Why you should not appeal until you read your claim file

Most group disability claims are governed under the law of ERISA. ERISA claims can be complicated, and the law is weighted heavily in favor of the insurance company (2 reasons why you should hire an experienced ERISA disability attorney). There is, however, one good thing about the claims:

Before you appeal your claim, you are entitled to their claim file and to a complete copy of your company's disability insurance plan. This is imporant because, when the insurance company wrote you the denial letter they usually did not tell you the complete story. The claim file will contain all of the reports and comments, including reports favorable to you that the insurance company wants to ignore.

Here are some things you may find in a disability insurance claim file:

  1. Essential claim data such as date of birth, salary, date of disability, date of employment
  2. The entire "activity" log of everyone at the insurance company who has worked on your case
  3. Written reports from investigators the insurance company may have hired to spy on you.
  4. Internal reports about claim meetings, or "roundtables" where the insurance company discussed how to defeat your claim
  5. FAVORABLE reports from their own doctors that they didn't want you to know about
  6. Information about you they may have gathered from neighors, the Internet and from your doctors.

If you are going to handle your own appeal (bad idea, according to federal judges who will ultimately review your claim) then you should obtain and review your claim file before doing anything. You have a right to the file as soon as the claim has been denied or terminated.

If you would like to know more about disability insurance claims go and download a copy of my book, Robbery Without a Gun, Why Your Employer's Long-Term Disabiltiy Policy May be a Sham. It's Free!

Ben Glass
Ben Glass is a nationally recognized Virginia injury, medical malpractice, and long-term disability attorney