ERISA Claims & 5 Mistakes Made When Filing - Mistake #5
Over the last few weeks, we have discussed four of the five mistakes made when filing ERISA claims for long term disability and short term disability, life insurance, pension or retirement, and sometimes large medical benefit claims.
The fifth and final mistake is failing to understand the burden of proof and then meet that burden of proof.
Many times, one may assume that if they've signed a medical authorization or a social security authorization, the insurer or the plan administrator will obtain those documents, but the policy or the plan may actually leave that burden on the insured or on the participant. If that is the case, then you are making a mistake to rely upon the insurance company or plan administrator to obtain favorable evidence for your claim.
In our opinion, they certainly should because they are a claim fiduciary, and they have an obligation to fairly and honestly evaluate your claim. Unfortunately, that doesn't always occur. Therefore, it's very important for you to obtain the medical records that you may need for your claim and any other evidence or documents that are your burden to provide to the insurer or plan administrator.
You must review the plan document very carefully to understand exactly what the burden of proof entails and then,diligently and expeditiously attempt to meet every element of the burden of proof that is on the ERISA claimant.