2018 DOL ERISA REGULATION AMENDMENTS – NEW EVIDENCE

If you believe you have been wrongfully denied your ERISA, or non-ERISA, long-term disability benefits, give us a call for a free lawyer consultation. You can reach Cody Allison & Associates, PLLC at (615) 234-6000, or toll free (844) LTD-CODY. We are based in Nashville, Tennessee; however, we represent clients in many states (TN, KY, GA, AL, MS, AR, NC, SC, FL, MI, OH, MO, LA, VA, WV, just to name a few). We will be happy to talk to you no matter where you live. You can also e-mail our office at cody@codyallison.com. Put our experience to work for you. For more information go to www.LTDanswers.com

On April 1, 2018, The Secretary of Labor’s (DOL) new regulations concerning review of ERISA claims went into effect. These new regulations were put into place to create a fairer system within the ERISA claims review process.  “New Evidence” was one of the areas on which the DOL focused.

“New Evidence” refers to any information added to the Administrative Record in the appeal period on which the insurance company will rely in making a benefit determination.  The Claimant must be given timely notice of this new information and the opportunity to respond.

While insurance companies opposed this provision being added to the new regs. They have since been forced to modify their processes to given claimants a reasonable opportunity to respond to the new information.  Prior to this regulation change it was not uncommon for an insurance company to send a final denial letter that contained a report from a doctor they hired to review the claim.  This final denial would end the appeal process and the claimant did not have an opportunity to review the report, or better yet, have their doctor review the report, prior to the time the claims file (Administrative Record) would close.  As many could see, this old process gave the insurance company a tremendous advantage in having the last word.

While having an opportunity to respond to “New Evidence” is a good for the claimant it can cause the appeal process to drag out for a greatly extended period of time.  Remember, the Administrative Record closes after final denial and only in extremely limited circumstance can any information be added to the record after that point.  If given a final denial, you will bring the Administrative Record, as it exists at the time of final denial, into court should you pursue a lawsuit after that point.  It is very important to add all information in your favor to the Administrative Record prior to final denial.