Understanding ERISA Disability Claims For Short-Term And Long-Term Needs

Last updated on August 11, 2026

Both short-term and long-term disability insurance plans provided by employers typically fall under the rules of the Employee Retirement Income Security Act of 1974 (ERISA). In most states, employees may choose to purchase disability insurance through payroll deductions. Other states require employers to provide short-term and/or long-term disability insurance benefits to employees. To understand your employer’s and your state’s offerings and requirements with regard to long-term and short-term claims, ask your human resource (HR) department or an ERISA attorney.

Most people who contact Toledano Disability Law in New Orleans do so because they are facing a problem getting or keeping ERISA disability insurance benefits. However, attorney Reagan Toledano also answers questions for people who have not encountered trouble yet, but simply want to understand their short-term and long-term disability insurance options or mandates.

About Short-Term Versus Long-Term Disability Benefits

Private and public disability insurance provided or offered by employers is not the same as workers’ compensation or Social Security Disability. If you are unable to continue working because of an injury, illness or chronic condition, you may tap into one or more of the following:

• Paid time off, also known as sick leave, provided as a benefit by your employer
• Workers’ compensation wage-loss benefits, which may start after you have missed work for three days because of a workplace accident or occupational illness
• Short-term disability insurance through your public or private sector job, typically a percentage of your regular salary available for about three to six months
• Long-term disability insurance through your public or private sector job, typically a percentage of your regular salary payable for one to two years or more, up to age 65
• Social Security Disability insurance if you will be out of work for a year or longer because of a disability

The percentage of your normal salary that you may receive is likely different for your short-term versus long-term disability policies. Assuming you have both short-term and long-term disability benefits available to you, you may be required to use up all available short-term disability insurance before filing a long-term disability claim.

Regardless of the details of your employer-provided short-term or long-term disability insurance, Reagan can explain how you can receive a portion of your salary while you cannot work. His years of experience and dedication to clients’ well-being can work to your advantage. He focuses on representing people seeking disability through benefit plans covered by ERISA, but he also advises people with non-ERISA-governed benefit plans.

Transitioning From Short-Term To Long-Term Disability Benefits

For many people, the most difficult moment in the disability claims process is not filling out the initial application. It is what happens when short-term benefits run out and the long-term disability claim needs to take over. This transition period is where claims get denied most often, and it catches claimants off guard more than any other stage of the process.

Why This Window Is So Risky

Short-term and long-term disability policies are separate agreements, and they do not always play by the same rules. The insurer administering the long-term policy may be an entirely different company, and the definition of disability they apply is often stricter. Many long-term policies start by asking whether a claimant can perform their own occupation. After a set period, that standard frequently shifts to whether the person can perform any occupation at all. That is a meaningful change, and claimants who were approved for short-term benefits sometimes find themselves denied long-term coverage even though their condition has not improved.

Insurers tend to be most active during this window. Independent medical examinations get scheduled. Surveillance may be conducted. Requests for updated records arrive with short response deadlines. A claimant who is unprepared for this level of scrutiny can easily stumble in ways that give the insurer a reason to close the claim.

What To Do Before Short-Term Benefits Run Out

Reagan has helped many clients get through this transition without a gap in benefits, and the common thread is preparation. A few things worth doing before short-term coverage ends include:

• Reading the long-term disability policy carefully before the clock runs out, paying particular attention to how disability is defined and what documentation is required to open the claim
• Making sure treating physicians have documented functional limitations clearly and consistently, since vague or incomplete medical records are one of the most common reasons long-term claims are denied at this stage
• Responding to every insurer request fully and on time, because missed deadlines and incomplete responses give the insurer procedural grounds to deny the claim regardless of the underlying medical picture
• Talking to an ERISA disability attorney before submitting the long-term application, not after a denial letter arrives in the mail

That last point matters more than people often realize. Under ERISA, courts reviewing a denied claim are generally limited to the evidence that was already in the administrative record when the denial was issued. What goes into the record during the application process can determine what options are available later. Getting the documentation right the first time is not just a good idea. It is often the deciding factor.

If short-term benefits are winding down and the long-term application is coming up, Reagan can walk you through what that process looks like for a specific policy and situation. Reach out by email or call 877-281-4789 to get ahead of the transition before it becomes a problem.

What Steps Should You Take To Make A Claim For Long-Term Disability Benefits?

Inform your employer that you will be making a claim and ask to review the terms of the policy through which you intend to file a claim. Obtain an application and seek a thorough medical evaluation (perhaps through more than one doctor visit). Then request both employment and medical records to document your application. As you complete the application, focus on the key aspects of your disability that prevent you from continuing to work full-time. Recognize that the insurance claims administrators will look for reasons to deny your claim. Bolster your claim accordingly with evidence that addresses those points. After you submit your application, be ready to respond promptly and adequately to further requests for information. Consult with an attorney who can determine whether the insurer’s claim evaluation process is ERISA-compliant.

How Does The Disability Law Attorney At Toledano Disability Law Help Clients Overcome Denials?

Ideally, he has the opportunity to advise a client from the beginning of the claims process. Along the way, he helps them document their disabilities in ways that will be difficult for insurers to refute. He helps clients prepare explanations with ample documentation confirming the impediments to working on the basis of qualifying disabilities. He represents claimants in correspondence, hearings and, if necessary, trials in state or federal courts.

What Are Common Reasons That Insurance Companies Give For Denying Claims?

Insurers may deny claims for technical reasons (such as alleged missed premiums or belated applications), substantive medical reasons (such as insufficient evidence presented by doctors), policy exceptions (such as noncoverage for preexisting conditions) or procedural reasons (such as when a claimant fails to respond promptly or appropriately to requests or directives), to name a few. To protect your rights, get legal counsel early in the process.

Get Answers To Your Long-Term And Short-Term Claims

Since 2005, Reagan has been providing clients with answers to questions about disability benefits and related issues. Churches and some public-sector occupations may offer or provide disability benefits not covered by ERISA.

If you are having trouble getting the long-term or short-term disability benefits that you are eligible for, contact Reagan by email or at 877-281-4789. The firm is located in New Orleans and serves clients nationwide.