Under ERISA, more than two-thirds of disability claims are denied, according to government statistics. The Employee Retirement Income Security Act (ERISA) requires plan administrators to give a “full and fair review” before denying a claim. It can be an exhausting and confusing process for people who may already be feeling overwhelmed or vulnerable.
Under ERISA, claims begin with the plan managers. Most benefit plans will have some kind of an internal appeal process by which claim denials are reviewed, administratively. As a general rule, the claimant must exhaust that internal review process before he can file a lawsuit.
While a benefit claim is working its way through that internal system, though, the insurance company or plan manager may well be building what the law calls an “administrative record.” It can include any medical records, reports, vocational reports or bills submitted by the claimant, as well as any claim-related correspondence. It may also include any internal reports of the plan’s own reviewing physicians or vocational “experts.” The law says that managers don’t have to disclose these internal records to someone making a claim. Frequently, plan administrators and insurers build their own private administrative record; the people fighting for their rights don’t find out about those records until they’ve had to hire a lawyer and go to court.
Getting the administrative record right can be essential to a successful case. Courts usually restrict their review to the administrative record. Judges often defer to plan administrators so it can be enormously helpful to put together an administrative record that supports your disability claims.
The lawyers here at Underwood have decades of experience helping people through the ERISA maze. If you or a loved one needs help, we’re ready to go the distance with you: Contact us for a free consultation, today.