If your disability benefits have been denied, one of the first questions you should ask is whether your claim is governed by the Employee Retirement Income Security Act (ERISA). The Wisconsin ERISA benefits lawyers at Hawks Quindel help employees understand how ERISA affects disability claims, appeal deadlines, the evidence needed to support a claim, and the legal options available when insurance companies refuse to pay benefits.
Many people do not realize that the rules governing an employer-sponsored long term disability plan can be dramatically different from those that apply to an individually purchased disability policy. Those differences may affect everything from the deadline to file an appeal to the evidence that can be considered if your case eventually reaches court. Understanding which laws apply to your claim is one of the most important steps you can take after receiving a denial.
For more than 60 years, the attorneys at Hawks Quindel have represented Wisconsin workers and individuals seeking the disability benefits they have earned. Whether your claim involves an ERISA-governed disability plan, a private disability insurance policy, or multiple overlapping benefit programs, our team can explain your rights and develop a strategy tailored to your circumstances.
Why You Should Choose Hawks Quindel For Your ERISA Benefits Claim
ERISA disability claims are unlike most other legal disputes. Success depends on understanding detailed federal regulations, gathering persuasive medical and vocational evidence, and meeting strict procedural deadlines long before a lawsuit is ever filed.
Many disability claimants are also navigating related legal issues involving Social Security Disability Insurance (SSDI), workers' compensation, Family and Medical Leave Act (FMLA) protections, or employment concerns after becoming unable to work. Addressing these issues separately can create unnecessary complications.
The attorneys at Hawks Quindel take a coordinated approach, working across many practice areas to evaluate how each benefits program affects the others.
"We can take a holistic approach, because we have all of it under one roof and we can get all of the attorneys on the case… in the room together to figure out what's best for the client." ~ Attorney Timothy Maynard, Hawks Quindel
That collaboration allows our attorneys to identify potential issues early, coordinate related claims when appropriate, and develop legal strategies that consider your overall financial security—not just a single disability benefit.
Whether your claim is still being reviewed by the insurance company or you are preparing an appeal after receiving a denial, our attorneys can help you understand the process and protect your rights at every stage.
What Is ERISA?
The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that establishes standards for many employer-sponsored benefit plans, including most employer-provided short term and long term disability insurance plans.
ERISA was enacted to create consistent rules governing employee benefit plans across the country. Among other things, the law establishes requirements for plan administration, claims procedures, appeals, fiduciary responsibilities, and participants' rights to information about their benefits.
Although ERISA governs many employer-sponsored disability plans, it does not apply to every disability insurance policy. Determining whether your claim falls under ERISA is one of the first questions our attorneys will evaluate because it affects nearly every aspect of how your claim proceeds.
Why Does It Matter Whether Your Disability Claim Is Governed by ERISA?
For many claimants, the most important question is not simply whether ERISA applies—it is why that matters.
An ERISA-governed disability claim follows a very different legal process than most insurance disputes. Before filing a lawsuit, claimants must complete the plan's administrative appeal process. During that appeal, they must submit the medical records, physician opinions, vocational evidence, and other documentation supporting their claim.
That administrative record becomes the primary evidence a federal court will later review if litigation becomes necessary. Unlike many other types of lawsuits, claimants often cannot simply wait until litigation begins to gather additional evidence.
Because these procedural requirements can significantly affect the outcome of a case, preparing a thorough administrative appeal is one of the most important steps in an ERISA disability claim.
Hear From Our Clients
“happy with our settlement”
Bill Parsons and Brook Tylka and the rest of the staff from Hawks Quindel were very helpful with our case. They kept me up to date on the progress of my claim from the very beginning. After our first conciliation, we felt very confident we had the right attorney to...
“a practice someone can trust”
Hawks and Quindel are an amazing law firm to deal with. It’s a scary time and everyone there puts you at rest that they have your best interest at heart. They never make you feel like you are bothering them and they kept me in the loop with answers before...
“thoroughness, patience, and insight”
I can’t praise Aaron Halstead and Connor Clegg enough for their work on my legal matter. I especially appreciated their thoroughness, patience, and insight. They were always responsive to my questions. They helped me navigate a challenging workplace issue and obtain a good outcome. I would and do recommend them.
“highly recommend seeking the services of this firm”
During this very difficult time, the staff at Hawks and Quindel kept me reassured and informed every step of the way. I had the pleasure of working with Attorneys Jessa Victor and Brook Tylka. Jessa, Brook, Matt, and Hadley, thank you for all of your hard work, professionalism and compassion!...
“my case was won”
From our first phone call with Donnie Malchow, we knew we'd found the right person to help us. I had filed for disability and been denied. He was willing to walk beside us and thoroughly explain the entire process (lasted over a year and a half) and expectations (gave us...
“I would wholeheartedly recommend HQ”
I had another law firm representing me on a non-compete, and when it became clear that I needed new representation, I reached out to Hawks Quindel. Aaron Bibb took my case and he represented me extremely well to an agreeable resolution of the case, and costs were extremely reasonable and...
“went above and beyond”
Attorney Halstead and his team went above and beyond to not only win my case, but because of certain circumstances I had going on, they did everything they could to help and rush the settlement through. They were always quick at responding to emails and phone calls with questions I...
“I highly suggest this firm”
I can't imagine using any other firm after having Hawks Quindel, they were so knowledgeable and experienced but yet so down to earth to talk with. They kept me informed every step of the way and always answered when I had a question. What a staff, so many great people,...
“empathy, intelligence, and professionalism”
I reside in New Mexico but drove a semi-truck coast to coast for an unscrupulous trucking company out of Wisconsin. This logistics company harassed, bullied lied and discriminated against me, keeping my earned wages, and leaving me in a financial hole. Devastated I called and left a message for the...
“people treat you like family”
Top notch law firm Jacob and Natalie were my 2 attorneys that represented me on both of my cases? They did a fantastic job. Speaking up for me as they do for thousands of people and especially the little guys down-to-earth, people treat you like family, these people are godsons.
“Way beyond my expectations”
Many thanks from my family to all of you at the firm!!! Hawks Quindel, S.C. is the only place I would consider for LTD, disability, SSDI, ERISA, EEOC, DRoW legal help!! Jessa Victor and her team got me all the answers and results when I didn't think it was possible!!!...
“His team were patient and professional”
I had the pleasure of being represented by Aaron N. Halstead, Shareholder, on my discrimination case. His team were patient and professional. I would highly recommend this firm for the professionalism and efficiency for working through my case.
“If there were 10 stars”
If there were 10 stars I would give them that. There are not enough words to express my gratitude for Aaron, Ben and their team. I felt strong with them behind me. Exceeded expectations is an understatement.
“wonderful to work with”
I had mauve she was wonderful to work with! She helped me with my long battle to get SSI and SSDI. Which thankfully I now have! She's a delight and really helps boost anyone's confidents.
“Extremely knowledgeable”
I had an incredible experience regarding my workers compensation case with Jakob Feltham! It was my first workers compensation case (*or first case ever), and I didn't know anything about the legalities surrounding my issue, or what I was entitled to? Jake Feltham had ALL my answers, and made it...
“I’m happy with the work they did”
They were extremely responsive and good at communication throughout the process. They were accommodating of my disability and explained things well, taking time to answer all my questions. I'm happy with the work they did. Felt like I really had people on my side during a confusing and difficult time.
“consistently responsive and professional”
My recent experience with Hawk Quindel, and in particular with John Leppanen in the Milwaukee office. He, was extremely valuable. The support/intake staff responded quickly to my initial inquiry, and John was responsive and made time soon after our initial contact to begin work on my case. John was able...
“the best lawyers, trustworthy”
Excellent people, the best lawyers, trustworthy, always seeking the best results in the shortest possible time. I highly recommend them.
“Very Helpful”
Eze the intake coordinator was awesome, very helpful and connected me with the right people to help with my situation! Thank you Eze!
“Had My Back”
In 2010, I returned home from my second deployment. In 2012, I was told by the VA I couldn’t return to the job I was working at. It is now 2019, and through 7 years of needing legal representation, Hawks had my back through 3 separate issues: short term disability,...
“Best Decision”
I really don’t know how to put this in words to express how happy, satisfied, and really just overwhelmed with a sense of justice being handed out on my behalf. This big corporate work comp insurer treated me wrong, but before I decided to give up I contacted Hawks Quindel,...
“Highly Recommend”
The attorneys at Hawks Quindel worked tirelessly on my behalf. They were transparent at every step of the way, and answered any questions I had directly and in ways that someone without a legal background could easily understand. Although I would highly recommend them to anyone who is potentially facing...
Which Disability Plans Are Usually Governed by ERISA?
Most employer-sponsored disability insurance plans fall under ERISA. If your employer provides disability insurance as part of your employee benefits package and contributes to the cost of the plan, there is a good chance the policy is governed by federal ERISA requirements.
Employer-sponsored plans are common across many industries, including manufacturing, healthcare, education, financial services, retail, construction, and professional services. However, the specific terms of each plan differ, including how disability is defined, what evidence is required, and how long benefits may continue.
Simply having employer-provided disability insurance does not answer every legal question. We can review your plan documents to determine which deadlines apply, which appeal rights exist, and which procedures must be followed after a denial.
When ERISA Does Not Apply
Not every disability insurance claim is governed by ERISA. Several important categories of disability plans are generally exempt from the federal law, including certain government employee benefit plans, many church-sponsored benefit plans, and disability insurance policies purchased directly by individuals rather than through an employer.
These non-ERISA claims usually proceed under state law rather than federal law. Depending on the circumstances, claimants may have different legal remedies available, including breach of contract claims or, in some situations, insurance bad faith claims.
Understanding whether your claim is governed by ERISA or state law is important because the available legal procedures, deadlines, and potential remedies may differ significantly.
Why the Administrative Appeal Is Often the Most Important Stage
One of the biggest misconceptions about ERISA disability claims is that the lawsuit is where most of the work occurs. In reality, the administrative appeal can be the most important stage of the entire case.
This is often the final opportunity to supplement the record with additional medical documentation, specialist opinions, functional capacity evaluations, vocational assessments, and legal arguments explaining why benefits should be approved. Once the administrative process concludes, opportunities to introduce new evidence are extremely limited.
For that reason, every appeal should be prepared carefully and strategically. That philosophy reflects the approach the attorneys at Hawks Quindel take when preparing ERISA disability appeals. We thoroughly prepare and carefully review the medical evidence and anticipate the issues the insurance company is likely to raise to help build the strongest possible administrative record before litigation is ever considered.
Common Mistakes After Receiving an ERISA Benefits Denial
Receiving a denial letter from a disability insurance company can be frustrating, but the decisions you make immediately afterward may significantly affect your ability to recover benefits.
One of the most common mistakes is assuming the denial is final. Under ERISA rules, claimants must usually complete the plan's internal appeal process before they can file a lawsuit. Missing an appeal deadline or failing to submit key evidence during the appeal process can make it much more difficult to challenge the denial later.
Other common mistakes include:
- Failing to carefully review the reasons given for the denial.
- Submitting only a brief appeal without additional medical evidence.
- Assuming the insurance company already has all of the necessary medical records.
- Waiting until litigation begins to gather physician opinions or vocational evidence.
- Missing important deadlines established by the plan.
Every denial should be reviewed carefully so that the appeal directly addresses the insurance company's stated reasons for denying benefits.
Understanding Your Plan's Fiduciary Protections
ERISA places important responsibilities on the individuals and entities responsible for administering employee benefit plans.
Generally speaking, plan fiduciaries are expected to administer benefit plans in accordance with the plan's terms while complying with ERISA's legal requirements. They must provide participants with certain information about their benefits, follow established claims procedures, and give claimants an opportunity to appeal benefit denials.
If a disability claim is denied, the insurance company or plan administrator must explain the reasons for its decision and identify the information needed to perfect the claim. These procedural protections are intended to give claimants a meaningful opportunity to respond before pursuing litigation.
We can explain these rights and help you recognize whether the claims process has been handled appropriately and whether additional action may be necessary.
ERISA vs. Non-ERISA Disability Claims
Although both types of claims involve disability insurance benefits, the legal rules governing them can differ substantially.
| ERISA Disability Claims | Non-ERISA Disability Claims |
| Usually involve employer-sponsored disability plans. | Often involve individually purchased disability policies or exempt employer plans. |
| Governed primarily by federal law. | Governed primarily by Wisconsin state law. |
| Administrative appeal is generally required before filing suit. | Procedures depend on the policy and applicable state law. |
| Lawsuits are typically filed in federal court. | Disputes proceed in Wisconsin state court. |
| ERISA establishes fiduciary responsibilities and claims procedures. | State contract and insurance laws generally determine available remedies. |
Because these differences can affect deadlines, available evidence, and legal remedies, determining which rules apply should be one of the first steps after a disability claim is denied.
Coordinating ERISA Disability Benefits With Other Benefit Programs
Many people pursuing ERISA disability benefits are also receiving—or considering—other forms of financial assistance, including Social Security Disability Insurance (SSDI), workers' compensation benefits, or employer-provided leave.
These programs often interact in ways that are not immediately obvious. Some disability policies reduce monthly benefits if Social Security Disability benefits are awarded, while workers' compensation payments may also affect the amount ultimately received.
As attorney Timothy Maynard explains:
"There's a lot that goes into sequencing in these kinds of cases. We could coordinate the benefits so that they pay out the most because there are offsets between workers' compensation and Social Security. There are also offsets between Social Security and long-term disability."
By evaluating these issues together, we can help avoid unexpected reductions in benefits and ensure important deadlines are not overlooked.
How the Team at Hawks Quindel Helps With ERISA Disability Claims
ERISA disability cases require careful preparation from the very beginning. Because the administrative appeal often becomes the foundation for any future litigation, it is important to develop the strongest possible record before the appeal process concludes.
Depending on your situation, the attorneys at Hawks Quindel can:
- Review your disability insurance policy and plan documents.
- Analyze the insurance company's denial letter.
- Gather additional medical and vocational evidence.
- Prepare a comprehensive administrative appeal.
- Communicate with the insurance company throughout the claims process.
- Represent you in federal court when litigation becomes necessary.
Whether you are filing an initial appeal or evaluating your options after an unfavorable decision, our team is committed to helping you understand your rights and pursue the disability benefits you have earned.
Frequently Asked Questions About Wisconsin ERISA Claims
How long does an ERISA disability appeal usually take?
The timeline varies depending on the terms of your disability plan and the complexity of your claim. In many cases, ERISA requires plan administrators to issue a decision within specific timeframes after receiving an appeal, although extensions may be permitted in certain circumstances.
What documents should I gather before appealing an ERISA disability denial?
The strongest ERISA appeals are typically supported by more than just the insurance company's claim file. Helpful evidence may include updated medical records, treating physician opinions, diagnostic test results, functional capacity evaluations, vocational assessments, prescription histories, and statements explaining how your condition affects your ability to work.
What if I miss the deadline to appeal my denial?
ERISA plans typically impose strict appeal deadlines. Missing those deadlines can result in the loss of important legal rights, so it is important to review the denial letter carefully and act promptly.
How do I know whether my employer's disability plan is governed by ERISA?
The answer often depends on the type of employer and the structure of the benefit plan. Our attorneys can review your policy and plan documents to determine which laws apply to your claim.
Speak With a Wisconsin ERISA Benefits Lawyer at Hawks Quindel Today
If your disability benefits have been denied, understanding whether your claim is governed by ERISA is one of the most important steps in protecting your rights. The attorneys at Hawks Quindel have extensive experience helping individuals navigate complex disability benefit claims, prepare thorough administrative appeals, and pursue the benefits they deserve.
Contact Hawks Quindel today by calling our Madison office at (608) 257-0040 or our Milwaukee office at (414) 271-8650, or fill out our confidential contact form to discuss your ERISA disability benefits claim.