Must a Long Term Disability Carrier Give You Medical Reports They Rely on To Deny Your Claim? | Tampa St. Petersburg Disability Insurance Attorney
The ERISA statute, 29 U.S.C. 1133(2) says that a person asking for payment of long term disability benefits should be given “full and fair review … of the decision denying the claim.” You also must be given “all documents, records, and other information relevant to the claimant’s claim for benefis for a review to qualify as a full and fair review.”
Doesn’t that sound reasonable? Reality is different!
Ms Glazer, who had myofascial pain, fibomyalgia, cervical spodylosis and radiclopathy, was cut off by Reliance, based on the report of a notorious “peer review” doctor who always opines “there is no medical evidence” to support a continuing claim for disability benefits.
Ms. Glazer wanted, like you would want, to see the “peer review” report Reliance had produced while it was reviewing the initial denial of benefits. Reliance said “no!”
The 11th Circuit Court of Appeals has agreed with Reliance! The Court has ruled, in a circular fashion, that a “relevant document” is not relevant until Reliance relied on it to deny Ms. Glazer’s claim. Only AFTER, Reliance relied on the peer review report and denied Ms. Glazer’s claim, would Reliance have to produce the damining report of its peer review physician.
The 11th Circuit justified this by holding that if Reliance produced the peer review report (which it got for the sole purpose of denying Ms. Glazer’s claim) earlier it would “create an unnecessary cycle of submission, review, resubmission, and re-review.”
I don’t disagree but let’s remember that Reliance started this review for the sole purpose of terminating Ms. Glazer’s benefits. There was nothing fair about the process and letting Reliance hide this report during the review of the initial denial forces claimants like Ms. Glazer to try to “put the horse back in the barn.”
You can look at Glazer v. Reliance Standard Life Insurance Company at http://www.ca11.uscourts.gov/opinions/ops/200615855.pdf
Answering these broad-based questions isn’t easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.