Info Library

 Clear Information About Long Term Disability Claims

The Info Library is a comprehensive educational resource for people navigating long term disability claims.

Here, you can learn how disability insurers evaluate medical conditions, occupational duties, policy language, medical evidence, appeals, benefit terminations, and litigation. Each guide focuses on a specific issue that may affect your eligibility for benefits or the strength of your claim.

Use the search feature above or browse the topic areas below.

Diagnoses

A medical diagnosis can have a profound impact on your ability to work, but not every diagnosis is evaluated the same way by disability insurance companies.

Our diagnosis guides explain how specific medical conditions may affect your eligibility for long term disability benefits, the evidence insurers typically look for, and the unique challenges claimants often face throughout the claims process.

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Occupations

Your occupation is one of the most important factors in a long term disability claim. Disability insurance companies evaluate more than just your diagnosis; they assess whether your condition prevents you from performing the material duties of your specific occupation.

Our occupation guides explore the unique demands of different professions and the evidence that can help support a successful disability claim. Whether you are filing an initial claim, appealing a denial, or protecting ongoing benefits, understanding how your occupation is evaluated is essential.

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Insurers

The insurance company handling your long term disability claim can significantly impact your experience throughout the claims process. While every insurer evaluates disability claims differently, each has its own procedures, priorities, and common reasons for delaying, denying, or terminating benefits.

Our insurer guides examine the practices of major disability insurance companies, explain the challenges claimants commonly encounter, and provide insight into the strategies that can help strengthen your claim at every stage.

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Policy Terms

Your disability insurance policy is the foundation of your claim. The language in your policy determines who is eligible for benefits, how disability is defined, what limitations or exclusions may apply, and what evidence you need to provide throughout the claims process.

Our policy guides explain the key provisions found in many long term disability policies and help you understand how your policy can affect your eligibility, benefits, and claim strategy.

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Claim Strategies

Every long term disability claim presents unique challenges, and the steps you take throughout the process can have a significant impact on your ability to obtain and maintain benefits. Understanding how disability insurers evaluate claims can help you make informed decisions from the outset.

Our claim strategy guides cover important topics such as documenting your disability, working with your treating physicians, responding to insurer requests, preparing appeals, and protecting your benefits throughout the life of your claim.

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Litigation Issues

If your long term disability claim cannot be resolved during the administrative claims process, the next step may involve litigation or mediation. Understanding how these proceedings work can help you make informed decisions about your legal options and what to expect as your case moves forward.

Our litigation and mediation guides explain important legal concepts, court procedures, settlement discussions, standards of review, and other issues that may arise after a claim has been denied or terminated.

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Topic

Litigation Erisas Claims Procedure Regulations

Rappaport v. Guardian: ERISA Disability Claim Regulations Survive Post-Loper Bright Challenge

ERISA News Guardian Success Story ERISA's Claims Procedure Regulations

Riemer Hess LLC is excited to share a significant victory for our client, Jason Rappaport, in his ongoing case against Guardian Life Insurance Company of America.  On November 22, 2024, Judge Jennifer L. Rochon of the United States District Court for the Southern District of New York issued a ruling that reaffirms the strength of ERISA’s procedural safeguards for claimants in the Second Circuit and beyond.

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American Bar Association (ABA) Publishes Riemer Hess LLC Article on ERISA Disability Claims Regulations

ERISA News ERISA's Claims Procedure Regulations Strategy - ERISA's Claims Procedure Regulations

We are pleased to share that Partner Jennifer L.  Hess and Associate Ryan J.  McIntyre of Riemer Hess LLC have authored an important article in the American Bar Association’s Tort Trial & Insurance Practice Law Journal.  The piece, titled “Assessing the 2018 ERISA Long-Term Disability Claims Regulations: Five Years Later,” provides a critical analysis of the major regulatory changes made in 2018 under the Employee Retirement Income Security Act of 1974 (ERISA). 

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Riemer Hess Convinces NY Court That First Reliance Violated ERISA’s Regulations

ERISA News Success Stories Standard of Review First Reliance DOL Regulations Success Story ERISA's Claims Procedure Regulations Strategy - ERISA's Claims Procedure Regulations

Riemer Hess Secures Legal Victory on Behalf of Financial Engineer with a TBI

Riemer Hess LLC is proud to announce a significant legal victory in Rhodes v. First Reliance Standard Life Insurance Company, No. 22 CIV. 5264 (AKH), 2023 WL 3099294 (S.D.N.Y. Apr. 26, 2023).  The Court’s decision sends a powerful message to long term disability insurance companies: they will be held accountable for failing to follow the regulations provided by the Employee Retirement Income Security Act of 1974 (ERISA).

The plaintiff, Mr. William Rhodes, a Financial Engineer for a major financial institution, filed a claim for disability benefits after suffering a traumatic brain injury (“TBI”).  First Reliance initially approved Rhodes’s claim but later terminated his benefits and denied his appeal.  After the appeal denial, Mr. Rhodes consulted with Riemer Hess to sue First Reliance on his behalf.

In the litigation, Judge Alvin K. Hellerstein granted Rhodes’s motion for a de novo standard of review, holding that First Reliance failed to “strictly adhere” to ERISA’s claims procedure regulations.  As a result, the Court would apply no deference to First Reliance’s previous decision, even though the plan granted discretion to First Reliance.

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When Can You File Your ERISA Long Term Disability Litigation?

ERISA Preparation for Litigation ERISA's Claims Procedure Regulations Statute of Limitations Complaint Deadlines Exhaustion Requirement

Introduction

Timing is critical for ERISA long term disability litigation – and a factor claimants often overlook or misunderstand. Failure to file your ERISA litigation at the correct time can have dire consequences for you and your disability benefits.

If you file too early, the court often will dismiss your case, thus costing you valuable time and money spent on preparing your litigation. You may have an opportunity to correct the error of filing too early, as detailed below. However, there are much more serious and permanent consequences if you file your lawsuit too late. If you file after the statute of limitations, your claim will likely be dismissed, and you will be permanently unable to recover your benefits in court.

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Court Strips Aetna's Discretionary Authority in Long Term Disability Litigation

ERISA News Success Stories Standard of Review Aetna Success Story ERISA's Claims Procedure Regulations

In an ERISA New York disability litigation against Aetna, Riemer Hess successfully argued the Court should review the case under the plaintiff-friendly de novo standard – substantially increasing the Plaintiff’s chances of prevailing.  The Court, in following the Second Circuit Court of Appeals’ ruling in Halo vs. Yale Health Plan, stripped Aetna of its discretionary authority because it failed to to strictly adhere to the ERISA claims regulations, and its violations were neither inadvertent nor harmless.

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