Comprehensive Legal Services in Employee Benefits & Disability Law
The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry. As a former IRS National Office attorney with decades of experience in employee benefits law, Frederic N. Ornitz provides comprehensive representation in all aspects of ERISA compliance and litigation.
ERISA Title I governs the administration of employee benefit plans, establishing fiduciary responsibilities, participation requirements, and claims procedures. Our firm handles:
Challenging wrongful denials of pension benefits, health insurance claims, and other employee welfare benefits under ERISA plans.
Representing participants in claims against plan fiduciaries for breach of duty, mismanagement of plan assets, or prohibited transactions.
Advising employers on ERISA compliance, including Form 5500 preparation, summary plan descriptions, and DOL audit responses.
Navigating the ERISA claims and appeals process to ensure participants receive proper review of denied benefits before litigation.
ERISA Title II addresses the tax qualification requirements for retirement plans under the Internal Revenue Code. With five years of experience at the IRS National Office in Employee Plans and Exempt Organizations, our firm provides sophisticated guidance on:
ERISA cases involve complex federal regulations, strict procedural requirements, and limited standards of judicial review. Having an attorney with deep regulatory knowledge and litigation experience can make the difference between a successful recovery and a denied claim. Our background includes both drafting regulations at the IRS and litigating ERISA cases in federal court.
Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) provide critical financial support to individuals unable to work due to severe medical conditions. The application and appeals process can be lengthy and complex, with high initial denial rates. Our firm provides experienced representation at every stage of the Social Security disability process.
We assist clients in preparing thorough initial disability applications to the Social Security Administration, gathering medical evidence, obtaining treating physician statements, and presenting a compelling case for disability benefits from the outset.
When the SSA denies an initial claim, we pursue reconsideration and prepare detailed appeals that address the specific reasons for denial. Our appeals include updated medical evidence, functional capacity assessments, and legal arguments supporting disability eligibility.
We represent clients at hearings before Administrative Law Judges (ALJs), presenting medical evidence, examining vocational experts, and advocating for our clients' right to disability benefits. Proper preparation and effective hearing advocacy significantly increase the likelihood of a favorable decision.
Social Security Disability Insurance for individuals with sufficient work history and qualifying disabilities.
Supplemental Security Income for disabled individuals with limited income and resources.
Challenging unfavorable ALJ decisions before the SSA Appeals Council.
Filing civil actions in federal district court when administrative appeals are exhausted.
To qualify for Social Security disability benefits, you must be unable to engage in substantial gainful activity due to a medically determinable physical or mental impairment expected to last at least 12 months or result in death. The SSA uses a five-step sequential evaluation process to determine disability. Our experience with this process helps clients navigate each step effectively.
Many employees have long-term disability (LTD) insurance through their employer or individual policies. When disability strikes, insurance companies often deny legitimate claims or terminate benefits prematurely. Because most employer-sponsored disability plans are governed by ERISA, these cases require specialized knowledge of both insurance law and federal benefits regulations.
We challenge wrongful denials of disability insurance claims, representing clients in appeals and federal court litigation. Common reasons for denial include insufficient medical evidence, disputes over the definition of disability, surveillance evidence, and independent medical examinations arranged by the insurer.
The legal framework for disability claims depends on whether the policy is governed by ERISA or state insurance law. ERISA plans (typically employer-sponsored group policies) are subject to federal law and limited remedies. Individual policies may allow for bad faith claims and additional damages under state law. We analyze each case to determine the applicable law and pursue the most effective legal strategy.
ERISA requires claimants to exhaust administrative appeals before filing suit. We handle the administrative appeal process, submitting additional medical evidence, independent expert opinions, and legal arguments to overturn denials. A strong administrative record is essential for success in subsequent federal court litigation.
Many disability policies provide "own occupation" coverage for an initial period (often 24 months), meaning you are disabled if unable to perform your specific job. After this period, coverage may shift to "any occupation," requiring proof that you cannot perform any occupation for which you are reasonably suited by education, training, or experience. Understanding these definitions and gathering appropriate evidence is critical to maintaining benefits.
Beyond our core practice areas in ERISA and disability law, we provide related legal services to support our clients' comprehensive needs:
When the Social Security Administration claims you were overpaid benefits and demands repayment, the consequences can be devastating. The SSA may withhold your entire monthly benefit, garnish tax refunds, or refer the debt to Treasury for collection. Many overpayment determinations are incorrect or fail to consider whether you were at fault. We provide experienced representation to challenge improper overpayment determinations, request waivers of recovery when you were without fault, and negotiate affordable repayment terms that won't leave you unable to meet basic living expenses.
Learn more about Social Security Overpayment Defense →
Insurance companies often deny legitimate claims or offer unreasonably low settlements for property damage and auto accidents. Whether your homeowners insurance denied coverage for storm or fire damage, your auto insurer disputes fault in an accident, or your property claim was undervalued by an adjuster, we fight to hold insurers accountable. Our representation includes challenging wrongful denials, disputing damage valuations, pursuing bad faith claims when insurers act unreasonably, and litigating coverage disputes in court when necessary.
Learn more about Insurance Claim Disputes →
Representing participants in disputes over denied health insurance claims under ERISA-governed plans, including claims for medical treatments, prescription drugs, and mental health services.
Assisting beneficiaries with wrongfully denied life insurance claims under employer-sponsored group plans or individual policies.
Drafting wills and trusts, probate administration, and will contests, with particular attention to the tax implications of retirement plan distributions and beneficiary designations.
IRS representation in tax disputes, including tax liens, levies, appeals, and litigation related to retirement plan taxation and employee benefits.
Schedule a consultation to discuss your ERISA or disability case
Contact Our Office