Creating a Record During the Administrative LTD Benefits Appeal Process

Creating a Record During the Administrative LTD Benefits Appeal Process

Obtaining long-term disability benefits should be a straightforward process when your medical conditions keep you from working. Unfortunately, that is not always the case. Creating a comprehensive record with as much information as possible in your long-term disability claim can be crucial to a successful appeal.

ERISA-governed LTD plans require at least one level of administrative review before you can go to court to appeal a denial of benefits. The record that you create in submitting your administrative appeal is the same record that a court will consider if the insurance company still denies your claim for benefits. When you file a lawsuit appealing the denial of LTD benefits under a plan that is subject to ERISA, you cannot submit any new or further evidence in support of your appeal. Instead, the court must solely rely on the administrative appeal record that already exists.

As a result, you must take all steps necessary to ensure that your administrative appeal record has all the information that is essential to your claim. Your first step should be to review the insurance company’s file, which should contain copies of all records, internal notes, outside reports, and any other documentation that the insurance company relied upon in deciding to deny your LTD claim. You are entitled to a copy of all these materials so that you know what you need to add to the record to strengthen your claim.

You should make sure that a complete copy of your medical records is included in the administrative record. Your medical records consist of any reports of examinations by outside doctors that your insurance company required you to undergo. You should ask your primary doctors and specialists who regularly treat you to supplement those records with personal letters or statements that more fully explain your condition and the impact of your symptoms and side effects on your ability to perform daily activities. Statements from other health care professionals, such as chiropractors and physical therapists, also may be useful in bolstering your claim.

If you can do so, you might approach your former employer or supervisor and ask them to write a statement about your situation. They are in the best position to comment on how your medical conditions adversely impacted your work performance and your general ability to do your job. Likewise, you can seek written statements from people who assist you in your household or live with you. While they may not be medical professionals, they are people who are with you every day and can share some insight into your daily struggles due to your medical condition.

Bonnici Law Group has handled the claims of countless individuals who have encountered difficulties in procuring long-term disability benefits under their employers’ ERISA-governed insurance policies. We will protect your rights and advocate on your behalf throughout every stage of the claims process. Call our office at 619-259-5199 to set up an appointment to speak with us today.

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