• Can I Add To My Claim File After An Insurance Company Enters A Final Denial Of Benefits?

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?

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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Questions About Hiring Us

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

John B., MD

In my first phone conversation with Greg Dell he asked a series of probing questions for about ten minutes, and one could sense he was building an understanding of my case and me as a person. I have worked with him almost a year, and he has always been available with a thoughtful answer to any question or concern. He has a thorough knowledge of my disability policy and the workings of a major insurance company like Unum. I have a distinct feeling that Unum knows it will not be able to take advantage of me. Greg has an uncanny insight into the core of any issue and is always thinking several steps ahead. At first I found this amazing, then -remembering he was on my side – comforting.

***** 5 stars based on 202 reviews

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