The ERISA Record, Potentially Your Trial

Before filing a lawsuit, a claimant must exhaust the available remedies under the plan, so long as the plan’s procedures are reasonable. This typically means a claimant must apply for benefits in accordance with the plan’s application procedures. If the claim is denied, the claimant must appeal under the plan’s appeal procedures. A claimant is required to “exhaust” his or her administrative remedies before filing an action in court.

It is crucial to understand that the record closes when the insurance company or ERISA administrator issues its final decision.  Claimants must submit all the evidence they want to be considered during the administrative appeal process, and may not submit new evidence regarding the merits of their claim once the case is in court.

In other words, the basic rule is that the record closes when the administrator or insurance company makes its final denial, and it is often impossible to submit new evidence in litigation that was not sent to the insurance company before it denied the claim. This typically leads to extremely curtailed records requests and reviews by insurers. Willful blindness helps them later on in court.