LTD carrier’s failure to produce the entire administrative record may result in a ruling favorable to the claimant.

The Employee Retirement Income Security Act of 1974 (ERISA) provides that the claims procedures of a disability benefits plan is reasonable only if, “a claimant shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant’s claim for benefits.” A document, record, or other information shall be considered “relevant” to a claimant’s claim if such document, record, or other information was relied upon in making the benefit determination; was submitted, considered, or generated in the course of making the benefit determination, without regard to whether such document, record, or other information was relied upon in making the benefit determination; demonstrates compliance with the administrative processes and safeguards required by ERISA in making the benefit determination. The persistent core requirements of review intended to be full and fair include knowing what evidence the decision-maker relied upon, having an opportunity to address the accuracy and reliability of that evidence, and having the decision-maker consider the evidence presented by both parties prior to reaching and rendering his decision. A LTD benefits claimant simply cannot know what evidence the decision-maker relied upon, nor have an opportunity to address the accuracy and reliability of that evidence, if it is withheld from the claimant.

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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