Insurance Company May Allow Extra Time For New Medical Evidence

Insurance Company May Allow Extra Time For New Medical Evidence

Need more time to submit additional evidence to your long term disability carrier? Your insurance company’s refusal to grant your request for an additional extension of time within which to submit further medical evidence could be found by a federal court to be arbitrary and capricious.  In such cases, courts consider the disproportionately long period of time that the long-term disability benefits carrier normally has to gather its own medical evidence.

One court held that a plan administrator acted unlawfully by refusing to consider additional medical evidence submitted by the claimant after the administrator’s initial denial of benefits, because the insurance policy (“plan”) did not “require” the administrator to “forestall consideration of additional evidence”.  An extension sufficient to allow the plan participant to submit the remainder of the evidence “needed in order to perfect [his] appeal,” has also been found by the courts to be reasonable.

In another case, a physical therapist’s report was allowed by the court after the disability carrier had closed the administrative record.  The physical therapist had relied heavily upon the behavioral abnormalities that the claimant exhibited during a separate doctor’s examination (the primary piece of medical evidence supporting the company’s denial of benefits). The court held that the physical therapist’s report was crucial to the claimant because it explained the reasons for the claimant’s behavior during the doctor’s examination.

Your own request for an extension should be submitted by you or your attorney to your LTD insurer in writing, specifying the reason for the extension, the name of your healthcare provider, the date of the upcoming exam, test, or report, and the date you will supply your insurer with the new information.  Your request must be honored by the disability insurer so long as the information you are submitting is new noncumulative evidence; the evidence relates to your disability; and, there is good cause for your failure to submit the evidence previously. 

Remember, even if it appears that the long-term disability administrator has already made up his or her mind to deny your claim, you must create a complete record of your reasonable attempts to submit evidence of your disability.  That way, proper consideration can later be given by the court to your claim pursuant to the Employee Retirement Income Security Act of 1974 (ERISA).

Alan Olson writes this web-log to provide helpful information regarding long-term disability cases. He practices long-term disability law throughout the United States from his offices in New Berlin, Wisconsin. Attorney Olson may be contacted at [email protected] with questions about the information posted here or for advice on specific disability benefit claims.

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