinions not submitted during the appeal cannot be introduced in federal court. If you wait until after a final denial to hire an attorney, you may be locked into a thin record that limits what a court can consider.

This is why early involvement matters. We get into your case during the appeal stage — when the record is still open and we can shape what the court will eventually see.

The Two-Stage ERISA Appeal Process

ERISA requires insurance companies to provide at least one full and fair review of a denied claim before you can file suit. In practice, most plans offer two internal appeal levels. Understanding how this works is the first step to working it effectively.

1. First-Level Administrative Appeal

After a denial, you have a defined window — typically 180 days — to submit your first appeal. This is not the time to send a letter expressing disagreement. It is the time to submit every piece of supporting evidence: updated medical records, treating physician statements, functional capacity evaluations, and any vocational or occupational analysis relevant to your specific policy definition of disability. We prepare this submission as if it is going to a judge — because it may.

2. Second-Level Administrative Appeal (If Required)

Some plans require a second internal appeal before federal litigation is available. We treat this stage the same way: as a record-building opportunity, not a formality. Every piece of evidence that belongs in your file goes in now. Once this stage closes, the record is sealed.

3. Federal Court Review

If the insurance company upholds the denial after the internal appeal process, we can file suit in federal court. Courts review ERISA LTD denials under an abuse of discretion standard — which means we have to show the insurer's decision was unreasonable given the evidence in the record. The strength of the administrative record we built in steps one and two directly determines how strong that case is.

Mid-Stream Terminations Are Common — and Often Beatable

Not every LTD dispute starts with a denial. Many clients come to us after receiving benefits for months or years, only to have them cut off without warning. These terminations are frustrating precisely because the claimant did everything right — and the insurance company still found a reason to stop paying.

One of the most common triggers is a policy definition shift. Many LTD plans define disability as the inability to perform your "own occupation" for the first 24 months of benefits. After that, the definition changes to the inability to perform "any occupation." When that shift happens, insurers frequently conduct new reviews, order independent medical examinations, and terminate benefits based on a standard the claimant was never told was coming.

Being cut off is not the same as no longer qualifying. We challenge terminations directly — reviewing the basis the insurer used, identifying procedural failures or selective evidence, and building the appeal record needed to reverse the decision.

What We Look for When We Review a Denial

Every LTD denial letter contains the insurer's stated reason for the decision. What it rarely contains is the full picture of how that decision was made. When we take on an LTD case, we review:

• The full policy language, including every definition of disability that applies at each benefit stage
• The administrative file the insurer compiled — including any independent medical reviews or surveillance
• Whether the insurer followed ERISA's procedural requirements for notice, review, and response timelines
• The treating physician records and whether they were accurately characterized in the denial
• Whether a vocational analysis was used — and whether it was based on your actual functional limitations
• Any prior approvals or correspondence that contradict the insurer's current position

A Note for Workers' Comp Clients Whose Benefits Have Ended

Some clients reach us after a workers' compensation case has closed and their long-term disability benefits have been denied or are about to run out. If you received a workers' comp settlement or your comp benefits ended, a separate LTD claim may still be available — and the two systems have different rules, different timelines, and different legal standards.

We handle both. If you are navigating the transition between workers' comp and long-term disability, we can review where you stand under each and help you understand what options remain.

Why Florida LTD Claimants Work With Us

• Our labor and employment attorneys have handled ERISA claims at both the administrative and federal court level
• We understand how insurance companies build their case against claimants — and how to dismantle it
• We represent clients statewide, with offices in Tampa, St. Petersburg, and Land O' Lakes, and virtual consultations available throughout Florida
• No fees unless we recover benefits for you
• Spanish-speaking attorneys available for clients who prefer to communicate in Spanish

Frequently Asked Questions About Long-Term Disability Denials in Florida

Your Benefits Were Denied. That's Not the Final Word.

Insurance companies count on claimants giving up after a denial. We make sure that doesn't happen. If your long-term disability claim has been denied or terminated, contact us today for a free consultation — we'll review your policy, your denial letter, and your options at no cost to you.