If your long-term disability claim was denied in Maryland, you generally have a limited window to appeal, and how you use that time can make or break your case. Whether your policy falls under ERISA or is a private policy affects your deadline, your appeal process, and even your options if the appeal doesn't succeed, which makes identifying your policy type the very first step.
Lebau & Neuworth’s dedicated long term disability lawyers help Maryland claimants understand exactly what kind of policy they have and how to build the strongest possible appeal before time runs out. If your long-term disability claim was denied, call (410) 296-3030 to talk with our team.
Long-term disability claims get denied for a range of reasons, including insufficient medical documentation, a determination that the medical evidence doesn't support the claimed level of impairment, surveillance or social media activity that the insurer argues contradicts the claimed limitations, a missed deadline or incomplete paperwork, or a policy provision the insurer argues excludes or limits the specific condition at issue.
If your long-term disability coverage came through an employer-sponsored plan, it's generally governed by the federal Employee Retirement Income Security Act, or ERISA, which imposes its own specific claims and appeals procedures.
If you purchased an individual long-term disability policy directly rather than through an employer, ERISA generally doesn't apply, and your appeal rights are instead governed by the terms of your specific policy and Maryland insurance law.
If your policy is governed by ERISA, you generally have 180 days from the date of your denial letter to file a formal appeal. This deadline is strict, and missing it can permanently forfeit your right to challenge the denial through the plan's internal appeal process, which is often a required step before you can pursue further legal action. Private policies not governed by ERISA may have different deadlines specified in the policy itself, making it just as important to identify the applicable deadline for your specific situation right away.
A strong long-term disability appeal generally requires more than simply restating that you're unable to work. It requires directly addressing the insurer's stated reasons for denial with specific evidence, including updated medical records, statements from treating physicians addressing your specific functional limitations, and, where appropriate, vocational or functional capacity evaluations that speak directly to your ability to perform your job duties.
Everything submitted during your appeal becomes part of what's known as the administrative record. If your appeal is ultimately denied and your case proceeds to litigation, particularly in an ERISA case, a court will typically only review the evidence that was already part of this administrative record. This means your appeal isn't just a request for reconsideration; it's often your last opportunity to submit new evidence that a court could later consider.
Unlike some other legal processes where new evidence can be introduced later, an incomplete appeal can permanently limit what a court is able to consider if your case proceeds further. This is why building the strongest possible appeal the first time, rather than treating it as a quick formality, matters so much.
If your administrative appeal is denied, your next steps depend on your policy type.
For ERISA-governed plans, this generally means the option to file a lawsuit in federal court, based largely on the administrative record already established during your appeal.
For private policies not governed by ERISA, your options may include filing a lawsuit in state court, potentially with the ability to introduce additional evidence beyond what was submitted during your appeal, depending on the specific policy and circumstances involved.
An experienced disability attorney can help identify exactly what the insurer's denial letter is really disputing, gather the specific type of medical and vocational evidence needed to address those disputes, and make sure your administrative record is as complete as possible before it becomes the foundation for any further legal action.
Given how much weight the administrative record carries, particularly in ERISA cases, having experienced guidance during the appeal stage itself, rather than only after a lawsuit becomes necessary, can make a meaningful difference in the outcome of your case.
A long-term disability denial can feel like the end of the road, but a well-built appeal can change the outcome, especially when it's filed within the strict deadlines that apply to your specific policy. Given how much the administrative record matters, particularly for ERISA-governed claims, the appeal stage isn't the time to cut corners.
Lebau & Neuworth focuses exclusively on representing individuals in employment law and employee and disability benefits disputes; not companies, unions, or insurance companies. Our team brings decades of combined experience to every long-term disability case we handle, and that focus has earned us a national reputation for successfully representing clients in court, mediations, negotiations, and arbitrations. We work with the full range of the workforce, from executives and doctors to teachers, retail workers, and everyone in between, and every one of them gets the same aggressive protection of their individual rights.
Our Maryland long-term disability team can help you understand your policy type, meet your appeal deadline, and build a complete administrative record addressing the specific reasons for your denial. If you're also navigating Social Security disability benefits or need guidance on workplace accommodations while your appeal is pending, our team is ready to help with that as well.
Contact a disability benefits lawyer at Lebau & Neuworth at (410) 296-3030 today.
If your policy is governed by ERISA, you generally have 180 days from the date of your denial letter to file an appeal. If your policy is a private policy not governed by ERISA, the deadline may be different and is generally specified in your policy documents, so it's important to confirm your specific timeline right away.
An ERISA plan is generally an employer-sponsored benefit governed by federal law, with its own specific claims and appeals procedures and deadlines. A private policy, purchased individually rather than through an employer, is instead governed by the terms of the policy itself and applicable state insurance law, which can mean different deadlines and different options if your appeal is denied.
The administrative appeal is often your last opportunity to submit new evidence, since everything you provide becomes part of the administrative record. Particularly in ERISA cases, if your appeal is denied and you pursue litigation, a court will typically only review the evidence already contained in that record, making a thorough appeal essential.
Generally, no, especially for ERISA-governed plans, which typically require you to exhaust the plan's internal appeal process before you're permitted to file a lawsuit. Skipping this step can result in your case being dismissed for failing to exhaust the required administrative remedies first.
