What's the "Administrative Record" in my Long-Term Disability Claim with Guardian?

 

Your ERISA long term disability appeal depends on the administrative record in your case.

But what the heck is the administrative record? Where and how do I get it? What do I do with it?

If you've received a denial letter from your long term disability insurance company, indicating your benefits have been denied, or if you've been receiving long term disability benefits, that they have terminated or will end, your next step is to appeal that denial to the insurance company.

Here's some information on how to get ready to file your long term disability appeal. 

That's the first step that you have to take to restore your benefits - and it's a big one.  Your appeal is not just a letter to the insurance company saying that you disagree, or your most recent doctor's note saying you can't work.  It's not a form you fill out.

Appealing your long term disability denial is a lot more than that - and here's why:  your appeal, everything you put into it, will be the administrative record in your case if you have to file a federal lawsuit (ERISA is federal law so any lawsuit will have to be filed in federal court).  That seems like we're getting ahead of ourselves, but the other critical piece of information is that the federal judge who decides the case will decide it on the administrative record.

Here are some tips on filing your long term disability appeal.

Sounds like we're going in circles a bit here, doesn't it?

First, you have to appeal the denial of benefits to the insurance company that just denied your benefits.

Then, if the same insurance company that just denied your benefits doesn't grant your appeal and reinstate your benefits, you have to sue them in federal court.

And the judge deciding the case will only review the administrative record (the appeal you provided to the insurance company and the information they reviewed to make their decision) and you don't get to testify about how you can't work, offer new evidence, or fix mistakes in your appeal.

Most people don't realize it, but you or your ERISA long term disability lawyer (especially if that's us) will spend a lot of time analyzing your entire claim file and then producing evidence that will help your appeal - working with medical experts and consultants, vocational experts, conducting interviews, recommending testing - all of it designed to give the insurance company (and later a federal judge) the real picture of the limitations and disability caused by your medical condition.

This starts with analyzing your long term disability insurance policy and the provisions that define disability. It really requires an in depth analysis of what the insurance company considered, why they denied your benefits and then what additional evidence would lead to the reversal of that decision.

If you're holding a denial letter, there is a lot of work to do.  And under ERISA, you only have 180 days to file that appeal and create that administrative record.

So call us today at (202) 393 - 3320 so we can review your denial letter and see what we can do to put you in the best position to help get your long term disability benefits reinstated.