The Crucial Step: The Administrative Appeal in ERISA Disability Claims
If your long-term disability (LTD) claim has been denied and it falls under the Employee Retirement Income Security Act of 1974 (ERISA), you are required to take one very important step before filing a lawsuit: the administrative appeal.
This is not just a formality. ERISA mandates that claimants must “exhaust administrative remedies” — meaning you must submit an internal appeal to the insurance company before filing suit. Failing to do so will likely result in your lawsuit being dismissed, regardless of the merits of your claim.
What makes this appeal process even more critical is its impact on the potential lawsuit that follows. In most ERISA disability cases (especially for claimants in Texas), the court will not allow new evidence or testimony beyond what was included in the claim file during the administrative appeal. The appeal, in effect, becomes your final opportunity to build the evidentiary record for your lawsuit. If something is left out—an important medical record, a vocational evaluation, or a supporting statement from your doctor—most likely it won’t be considered later in court.
Given the tight deadlines (typically 180 days from the date of the denial letter) and the high stakes, it’s essential to approach the administrative appeal with the same level of seriousness and preparation as you would a full trial. Working with an experienced ERISA attorney can help ensure that your appeal is both comprehensive and strategic—maximizing your chances of success on the appeal and protecting your rights should litigation become necessary.
In short, the administrative appeal isn’t just a procedural step—it’s the foundation of your entire lawsuit.
Reviewed/Edited/Finalized by John L. Thompson
(initial draft using AI assistance)