What To Do If Your Long Term Disability Claim Was Denied

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Congress enacted the Employee Retirement Income Security Act (ERISA) in 1974 to help protect employee benefits and to mandate a set of requirements for the application of such benefits by employers. In 2002, the Secretary of Labor amended the regulations to allow employees the right to sue under ERISA for failure to adhere to the regulations.

 

Eight Factors That Courts Consider During an Appeal

In order to help determine whether the administrator's decision to deny a long term disability claim was reasonable and based on substantial evidence, the Fourth Circuit formulated a non-exhaustive list of eight factors that a court may consider. 

  1. The language of the plan;
  2. The purpose and goals of the plan;
  3. The adequacy of the materials considered to make the decision and the degree to which they support it;
  4. Whether the decision-making process was recent and principled; 
  5. Whether the decision comports with other provisions in the plan and with earlier interpretations of the plan;
  6. Whether the decision was consistent with the procedural and substantive requirements of ERISA;
  7. Any external standard relevant to the exercise of discretion; and
  8. The administrator's motives or any conflicts of interest it may have.

 

Frank R. Kearney, Attorney-at-Law
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Experienced DC Workers' Comp, Long Term Disability & Accident Lawyer
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