By law, when an insurance company denies all or part of your Long Term Disability (“LTD”) or Life insurance claim and gives you the right to appeal their decision, you also have a right to request and receive, free of charge, a copy of all documents the insurance company produced or considered in the evaluation of your claim. This group of documents is commonly referred to as the “Claim File.” This includes all the correspondence, internal notes and memos, medical records, reports by outside vendors (surveillance reports and videos, reports from doctors they had you see or sent your records to for a peer review, vocational reviewers, etc.), and copies of your Plan and/or Policy.
Seems simple enough, and certainly that is the type of stuff you’d want to know before appealing their decision. So why then, do so many people appeal without requesting and reviewing their Claim File?
The main reason people fail to request their Claim File when their insurance claim is denied is because they don’t know that they can, even though insurers are required to notify you of this right within the denial letter. This is because insurers (not-so) cleverly try to hide your right to receive this information by burying it within the denial letter, or by phrasing it in a very inconspicuous manner. This is assuming they even mention it at all, as we have seen numerous denial letters that make no mention of your right to this information. Some examples: