Your employer is not required to carry short-term and long-term disability benefits but many employers do provide these benefits. Unlike Workers’ Compensation, short-term and long-term disability benefits are not limited to “work-related” injuries. These benefits cover any type of disability regardless of the cause.
If you need to claim Short-term or Long-term Disability benefits, Quatrini Law Group can help you. If you have already filed a claim or an appeal, and have not heard anything from the insurance company, you should not allow time to pass without knowing the deadlines that apply in your particular case. We have represented people throughout Pennsylvania to safeguard their benefits. Call for a free consultation.
How Long-Term Disability Claims Work
Short-term and long-term disability benefits may be covered by a contract that the employer has entered into with an insurance company on behalf of all eligible employees. The terms of these contracts can vary drastically from policy to policy in terms of duration of benefits, definition of disability, deductible sources of income and rehabilitation incentives.
Common Long-Term Disability Claim Issues
Unfortunately, insurance carriers routinely deny benefits after an initial application, or move to terminate benefits after any improvement in the medical condition(s). Quatrini Law Group is not afraid to litigate to help you get the benefits you are entitled to.
Denied Long-Term Disability Claims
We have seen benefits denied by nearly all of the large insurance companies, including New York Life, Hartford, Guardian, Lincoln, MetLife, Prudential, Unum, Reliance Standard/Matrix, Sun Life, Mutual of Omaha, Northwestern, Principal, Sedgwick, and Standard.
Benefits Depend on the Definition of Disabled
In most cases, you are considered disabled for an initial period if you cannot return to your prior occupation. In most policies, the definition of disability changes after a two-year period, and you are considered disabled only if you cannot engage in any occupation.
ERISA Appeals
Policies subject to ERISA have very strict procedures and regulations. Failure to follow them exactly can result in the loss of benefits or the right to file a civil action.
What to Do If Your Long-Term Disability Claim Is Denied
If your disability claim becomes disputed or denied, our team can help you navigate long-term disability benefits and appeals. You should obtain a copy of your disability policy. Federal regulations require employers to provide copies of these policies within 30 days of a written request. We will review the terms of your contract, which can vary drastically from policy to policy in terms of duration of benefits, definition of disability, deductible sources of income and rehabilitation incentives, and advise on the best course of action.
Understanding ERISA and Disability Insurance Law
If you have obtained disability insurance coverage through an employer (or you have purchased an employer-endorsed policy), whether the employer is actually paying for the benefit or not, claims are subject to the federal law known as ERISA or the Employee Retirement Income Security Act of 1974. Those cases that are subject to ERISA have mandatory appeal procedures and regulations that must be followed precisely. Failure to properly follow the ERISA procedures and regulations, including the timely filing of an administrative appeal, may result in the loss of the right to file a civil action.
Types of Disability Insurance Cases We Handle
Short-Term and Long-Term insurance policies are a little known benefit available to most employees through their employer. About half of large and mid-sized employers offer it to their workers. The injury or illness need not be work related. Short- and Long-Term Disability benefits are a monthly benefit (usually 60 percent of your wages) available to individuals who are unable to perform their specific occupation due to physical and/or mentally impairments.
Short-Term Disability Litigation
Benefits are typically paid on Short-Term Disability for 26 weeks if you cannot perform your regular occupation.
Long-Term Disability Insurance Litigation
Long-Term Disability benefits are typically paid for two years if you cannot perform your specific occupation. After two years, individuals must show they are unable to perform any type of gainful employment.
Disability Income Policy Disputes
Unfortunately, insurance carriers routinely deny benefits after an initial application, or move to terminate benefits after any improvement in the medical condition(s). In either case, you should request a copy of your Short- and Long-Term Disability policies in writing and contact QLG for a review of your policy and your appeal options.
Bad Faith Insurance Claims
If you have been denied contractual disability benefits which were not endorsed by an employer, you may have a cause of action against the insurance company for bad faith based on their conduct in intentionally and wrongfully denying your benefit. However, ERISA-type policies are limited to payment of back benefits, with interest. It is possible to obtain an attorney-fee award where benefits have been wrongly denied.
Why Clients Across Pennsylvania Choose Quatrini Law Group for Long-Term Disability Claims
The Quatrini Law Group is one of the few law offices in Western Pennsylvania that handle Long-Term Disability claims. There can be numerous and complex issues in these types of cases, including the interaction with the receipt of personal injury awards, Workers’ Compensation benefits, and Social Security Disability to name a few. If you are receiving a settlement or benefits, the carrier may be entitled to some portion of your settlement, or entitled to reduce or offset your benefit. Again, every case and every policy have different terms, so it is in your best interest to obtain a copy of your policy and have it reviewed by the Quatrini Law Group if you think you have been wrongfully denied benefits.
Meet Our Long-Term Disability Attorneys
Brian P. Bronson | (724) 552-2708
James A. Miller | (724) 552-2434
Long-Term Disability Case Results
Quatrini Law Group has helped many people claim their Short-term and Long-term Disability benefits. Here are just a few examples. We offer free case reviews, so reach out if you have questions about your policy.
LTD Denial Overturned – Pennsylvania Teacher (Non-ERISA Plan)
We successfully overturned a wrongful denial of long-term disability benefits issued by Sun Life Financial for a Pennsylvania public school teacher covered under a governmental plan (exempt from ERISA). The client suffered from a complex combination of conditions, including fibromyalgia, POTS, chronic fatigue, immune dysfunction, and severe cardiovascular instability, resulting in profound functional limitations.
Our administrative appeal included a Functional Capacity Evaluation, treating physician opinions (TMSS), an independent medical exam, a detailed vocational report, and extensive medical documentation demonstrating the client’s inability to sustain competitive employment. Upon receipt of our appeal, Sun Life reversed its denial and approved benefits in full.
Denied LTD Claim Forced Into Settlement After Federal Lawsuit
A woman over 60 with serious spinal and chronic pain conditions—including spinal stenosis, disc disease, and migraines—was forced to stop working. Despite clear medical issues, her long-term disability claim was denied multiple times, even after exhausting all appeals. The insurer relied on paper reviews and downplayed her limitations, claiming she could still work. At that point, the only path forward was federal court litigation under ERISA.
We built a case the insurance company couldn’t ignore:
- Functional Capacity Evaluation (FCE): Proved she was limited to less than full-time sedentary work with strict limitations
- Physician narratives: Connected medical findings to real-world inability to work
- Client deposition (key strategy): Locked in credible, detailed testimony—something most firms don’t do
- Federal lawsuit: Forced accountability for failure to properly evaluate the claim
The case was resolved through mediation, resulting in a favorable financial settlement.
Why This Case Matters
- Multiple denials are not the end of the road
- Strong functional evidence can change everything
- Federal litigation creates real leverage against insurance companies
MetLife Denial Reversed Using Neuropsychological and Vocational Evidence
A senior-level data analyst developed post-COVID cognitive impairment along with autoimmune and chronic pain conditions. She applied for LTD benefits—but MetLife denied the claim, arguing she could still perform her job. MetLife minimized cognitive symptoms—something that happens frequently in “invisible illness” cases.
We built the case around objective cognitive proof and job-specific demands:
- Neuropsychological testing: Documented measurable deficits in attention, processing speed, and endurance
- Vocational expert report: Showed her high-level job was no longer sustainable
- TMSS physician support: Converted diagnoses into real functional limitations
- Client deposition: Reinforced credibility and demonstrated day-to-day impact
MetLife reversed its denial on appeal, awarding full LTD benefits—no lawsuit required.
Why This Case Matters
- Cognitive and post-COVID claims are often wrongly denied
- Objective testing + vocational analysis is a powerful combination
- Strong appeals can win without going to court
Traumatic Brain Injury – Benefits Reinstated After Appeal
An engineering consultant came to us for help with a Long-Term Disability application due to a traumatic brain injury. The application was initially approved for Long Term Disability benefits under the Own Occupation standard. At the two-year mark, the carrier denied the claim under the Any Occupation standard, stating that our client was not totally disabled from any job for which he was reasonably suited by education, training, and experience, even though the client continued to experience severe cognitive difficulties, speech deficits, significant headaches, and profound fatigue. Based on our appeal efforts and with the support of a doctor who specializes in traumatic brain injuries, the carrier relented and reversed their own decision and approved the benefit claim.
Commutation of Long-Term Benefits to a Lump Sum
We recently helped a long-term client of the firm who had used our services in handling prior workers’ compensation and Social Security cases commute a long-term disability claim that was being paid monthly into a lump-sum payment of future benefits. The client suffered from degenerative medical conditions that prevented him from returning to his prior work, and his conditions remained relatively stable. By commuting his benefits, we were able to minimize his risk of a future denial by allowing him to receive payment for future benefits in the form of a lump sum. We used our extensive experience in valuating cases to negotiate a fair and equitable commutation using the net present value of the claim.
Successful Appeal for a Client with MS
Cigna (LINA) recently voluntarily overturned its decision to deny our client’s long-term disability after reviewing the appeal letter and documentation submitted by the attorneys at QLG. The client suffered from severe multiple sclerosis and had been on claim until the claim was reviewed and denied under an any occupation disability standard. After using our approach to build an administrative claims file, which included the use of vocational and medical reports, as well as the use of a client deposition (that the carrier did not attend after we extended an invitation), Cigna overruled itself and reinstated our client’s claim for continued long-term disability benefits.
Related Legal Services
Frequently Asked Questions About Long-Term Disability Claims
What is the difference between Short-Term vs. Long-Term Disability?
Short-term disability covers temporary inability to work, typically for a few weeks up to 6 months. Long-term disability kicks in after that, covering extended or permanent inability to work, sometimes until retirement age.
What is ERISA and why does it matter?
ERISA (Employee Retirement Income Security Act) is a federal law that governs employer-sponsored benefit plans, including group disability insurance. It matters because if your disability coverage comes through your job, ERISA controls your claim — and it heavily favors insurers.
Can I sue my disability insurance company?
Yes, but it depends on your policy type. If it’s an employer-sponsored plan, ERISA applies and your options are limited — you can only recover the benefits owed, with interest. If it’s a private (individual) policy you bought yourself, Pennsylvania law applies and you have broader rights, including potentially suing for bad faith and seeking punitive damages.
Speak With a Long-Term Disability Lawyer in Pennsylvania
Every case and every policy have different terms, so it is in your best interest to obtain a copy of your policy and have it reviewed by the Quatrini Law Group if you think you have been wrongfully denied benefits. To schedule a consultation with our lawyers at our Greensburg, Pittsburgh, Latrobe, Somerset, Uniontown, or Altoona office locations, call 888-534-6016 or complete our online form.