If you or your family member is covered by a long term disability plan obtained through a private-sector employer, it is likely that the policy is governed by a federal law called the Employee Retirement Income Security Act (ERISA). Unfortunately, some employees and beneficiaries struggle to get access to long term disability benefits when they need them the most.
If your claim was denied, you have the right to file an appeal. In fact, ERISA guarantees all applicants a “full and fair” review of their long term disability denial. Here, our Philadelphia long term disability lawyer provides an overview of some of the important elements of a long term disability appeal — the administrative record.
In ERISA disability claims, the claim file, which is sometimes inaccurately and incorrectly described as the “administrative record” is made up of all of the documents, records, and information sent to the disability plan fiduciary responsible for adjudicating claims for disability benefits. In many cases, that fiduciary is a disability insurance company. Under United States federal law and its implementing regulations (29 U.S.C. § 1133 and 29 CFR § 2560.503-1), the claim file or “administrative record” includes any and all documents that were “considered” or “generated” by the plan administrator or insurance company in the denial of your long term disability claim. Notably, the claim file or so-called “administrative record” cover the time from when an applicant first submitted a claim for benefits to when the administrator or insurance company issued its final denial.
In ERISA disability claims, the claim file matters. To ensure that your legal rights are protected, it is crucial that the administrator or disability insurance company receives all evidence relevant to your case. Certainly, this is important to help facilitate the proper handling of your claim; ideally, the administrator or insurer will issue benefits without the need to get a court involved.
Should litigation prove to be necessary, and depending on the standard of review applicable to your claim, the court may limit its review to the evidence contained within the so-called “administrative record.” Put another way, judicial precedent and court rulings may prevent disability benefit plan participants and beneficiaries from submitting additional evidence to support their lawsuit, unless an exception applies to the case.
The bottom line is that you need to make sure that all relevant evidence is submitted to the insurance company and gets into the claim file or “administrative record.” You have the right to get a copy of the “administrative record” to confirm that it is complete and accurate. Any issues/problems should be corrected immediately.
We are here to help. At The Garner Firm, our Pennsylvania ERISA Disability attorney has extensive experience handling long term disability claims. If you were denied long term disability benefits, it is imperative that you take immediate action to protect your rights. To get a free, fully private case evaluation, please contact our law firm today.
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