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.
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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 th... Read More >
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Who are Dell Disability Lawyers?
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.
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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.
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A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
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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.
What are your fees?
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.
Do I have to come to your office to work with your law firm?
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.
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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.