If you are employed and have long-term disability insurance through your company, there is a high likelihood that your policy is governed under the Employee Retirement Income Security Act of 1974 (ERISA).  If you become disabled and need benefits, you may find that you have a very difficult time accessing them, and ultimately that your claim is denied, even though your doctors support the finding that you are unable to continue working.

ERISA disability cases are handled quite differently than most other civil cases.  There is typically no right to a jury trial in these cases.  Rather, a judge will typically decide the case based on whether the "administrative record" - which is the documentary evidence gathered and submitted during the claim and appeal process, supports the claim.  Unfortunately ERISA law gives the insurance company wide discretion to determine benefit eligibility.  The playing field is not level and the claimant has an uphill battle in most cases.

These cases are usually determined based on a very high standard - whether the insurance company "abused" its discretion to decide the claim (or acted arbitrarily and capriciously).  In some circumstances, the Court will apply a lower standard, which is called de novo review, where the Court decides whether the insurance company had a conflict of interest because they are the claim administrator and reviewer.  In a de novo review, the Court can set aside the insurance company's decision if the Court feels the evidence supports the claimant's case.

If you end up being denied long-term disability benefits, the best thing you can do is to contact an attorney who is skilled and experienced in ERISA claims to help guide you through the process and protect your interests.  It is also important to remember that the time to appeal or bring lawsuits in these claims can be limited, so that you should act promptly to preserve your rights.