Counsel01 / Do I Have a Case?
What They Told You. What the Law Actually Requires.
Plan administrators write denial letters to discourage appeals. Every row below is a gap between corporate language and what federal courts have repeatedly required. The column highlighted in amber is almost always on your side.
"Your policy only covers disability for 24 months due to a mental/nervous limitation."
ERISA requires the plan to apply the same 24-month limit to all conditions equally. Physical diagnoses causing the same functional impairment cannot be capped differently. Courts have reversed these denials.
"After 24 months, you no longer meet the definition of disability because you can perform sedentary work."
If your policy promises "own-occupation" disability coverage, the administrator cannot switch standards at month 25 without explicit plan language. Many do this anyway — and courts hold them to the written terms.
"Our physician reviewed your file and determined you are not disabled."
A paper review by a hired physician who never examined you carries less weight than your treating doctors' records. Under Ninth Circuit and other precedents, heavy reliance on file-only reviews is evidence of arbitrary denial.
"You have 180 days to appeal. After that, your rights are forfeited."
ERISA mandates a full and fair review of every denied claim. If the plan failed to provide specific reasons or denied you documents you requested, the clock may be tolled. Missing the deadline with good cause has been excused.
"This procedure is not medically necessary and is considered experimental."
ERISA fiduciary duty requires the administrator to follow the plan's own clinical criteria, not internal cost targets. If peer-reviewed literature supports the treatment and your oncologist recommends it, "experimental" is not a blanket defense.
Recognize your situation in any row above?
A 30-minute case review costs you nothing. Attorney-client privilege attaches immediately.
02 / What Is ERISA and Does It Protect Me?
The Federal Law Your Plan Administrator Hoped You'd Never Read.
ERISA — the Employee Retirement Income Security Act — is a 1974 federal statute. In plain terms: if your employer offered you a benefit in writing, federal law can require them to pay it. Every concept below is a tool we use in your favor.
ERISA overrides most state insurance laws when your benefit comes through an employer plan.
Your case is heard in federal court — which has stronger discovery rules and a body of pro-claimant precedent that state courts do not provide.
The plan administrator is legally obligated to act solely in your interest when making benefit decisions.
When an insurer has financial incentive to deny — and denies — that conflict of interest is evidence courts use to scrutinize the decision.
You must exhaust the plan's internal appeal process before suing in federal court.
This sounds like a barrier — it is actually an opportunity. A well-built appeal record constrains the administrator's defenses in court.
Courts review some plan decisions under a deferential standard — unless the plan has a conflict of interest.
If your insurer both decides claims and pays them, that structural conflict lowers the deference courts give. More decisions get reversed than claimants expect.
ERISA claims must be filed within the window set by the plan or by federal law.
Plans often bury short limitation periods in plan documents. Missing the deadline can bar your claim — this is why getting counsel immediately after denial matters.
Still unsure if ERISA covers your situation?
We review your denial letter and plan documents at no cost. You'll know within 48 hours.
03 / What Does This Cost?
You Were Already Denied Once. We Don't Add to the Risk.
ERISA litigation is our only practice. We structure every engagement to remove financial barriers for workers who've already been wronged.
Hourly billing firms charge $400–$800/hr. A single appeal can cost $8,000–$25,000 before you see a court.
We work on contingency for ERISA litigation. You pay nothing unless we recover your benefits.
Hourly firms keep your retainer regardless of outcome. You absorb 100% of the financial risk.
On contingency, we share the risk. If we don't recover, you owe us nothing for attorney fees.
Most claimants don't know ERISA allows courts to award attorney fees against the plan.
Under 29 U.S.C. § 1132(g), courts regularly order the plan to pay our fees when we prevail — meaning you keep more of what's recovered.
Many firms charge a consultation fee before telling you whether you have a case.
We review your denial letter, plan summary, and denial reason at no charge. You leave the call knowing where you stand.
Contingency Fee
We only get paid when you recover benefits. No recovery, no fee.
Attorney-Client Privilege
Everything you share in your initial review is protected from day one.
ERISA Fee Shifting
Federal law can require the plan to pay our fees — you keep more of what's won.
04 / How Do I Start?
Get Your Denial Reviewed.
Tell us what was denied and when. No name or phone number required on the first step — attorney-client privilege attaches before you share anything sensitive.
Submit the type of benefit denied and your denial date.
We match your situation to applicable ERISA precedents within 48 hours.
You receive a written summary of your legal position — no obligation.
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Denied your benefits?
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