David C. Pellegrin
The Importance of Requesting Short-Term Disability (STD) and Long-Term Disability (LTD) Claim Files in Writing Before Appealing an Adverse Determination
Pursuant to Section 104(b) of ERISA and 29 C.F.R. §2560.503-1(h)(2)(iii), a long-term and/or short-term disability insurance company whose policy is governed by ERISA must provide the complete administrative claim file free of charge upon written request. This is important because it gives insight into the reasons the insurance company used to deny the claim and/or terminate disability payments. When a policyholder challenges an insurance company’s adverse action, it is essential to locate holes in the insurance company’s logic. This can be found in the claim file and claim notes. Many insurance companies interpret ERISA strictly and will not provide this information unless a specific written request is made. Penalties are available under ERISA for failure to provide this information timely.