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Can I add more information to my claim file in anticipation of filing a lawsuit after an insurance company enters a final denial of benefits?



Attorney Stephen JessupAuthor: Attorney Stephen Jessup

For all intents and purposes, no. The law is pretty clear that following a final denial of benefits no additional information can be added to the administrative record in anticipation of trial, as the administrative record consists only of the evidence that was before the carrier when it rendered its final decision to deny benefits.

A recent ruling by a Federal Magistrate Judge from New Jersey in the case of McCann v. Unum Provident, echoes this accepted proposition. In an interesting twist, the plaintiff filed a Motion to Strike a letter from his doctor, which was received by Unum forty-five minutes AFTER a final denial of his claim for long term disability benefits was rendered by Unum. Normally, it would be the insurance company who would presumably want a letter from an insured’s doctor being kept out of the administrative record for being untimely. However, Unum argued that it was appropriate to keep the letter from McCann’s doctor in the administrative record to be reviewed by Judge at trial. Although the Court’s opinion does not give detail as to the contents of the letter, it would seem that the letter may not have been favorable for McCann if Unum wanted it to be part of the record. Regardless of the contents of the letter, the Court determined that the administrative record, as it pertained to the lawsuit against Unum was effectively closed 45 minutes before the letter from McCann’s doctor was received by Unum, and as such should be stricken from the administrative record.

The importance of filing an ERISA Appeal

If your long term disability policy is governed by ERISA, one cannot stress enough the importance of filing as complete an Appeal as possible. As discussed throughout our website, your ERISA administrative appeal is essentially your last chance to present your evidence of disability not only to the disability carrier, but also to a federal judge should the case go to trial.

Many people who receive a denial letter from their insurance company detrimentally rely on the assertions made by the claims manager that all they have to do is “send a letter saying you disagree with the decision.” Not surprising, this usually results in a rubber stamped upholding of the initial denial. If there is no mandatory or voluntary second appeal under the policy – there is no chance to supplement the file with additional evidence of disability. Due to the nature of ERISA litigation and the requirements of meeting your burden of proof at trial this could be disastrous to your case and prevent you from collecting additional benefits under the policy as the above case reminds us.

If your claim has been denied, please feel free to contact our office to discuss how we may be able to assist you in filing your appeal.

Dell & Schaefer had no involvement in Dr. McCann’s claim for benefits.

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