Philadelphia Long-Term Disability Lawyers
When a serious illness or injury has taken you out of work, you expect your long-term disability insurance to be there. Then the denial letter arrived.
At Shipon Law Associates, our Philadelphia long-term disability lawyers help people across the Philadelphia area fight back against insurance companies that have denied, delayed, or terminated their disability benefits.
We work on contingency, so you pay no attorney fees unless we recover for you. Call us at 215-708-1234 for a free consultation.
Why Long-Term Disability Claims Get Denied in Philadelphia
Insurance companies deny long-term disability claims for many reasons, and most of them have nothing to do with whether you are actually disabled.
Insurers may argue your condition does not meet their definition of disability, that your medical records are insufficient, or that you failed to meet a procedural deadline you did not know existed.
Some denials are based on surveillance footage, independent medical exams conducted by physicians hired by the insurer, or review by in-house doctors who never examined you.
These tactics are common. They are also challenging.
Our attorneys have spent years working with claimants in the Philadelphia area who were wrongfully denied benefits they paid for.
We understand how insurers build their case against you, and we work to build a stronger one on your behalf.
Ready to talk through your denial? Call 215-708-1234 for a free case review.
How Long-Term Disability Insurance Actually Works
Long-term disability insurance is designed to replace a portion of your income when a medical condition prevents you from working. Most policies pay between 50 and 70 percent of your pre-disability income, typically after a waiting period following the end of short-term disability coverage.
The challenge is that insurance policies define disability in ways that work in the insurer’s favor.
Most policies use one of two definitions:
Own occupation: You are considered disabled if you cannot perform the duties of your specific job. This standard is more favorable to claimants and is common in professional policies.
Any occupation: After an initial period, usually 24 months, the policy shifts. You must prove you cannot perform any gainful occupation for which you are reasonably qualified by education, training, or experience. This is a significantly harder standard to meet.
Understanding which definition applies to your policy, and when it shifts, is often the first critical step in building a strong claim or appeal.
What Philadelphia Long-Term Disability Lawyers Do for You
Our role is to level the playing field between you and an insurance company that processes thousands of claims every year with a team of adjusters, physicians, and attorneys working to limit what it pays out.
When you work with our firm, we:
- Review your policy and identify the exact definition of disability that applies
- Gather and organize the medical documentation needed to support your claim
- Work with your treating physicians to ensure their records clearly reflect the functional limitations your condition creates
- Handle all communication with the insurance company
- Build the administrative record if your claim is governed by ERISA
- File appeals and, when necessary, pursue litigation
This matters especially in ERISA cases. The Employee Retirement Income Security Act (ERISA) governs most employer-sponsored disability plans.
Under ERISA, courts typically review claims based on the record built during the administrative appeal process, not new evidence introduced later.
That means the strength of your appeal is often the most important legal moment in your entire case.
Our attorneys understand how to build that record properly from the start.
Common Challenges in Long-Term Disability Claims
The Insurance Company Says Your Condition Is Not Severe Enough
Insurers often rely on their own medical reviews to minimize or dismiss the severity of your condition. Their reviewing physicians may have never examined you and may base their opinions entirely on a paper review of your records.
We work to counter this by developing complete, well-documented medical evidence from your own treating providers, including statements that address the functional limitations your condition creates in your specific occupation.
Your Benefits Were Approved, Then Terminated
A termination of benefits after approval is one of the most common and frustrating problems our clients face. Insurers often revisit claims after one or two years, particularly when the definition of disability shifts from “own occupation” to “any occupation.”
If your benefits were recently cut off, there are deadlines to protect your right to appeal. Acting quickly matters.
You Were Denied on a Technicality
Missed deadlines, missing forms, or documentation that does not match the insurer’s internal requirements can lead to denials that have nothing to do with your medical condition. These procedural denials are often appealable, but the window to respond is limited.
The Insurance Company Is Claiming You Can Return to Work
Insurers sometimes use surveillance, vocational assessments, or their own functional capacity evaluations to argue you are capable of working. These assessments do not always reflect your actual limitations, and they can be challenged with the right documentation and legal strategy.
Pennsylvania and ERISA Deadlines You Need to Know
Most long-term disability claims in Philadelphia are governed by ERISA, which sets specific timelines for appeals and legal action.
Under ERISA, you generally have 180 days to file an administrative appeal after a denial. Missing this deadline can permanently waive your right to challenge the decision in court.
If your administrative appeal is also denied, you typically have a limited period, often set by the policy itself, to file a lawsuit, sometimes as short as three years from the date of the denial.
For claims not governed by ERISA, such as those under individual disability policies purchased privately, Pennsylvania’s general statute of limitations for contract claims may apply. These timelines vary and are often shorter than claimants expect.
Note: Deadlines in disability cases are strictly enforced. The specific timeline that applies to your claim depends on your policy, your employer’s plan documents, and the facts of your case.
Speaking with an attorney as soon as possible after a denial is the most important step you can take to protect your rights.
You can review ERISA’s governing regulations through the U.S. Department of Labor. Pennsylvania-specific court procedures are available through the Pennsylvania Unified Judicial System.
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What Benefits May Be Available
If your long-term disability claim is successful, you may be entitled to recover monthly disability benefits going back to the date of wrongful denial, plus ongoing future benefits for as long as you remain disabled under the policy’s definition.
In some cases, additional relief may be available.
Back benefits: If your claim was wrongfully denied or terminated, you may be owed the monthly payments you should have been receiving from the date of denial forward.
Ongoing monthly benefits: If your disability continues, a successful claim restores your monthly payments for the remainder of the benefit period, which may extend to age 65 or longer depending on your policy.
Attorney’s fees: Under certain circumstances, ERISA allows courts to award attorney’s fees to a prevailing claimant. Our attorneys can explain whether this may apply to your situation.
Other relief: Depending on the type of policy and the nature of the insurer’s conduct, additional remedies may be available under state law for claims not governed by ERISA.
Insurance companies frequently underestimate or undervalue what claimants are owed. Our role is to pursue the full scope of benefits your policy provides.
Do You Have a Long-Term Disability Claim?
You may have a valid claim or appeal if your disability insurance denied, delayed, or terminated your benefits and your medical condition genuinely prevents you from working under your policy’s definition.
To have a strong claim, you generally need to show that your condition meets the policy’s definition of disability, that your medical documentation supports the functional limitations you are experiencing, and that you have followed the procedural requirements of the policy and any applicable federal or state law.
You do not need to already know the answers to these questions. That is what the consultation is for.
Call 215-708-1234 to speak with a Philadelphia long-term disability lawyer. Free consultation, no fee unless we recover.
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Ask Shipon Law Associates
Q: What should I do first after my long-term disability claim is denied in Pennsylvania? A: Read the denial letter carefully and note any deadlines it mentions. Under ERISA, you typically have 180 days to file an administrative appeal. Do not contact the insurance company without speaking to an attorney first. The appeal process is where your claim is won or lost, and building the right record from the start is critical.
Q: Can I appeal a long-term disability denial on my own? A: You can, but it carries significant risk. ERISA appeals are the foundation of any future lawsuit, and courts generally review only the evidence submitted during that administrative process. An attorney can help you develop the medical evidence, legal arguments, and documentation that give your appeal the best chance of success before any litigation becomes necessary.
Q: How long does a long-term disability appeal take in Philadelphia? A: Under ERISA, the insurance company generally has 45 days to decide a disability appeal, with one possible 45-day extension. If your appeal is denied, pursuing litigation can take considerably longer depending on the complexity of the case and the court’s schedule.
Q: Does it cost anything to hire a Philadelphia long-term disability lawyer? A: At Shipon Law Associates, we work on a contingency fee basis for disability claims. You pay no attorney fees unless we recover benefits for you. There are no upfront costs and no hourly charges.
Q: What if I am still receiving some benefits but the insurance company is threatening to cut them off? A: Do not wait for the termination letter to arrive. If you have received notice that your benefits are under review or may be terminated, speaking with an attorney now can help you prepare documentation and understand your rights before the insurer makes a final decision.
Frequently Asked Questions About Long-Term Disability Claims in Philadelphia
What conditions qualify for long-term disability benefits?
Whether a condition qualifies depends entirely on your specific policy, not on a general list of approved diagnoses. Policies cover conditions that prevent you from working, which may include serious physical conditions, mental health conditions, neurological disorders, and others. The key question is whether your condition, as documented by your medical providers, meets your policy’s functional definition of disability. A free consultation with our team can help you assess whether your situation may qualify.
What is ERISA and how does it affect my disability claim?
ERISA, the Employee Retirement Income Security Act, is a federal law that governs most employer-sponsored benefit plans, including group disability insurance. If your disability insurance came through your employer, ERISA almost certainly applies to your claim.
ERISA sets strict procedural rules, limits the evidence courts can consider, and caps certain types of damages. It is a complex area of law, and having an attorney who understands ERISA is particularly important in these cases.
Can I apply for Social Security disability and long-term disability at the same time?
Yes, and many claimants pursue both. These are separate programs with different eligibility standards. It is common for long-term disability policies to include an offset provision, meaning your monthly disability benefit may be reduced by the amount you receive from Social Security.
Understanding how these programs interact is important for planning your overall financial situation while out of work. You can also learn more about how to improve your chances of winning your disability case on our blog.
My doctor supports my claim. Why was I still denied?
Insurance companies are not required to follow your treating physician’s opinion. They may rely on their own reviewing physicians, who often reach different conclusions.
Courts have increasingly scrutinized this practice, but insurers continue to use it. Building a stronger, more complete medical record that directly addresses the insurer’s objections is often the most effective response to this type of denial.
Does Shipon Law Associates handle disability cases in Philadelphia and the surrounding area?
Yes. Our firm serves clients throughout the Philadelphia area, including from our Philadelphia office at 236 E Hunting Park Ave Suite 101. We also serve clients from our Jenkintown location and handle cases across southeastern Pennsylvania.
If you are unsure whether we can help based on where you live or where your employer is based, call us and we will give you a direct answer.
Related Practice Areas
If your situation involves related legal questions, the following pages may be useful:
- Social Security Disability — For those pursuing federal disability benefits through the SSA
- Short-Term Disability Appeals — For claims earlier in the disability benefit process
- ERISA Claims — For a broader overview of how ERISA affects your benefits rights
One Conversation Can Change Your Next Step
A denial is not the end of the road. For many claimants in Philadelphia, it is the beginning of a process that, with the right legal help, ends with their benefits restored.
Our 24-hour call center means you do not have to wait until Monday morning to get answers. When you are ready to talk, we are available.
Shipon Law Associates serves Philadelphia and the surrounding area with straightforward, experienced legal representation for long-term disability claimants who have been wrongfully denied.
Call 215-708-1234 or visit our website to schedule your free consultation. No fee unless we recover.
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This page provides general legal information and does not constitute legal advice. Every case is different. Applicable laws, deadlines, and procedures may vary depending on the specific facts of your situation. Speak with a licensed Pennsylvania attorney to understand your rights.