Every day across America, workers and families believe that being denied disability or health benefits is the end of the road. Too often, that is not true. A little-known federal law, the Employee Retirement Income Security Act (ERISA) of 1974, can be the key to reversing a denial. Yet many people do not even know ERISA regulations exist, let alone how to use them to their advantage.
ERISA regulates private employer-sponsored health, retirement, and disability plans. It requires plans to provide clear information to participants, governs fiduciary behavior, and lays out the process for appealing denied claims. It also permits participants to sue for benefits after exhausting the plan’s internal appeals process or when a participant can show their claim was denied a full and fair review.
That appeals process is where too many people go wrong. Most don’t realize that they can challenge a denial, especially in disability cases. Even fewer understand the urgency. In most cases, you have a limited amount of time to file an appeal and, if you miss that deadline, your right to challenge the decision in court may vanish.
This is especially true for long-term disability claims. Many people receiving denials face pages of medical jargon and policy citations that make the process feel hopeless. But that is exactly when ERISA matters most. A well-prepared appeal can overturn a denial and secure adequate benefits; but only if it’s done right, and on time.
ERISA’s protections are not just for office workers. They are just as important for professional athletes, firefighters, police officers, and other physically demanding professions. For example, retired NFL players have faced the same battles as any injured worker: plans demanding “objective evidence” when the plan does not require objective evidence, ignoring favorable evidence, or relying only on the conclusions of doctors hired by the plan itself to justify a denial. First responders whose careers end early due to injuries or illness also depend on ERISA-compliant plans to secure early retirement and ongoing support. Without these protections, many would be left without income or medical coverage when they need it most.
So why do so few people take advantage of these rights? In part, because ERISA is complicated. Denial letters often read like they are written for lawyers, not ordinary people. Many claimants never request their full claim file, which can contain critical internal notes, emails, and medical reviews. Others fail to submit key medical records or personal statements that could strengthen their case. And almost no one realizes that what they submit during the appeal will be the only evidence a judge ever sees.
We can do better. Employers and plan sponsors should make it clear (in plain language) that workers have the right to appeal, and exactly how to do it. And the media should shine a light not only on stories of unfair denials, but also on cases where appeals succeed, so people know the process is worth pursuing.
ERISA is not an obscure technicality. It is a lifeline. It exists to protect the rights and benefits employees have earned, from a nurse recovering from a serious injury to a firefighter forced to retire early, from a teacher battling a chronic illness to an athlete retired by a career-ending hit. But those protections only work if you know about them, act quickly, and present the strongest possible case – something that a qualified attorney can be a huge help with.
Too many people are walking away from benefits they are entitled to simply because they do not understand the complexities of this system. ERISA was designed to give workers a fair shot. But only if they take it.
Sam Katz is the founder of Athlaw LLP, a law firm that navigates complex ERISA-regulated benefits and rights, including the NFL’s Disability and Survivor Benefit Plan and concussion settlement.
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