This is a great, and I think pretty even handed, article by Bloomberg on litigating LTD claims under ERISA. Although the headline and the central thrust of the article are about obtaining LTD benefits for claims of long Covid, the article really does a nice job of explaining the entire LTD claim process and the inherent litigation issues for any type of claim for LTD benefits.

What I particularly liked was its discussion of the importance of the appeal process during the administrative claim proceeding, prior to an insurer issuing a decision on the claim and before any litigation could be filed over a denial of the benefit. As a matter of law, the entire administrative process in front of the insurer, seeking an award by the insurer of the LTD benefits, must conclude before the claimant can sue to recover the LTD benefits. There are some, very narrow, exceptions to this rule, but they seldom come into play or actually apply (no matter how many times lawyers for claimants argue that the exceptions apply). Furthermore, again as a matter of law and subject to certain limited exceptions, once that claim process in front of the insurer has concluded and the claimant is thus able to file suit seeking an award of benefits, the claimant and the insurer are generally restricted in the court case to the evidence that was submitted to the insurer during the claim process.

As a result, the single most important stage of a claim for LTD benefits isn’t actually the court proceeding, but is instead the administrative claim process before the insurer and the submission at that time of relevant medical evidence, either supporting or negating the claim of disability. The article does a nice job of highlighting that the key to a successful LTD claim is how well the claim is evidenced and documented in front of the insurer during the claim process and before any suit is filed – because by the time the suit is filed, it is too late, in many cases, for any more of that evidence to be put into the record.