The letter you have
Benefits cut after a paper review. A definition of disability that changed at 24 months. An employer plan that now says you can work.
At stake: $10,000 – $500,000+
Health & Medical
You found the right place.
Your Disability Benefits Were Denied. Here's How to Appeal ERISA.
What we do with it
We read the letter. We explain it in plain English. In about 30 seconds you’ll know where you stand — and what to do next.
No account needed · Results in about 30 seconds · Free to start
ERISA or individual policy — the record is everything
If the coverage came through your employer, ERISA almost always applies. A later court will generally only see what went into your internal appeal, so that record has to be complete the first time. If you bought the policy yourself, state insurance law applies instead — including your state commissioner and, in many states, broader remedies.
ERISA internal appeals are typically 180 days. Individual policies are often 60–180 days. Check the denial letter; missing the deadline can end the appeal.
What Does a High Viability Score Mean?
A score above 70 means the denial has a real gap — a paper review that ignored treating records, an "any occupation" finding that does not match your work history, or a mental-health cap applied to a physical diagnosis. For ERISA plans, that score also flags what must go into the administrative record before internal appeals run out.
90–100Record error or legal mismatch — fighting back is very likely to work
70–89Solid case — strong grounds if the record is complete
50–69Possible — depends on treating evidence and which law applies
Three Disability Denials — and Why They Are Overturnable
These are the patterns disability insurers follow. Understanding them is the first step to defeating them.
Definition Change Denial
76
Viability
The insurer switched from "own occupation" to "any occupation" at the 24-month mark and terminated your benefits — claiming you can perform some job, somewhere.
"Your policy provides own-occupation disability benefits for a maximum period of 24 months. The definition of disability now changes to any occupation. After review, we have determined you retain the functional capacity to perform gainful employment. Your benefits are terminated."
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.
IME / File Review Denial
74
Viability
The insurer arranged a file review or independent medical examination by a physician who has never treated you — and used their findings to deny or terminate your benefits.
"Our independent medical reviewer has conducted a comprehensive review of your claim file and medical records. Based on this review, our reviewer has concluded that the medical evidence does not support functional limitations that would prevent you from performing the duties of your occupation. Your claim for disability benefits is denied."
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.
Mental Health Limitation
72
Viability
The insurer applied a 24-month mental health benefit cap to your claim — even though your primary disabling condition is physical.
"Your claim has been reviewed under the mental health and behavioral conditions limitation in your policy. As your disability is found to be primarily caused by mental health, behavioral, or nervous system conditions, benefits are limited to 24 months. Your benefits are terminated."
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.
Here's How It Works — Three Simple Steps
From denial to appeal-ready in about 3 minutes. Building the record correctly from the start protects your rights at every level.
1
Upload Whatever You Received
Take a photo or upload a PDF — that's really all it takes.
2
We Identify Every Legal Ground to Challenge
Within seconds — and we flag whether ERISA or state law governs your plan.
3
Your Complete Appeal Letter Is Ready
Formally written, legally grounded, record-building — for $39.
How to appeal an ERISA disability denial — start free
Upload your disability denial. In under a minute, you will know every ground to challenge — and what the administrative record needs to include.
Start My Free Analysis →Free to analyze · $39 complete appeal · No subscription · ERISA record-building included · Not legal advice