If your long-term disability claim is denied, you should immediately request your claim file from the insurance company. (If you have an experienced ERISA disability attorney, they will do this for you.)
If your policy is through your employer, the disability insurance company must provide the claim file. If it is a private policy, they may or may not provide it, but you should ask anyway. (You just never know what the person at the company getting the letter will do with your request.)
For group disability policies through your employer, the insurance company has 30 days to provide the documents. The claim file is important because it will disclose:
- what medical records from your doctors the insurance company relied on;
- what "independent" reports from doctors the insurance company went out and got and relied on;
- the claim handler's notes-so you can see what they did, and when;
- documents your employer may have sent that you may not be aware of;
- any surveillance or other investigation into your personal life the insurance company did.
- whether there are any mistakes or errant doctor notes taken out of context in the file
Here is the official rule under ERISA:
When the insurance company denies your claim, the denial letter must contain (among other things)
(D) A statement that the claimant is entitled to receive, 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. 29. C.F.R. § 2560.503-1.
You can listen to Ben Glass arguing in the 4th Circuit Court of Appeals when an insurance company refused to provide an unrepresented claimant with a copy of the claim file.
