Hire an attorney. Although a long-term disability claimant – the insured – carries the burden of showing she is entitled to benefits, 6 ERISA administrators (usually, but not always, insurance companies) have a fiduciary duty to conduct an adequate investigation when considering a claim for benefits. Cady v. Hartford Life & Accidental Ins. Co., 930 F. Supp. 2d 1216, 1226 (D. Idaho 2013)(citing Booton v. Lockheed Med. Ben. Plan, 110 F.3d 1461, 1463 (9th Cir. 1997)). See also, Rasenack v. AIG Life Ins. Co., 585 F.3d 1311, 1324 (10th Cir. 2009). “This requires that the plan administrator engage in ‘meaningful dialogue' with the beneficiary. If the administrator ‘believes more information is needed to make a reasoned decision, they must ask for it.'” Cady, 930 F. Supp. 2d at 1226 (quoting Booton, 110 F.3d at 1463). A plan administrator may not “shut [its] eyes to readily available information when the evidence in the record suggests that the information might confirm the beneficiary's theory of entitlement." Rodgers v. Metropolitan Life Ins. Co., 655 F. Supp. 2d 1081, 1087 (N.D. Cal. 2009) (citations omitted).
However, all too frequently that is what happens – an insurance company fails to engage in any meaningful dialogue with its insured and, accordingly, fails to conduct an adequate investigation such that its behavior is arbitrary and capricious under the law. If you hire an attorney he or she can force the insurance company to pay attention to your claim.