Tennessee Disability and Life Insurance Blog
In an ERISA case, at the center of any dispute over a claimant’s eligibility for long-term disability benefits is the administrative record.
The administrative record is legalese for all the medical records, documents and other information obtained by, and submitted to, the plan administrator during the initial stages of the claim and through the appeal process.
One reason the administrative record is so important is that a claimant who challenges a denial of long-term disability benefits by filing a court action generally cannot present evidence to the court that is not in the record. Another reason is that disability insurers and plan administrators can—and will—take information from the administrative record out of context to justify denying a claim for disability benefits.
Here is a real-life example: A claimant filled out an “Activities Questionnaire” for her plan administrator and answered questions about her abilities. In the questionnaire, the claimant reported that she walked two miles a week on an underwater treadmill. One key advantage of the underwater treadmill is that it can make it easier for a person experiencing joint pain to walk because the water diminishes the pounding on the person’s knees, hips and neck. In addition, the person can hold onto the handlebars of the treadmill for support. Given these features, it is much easier to walk on an underwater treadmill than on a sidewalk or around a high school track.
The plan administrator denied the claim. In its letter explaining why it rejected the disability claim, the plan administrator specifically mentioned that the claimant was able to walk two miles a week, while neglecting to point out that she did so on an underwater treadmill. This omission was obviously self-serving because it gave an exaggerated depiction of the claimant’s abilities and condition.