Insurance Claims

How to File an ERISA Claim

Filing a disability claim under an employer-sponsored benefit plan is not the same as applying for state disability or Social Security benefits. If your benefits are provided through your job, they are often governed by ERISA—the Employee Retirement Income Security Act of 1974. While ERISA was designed to protect employee benefits, in practice its claims procedures are highly technical and full of traps for the unwary. 

This guide explains what an ERISA claim is, how to file one properly, what rules and regulations apply, and why legal guidance can make all the difference when your livelihood is on the line.

What Is an ERISA Claim? 

At its core, an ERISA claim is a request by a participant or beneficiary of an employer sponsored benefit plan for the payment of a benefit owed under the terms of the plan. This could include health insurance, life insurance, retirement benefits, or, most commonly in our practice, long-term disability benefits. 

Unlike other types of insurance claims, an ERISA claim is not purely contractual. It is governed by federal law1 with strict timelines, required notices, and specific rules about appeals.2 Because of these added layers, even a straightforward benefit claim can quickly become complex. 

Understanding ERISA Claims Procedures 

ERISA claims procedures are set out in Department of Labor regulations that apply to most employee benefit plans. These rules dictate how quickly insurers must respond to requests for benefits (claims), and what rights you have if your claim is denied. 

For disability benefits, the regulations require insurance companies to make a decision within 45 days of the claim, though they can extend the deadline by 30 days twice if they provide valid reasons, for a total of 105 days.3 If they request information from you, the claimant and have to wait for it, the insurers can “toll” their deadline to decide the claim, resulting in additional delays.4 

If the insurer denies your claim for disability benefits, it must provide you with a written explanation (adverse benefit determination) cites the specific reasons, the plan provisions relied upon, and the evidence considered.5

Many courts, including in the 9th Circuit, have stated that the insurer must explain “why” the evidence you proffered in support of your claim was insufficient, or “why” your medical evidence was unreliable. In practice, most insurers fail to explain with specificity the “why” of its rejection of your medical evidence. See, e.g., Saffon v. Wells Fargo Co. Long  Term Disability Plan (9th Cir. 2008) (argued by Cassie Springer Ayeni, chastising MetLife for not explaining “why” the treating physician’s report and an MRI “did not amount to ‘objective clinical information’ or was not ‘clear’,”), available at https://caselaw.findlaw.com/court/us-9th-circuit/1106709.html 

It is important to understand that the appeal process is not optional. Under ERISA, you must exhaust the internal appeals process before filing a lawsuit in federal court. Failing to follow this step can end your case before it ever begins.

Preparing to File 

When people ask how to file an ERISA claim, the most important advice is to prepare thoroughly before you even submit the paperwork. Insurers will require medical documentation, employment records, and often statements from your treating doctors. Gaps in the evidence at this early stage can lead to delays or outright denials. 

The Employee Benefits Security Administration lays out some beginning steps to file a claim for disability benefits in its publication, “Filing a Claim for Your Disability Benefits.”6 

We at Springer Ayeni believe strongly that preparation is key. You should:  

• Make sure you have a copy of your Long-Term Disability insurance policy, which may include a summary plan description. These documents set out the rules for coverage, definitions of disability, and deadlines.
• Talk with your treating physicians to ensure they are willing to support your claim with detailed medical records and, by completing necessary forms, and, when appropriate, written statements. 
• Gather employment records that describe your job duties, since the insurer will evaluate whether you can perform the material and substantial duties of your position. 
• Prepare a statement outlining why you are unable to do your job, and how your disability affects your everyday life as well. This will help you get your thoughts organized when the insurer asks you to explain why you can’t work. 

Completing the Forms 

Most insurers require that you fill out their own claim forms, which often include separate forms for you, your employer, and your physician. Some people search for an “ERISA complaint form,” but in reality, each insurer provides its own forms tailored to its policy.  

Be careful when completing these forms. Insurers scrutinize every word. For example, if you minimize your symptoms in an effort to appear resilient, the insurer may use that against you. At the same time, exaggeration can harm your credibility. Accuracy, honesty, and consistency are critical. 

Also be aware that the forms provide very narrow boxes to explain complicated conditions. Do not feel limited to the box.Instead, if needed, attach an addendum that continues your written answer on a separate page. 

Submitting Medical Evidence 

The heart of most ERISA disability claims procedures is the medical evidence. Insurers want to see not only a diagnosis but also documentation of how your condition limits your ability to work: 

• For physical conditions, this may include imaging, lab results, or surgical reports.  
• For mental health conditions, detailed treatment notes and evaluations can be just as important.  
• For progressive conditions, the months or years leading up to your disability claim will be scrutinized to analyze how you were previously able to work but currently are not.  

In the months leading up to a claim, be sure to communicate regularly with your physician  about your symptoms so that they, and your doctor’s recommendations and treatment, are actually in your medical records when the time comes for the insurer to review them.  

Do not assume that the insurer will collect everything for you. Even though you may sign a release, insurers often fail to request or review every record. Submitting complete documentation yourself helps ensure that your case is evaluated fairly. 

Following ERISA Claims Regulations 

ERISA disability cases are governed by strict federal regulations that outline mandatory timelines, notices, and appeals.7 For example: 

Claims must be decided within a maximum of 105 days after submission (but this may be  tolled if the insurer asks the claimant for information and it is waiting to receive that information).8  

Denials must include specific reasons and instructions for appeal.9 

Appeals must be filed within 180 days of the denial letter.10 

Insurers must give you access to all relevant documents upon request. When you make the request, be sure to ask for everything relevant to your claim, which can include claim notes, medical reports, surveillance footage, and even audio recordings of phone calls. In fact, the Employee Benefits Security Administration specifically informed Cassie Springer Ayeni that audio recordings are relevant to a claim file and must be disclosed.11  

Missing a deadline or failing to request documents can severely weaken your case, and even can terminate your right to your benefits altogether. That is why it is important to seek competent ERISA legal assistance as soon as possible, even before submitting an initial application, and certainly immediately after receiving a denial letter.

The Appeal Process 

If your claim is denied, you have the right to file an internal appeal. This is not simply a chance to re-argue your case; it is your last opportunity to add evidence to the record. Under ERISA, the administrative record created during the claim and appeal stages is usually the only evidence about the facts of your disability that a federal judge will review if you later file a lawsuit. 

Because of this, it is critical to submit everything you may ever want considered at this stage: updated medical records, statements from your doctors, vocational evaluations, witness statements, symptom logs, pictures, or video evidence, etc. 

Filing an appeal without a clear strategy can be disastrous. Once the record closes, you may never get another chance to add the missing evidence. 

How to File an ERISA Complaint 

If your appeal is denied, your next step may be to file a lawsuit in federal court. At this stage, some people search for how to file an ERISA complaint, but it is not as simple as filling out a form online. You need an attorney for this process. A complaint must be drafted in compliance with federal court rules, filed in the correct jurisdiction, and served on the appropriate parties. There are certain mandatory requirements for all federal lawsuits, and failing to comply with them may result in a dismissal of your case. 

Why Legal Guidance Matters 

Filing an ERISA claim can feel deceptively simple: fill out forms, attach records, wait for an answer. But behind the scenes, insurers rely on teams of claims administrators, nurses, and physicians to scrutinize your file, and the forms are a very small percentage of what they are reviewing when building your “claim file.” In my decades of experience, I have seen, time after time, claims handlers searching for a “reason to deny” rather than evaluating all of the evidence as a “reason to approve.”  

Unfortunately, because of the limitations of ERISA law, the cards are often stacked against an ERISA plaintiff in court, so it is important to get the evidence right from the get-go. Knowing how to file an ERISA claim correctly, from the very beginning, is critical. Working with an attorney ensures that your claim is presented in the strongest possible way. Legal guidance can help you avoid missed deadlines, frame your medical evidence effectively, and preserve your rights for litigation if needed.

Bringing It All Together 

Filing for disability benefits under an employer-sponsored plan is not just about paperwork. It is about protecting your financial security when illness or injury prevents you from working. Understanding what an ERISA claim is, how the claims procedures work, and what evidence is required can make the difference between approval and denial. 

The process may seem overwhelming, but you do not have to face it alone. At Springer Ayeni, we have guided clients through ERISA disability claims procedures for more than two decades. We know how insurers operate, and we know how to build strong cases under the law. 

If you are preparing to file a claim, facing a denial, or simply want to understand your options, reach out to us. We can help you navigate the process with clarity, strategy, and compassion, so that you can focus on your health while we focus on protecting your benefits. 

1 Employee Retirement Income Security Act (ERISA). U.S. Department of Labor.  (https://www.dol.gov/general/topic/retirement/erisa), 

2 Filing a Claim for Your Disability Benefits. U.S. Department of Labor, Employee Benefits  Security Administration. https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our activities/resource-center/publications/disability-benefits-claim-filing.pdf 

3 29 CFR Sec. 2560.503-1(f)(3). Cornell Law School Legal Information Institute.  https://www.law.cornell.edu/cfr/text/29/2560.503-1  

4 29 CFR Sec. 2560.503-1(f)(4). Cornell Law School Legal Information Institute.  https://www.law.cornell.edu/cfr/text/29/2560.503-1. 

5 29 CFR Sec. 2560.503-1(g). Cornell Law School Legal Information Institute.  https://www.law.cornell.edu/cfr/text/29/2560.503-1.  

6 Filing a Claim for Your Disability Benefits. U.S. Department of Labor, Employee Benefits  Security Administration. https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our activities/resource-center/publications/disability-benefits-claim-filing.pdf 

7 29 CFR Sec. 2560.503-1(f)-(g). Cornell Law School Legal Information Institute.  https://www.law.cornell.edu/cfr/text/29/2560.503-1 

8 Benefit Claims Procedure Regulations, C-3. U.S. Department of Labor.  https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource center/faqs/benefit-claims-procedure-regulation

9 Benefit Claims Procedure Regulations, C-16. U.S. Department of Labor.  https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource center/faqs/benefit-claims-procedure-regulation 

10 CFR Sec. 2560.503-1(f)(3). Cornell Law School Legal Information Institute.  https://www.law.cornell.edu/cfr/text/29/2560.503-1  

11 Information Letter 06-14-2021. U.S. Department of Labor, Employee Benefits Security  Administration. https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource center/information-letters/06-14-2021

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I’m a Physician with a Disability—What Can I Do to Protect Myself?

As a physician, you’re trained to solve complex problems under pressure.  You have worked hard for your career, and probably never expected to have to stop working due to a disability.  Perhaps you applied on your own for those benefits and the insurance carrier denied your claim, or perhaps you’re beginning the process of applying for long-term disability insurance benefits.  What can cause highly educated medical professionals to lose their long-term disability appeals?

It’s not a lack of intelligence. And it’s definitely not because you’re “not really disabled.”

In my work representing physicians and other high-income professionals, I’ve seen a frustrating pattern: doctors who rightfully file for disability benefits are denied just as frequently (and sometimes more so) as people who are not trained in medicine.

Here’s what’s going wrong, and how you can protect your livelihood and your future.

•  Doctors are often treated on an informal basis by their colleagues

Any professional with a large network of trusted colleagues will turn to them first when something in their field goes wrong.  That’s a given, and I get it.  My father was a general practitioner from 1969 until 2021, when he passed away, and he was my first, and often only, phone call when I or my family had a medical concern.  However, these initial, informal phone calls and diagnoses don’t make it into your medical records.  So while you may have a months- or years-long history of seeking medical advice for your ailment, the medical records may look as though you just started treatment for a condition that has now become disabling.  My first task with any of my clients in the medical field is to request their complete relevant medical records, so that I can ascertain how supported their disability is within the records that the insurer will review.  And if those records are incomplete or sparse, I develop a strategy, through declarations, letters, or any other means, to make sure that the true course of treatment is documented in the long-term disability claim file.

• Insurers may use narrow definitions of “Disabled” for doctors

If you’re a surgeon who can’t operate anymore, that may seem clearly disabling to you. But your policy might say otherwise—especially if it’s a group policy through your hospital or medical group.

Many doctors are shocked to learn that their policy allows the insurer to deny benefits if they can do any work in a related field, such as consulting or teaching.

What to do: Get a copy of your full policy—not just the summary. A legal review by Springer Ayeni can help uncover how your “own occupation” is actually defined.

• Doctors may think it’s better to scale back to part-time rather than filing a disability benefit claim

In my experience, physicians and other professionals who have dedicated their lives to developing their expertise through education and practice, are incredibly determined to hang onto even part of their work rather than file a claim under disability insurance policies.  Why?  Because you have worked for your entire life to become a physician, and you may have even set that personal goal when you were just a child.  My father never retired as a physician, and even when he became frail and sick, he kept working, forsaking all else, until shortly before he passed.  For those of us who truly enjoy helping others in our profession, we may not even contemplate retirement, let alone leaving the practice much earlier than expected due to a disability.  

Unfortunately, long-term disability insurers often operate under what I have dubbed the “hit by a bus theory,” where one day you are fully capable of performing your job without limitation, then you get “hit by a bus,” and the next day you are disabled.  Most disabilities are not so straightforward, and many physicians continue working as long as they can with progressive disabilities,.  

If you have strived in your profession for years and years, then your medical condition causes you to lose some capacity, you might start by scaling back your hours, or switching to more administrative tasks.  Before making this kind of career move, please give me a call at 510-926-6768, so I can discuss the strategy of whether you might qualify for long-term disability benefits, and what the impact of switching job duties or reducing hours might be on an eventual disability claim.  

What to do:  Call me to discuss your disability and the terms of your benefit plan as soon as possible so that you can develop a strategy for whether, and how, you might either scale back your duties, file for disability benefits to replace your lost income, or both.  Ironically, disability insurers often scrutinize partial disability claims harder than total disability claims, seeming to punish those who have tried heroically to keep working despite disabling limitations.  I am here to help and advise, and I encourage you to let me help you make an informed decision about reducing your hours or filing a disability claim.

• Medical Records or Treating Physician Forms Alone Usually Aren’t Enough

Insurers don’t just want to know your diagnosis. They want to see how your condition limits your ability to perform your specific job duties.  In the ultimate “gotcha,” however, insurance forms for treating physicians to fill out either don’t ask the right question (“how”) or don’t leave enough room for your doctor to answer that question thoroughly.  Stating an ICD Code and a condition, like “long-COVID,” “Parkinson’s Disease,” “Mild Cognitive Disorder,” “Major Depressive Disorder,” or “Migraine,” etc., is insufficient to prevail on a claim for disability benefits.  You and your doctor need to explain how your condition affects your ability to specific tasks in your practice, such as stand during rounds, hold your arms in the correct position during surgery, respond adequately to emergencies, work a nightshift or be on-call, or manage a high-stress practice.

What I suggest:  Work with your treating doctor to create a detailed functional report—not just a chart note, by writing down a list of what specific job duties are affected by your disability, and going over that list with your treating physician.  It’s best if your medical records can be as detailed as possible about what you are unable to do at work. Also, the boxes on insurance forms are not a limitation!  Put in an asterisk and attach a supplemental page or 2 to submit as much helpful information as possible.

• Doctors Are Prime Targets for Surveillance

High-income professionals like doctors are often watched, because they are expensive claims for the insurer to pay. A short video of you walking, driving a distance longer than your restrictions permit, shopping in a store, or attending your child’s sports game can be twisted to argue you’re not truly disabled.

What to do:  Make sure all of your social media settings are set to “private.”  Be mindful of what you do in public and what your restrictions and limitations are.  Be honest in disclosing your actual activities on forms.  For example, if your physician has recommended exercise to improve your disabling conditions, make sure you state on your application or update forms what you do and why it was prescribed by your doctor.  If benefits have been denied, be sure to request and review all surveillance footage so that you can include context for what was actually happening on that day.  Judges ultimately appreciate context, and understand that there may be anomalous events that do not necessarily mean that you can return to the full-time practice of medicine.  While insurers may be looking for a “gotcha,” have faith that most judges are wise enough to see the big picture. 

• ERISA is brutally technical

The ERISA process has strict rules. You often get only one appeal to submit your evidence, and it must be submitted by a specific date or you lose your right to the claim.  Moreover, if you miss including key documents, you may not have the chance to get that evidence in front of the court if you later go to court.

What to do: Don’t wait until after your appeal is denied to consult a lawyer. The best time to get legal help is before you submit your appeal—when there’s still time to shape the record.  Reach out to me at www.benefitslaw.com or 510-926-6768 and I would be happy to discuss your specific issue with you in more detail.

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The Elephant in the Room: Can AI Really Handle Your ERISA Disability Claim and Appeal?

Why Turning to a Bot for Legal Advice Could Hurt Your Claim—And What You Deserve Instead

Let’s be honest: more and more people are asking AI tools like ChatGPT or Google’s Gemini how to appeal a denied disability claim before they ever think of calling a lawyer.

I get it. AI is fast. It’s available 24/7. It doesn’t require talking with a live person about the difficult details of your health.  And, of course, AI is free or low-cost.

But when your financial stability and health are on the line, you need to know the full truth: AI is not a substitute for experienced legal counsel.  In fact, trusting AI blindly could do more harm than good.

As someone who has spent 23 years representing clients in ERISA disability cases, I’m not here to bash technology.  There is much to gain from the efficiency of evolving technology and I am certainly not advocating AI abstinence.  I am here, however, to lay out the risks, differences, and reasons why having a compassionate, strategic, and knowledgeable attorney matters for something as critical to your financial health as your long-term disability benefits.

Why People Turn to AI—and Where It Falls Short

If you type into ChatGPT:

“How do I appeal a denied ERISA disability claim?”

You’ll probably get something like this:

“Request your claim file. Review the denial letter. Submit additional medical evidence. Write an appeal within 180 days.”  You might even get general “advice” about including medical records and statements in support of your appeal.  However, even AI knows its own limitations.  A common Bot disclaimer goes something like this:

“Generative AI features are not intended for professional advice. Do not use generative AI features to seek or provide legal, medical, financial, or other kinds of professional advice or any opinions, judgments, or recommendations without conducting your own independent consultation or research. Generative AI features cannot replace advice provided by a qualified professional and do not form any such relationship (e.g., attorney-client relationship).” (https://www.adobe.com/legal/licenses-terms/adobe-gen-ai-user-guidelines.html)

Even tech giants know that the disclaimer is necessary because AI advice is not strategic, not confidential, not detailed, and, in fact, is dangerously simplistic.

For example, AI does not, and cannot, analyze whether your plan’s language requires a de novo or abuse of discretion standard of review in court; whether the facts of your case meet the definition of disability under your plan language; whether the insurer has disclosed all required information in its claim file; whether there is evidence of biased claims handling in your file; whether the insurer has calculated offsets accurately in your case; what evidence in the claim file needs to be rebutted in an appeal; what the likelihood of settlement and possible settlement amount in litigation might be.  The list goes on and on.  These are the kinds of distinctions that change the outcome of a case—and they’re not in an AI’s toolbox.  

The bottom line: AI gives you non-confidential general advice.  Springer Ayeni gives you a legal strategy based on decades of experience handling ERISA long-term disability cases.

AI “Hallucinations” and Fake Law: A Dangerous Trend

AI tools are known for hallucinating legal citations—that is, making up case law that sounds real but isn’t. See https://hai.stanford.edu/news/ai-trial-legal-models-hallucinate-1-out-6-or-more-benchmarking-queries  I’ve read up on examples of how AI will generate completely fictitious case references and quotes from decisions that don’t exist.  This isn’t just sloppy, it’s dangerous.

First, if you submit an appeal letter to an insurer or judge citing bogus cases, you undermine your credibility.  Second, insisting that there are cases in your favor when you reach out to an attorney, when those cases are entirely fictious (unbeknownst to you), will make an attorney hesitant to offer to represent you.  Attorneys and their clients should be on the same team at all times. Most importantly, you won’t even know when AI has done you dirty with a fictitious citation, because it often sounds right and the wrong cases are mixed right in with actual cases.  

The bottom line: Legal writing is not just writing. It’s advocacy, precision, and ethics.  AI is still a baby in the world of law, and cannot be trusted to do actual legal research.

AI Is NOT Confidential, and that Can Put You at Risk

AI is not a lawyer. It doesn’t form an attorney-client relationship, as all of the tech User Guidelines state. That means: 

1. There is no legal confidentiality. What you input may be stored, analyzed, or even discoverable later.  
2. You might waive privilege by sharing facts about your medical condition, employment, or insurer.  Moreover, AI remembers your input from search to search, so even if you don’t share all the facts in one session, it may know a lot more about you, your condition, your family, your history, your dreams, and your goals from all of the data you have input in previous searches.
3. There is no duty of loyalty. AI doesn’t protect your interests—it just completes a task.  For example, when Chat GPT conversations are shared, Google produces those conversations as “results” upon a simple search.  See https://cybernews.com/ai-news/chatgpt-shared-links-privacy-leak/ 

As an attorney, I never input confidential client information into AI platforms. Doing so risks ethical breaches and the security of your case. Some lawyers are misusing AI and unknowingly exposing clients. That’s not how I work.

If I use AI at all, it’s only for mundane administrative tasks—not for case strategy, legal analysis, or communication. 

The bottom line: Your trust is sacred. And your privacy is non-negotiable. AI will not protect you and advocate for you like a good attorney will.

A Real Appeal Tells the Real Story—Not Just the Medical One

An AI might focus only on lab results and doctor notes. But I know that winning a disability appeal requires telling your whole story, not just summarizing medical visits.  It also requires understanding the law and how it applies to the facts of your case, and being able to spot and rebut flaws in the insurer’s claims handling and medical reviews.

I listen for and translate the truths that often don’t make it into a medical file, like how your fatigue crashes your productivity by noon, or how your brain fog makes multi-step tasks impossible not just at work but in your everyday life, or how your anxiety prevents you from completing your tasks efficiently, or even how you have good days and bad days, requiring you to rest for days if you have over-exerted yourself on a good day.  

I draw out the details of your daily life, your work history, and your limitations, and I explain them clearly and persuasively to the insurance company. This isn’t something a chatbot can do. It takes time, training, empathy, experience, and sound judgment.

The bottom line: I’m not just reviewing records. I’m building your narrative, filling gaps in the file, rebutting arguments, and fighting for your future.

AI Can’t Show Up for You. I Will.

Some pundits say AI will replace lawyers. I do think that technology can make lawyers more efficient at administrative tasks that take away from time spent on actual cases.  However, the best lawyers, those who listen, advocate, strategize, work as a team with their client, and ultimately are successful in cases, cannot ever be replaced by a bot.   Technology will evolve, but compassion, reputation, and results still matter.

When you retain me, you’re not getting a script. You’re getting:

• 23 years of ERISA disability experience
• Strategic, circuit-specific legal knowledge
• A reputation for success and tenacity among colleagues, insurers, and opposing counsel
• A teammate who sees you as more than a claim number
• A fierce advocate who will not ignore you or reduce you to a piece of datum that will influence future actions

The bottom line: You deserve someone who understands not just the law, but the weight of what’s at stake. You deserve someone who knows how to get results and treats you with dignity along the way.

Final Word: Don’t Trust a Bot with Your Livelihood

AI has its place, but not as your attorney. Not when your disability benefits, your financial survival, and your mental and physical health are on the line.

Before you go down a rabbit hole of chatbot answers, talk to someone who’s been through this hundreds of times, someone who won’t hallucinate law, who respects your privacy, and who knows how to win an appeal, not just write about it.

Contact Springer Ayeni today. Let’s protect what matters most—your income, your dignity, your future.

Springer Ayeni: Compassion. Reputation. Results.
www.benefitslaw.com

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Cassie Springer Ayeni Named SuperLawyer 6 Years in a Row

For the 6^th consecutive year, Cassie Springer Ayeni has been named a SuperLawyers Top 50 Women Attorney for Northern California, and a Top 100 Attorney for the 5^th consecutive year.  She has been named to the SuperLawyers list for her expertise in employee benefits for 8 consecutive years.

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Incoming chair message to Employee Benefits Committee

So much has happened in these few months since I wrote this message to the Employee Benefits Committee as one of its incoming co-chairs.  Since then, we had a successful midwinter meeting in Rancho Mirage, but none of us knew that would likely be our last travel occasion for the foreseeable future.   Here’s a blast from the near past, which feels like a lifetime ago: 

https://www.americanbar.org/groups/labor_law/publications/ebc_news_archive/holiday-2019-issue/message-from-new-co-chair/

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Here’s a blast from the near past, which feels like a lifetime ago

So much has happened in these few months since I wrote this message to the Employee Benefits Committee as one of its incoming co-chairs.  Since then, we had a successful midwinter meeting in Rancho Mirage, but none of us knew that would likely be our last travel occasion for the foreseeable future.   Here’s a blast from the near past, which feels like a lifetime ago: 

https://www.americanbar.org/groups/labor_law/publications/ebc_news_archive/holiday-2019-issue/message-from-new-co-chair/

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Springer Ayeni Wins Disability Case Against Aetna

Even in tough times, we are grateful for the hard-working judges and court personnel who continue to decide cases and keep the wheels of justice turning.  On March 24, 2020, the attorneys at Springer Ayeni achieved a victory for our client, a man disabled by shoulder pain and denied disability benefits by Aetna Life Insurance Company.  Judge Chesney of the Northern District of California ordered benefits paid for Mr. Shaikh’s own occupation and remanded for a determination on the amount.  The Court found that Aetna “overly focused” on objective medical evidence and “essentially disregarded” Mr. Shaikh’s credible complaints of pain.   Springer Ayeni is now pursuing attorney fees against Aetna.    https://law.justia.com/cases/federal/district-courts/california/candce/3:2018cv04394/329565/46/

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A Conversation with Attorney Cassie Springer Ayeni

Q: When did you know you would pursue a career in the legal field?
CSA: As early as junior high or high school, I felt the need to advocate for others, to make a point to stand up for the kids who were being bullied or ostracized. I also realized around the same time that I truly enjoyed writing, reasoning, and debating. The law seemed a natural fit: I could use my skills to make a palpable difference in people’s lives. I had settled on a career in law by the time I was 16 and never looked back.

Q: Can you explain what types of cases an ERISA Attorney handles and why you chose this area of law?
CSA: I primarily help people with their employer-sponsored disability benefit claims. ERISA governs all private employer benefit plans, not just pension plans. Many employers provide disability benefit plans in addition to health and pension benefits. In fact, 65% of ERISA litigation is over denied disability benefit claims. The plans are often insured, and clients typically come to me after they stop working, apply for disability benefits to the insurance company, and are denied. I then step in to try to get their disability benefit income restored while they focus on their health.

Q: What is your approach or philosophy to winning or representing a case?
CSA: I lead with kindness. I want to understand truly what my clients have gone through medically, economically, and emotionally to get to this point in their lives, and how I can help. In representing a client, I am there for that person: I am responsive and listen with an open heart. I believe this the secret to winning a case as well – if I am doing my job right, I am painting a picture of the person and the case to help the court appreciate why my client is deserving of their disability benefits. I have the paintbrush and paint ready because I have spent months getting to know my clients and researching the law. And I also aim to be the best-prepared lawyer in the room with the most compelling brief … that helps too.

Q: If we interviewed all your past clients … what is “one” common word that comes up when they describe working with your law firm?  
CSA: Compassion

Q: What are some of the most popular topics you are asked to lecture on?

CSA: I speak frequently on ERISA topics, especially in my current role as the co-chair of the ABA’s Employee Benefits Committee. I love presenting to newer attorneys about the fundamentals of ERISA litigation, because I am eager to energize attorneys about how engaging ERISA work is. ERISA is fun! The law is always evolving, providing constant intellectual stimulation, and practicing ERISA law is also a great way to help people in need. I also enjoy speaking to women about re-defining what it means to be a successful litigator, and how to challenge traditional law firm standards to achieve a better work-life balance.

Q: What advice would you give to young women who want to pursue a career as an Attorney? 
CSA: Any woman who wants to pursue a career as an attorney should make sure that her potential work environment values diversity and inclusion, fosters a sense of belonging, and creates opportunities for women at every turn. If she is unable to find that environment, she should open her own law firm and create those opportunities herself. 

Q: How do you maintain a work/life balance?
CSA: Being the owner of my firm allows me to make up the rules: I look to the best practices of progressive companies and pick policies that I believe are imperative to work/life balance for everyone. I figure that everything I need to raise four children and work full-time as an attorney is what everyone at my firm needs too. I offer unlimited PTO, great benefits, four months of fully paid maternity leave, the ability to bring children in to work as needed (in fact I have brought each of my babies into work until they needed another environment), the ability to work from home, and a practical approach to parenting … like closing the office on Halloween and Valentine’s Day so that we can all attend class parties without rushing to or from work. I, of course, avail myself of each of these policies, which is why I created them in the first place. That’s not to say that I don’t wake up early to work for a bit so that I can focus fully on my kids to take them to school, or grab a few hours on the weekend to pound out a brief, but family always comes first, for me and for everyone who works at Springer Ayeni.

Q: What’s one lesson you’ve learned in your career that you can share with our audience?
CSA: I have always learned to be myself. If you are authentic, you are compelling as an advocate and a counselor: you listen and communicate better when you are not spending energy on worrying about how you should come across. I also believe in the power of preparation. If you are committed to doing your best and preparing your utmost, then even a negative outcome cannot be met with regret, but a positive outcome is much more likely. And if you’re nervous before a court appearance or speaking engagement, just take a breath and realize that even in a worst-case scenario, you will survive and move forward … we all do.

Q: What are some of the challenges you feel women face today?
CSA: Looking at women lawyers only, there is much progress to be made. As Joan Williams at the UC Hastings Center for WorkLife Law has analyzed convincingly, women lawyers (and women in other fields too) are asked to “prove it,” then “prove it again.” In other words, women need to do the job before getting the promotion, whereas men are promoted based on potential. This is a major obstacle to women’s promotion and needs to be addressed systematically.

Five Things About Cassie Springer Ayeni

1. If you could talk to one famous person past or present, who would it be and why? 
There are so many! But if I had to pick one it would be Harriet Tubman – her courage and vision even in the face of medical problems were and are awe-inspiring.

2. What’s your favorite holiday? Why? 
Valentine’s Day! I don’t view it as just a romantic holiday, but as a day to express to those around you how much you care.

3. If you were a superhero, what would your special powers be?  
Time-traveling. That would be magical!

4. What app can’t you live without?  
Facebook – it has allowed me to make great connections with other lawyer moms – lawmas!

5. Favorite food to eat? 
Strawberries. Now, then, forever, and always.

See the interview at https://bayareawomenmag.com/news/view/11665/Her_Firms_Achievements_-_Results_are_Measured_by_the_Satisfaction_of_Her_Clients_A_Conversation_with_Attorney_Cassie_Springer_Ayeni

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