Call Today 262-373-9786

May 2007 Archives

LTD Carrier That Exceeds 45 Day Review Period is Held to Stricter Standard

After a claimant for long-term disability benefits is denied by the insurer and brings suit under the Employee Retirement Income Security Act of 1974 ("ERISA"), the parties often contest the standard of review that the court should adopt in reviewing the insurer's actions. The court's review under the de novo standard allows the court to supplant its own reasoning for that used by the insurer in denying benefits. In contrast, the arbitrary and capricious standard requires the court to give more deference to the insurer's decision to deny LTD benefits. A denial of LTD benefits is normally to be reviewed under a de novo standard unless there is specific language in the LTD insurance policy that gives the administrator discretionary authority to determine eligibility for benefits or to construe the terms of the plan. There is an exception to this rule, however, when the LTD insurer does not render its decision on the claimant's appeal in a timely fashion.

Alan C. Olson & Associates | 2880 S Moorland Rd | New Berlin, WI 53151
Phone: 262-373-9786 | Toll Free: 1-888-742-9520 | Map & Directions