Do Not Sleep on Your Rights to Disability Benefits

In a recent case out of New York, the court found that the Plaintiff did not provide a good enough reason for failing to timely file his ERISA action.

New York in Viti v. The Guardian Life Insurance Company of America, the plaintiff’s disability was not disputed; both parties agreed that his disability was genuine and prevented him from returning to work. However, the plaintiff missed the deadline for filing his appeal. He filed an action to compel reconsideration of his application but did so well after the contractual three-year statute of limitations had run. The question came down to whether the plaintiff had a good enough reason for his very late filing.

Courts have sometimes excused claimants’ failure to pursue their rights to disability benefits under a doctrine called “equitable tolling” where plaintiff’s mental or physical condition prevented him or her from filing within the time limit. Under this doctrine, a plaintiff’s late appeal would be excused only if the reviewing court found that extraordinary circumstances existed. Moreover, the plaintiff must also show the court that he acted with “reasonable diligence” to pursue his application during the tolling period (the period during which the statute of limitations does not run).

In this case, the plaintiff became disabled as a result of witnessing firsthand the terrorist attacks of September 11th. Shortly after being diagnosed with General Anxiety Disorder he applied for disability benefits under his disability plan with Guardian. Guardian denied the plaintiff’s application and explained the process for appealing the decision, specifically warning the plaintiff that no appeal could be brought more than six months after the date of the initial denial. As we already know, the plaintiff did not appeal the denial by the deadline.

Extraordinary Circumstances Did Not Exist

The plaintiff argued that his mental or physical condition prevented him from filing within the time limit. However, during the court’s review, the court acknowledged that the plaintiff was able to file an application for Social Security benefits during the claimed period of incapacity.

Plaintiff claimed that his application for Social Security benefits was irrelevant because his wife was the true force behind the application. Indeed, New York courts have held that only the claimant’s own mental illness is relevant in tolling calculations. Unfortunately, the court found that such didn’t apply to plaintiff’s case because the statute of limitations was not taken from New York state law.

Furthermore, since plaintiff provided no evidence to support his assertion that his wife was the true force behind his Social Security application it was concluded that the plaintiff had filed his own Social Security application with his wife’s assistance.

Plaintiff Did Not Act With Reasonable Diligence

As the court explained, “mental incompetence alone does not excuse a plaintiff from the responsibility of pursing his disability application; the claimant must attempt to preserve his claims and pursue his rights with reasonable diligence, with due regard for his condition.”

Since no extraordinary circumstances were found to exist and the plaintiff did not show that he had acted with reasonable diligence during the claimed period of incapacity his late appeal was not excused.

This case is a good reminder of why it is important to not sleep on your rights to disability benefits. Even if extraordinary circumstances are found to exist, a claimant must attempt to preserve his claim. Ultimately, every disability claim has time limitations that must be followed, and as we know, failure to abide by the deadline can only be excused in extraordinary circumstances. The time limitations for filing a lawsuit on a denied disability claim are different for each disability policy and it is important to seek the advice of a disability attorney to ensure that your rights are not forfeited for neglecting to timely pursue them.

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There are 4 comments

  • S. Dixon, I would suggesting finding an attorney fast.

    Disability cases are handled and flagged differently when an attorney is involved. Companies like Unum know they can’t get away with that kind of stuff with an attorney. Make sure you find one in your area that is VERY familiar with ERISA law, you don’t want someone who only dabbles, but someone who really knows what they are doing.

    Beverly M.Apr 9, 2014  #4

  • S. Dixon,

    Please feel free to contact our office to discuss your claim. Despite Unum’s denial of your claim for benefits you may still be able to bring legal action. We will need to review the information to be able to better advise you.

    Stephen JessupApr 3, 2014  #3

  • I’d never heard of equiable tolling prior to your article. My appeal to UNUM was recently denied because they said my Appeal was received late by one day per their estimate of when I should have received it. Both ERISA and my Benefits Contract say the 180 days start once I RECEIVE the original denial. I was having a terrible time with my disability at the time so it was close and past the date of UNUM’s Letter. However, and I put it in my Appeal, I’d been having trouble receiving mail during the time frame the denial letter was sent. There was a foreclosure in my condo complex and the mailperson kept thinking it was my unit and withholding mail. It took 2-3 weeks to rectify the mail situation and I received the withheld mail after that time in a big batch. Since I do most of my key business online I hadn’t really missed the mail that much- more of an annoyance at that time. The UNUM letter was in the mix. UNUM in their denial of the Appeal Letter gave their own date which was a day later of what UNUM calculated my receipt would be- to my knowledge they can’t just declare a date for receipt. I’m currently at a loss of what to do. The original denial was based on unconfirmed information and even a document I had sent (medical report) that UNUM physically altered and said I did it. Crazy thing was that same document was in their file from an earlier date in its original condition – all along. I also found out when I received my UNUM file it had been approved ERD Max Duration. Right after that sent to triage for finding more offsets. All a sham on UNUM’s part.

    S. DixonApr 2, 2014  #2

  • In my humble opinion it is relatively easy for a disabled claimant to fall into a trap and have his/her claim time-barred. Claimants who are physically and/or mentally ill get flooded with claims documentation by insurers and many are unable to gather all required information and complete those forms. More often than not, insurers are unwilling to offer any assistance.

    RichardApr 2, 2014  #1

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