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THE ERISA LTD INSURANCE ADMINSITRATIVE RECORD-WHAT IS IT AND WHY IS IT IMPORTANT

The administrative record is simply all of the documents provided to the LTD insurance company during the claims process, the claims file, the documents provided during the administrative appeal and the contract documents.

One of the little known but critical rules in ERISA Long Term Disability cases is that the Court will only consider the documents contained in the administrative record. Accordingly, it is extremely important that the insurer be provided all favorable information during the administrative appeal process. Otherwise, the claimants chances of winning in court can be very slim.

SMDA has had a couple of recent examples of the importance of this fact. We recently represented a client who filed her own administrative appeal by simply writing a letter explaining to the LTD insurer why she believed the claims denial decision was erroneous. Also contained in the record was a form completed by her primary care physician that indicated she needed a functional capacity examination in order to determine if she was disabled. The client was not aware of her doctor’s opinion and took no steps to provide the information suggested necessary by her own doctor.

In another case, an SMDA client again attempted to handle his own administrative appeal. He did not provide the insurer with the results of a key test which finally enabled his doctors to definitively identify the source of his knee pain prior to the appeal denial decision.

In both of these cases SMDA was able to negotiate a settlement for the client. However, each settlement was for significantly less money than otherwise likely would have been achieved if the administrative record had been properly supplemented.

Over the years SMDA has developed the experience and expertise to identify and provide the information required to adequately supplement the administrative record in order to give each client the best chance of winning their LTD ERISA claim and case.