One of the largest obstacles facing an insured in bringing a lawsuit against a disability insurance company for benefits under an ERISA governed group disability policy is the inability to add additional information, in most cases medical information, to the administrative record after a final denial has been entered by the insurance company.
This general rule was reaffirmed in a recent ERISA disability lawsuit against Hartford Financial Insurance Company in California. The insured attempted to introduce an updated medical record that had not been provided during the administrative appeal process. The insured argued that since the Court was reviewing Hartford’s termination of benefits under what is known as a “de novo” standard of review, the Court is allowed to consider this new evidence to determine whether Hartford correctly denied the claim.
The Court disagreed stating that the report was of limited relevance to its determination as the new medical information was dated two years after the claim had been denied and did not provide relevant information as to the correctness of Hartford’s initial denial. As such the report was not to be admitted into the record or considered by the Court in making its decision.
ERISA Laws Are Very Strict And You Must Understand The Rules To Win Disability Benefits
Litigation under ERISA governed policies is limited to what is contained in the administrative record at the time of the final denial. Only under very limited and strict circumstances can additional information be admitted for consideration by the Court.
This is why it is imperative that an insured submit as thorough and complete an Appeal as possible, containing as much supportive medical and nonmedical evidence of disability as possible.
An insured whose claim has been denied should view any Appeal being filed as forming the basis of what can be argued at trial. If relevant information that could support your inability to work is not included in the appeal and not submitted before a final denial of benefits you can be precluded from ever having a Court consider it.
If your disability insurance claim has been denied please feel free to contact Attorneys Dell & Schaefer at 1-800-828-7583 to discuss your options and how we may be able to assist you.