Erisa
claimants are getting the biggest break of all under the terms of
the multistate settlement agreed to by UnumProvident, and its companion
companies, Unum Life Insurance Company of America, The Paul Revere
Life Insurance Co. and The Provident Life and Accident Insurance Co.
The big news is that claimants will be able to add
material to their evidence that was barred under Erisa law because
it was not presented to the hearing officer at the hearing.
This result will prove very helpful to Erisa claimants
whose cases are reopened under the terms of the settlement. They will
be allowed to put into evidence material that would have been barred
under the normal Erisa law.
For many years Erisa claimants across the nation
have suffered from the unjust impact Erisa has had on health and life
claims under most employer sponsored group health plans. The Employee
Retirement Income Security Act (Erisa), was passed in 1974 and hailed,
at the time, as a landmark piece of legislation designed to better
protect workers’ benefits from being improperly denied by their
employers.
In the 30 years since, it has served the exact opposite
purpose. Claimant after claimant, acting without legal counsel, fails
to put into the administrative record of the first insurance company
hearing, all available evidence to support his or her claim.
But, the claimant is bound by the record. Attempting
to add to or modify the record on appeal is not permitted. If evidence
isn’t put before the insurance company hearing officer during
the claims process, you generally cannot use that evidence when you
file a lawsuit against the insurer.
In other words, you are bound by the record of information
which you gave the carrier at the hearing, before you hired a lawyer
to file suit. Even a judge on an appeal from the disability insurance
company’s ruling cannot allow additional evidence to be added
to the case. Erisa judicial decisions have many times carried statements
by the judge that he would rule in favor of the claimant but can’t
because he is bound by the record made in the insurance company hearing.
Any lawyer who knows this area of the law will tell
you that the cards are stacked against the beneficiary in an Erisa
contest.
Unfortunately, Erisa is a complicated, legal system,
independent of our civil justice system, about which claimants know
very little. By the time they hire a lawyer, it is most probably too
late to supplement a claim with new evidence.
But, the settlement reached with UnumProvident and
its subsidiary companies seems to have heard the cries of “injustice”
from claimants and will allow prior hearing records to be supplemented.