When your long-term disability claim gets denied, the insurer sends a letter citing policy language, medical opinions, and procedural terms you’ve never heard of. What they don’t tell you is what matters most. Behind every denial is a person whose life just became exponentially harder.
At DeBofsky Law, we’ve spent decades translating insurance company doublespeak into clear answers and real results. But this work isn’t just about mastering ERISA statutes or dissecting policy exclusions. It’s about understanding the full picture. When someone loses their income due to illness or injury, they’re often facing the worst moment of their life.
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The Partnership You Need When Stakes Are Highest
We don’t sugarcoat outcomes or make promises we can’t keep. Instead, we treat every case as a partnership built on transparency. You’ll know exactly where your claim stands, what obstacles we’re facing, and what strategies we’re deploying to overcome them.
Why does this matter? Because a successful appeal isn’t just a legal victory. For many clients, it’s the difference between financial security and devastating dependence on others. When we call to share news of a win, clients often go silent on the other end of the line. They’re processing that months or years of uncertainty just ended in their favor.
When One Case Changes Everything
Some victories go beyond helping a single client. They set legal precedents that protect thousands of future claimants nationwide.
Accidental Death Benefits (Prather v. Sun Life): A young man died from a pulmonary embolism after tearing his Achilles tendon in a pickup basketball game. Sun Life denied the claim, arguing his death resulted from medical treatment, not the accident itself. We traced the chain of causation back to the injury. The result was a precedent-setting decision that now protects families facing similar denials.
Federal ERISA Standard (Fontaine v. Metropolitan Life): ERISA, the federal law governing most employer-sponsored benefits, operates like a legal steamroller. It preempts state laws unless they specifically regulate insurance. In Fontaine, we challenged how courts review insurer decisions. We won a Seventh Circuit ruling that leveled the playing field. Now, many jurisdictions apply a “de novo” standard. This means judges evaluate the evidence from scratch rather than deferring to the insurer’s initial decision. Learn more about how this standard affects your claim in our guide to filing a winning ERISA claim.
In practice, those precedents matter when your own claim is on the line.
Landmark Cases: DeBofsky Law’s Precedent-Setting Victories
| Case Name | Citation | Issue | Outcome |
| Prather v. Sun Life Assurance Company of Canada | 843 F.3d 733 (7th Cir. 2016) | Accidental death benefits denied due to alleged medical treatment causation | Victory in Seventh Circuit establishing that accidental injuries causing death qualify for AD&D benefits even when medical treatment is involved |
| Fontaine v. Metropolitan Life Insurance Company | 800 F.3d 883 (7th Cir. 2015) | ERISA standard of review in disability claims | Victory establishing de novo review standard, changing how federal courts evaluate insurer decisions and leveling the playing field for claimants |
Can Insurance Companies Deny My Claim for Pre-Existing Conditions?
One of the most common denial tactics is the pre-existing condition exclusion. The Affordable Care Act eliminated these denials for health insurance. However, they remain a real threat in disability insurance. Many policies are issued without medical underwriting. Understanding why disability claims get denied is the first step toward fighting back.
Here’s what insurers won’t tell you:
General symptoms don’t count.
Say you had a persistent cough five years ago and were later diagnosed with lung cancer. The insurer cannot retroactively claim your cough was a pre-existing condition for cancer. Courts recognize that vague symptoms rarely predict specific diagnoses.
Look-back periods are limited.
Insurers can only scrutinize a defined window before your coverage began, typically 90 to 180 days.
Time is your friend.
Under most group policies, pre-existing condition clauses expire after a year of continuous employment. The policy language matters, but duration of employment often nullifies these exclusions.
Understanding these rules transforms what looks like an insurmountable barrier into a winnable argument. For a deeper look at how courts have limited these exclusions, read our comprehensive guide on defeating a pre-existing condition exclusion denial.
Why We Do This Work
Insurance companies count on you being overwhelmed. They have legal teams, institutional playbooks, and time on their side. You’re dealing with medical appointments, bills, and uncertainty about your future. We level that fight.
Your claim was denied. What happens next is up to you. If you’re facing a disability, life, or ERISA benefits denial, time matters. Appeal deadlines are strict, and the quality of your submission can determine whether you recover what you’re owed or lose your claim permanently.
Contact DeBofsky Law to discuss your situation with an attorney who understands ERISA from the inside out.
