Daily Archives: January 13, 2020

Withholding Doctor’s Reports Until the Date of Denial Violates an Insured’s Right to a Full and Fair Review

Posted in: Disability Insurance, ERISA, Full & Fair Review, Insurance Litigation Blog January 13, 2020

ERISA requires that an administrator provide a claimant with a “full and fair” review if a denial decision is made.  It has long been held that an administrator must provide a claimant with copies of internal medical reports it generated and relied upon when making its decision to deny a claim, but when do these internal medical reports need to be disclosed?  This question was addressed in the recent decision, Wagenstein v. Cigna Life Insurance Co., 2020 WL 68394 (9th Cir. Jan. 7, 2020) (“Wagenstein”).  The Ninth Circuit held in Wagenstein that when an administrator “has engaged in a procedural irregularity, it must provide the claimant a fair opportunity to submit additional evidence.”

Lea Wagenstein (“Ms. Wagenstein”) filed a …

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