Employer-sponsored disability plan terminated your benefits. Private insurer denied your claim based on a paper review. Definition of disability changed at 24 months. ClaimCompass reads your denial, identifies every legal ground to challenge, and writes your complete appeal — free to start.
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If your disability benefits come through your employer, your plan is almost certainly governed by ERISA. Under ERISA, if your internal appeal is denied and you later sue in federal court, the court will generally only review the evidence that was in your administrative record. Everything you want a court to see must go into your internal appeal. ClaimCompass helps you build that record correctly from the start.
These are the patterns disability insurers follow. Understanding them is the first step to defeating them.
Why it overturns: "Any occupation" does not mean any job that theoretically exists. Under ERISA and most policy interpretations, it means any occupation for which you are reasonably qualified by education, training, and experience — at comparable income to your prior career. The insurer cannot point to a minimum-wage position as evidence you are not disabled from your occupation. A vocational rehabilitation expert analysis, your treating physician's detailed functional capacity assessment, and documentation of the specific income and skill requirements of your prior work build the foundation for reversal. These decisions are also frequently based on paper reviews by physicians who have never examined you — a conflict that ERISA adjudicators and federal courts consistently weigh against the insurer.
Why it overturns: File reviews conducted by physicians selected and paid by the insurer are among the most contested practices in disability insurance. These physicians are not bound by the treating physician-patient relationship, may review hundreds of similar cases for the same insurer annually, and have an undeniable financial relationship with the company denying your claim. Your treating physician's clinical opinion — based on an ongoing relationship and repeated examinations — carries significant weight against a one-time paper review. If you have received or are eligible for Social Security Disability Insurance approval, that determination is powerful corroborating evidence the insurer must specifically address. Under ERISA, insurers also have a fiduciary duty to weigh all evidence — ignoring favorable evidence in the record is itself a ground for reversal.
Why it overturns: Mental health limitations are frequently misapplied when the primary disabling condition is physical. If your disability results from a documented physical condition — chronic pain, autoimmune disease, neurological disorder, cardiac condition — the mental health cap cannot be applied simply because anxiety or depression appears as a secondary diagnosis. The Mental Health Parity and Addiction Equity Act prohibits more restrictive limitations on mental health benefits for many ERISA plan types. Your treating physician must clearly document that the primary disabling diagnosis is physical, and that any behavioral component is secondary. A detailed treating physician letter specifically addressing the primary versus secondary diagnosis classification, and directly challenging the insurer's application of the limitation, reverses these denials at a meaningful rate.
Your disability insurance is governed by one of two completely different legal frameworks — and your appeal strategy depends on which one applies.
If your disability coverage comes through your employer, it is almost certainly governed by ERISA. The administrative record you build during your internal appeal is the record a federal court will review. Everything matters — every piece of evidence, every letter, every physician statement. File internally first. Build the record completely. External litigation is your option after exhaustion.
If you purchased your disability policy yourself, it is governed by state insurance law — not ERISA. State law typically provides broader remedies, including bad faith claims, punitive damages, and your state insurance commissioner as an additional enforcement avenue. Appeals follow your policy's terms and state insurance regulations.
Check the source of your coverage. If your employer offered it as a benefit — even if you paid part of the premium — it is almost certainly an ERISA plan. If you bought it independently through an insurance broker or directly from an insurer, it is an individual policy. Your denial letter may also reference ERISA directly.
ERISA plans: typically 180 days to file an internal appeal from the date of denial. Individual policies: varies by state and policy terms — often 60 to 180 days. Both have firm deadlines. Missing them can forfeit your right to appeal entirely. Check your denial letter immediately for your specific deadline.
From denial to appeal-ready in about 3 minutes. Building the record correctly from the start protects your rights at every level.
Take a photo or upload a PDF — that's really all it takes.
Your disability denial letter, benefit termination notice, IME summary, or any short or long-term disability correspondence. PDF or a phone photo works. Your document is handled securely and automatically deleted if you do not continue. No account needed to start.
Within seconds — and we flag whether ERISA or state law governs your plan.
Our AI analyzes your denial, identifies the specific basis — definition change, IME dispute, mental health limitation, or other grounds — and gives you a viability score from 0 to 100. For ERISA plans, we specifically identify what must go into your administrative record before you exhaust internal appeals. Completely free. No payment required.
Formally written, legally grounded, record-building — for $49.
ClaimCompass generates a complete appeal letter challenging the specific denial — citing ERISA fiduciary standards, applicable policy language, the insurer's evidentiary burden, and the evidence that must be in the record. Every escalation level included. One payment. No additional charge if the first appeal is denied.
Upload your disability denial. In under a minute, you will know every ground to challenge — and what the administrative record needs to include.
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