Long-Term Disability Claims Attorney In Georgia
Last updated on October 23, 2026
Rogers, Hofrichter & Karrh, LLC, represents and advises employees who are, or might become, involved in an appeal or a lawsuit as a result of having been denied short- and/or long-term disability benefits from their employer. The law governing this area is called ERISA, which stands for Employee Retirement Income Security Act. We have an extensive background in this area of the law and understand the intricate detail in resolving these disputes.
Rogers, Hofrichter & Karrh, LLC, has received the AV rating,* signifying excellence in our specific practice areas of disability law. We focus on resolving long-term disability claims at the initial levels in order to help you avoid complex issues that often arise during the appeals process. In the event litigation becomes necessary, our attorneys are trained and experienced litigators who will aggressively protect your rights and pursue your benefits at all levels of state or federal courts. We frequently speak at seminars and other forums concerning issues involving long-term disability claims.
If you have become injured or have suffered an illness that will not allow you to earn an income for an extended period of time, we can help your family recover the benefits you need. Contact our offices in Fayetteville, Georgia, to schedule a free consultation about your claim. We serve residents, professionals and business owners of communities throughout the Atlanta, Georgia, metropolitan region.
Learn more about disability insurance claims at these pages:
We have helped numerous people resolve ERISA and other long-term disability insurance claims issues such as:
- Initial disability insurance claim
- Denied benefits dispute resolution
- Litigating an ERISA claim
We work successfully with some of the largest long-term disability insurance companies in the United States, such as:
- Hartford
- UNUM Provident
- MetLife, Cigna
- Aetna
- Paul Revere
- Prudential
- Reliance
- Standard
- St. Paul Companies
Combining Your Disability Insurance Claim Benefits
If you have suffered an accident or illness that will not allow you to earn an income over an extended period of time, you may be able to combine Social Security, Worker’s Compensation and other disability insurance claim benefits. Rogers, Hofrichter & Karrh, LLC, is a recognized leader in the area of combined benefits claims and has written and taught extensively on the topic.
Contact our offices to meet with us about your long-term disability and other disability insurance claim needs. We make a difference in people’s lives.
Understanding ERISA And Your Long-Term Disability Rights
ERISA is a federal law that strictly governs how employer-sponsored disability plans must be run. It sets the rules insurers must follow at every stage of a claim. Because it is a federal law, it overrides state law in these disputes. ERISA gives claimants certain rights, but it also limits what you can recover if you win.
Two rules shape every LTD dispute under ERISA. First, you cannot sue your insurer in federal court until you complete all required appeals with the insurance company. Second, ERISA sets strict deadlines at each step. You have 180 days from the date you receive your denial notice to file your appeal. Missing that deadline eliminates your right to file a federal lawsuit.
For claimants, these rules mean one thing: the appeal is where you build your case. Everything you submit during the appeal becomes the evidence a federal judge will rely on. Building a complete file during the appeal is not optional. It is the only chance you have to put the right evidence in front of a court.
Own-Occupation Versus Any-Occupation: How Your Policy Defines Disability
Long-term disability policies use two standards to decide if you qualify for benefits. Which one applies, and when it changes, determines what you must prove to stay eligible.
Under the own-occupation standard, you qualify as disabled if your condition stops you from doing the essential duties of your regular occupation as it is normally performed in the national economy. An electrician who develops severe nerve damage in both hands qualifies under this standard, even if he could do a different type of work.
Under the any-occupation standard, you qualify as disabled only if your condition stops you from doing any paid work that fits your education and background. That same electrician could be denied benefits if the insurer finds a desk job that meets the policy’s earning threshold, often 60% or more of prior pay. Most employer plans apply the own-occupation standard for the first 24 months, then shift to the any-occupation standard at month 25.
What This Means For Your Claim
Surviving this shift requires more than routine treatment records. A standard doctor’s note carries very little weight with an insurer at this stage. You need formal, objective records that show specifically what you cannot do.
For physical limits, a Functional Capacity Evaluation, or FCE, measures how long you can sit, stand, walk and lift. For cognitive limits such as brain fog or memory loss, neuropsychological testing provides similar objective data. Both types of testing produce results that are harder for an insurer to dismiss than a standard physician statement.
Your doctor should also complete a form that lists your specific work restrictions. If you are approaching the 24-month mark, an attorney can help you build this evidence before the review begins.
Common Reasons Long-Term Disability Claims Are Denied
Insurance companies deny LTD claims based on specific, recurring patterns. Knowing which one applies to your case is the first step toward challenging it.
Insufficient Medical Evidence
Insurers look for sparse treatment records or routine notes that suggest a patient is stable. A formal physician statement that lists specific functional limits can directly address that gap.
Lack Of Objective Findings
Some conditions, such as fibromyalgia, chronic fatigue syndrome or long COVID, do not produce measurable imaging or lab results. Federal courts have held that insurers cannot demand objective lab or imaging proof to diagnose conditions that naturally lack them. Specialized functional and neuropsychological testing can provide the measurable data insurers claim is missing.
Surveillance Evidence
In some cases, insurers hire investigators or monitor social media to document claimants doing everyday activities. A brief video of someone running an errand does not prove the ability to work full time. Our attorneys can challenge this type of denial by placing the activity in its proper medical context.
Failure To Follow Treatment Recommendations
Missed appointments or changes in a treatment plan can prompt a denial. A physician letter that explains the medical or financial reasons behind those changes directly addresses this argument.
Preexisting Condition Exclusions
Insurers review your medical history during a set period before your coverage started. They sometimes overreach by linking unrelated prior conditions to your current disability. Our attorneys can establish clear distinctions between those conditions to challenge this type of denial.
Claimed Ability To Perform Sedentary Work
Insurers often assume that even if you cannot do physical labor, you can manage desk work. Sustained sitting, fine motor use and continuous focus make desk work far more demanding than it sounds. Documenting your specific limits is a strong basis for challenging this type of denial.
You can challenge each of these denials with the right evidence and legal strategy. Our attorneys can identify the grounds for your denial and map out a path forward.
The Administrative Appeal: A Critical Deadline
Under most employer-sponsored disability plans governed by ERISA, you have 180 days from the date you receive your written denial notice to file a formal appeal with the insurance company. The appeal is a critical phase of the claims process. Every document you submit becomes part of the administrative record. If your case goes to federal court, the judge generally reviews only what is already in that record.
A strong appeal record requires several types of documentation:
- Updated medical records: Every recent doctor’s note, lab result, imaging scan and treatment summary since the date of the denial.
- Physician narrative letters: Detailed letters from your treating doctors that address the insurer’s specific denial reasons, not just general office notes.
- Residual functional capacity forms: Forms completed by your physician that translate your condition into concrete work limits, such as how long you can sit, stand or focus during a workday.
- Functional capacity evaluation: An objective physical assessment that produces data on your limits that is far more difficult for an insurer to dismiss than a general physician statement.
- Vocational assessment: A report from a certified vocational expert that matches your documented limits against the demands of your job or any job in the national economy.
If a key piece of evidence is not in the record before the insurer issues its final decision, it can rarely be considered by a federal court. Six months may seem like ample time, but scheduling evaluations and gathering records often consumes most of that window. That is why working with an attorney early makes a meaningful difference.
Our attorneys represent claimants in ERISA appeals and federal court cases throughout Georgia. They understand what the record must contain to support a viable challenge.
When Litigation Becomes Necessary
After the insurer upholds its denial at the close of the appeal, filing a lawsuit in U.S. District Court is the only remaining option for recovering your benefits.
What To Expect In ERISA Litigation
ERISA cases are very different from standard civil lawsuits. A federal judge decides the case based almost entirely on the administrative record. There are no juries and no live witness testimony. In most cases, there is also no traditional discovery process.
How Courts Evaluate Your Claim
The outcome depends on the standard of review the court applies. When a disability plan gives the insurer the power to make final decisions about who qualifies for benefits, courts apply an “arbitrary and capricious” standard. This means the insurer’s decision stands unless it had no reasonable basis in the record.
When the plan does not include a valid discretionary clause, courts apply “de novo” review. The judge then reviews the evidence independently without deferring to the insurer.
What You Can Recover
If you prevail, the court may award past-due benefits with interest and reinstate your monthly payments. The court may also order the insurer to pay attorney’s fees under ERISA’s fee-shifting provision.
ERISA does not allow recovery for pain and suffering or punitive damages. Most ERISA cases resolve within 12 to 24 months of filing, and many settle through court-ordered mediation before a judge issues a ruling.
Denied Long-Term Disability Benefits? We Can Help.
If your long-term disability claim has been denied, our attorneys at Rogers, Hofrichter & Karrh, LLC, are ready to fight for your benefits. They never let up, and they give every client the personal attention their case deserves. Call us at 770-884-6705 or send us an email to schedule a free consultation.
* AV®, AV Preeminent®, Martindale-Hubbell Distinguished and Martindale-Hubbell Notable are certification marks used under license in accordance with the Martindale-Hubbell certification procedures, standards and policies. Martindale-Hubbell® is the facilitator of a peer review rating process. Ratings reflect the anonymous opinions of members of the bar and the judiciary. Martindale-Hubbell® Peer Review Ratings™ fall into two categories — legal ability and general ethical standards.