By Elliott Andalman, Esq.
301-563-6685
eandalman@a-f.net
Andalman & Flynn Attorneys Elliott Andalman and Peter Casciano sent comments to the Department of Labor (DOL) on January 19, 2016, on the DOL’s proposed changes to procedures for handling long term disability (LTD) claims, arguing that the regulations should not allow LTD Administrators (generally an insurance carrier) to require Insurance Medical Exams (IMEs) during the claims appeal process.
Long Term Disability Appeal Process
One of the most unfair procedures used by insurance companies involves the use of IMEs during the appeal process. Unfortunately, current DOL regulations do not prohibit a Long Term Disability (LTD) Plan Administrator (i.e., insurance carrier) from collecting new evidence during the appeal process and making a denial decision based on that evidence without ever allowing the claimant to see the evidence or an opportunity to respond to the evidence. For example, the carrier can during the appeal process require a claimant to attend an IME selected and paid for by the carrier and then make a denial decision on your claim without ever giving you an opportunity to see and respond to the report submitted by the IME doctor.
The changes that DOL is proposing will require the insurance company who sets up such an examination to share the results with the claimant and allow the claimant an opportunity to respond to the IME report before making its decision on appeal. This corrects a significant gap in the current regulations.
Comments on the Proposed LTD Regulations
However, my law partner, Peter Casciano, and I, have submitted comments on the proposed regulations which request that DOL go further and ban IME examinations during the appeal process. Almost all LTD Plans (LTD insurance contracts) allow the insurance companies to obtain IMEs. However, we take the position that if the Plan wants an IME, it should get it as part of its investigation of the claim on initial application or review, and not as part of the appeal process.
The problem with allowing an IME during the appeal is that the process becomes longer, more expensive and more burdensome on claimants who will essentially have to do a second appeal in order to respond and rebut the IME examination report.
If you have a possible LTD claim, or claim for STD (Short Term Disability), Disability Income, FERS disability retirement benefits, State of Maryland disability retirement and Social Security Disability benefit claims, please contact Elliott Andalman or Peter Casciano.
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