Contributing Author: Kristine Custodio Suero, Advanced Certified Paralegal

When you've spent years contributing to your retirement or relying on employer-sponsored disability coverage, a denial of benefits can be a deeply frustrating and confusing experience. At Schechter Benefits Law Group LLP, we regularly counsel individuals and plan sponsors on the intricacies of ERISA law, including denials of retirement and long-term or short-term disability (LTD/STD) claims. 

In this post, we address the most frequently asked questions about denied benefits under ERISA-covered plans and explain how our firm can help.

Common FAQs on Denied ERISA Benefits

1. Why was my claim denied?

• The most common reasons include:
  • Insufficient medical documentation or conflicting physician opinions
  • Missed claim deadlines or failure to follow procedures
  • The definition of “disability” not being met, or not satisfying eligibility requirements
  • Exclusion for pre-existing conditions or short durations of coverage
• Insurers may rely on internal medical reviews rather than your treating doctor's opinion, creating a biased or incomplete assessment.

2. What can I do if my claim is denied?

• First, request your full plan/policy documents and the denial letter, which must include the reason for the denial.
• You have the right to:
  • File a written administrative appeal under ERISA Section 503 (29 U.S.C. §1133)
  • Receive a full and fair review of your claim
  • Provide supporting documentation during the appeal
• Timelines matter: Most plans require appeals within 60 or 180 days depending on the type of benefit.

3. Can I sue the plan or insurance carrier if my appeal is denied?

• Yes. After exhausting internal plan appeals, you may file suit in federal court under ERISA Section 502(a) (29 U.S.C. §1132(a)).
• Courts will typically:
  • Review the administrative record “as is”
  • Apply a deferential “abuse of discretion” standard unless the plan allows de novo review

4. How long does a plan have to respond to my claim or appeal?

• Under DOL regulations (29 CFR §2560.503-1):
  • Initial disability decisions: within 45 days (plus extensions if justified)
  • Retirement benefits: within 90 days (plus one 90-day extension)
  • Appeals: usually 45 to 60 days for a final decision

5. What records should I gather for my appeal?

• Summary Plan Description (SPD) and full plan/policy document
• Initial denial letter and any medical or vocational evaluations used
• Your medical records, test results, attending physician statements, and employment documentation
• Any emails or letters from the plan or insurer

Why ERISA Legal Counsel Matters

Navigating an ERISA benefit denial isn't like a regular insurance claim. There are:

• Strict administrative procedures
• Narrow evidentiary windows (you often can't add new evidence later in court)
• Legal standards that favor the plan if not properly challenged

A misstep in the appeal process can seriously limit your legal options and financial recovery. That's why retaining experienced ERISA counsel early is critical. Our firm offers strategic, compassionate, and informed support to individuals facing denied benefit claims. We advise plan participants and beneficiaries throughout California and beyond.

Types of Plans We Handle:

• Long-Term and Short-Term Disability (LTD/STD) Plans
• Life Insurance/Accidental Death & Dismemberment
• Defined Contribution and Defined Benefit Plans
• Executive Compensation and Severance Plans
• Nonqualified Deferred Compensation (NQDC) Plans

Our Services Include:

• Reviewing benefit denial letters and plan/policy terms
• Preparing persuasive administrative appeals and evidentiary records
• Representing clients in negotiations with plan administrators or insurers
• Litigating ERISA claims in federal court when necessary

If you've received a denial of retirement or disability benefits, do not delay. Timelines are tight, and your financial security may be at stake. Contact Schechter Benefits Law Group LLP for a confidential consultation. Let our experienced ERISA attorneys help you protect what you've earned. 

*Nothing stated herein is to be construed as legal or tax advice and shall not form any attorney-client relationship. Each individual situation is unique. Please contact us and speak with one of our attorneys regarding your individual situation.