What Happens If You Sue Dearborn Before an LTD Appeal Decision?
In Lisa K. Bunner v. Dearborn National Life Insurance Company (Dearborn), Dearborn denied Plaintiff’s claim for long term disability (LTD) benefits, and she filed an administrative appeal. ERISA requires the Plan Administrator (Plan) to provide the claimant a decision within 45 days of the claimant’s appeal. The 45-day time frame can be extended if the Plan finds that “special circumstances” require an extension. Then, the Plan must provide notice to the claimant that the time has been extended. The extension is not to be longer than 45 days unless the extension “is due to the claimant’s failure to submit requested information, then the period for making the determination on review is tolled until the claimant responds to the request for additional information.”
This is exactly what happened in this case. The Plan informed Plaintiff that it was extending the time for decision on her appeal because it was waiting for her medical providers to send requested medical records. Plaintiff became inpatient and requested the Plan to consider the administrative record closed and make its decision on the evidence it already had. Dearborn said it would comply with this demand, and that the deadline for its decision was July 12, 2018. Plaintiff refused to wait for the decision and filed her lawsuit prematurely on June 2, 2018, prior to exhausting her administrative remedies.
Exhaustion of Administrative Remedies Required Prior to Filing an ERISA Lawsuit
The Court stated that “Plaintiff had an obligation to exhaust her administrative remedies unless it was futile to do so.” To show futility, Plaintiff must show a “certainty of an adverse decision.” Here, an adverse decision was not a certainty since Dearborn was still receiving Plaintiff’s medical records when she filed her lawsuit.
Plaintiff could have supplemented the record with necessary information if she so chose. The Court concluded, “Plaintiff filed her lawsuit early and now asks the court to close the administrative record before Defendants had rendered a final decision. The court declines to do so.”
In order not to penalize her by dismissing her lawsuit, and to give Dearborn a “fair opportunity” to consider the supplemented evidence,” the Court fashioned a remedy consistent with the Fifth Circuit’s policy of encouraging parties to settle their disputes at the administrative level.
Remedy for Filing a Lawsuit During Pendency of Administrative Appeal Will, Upon Motion by Plaintiff, Be Remanded to the Plan
The Court granted “Plaintiff leave to file a motion for remand to the plan administrator…” and stayed the case pending Dearborn’s final decision. If Plaintiff failed to file such a motion, the Court stated that Dearborn may then file a summary judgment motion based on the existing record.
This case was not handled by our law firm, but we believe it can be instructive to those who are impatient with their insurance company that seems to be taking too long to decide on their administrative appeal. If you have any questions about this case, or any other issue concerning your disability claim, either for short-term or long-term benefits, contact one of our attorneys at Dell & Schaefer for a free consultation.
Resources to Help You Win Disability Benefits
Submit a Strong Dearborn Appeal Package
We work with you, your doctors, and other experts to submit a very strong Dearborn appeal.
Sue Dearborn
We have filed thousands of disability denial lawsuits in federal Courts nationwide against Dearborn.
Get Your Dearborn Disability Application Approved
Prevent a Dearborn Disability Benefit Denial
Negotiate a Dearborn Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
Uses every dirty trick in the book
Unum is evil
Every month I get paid on a different date
They will do anything to not approve your claim
Reply
Don't trust them, they like to play games
Lyme Disease Disability Claim Denial
Disappointed with NY Life Disability Excuses
New York Life is a joke!
Dearborn National Disability & Lawsuit Tips
What Happens if I Sue Dearborn Before They Decide on My Long Term Disability Benefit Appeal?
Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company
Disability Benefit Denial Reason #3 - Video & Social Media Surveillance
How Do You Fight a Long-Term Disability Denial?
Disability Denial Reason #2 - Change of Disability Definition & Vocational Review
Seven Surgeries and The Standard Still Denies Disability Insurance Benefits
Sun Life Wrongfully Denies Disability After Paying For 23 Months
Nurse Denied Long-term Disability Benefits by Lincoln After the Definition of Disability Changed
Lincoln Reverses Decision to Terminate LTD Benefits of Corporate Attorney after Dell Disability Lawyers Appeals the Decision
Transportation Manager with Brain Injury Wins Unum Disability Benefit Appeal
Prudential reverses decision to terminate LTD benefits of MRI Tech with Primary Progressive Multiple Sclerosis and degenerative Disc Disease
Engineer With Depression Wins Prudential LTD Appeal
New York Life Approves Disability Benefits for School Teacher With Multiple Sclerosis
Reviews from Our Clients







5 Ways We Help Get Your Benefits Paid
Our goal is to get your application for disability insurance benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their hired gun doctor.
Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.
If your disability insurance benefits have been wrongfully denied, then our disability insurance lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.
Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.
98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability insurance attorneys have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the little guy against the multi-billion dollar insurance company giants.
We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.
Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.
Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.
Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.
Questions About Hiring Us
We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.
Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.
Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability insurance lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.
Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.
The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.
In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.
No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.
When you call us during normal business hours you will immediately speak with a disability insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.