ERISA Long Term Disability Case Citations and references

DISCLAIMER: Please note that every case is different and these verdicts and settlements, while accurate, do not represent what we may obtain for you in your case.

What Regulations Govern the Claims Procedures?

The governing regulations for ERISA  disability claims procedures, 29 C.F.R. § 2560.503 1, sets forth detailed and particularized processes for making claims, determining benefits, and providing for review of adverse benefit determinations. Regulation § 2560.501 1(h) specifically asserts that:

The claims procedures of a plan will not be deemed to provide a claimant with a reasonable opportunity for a full and fair review of a claim and adverse benefit determination unless the claims procedure (i) provide claimants at least 60 days following receipt of notification of an adverse benefit determination within which to appeal the determination; (ii) provide claimants with the opportunity to submit written comments, documents, records and other information relating to the claim for benefits; (iii) provide that a claimant shall be provided, upon request and free of charge, reasonable access to and copies of, all documents, records, and other information relevant to a claimant's claim for benefits ...; (iv) provide for a review that takes into account all comments, documents, records, and other information submitted by the claimant relating to the claim, without regard to whether such information was submitted or considered in the initial benefit determination.

29 C.F.R. § 2560.503 1.