Put Forth All Your Evidence During Administrative Review of Long-Term Disability Claims

Employees in Chicago and the rest of Illinois with claims for long-term disability insurance benefits frequently get frustrated with the long-term disability’s insurer’s requests for medical records and other evidence. Sometimes they request too much that is not particularly relevant to the issue of disability. Sometimes they do not request enough, only asking for evidence post-dating the disability date and ignoring significant medical history leading up to the disability date. But one thing is for certain; you want all the possible evidence supporting your claim submitted to the insurer before litigation, including your medical records, any doctor opinions, forensic test results, witness statements, etc. If the long-term disability insurer denies your claim and you must litigate it, you likely will not be able to introduce evidence you could have submitted to the insurer pre-litigation, as a recent case demonstrated.

In Gray v. United of Omaha Life Insurance Co., No. 24-700, 2024 WL 5001915 (9^th Cir. Dec. 6, 2024), Gray filed a short-term and long-term disability claim, asserting she was unable to perform her duties as a supervisor and mental health therapist due to back pain and sharp pain in her arms and hands. Though Gray submitted attending physician statements attesting she was disabled due to lumbar radiculopathy, she only submitted four office visit note records. After United of Omaha terminated short-term disability benefits and denied long-term disability benefits, Gray appealed. United of Omaha upheld its decision on appeal, and Gray sued under ERISA § 502(a).

On de novo review, the district court ruled in favor of United of Omaha, finding Gray failed to meet her burden of proof to show she was unable to perform the material and substantial duties of her occupation. Gray attempted to introduce new evidence, but the district court denied her request, finding no exceptional circumstances that should permit her to introduce evidence that was not submitted to United of Omaha. Gray appealed to the United States Court of Appeals for the Ninth Circuit. The Circuit court held there was no clear error in the district court’s findings of fact. The Ninth Circuit highlighted that Gray only submitted four office visit note records, and the district court properly excluded the new evidence Gray sought to introduce. The Ninth Circuit thus affirmed the district court’s ruling, leaving Gray empty handed on the long-term disability benefits.

If your claim for long-term disability insurance benefits has been denied, contact an experienced ERISA long-term disability lawyer immediately.