Liberty Life has been found to have failed to afford a claimant seeking long term disability insurance benefits with a full and fair review of her claim. The claimant presented a claim for both physical and mental impairments.
In terminating the claim and considering the claimant’s continued submissions of claim support, Liberty Life failed to provide the hired medical professional with all relevant medical records, a violation of the ERISA regulations. There were a number of significant medical records regarding the claimant’s mental health which were not provided to the reviewing physician, which impacted upon the completeness of the review. The Court found that Liberty Life “did not abide by its obligation to conduct a full and fair review” of claimant’s condition, thus, finding that Liberty’s Life claim to have afforded a full and fair review rang hollow.
Because the Court was unable to determine that the claimant was clearly entitled to benefits, however, it remanded the claim back to Liberty Life for a more complete review.
This is a common theme in many ERISA disability insurance cases, as insurers will filter the materials provided, which often leads to medical conclusions unfavorable to claimants. If your disability insurance company is pursuing a record review of your claim, you must ensure that all relevant records are provided to the reviewing physician.
Hayden v. Martin Marietta Materials, Inc.