When Insurers Don’t Explain Themselves: Why Vague Denials May Violate Federal Law
If your long-term disability, life, or AD&D claim was denied — and the insurance company didn’t clearly explain why — they may have broken the law.
This isn’t just frustrating. It’s not just bureaucracy. Under ERISA, vague denials aren’t allowed.
A recent decision by the Ninth Circuit Court of Appeals reinforces what we’ve known for years: if the insurance company doesn’t give you a clear, specific reason for saying no, they’ve violated your rights — and that opens the door to new legal remedies.
What Happened in Solis v. UnitedHealthcare
This July 2025 decision from the Ninth Circuit involved a health insurance denial — but its impact reaches far beyond that.
UnitedHealthcare denied coverage for part of a surgery. Their denial letters said the procedure “may be included” in another billing code, without pointing to any specific rule in the plan or explaining the reasoning.
Even worse, they offered new justifications for the denial months later — after the case was in court.
The court said that violated ERISA.
Under federal law, insurance companies must explain why they’re denying your claim, and they have to do it clearly and up front.
They cannot play hide-the-ball. And they don’t get a second chance in court to come up with better reasons.
Why This Matters for LTD, Life, and AD&D Claims
Insurance companies make this mistake in all types of ERISA claims:
In disability claims, they say your condition “doesn’t support disability” — without saying what part of the record is missing.
In life insurance cases, they say coverage “wasn’t in force” — without citing the lapse provision or grace period.
In accidental death claims, they say the injury “falls under an exclusion” — but never say which one or how it applies.
Then later — sometimes in court — they invent new reasons.
That violates ERISA. And thanks to Solis (and earlier cases like Harlick and Abatie), you now have stronger arguments to fight back.
What the Law Requires (and Why It Helps You)
ERISA requires insurers to follow strict procedural rules. When they deny a claim, they must:
State the specific reason for the denial (29 U.S.C. § 1133(1))
Cite the actual plan provision they’re relying on (29 C.F.R. § 2560.503–1(g))
Provide enough detail for you to challenge the decision
If they fail to do that, courts can:
Allow you to submit new evidence, even after deadlines have passed
Disregard new justifications raised after the denial
Review the denial more skeptically, instead of giving the insurer the benefit of the doubt
This isn’t a technicality. It’s a legal strategy — and it can make the difference between a denied claim and a paid one.
What to Do If You’ve Been Denied Without a Clear Reason
If you received a denial letter that felt vague, generic, or boilerplate, take these steps:
Request the full claim file and plan documents (you have the right to both under ERISA)
Check the denial for specificity — does it cite a plan provision? A reason?
Document any later communications where the insurer offers new reasons
Contact an ERISA attorney — even if you’re already deep into the appeal process
At Dorian Law, we build strong cases by challenging denials at their foundation. We hold insurers to the rules — and when they violate them, we use that violation to your advantage.
FAQs for Those Searching for Answers
1. What does ERISA require in a denial letter?
ERISA requires that insurers give you a specific reason for denial and cite the actual plan provision that supports the denial. Vague or generalized language is not enough.
2. Can an insurance company change its reason for denial later?
Not if it’s governed by ERISA. Courts have consistently held that ERISA insurers cannot offer new reasons after the administrative process is complete. Denials must be justified during the appeal process — not in court.
3. What happens if the insurance denial doesn’t give enough information?
If the insurer failed to provide a proper explanation, you may be allowed to submit new evidence, reopen the record, or even get a more favorable standard of review in court.
4. Does this apply to life insurance and accidental death claims?
Yes. These procedural protections apply to all ERISA-governed benefit plans, including LTD, life insurance, and AD&D. Solis was a health benefits case, but the legal rules are the same.
5. Is it legal for an insurer to just say “not supported” without more?
No. Under ERISA, a denial like “not supported” or “may be included” is likely insufficient. The insurer must explain why, based on your records and the plan language.
6. Where can I find legal help if I think my ERISA rights were violated?
You can contact Dorian Law. We specialize in ERISA disability, life, and AD&D claims. We know how to identify procedural violations and turn them into winning strategies.
Final Thought
Most people don’t know that vague denials are a legal issue. Most insurers hope you won’t notice.
We do.
And we’re here to help you fight back — with knowledge, strategy, and experience that keeps pace with every legal development in the country.
Denied a claim without a clear reason? Let's talk.
We’ll help you understand your rights — and take the next step toward justice.