File a disability insurance claim and appeal a denial
A disability claim filed on a complete evidentiary record, or a denial appealed inside the ERISA window—the policy’s definition of disability and elimination period established, an attending physician statement and objective diagnostics assembled to match that definition, the claim or appeal submitted, and the administrative record preserved for any further review.
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Who it's for
U.S. workers covered by an employer-sponsored short-term or long-term disability plan governed by ERISA who need to file a claim or appeal a denial. Also relevant for independent contractors who purchased an individual disability policy with ERISA-like procedures, though state-law appeal rules differ. Does not apply to claimants whose only coverage is a state disability program or SSDI.
About this playbook
A disability claim is approved or denied based on how well your medical evidence matches the policy’s specific definition of disability—not on how severe your condition feels. This guide walks you through locating your policy’s key terms, gathering objective medical evidence keyed to its definition of disability, filing the initial claim, and appealing a denial within the strict ERISA deadlines. It covers employer-sponsored short-term and long-term disability plans governed by ERISA, including navigating the elimination period, the own-occupation versus any-occupation standard, and the attending physician statement. It does not cover state disability programs (CA SDI, NY PFL, NJ TDI, RI TDI), Social Security Disability Insurance, or private non-ERISA policies, though the evidence you assemble here supports those separate applications. The claim file you build determines your outcome at every stage, because ERISA closes the administrative record at the end of the internal appeal—making the appeal the decisive step before any lawsuit.
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Phase 1: Understand Your Policy Terms and Deadlines
4 stepsPhase 2: Assemble Objective Medical Evidence That Matches the Policy Definition
4 stepsPhase 3: File the Initial Claim
4 stepsPhase 4: Navigate the Claims-Review Process
3 stepsPhase 5: Appeal a Denial Within the ERISA Window
5 stepsPhase 6: Preserve the Administrative Record for Further Review
2 steps
Details
What you need first
A physical or mental condition that has prevented you from working (or is expected to) longer than your policy’s elimination period. Access to the plan documents—Summary Plan Description and insurance certificate—from your employer, HR, or the insurer’s portal. Willingness to request medical records and communicate with your treating providers. If appealing, a written denial letter received within the last 180 days (or your policy’s specified appeal window).
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