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Does my insurance company have to consider my SSDI award if I received the award after my ERISA appeal was denied?

Claimants often ask if their award of SSDI benefits means that their LTD claim will be approved by their insurance company. As we have discussed in other articles and videos, an SSDI award does not guarantee that your LTD claim will be approved by your insurance company. However, in reviewing your claim, the insurance company should consider the SSA decision and the information relied on by the SSA. In fact, the failure of an insurance company to fully consider the SSA decision often results in a finding by a reviewing court that the insurance company’s decision to deny benefits was “arbitrary and capricious.” (Such a finding can result in an award of benefits to the claimant or a demand by the court that the insurance company review the claim again taking into account the SSA decision.)

Sometimes the SSA can take years before awarding SSDI benefits. So what happens if your claim is denied and the SSA approves your SSDI claim years after your LTD claim was denied by your insurance company and beyond the timeframe in which you could appeal the LTD claim denial?

In a recent case out of the Tenth Circuit, the claimant argued that she was approved for Social Security disability income benefits subsequent to Aetna’s final denial and that, as a result, Aetna, as a claim fiduciary, should have reopened her record and considered the Social Security determination and related documents. The reviewing courts rejected the argument.

Ms. Nelson worked for Bank of America as a premier accounts manager and was a participant in her employer’s Long Term Disability Program which was insured by Aetna. On March 3, 2009, Ms. Nelson left work due to a number of ailments including fibromyalgia, anxiety, fatigue, depression, and pain in the back, neck, and pelvis. Ms. Nelson filed a disability claim which was initially approved by Aetna. Aetna paid benefits to April 20, 2009 but denied beyond that date stating there was “no objective medical reason [Ms. Nelson] could not perform her job.”

Ms. Nelson appealed Aetna’s denial, but Aetna denied the appeal by letter dated July 24, 2009 forcing Ms. Nelson to file suit in federal court. On November 1, 2010, after the filing of the lawsuit against Aetna, Ms. Nelson received notice of a fully favorable decision from the Social Security Administration on an application for Disability Benefits she had filed in April 2009. The SSA found she had been disabled since March 4, 2009, one day after she stopped working at Bank of America. Ms. Nelson then asked the court to supplement the administrative record with the SSA’s decision or, in the alternative, to remand the matter back to Aetna so it could consider the SSA’s decision.

The court pointed out that “in reviewing a plan administrator’s decision under the arbitrary and capricious standard, the federal courts are limited to the administrative record.” The general restriction would apply to any extra-record materials sought to be introduced that relate to a claimant’s eligibility for benefits. Because the SSA decision concerned Ms. Nelson’s eligibility for benefits Ms. Nelson was prohibited from introducing it.

In ERISA cases reviewed under the arbitrary and capricious standard of review, the reviewing court is limited to the administrative record. Claimants are restricted from introducing more information after the administrative record has closed, which typically occurs after appeals have been exhausted and a lawsuit is filed. The appeal is therefore the last chance to supplement the administrative record and anything relating to a claimant’s eligibility for benefits, including the SSA decision, cannot be introduced. This is usually the case even if the SSA decision is made after the record closes.

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Disability Company Reviews

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Sedgwick

Don't trust them, they like to play games

Reviewed by Bob on November 14th 2024 Verified Policyholder | June 2024 date of disability

They suck the life out of people that need help. They falsely advertise for helping people that they care. Sorry to tell you it's all about money, they do not care for any... read more >

New York Life

Lyme Disease Disability Claim Denial

Reviewed by Bob C. on November 13th 2024 Verified Policyholder

I have had repeat claims for genuine medical leave and they have repeatedly been denied by NY Life. I have even been diagnosed with Lyme and going through treatments and t... read more >

New York Life

Disappointed with NY Life Disability Excuses

Reviewed by Carina S. on November 12th 2024 Verified Policyholder

I am beyond disappointed with NY Life Disability Insurance’s handling of my father’s claim. My father, a 66-year-old man who has suffered two strokes and continues to ... read more >

New York Life

New York Life is a joke!

Reviewed by Heather on October 3rd 2024 Verified Policyholder | August 2024 date of disability

This company sucks when it comes to disability claims. They are slow at processing stuff, then they always say they didn't recieve the doctors information. You spend your ... read more >

MetLife

They FULL OF ****

Reviewed by KM on October 3rd 2024 Verified Policyholder | August 2024 date of disability

MetLife is what everyone on this review are saying. They don't contact you to let you know what's going on with your claim or to let know you need additional info. I had a... read more >

Sedgwick

Worst Company Ever

Reviewed by RobRob on September 23rd 2024 Verified Policyholder | August 2024 date of disability

If something happens to you at work you better hope you die, my son is going through HELL because this company is handling his work comp. NO RETURN PHONE CALLS, TEXTS, EMA... read more >

MetLife

MetLife for disability? Avoid the surgery unless it's life-threatening

Reviewed by Jeff on August 22nd 2024 Verified Policyholder | August 2024 date of disability

The worst company I ever dealt with, never received a call from my claim manager.

Reliance Standard

Short Term Disability Claim/Inconsistent to NO Communication

Reviewed by GaKRN on August 22nd 2024 Verified Policyholder | June 2024 date of disability

When I did call & reach a live person they were kind & helpful. The person assigned to my claim left one phone message & I have not spoken to her since. Information she re... read more >

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Reviews from Our Clients

S.S.

I am a physician in my 30s who was practicing in my hospital based medical specialty until my Multiple Sclerosis diagnosis began to severely limit my physical ability to work.

My husband and I were obviously in distress at these very unwanted life changes and frankly overwhelmed with the possibility of a long and traumatizing legal battle ahead of us. We knew we were legally entitled to benefits through the separate private individual and employer based ERISA disability insurance policies we had, but even cursory research and discussion with colleagues made it clear that insurance companies will strategize with their own legal teams to find ways to not pay out benefits. We found many before us who had fallen unwittingly into legal pitfalls that prevented them from ultimately obtaining benefits. We realized we needed to seek legal counseling.

We found Dell Disability Lawyers through their YouTube channel where their partners have videos discussing the legal intricacies and latest developments in private disability law. I was impressed by their dedication to the field and reached out through their website to request a free consultation.

We were delighted to hear that Mr. Steven Dell himself would be willing to take our case and felt assured that we would be represented by the best of the best.

We have not been disappointed in our expectation and have, in fact, been consistently very impressed. Steven Dell is clearly both knowledgeable and wise about dealing with these issues but more importantly, has shown kindness and impeccable honesty at each step of the way.

Merlin has demonstrated a very high capacity for organizing and handling the endless myriad of documents and communications between us and the insurance companies. She has also been very compassionate, accessible and forthcoming in dealing with our many anxiety fueled emails and telephone calls to her and we are very grateful for her involvement.

For over 7 months, we have been working closely with Steven Dell and Merlin Bryan from Dell Disability Lawyers as they have guided us through the process of review and initial application for benefits from our two insurance policies (Hartford and Ameritas).

We are happy to announce we just received approval of claim from the Hartford insurance company.

At this time we are still working with this firm as we await the final decisions from Ameritas policy that we are hopeful will have a similar outcome.

As anyone with a chronic and progressive illness can tell you, time becomes a very precious commodity. Through their representation, Dell Disability Lawyers has allowed us to focus the majority of our time enjoying the time and function I have left while resting assured that our disability case laid in competent and caring hands.

The truth is that no amount of money can make up for what we have lost, but it is a huge comfort to have a team like Dell Disability Lawyers at our sides to help us ensure we will be able to continue to care for ourselves and our families.

We highly recommend Dell Disability Lawyers, Mr. Steven Dell and Ms. Merlin Bryan to handle your disability insurance claim.

Thank you Steven, thank you Merlin!

We will certainly plan on leaving another review for completeness once we have our final decision from Ameritas.

Paula B.

I have been working with Dell Disability Lawyers for the past 5 years concerning my disability as it pertained to my employer. I have been more than pleased with them the entire time. They have always kept me informed of any paperwork needing completed or any changes coming ahead. Nothing has been a surprise. I would recommend them to you to help with your disability case if you’re trying to dip into the policy you’ve been paying for.

Michael M.

I am a physician who has been disabled for over 10 years. During this time I have been represented by Cesar Gavidia and his assistant, Danielle Lauria. Their representation on my behalf has allowed me to concentrate on dealing with my disability/disease process and all associated complications and not having to deal with all the things that are necessary in a disability insurance claim. Based on my personal experience from many years of practicing medicine I would consider their work product, insight and effort in the disability insurance claim procedures to be superior. I would recommnend them, which I have done, with my highest level of confidence. In short, you will be well served with this practice.

Dan P.

I had to retire from my career due to a bad back that restricted me from performing my duties. I had LTD insurance and after a few years of receiving monthly benefits from this insurance company, they notified me that my benefits were terminated stating that I don’t qualify due to my duties not fitting into some “national job description” and a nurse had deemed me eligible to go back to work. It’s a crushing feeling to have this told to you over the phone with hardly any information given. Luckily, I came across Dell Disability Lawyers and spoke with Attorney Palamara who calmed me down and stated they would take my case. Within a couple of months my benefits were restored, and I had piece of mind. I cannot thank Attorney Palamara and the staff at Dell Disability Lawyers enough for their professionalism, no nonsense approach, personal and timely communication and quick ability to litigate my case.

Jen S.

I wanted to thank Mr. Symonds and his legal assistant Sonia for their professionalism, guidance and dedication towards my LTD insurance claim. Going through the denial process on my own was going to get me sicker and I knew it was time for help right away. I reached out to Dell Disability Lawyers for assistance and not too long after my call, I was connected with Sonia. Soon after that, I was talking about my case with Mr. Symonds. After a long and tedious process with the LTD insurer, we won the case. The wait can absolutely be lengthy, but in the end, it was all very much worth the fight. Thank you both so much for all that you have done for me! I also want to thank those who assisted in keeping me updated, as needed. Highly recommended for anyone who is going through the brutal process of an LTD denial.

Carl G.

I would like to thank Dell Disability Lawyers for taking care of my case and help me get the insurance coverage that I was rightfully in need of. Specially, I would like to thank Attorney Alexander Palamara and right-hand legal assistant, Sonia Nogueira, who made this process less stressful. They answered all my questions and kept me informed every step of the way.

Don’t get me wrong. They never promised or told me that I was going to win my case, as no one can guarantee that for you. What they did do, was letting me know that they were working hard for me and to keep positive. Something that I recommend everyone to do is to subscribe to their YouTube channel. That will give you an idea on how they operate and why they (for most of their cases) win their cases.

Since I was awarded disability, I am still having surgeries and thanks to them, I’ve been able to cover all those expenses.

Warm regards to everyone at Dell Disability Lawyers!

Clarisa B.

I’m so very Grateful and Thankful for the team at Dell Disability Lawyers. They worked tirelessly to get the best outcome for me. I’m so glad that I found them!!

Carole S.

Exceptional, efficient and professional service from Jay Symonds and Sonia Nogueira. They were both so helpful and knowledgeable and navigated me through a very stressful and difficult situation with New York Life.

K. S.

Awesome team. Jay and his team, Sonia and Francesca, truly care. This team is very professional and quick to respond. Jay always provided answers in detail to my questions. I strongly recommend Jay Symonds.

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