Failure to file a timely ERISA disability appeal can eliminate your right to file a disability lawsuit

A recent ruling was issued on an ERISA Disability Lawsuit that had been filed in Missouri against Hartford Life and Accident Insurance Company. While our firm did not handle this case, this case and its ruling is so important because it shows the importance of finding competent representation who have significant experience handling ERISA Disability Appeals and Lawsuits. This disability claimant’s case was dismissed because their attorney did not file a timely administrative appeal. The 180 days to submit an ERISA Appeal is strictly enforced by courts across the country. Unfortunately a court will let an insurance company drag their feet, but if a claimant misses a 180 day appeal deadline, then it is rare to see any forgiveness for a claimant.

Facts of the Disability Case Against Hartford

The claimant worked as a District Manager for RKM, Enterprises for thirteen years. Due to her employment at RKM, she was covered under a Long Term Disability Policy (LTD) which provided monthly insurance benefits should she become disabled. On April 17, 2005, the claimant stopped working due to physical impairments. Shortly thereafter the claimant filed an application for and was approved for long term disability benefits by the Hartford Insurance Company. Hartford paid her benefits even after the definition of disability changed from being unable to perform the duties of her “own occupation” to “any occupation.” However, a few months after 3 years of benefits, Hartford reassessed the long term disability claim and determined that her physical disability was not sufficient enough to prevent her from working a sedentary job. Hartford terminated her benefits by way of a letter dated November 25, 2008. In that letter, Hartford informed the claimant that she had 180 days to appeal the termination of her benefits.

Filing Appeal More Than 180 Days After The Initial Denial Results In Denial Of Lawsuit And Rejection Of Appeal Review By Hartford

After receiving this denial letter, the claimant realized she needed legal representation. She hired an attorney to handle her case against Hartford. By way of a letter dated December 12, 2008, her attorney quickly notified Hartford that she was represented by counsel. In that letter, the attorney also requested all medical documentation from the Hartford and informed the insurance company that they “will be reviewing the records and obtaining additional medical information for my client’s appeal of the decision to terminate her Long Term Disability (LTD) benefits”¦”

Hartford complied with her attorney’s request by sending the medical documentation over in February 2009. On or about July 8, 2009, her attorney submitted and Appeal letter stating their disagreement with Hartford’s decision of November 25, 2008. This letter included arguments and documentation in support of their opinion.

On or about August 6, 2009, Hartford responded to the attorney’s letter stating that the claimant’s file had been closed on May 28, 2009, the 180 day deadline to file an appeal. Hartford claimed that the claimant missed the appeal deadline by more than 42 days. The Claimant’s attorney replied by letter 9 days latter stating that their appeal was timely as she “entered her appearance to assist (the claimant) in this appeal on December 12, 2008.” Hartford disagreed and a lawsuit was filed shortly thereafter.

The Court’s Reasoning and Decision

Every experienced disability insurance attorney knows, before a claimant is able to file a disability lawsuit, he/she must exhaust the administrative remedies required under the ERISA disability plan and statutes. Only in very limited circumstances will a Court excuse a claimant from this requirement.

In this case, the Court noted that a “plan administrators decision will not be disturbed if it is reasonable.” Since the July 8, 2009, letter was filed outside the 180 day window, the Court then looked into whether Hartford was reasonable to conclude that the attorney’s letter of December 12, 2008, did not constitute an appeal of Hartford’s denial letter of November 25, 2008.

The Court determined that Hartford’s decision was not unreasonable as the December 12, 2008, letter’s stated purpose was to request records from Hartford and to notify the insurance company of its intent to review these records and gather additional records for an appeal. The Court noted that the December 2008 letter “did not provide any information, argument, or reasoning” that one would expect to find in an appeal of a denial letter. Therefore, the Court determined that it was reasonable for Hartford to interpret “the letter as a request for records in anticipation of a possible, future appeal and not an appeal itself.”

This is sad case because the disability claimant will never be able to receive disability insurance benefits as a result of her lawyer’s error. ERISA long term disability claims are complex and it is important to hire an experienced disability insurance attorney. This situation could have been avoided if the attorney either submitted the appeal timely or requested an appeal deadline extension. Not all extensions are granted, but in most cases they are. Our disability lawyers represent claimants nationwide and we always offer a free consultation to discuss your claim options.

Leave a comment or ask us a question

There are 6 comments

  • John,

    The carrier may allow you to file as many appeals as you want, but I would still be VERY cautious of any statute of limitations contained in the policy, as the laws relating to those are strict. If it has been nine years since the denial of your case there stands a likely chance you would be time barred to file suit. Please review the provisions of your policy.

    Stephen JessupMar 29, 2014  #6

  • Regarding your above writing that the Courts have held that one has to exhaust the administrative remedies, prior to being able to file ERISA lawsuit, “what happens in a situation were you file for Administrative Review and the outcome remains same, and you then file timely Appeal with the Administrative Review Board and they delay for a few years even responding to your Appeal, then with assistance of Dept. Of Labor letter or call to them, telling them they are required to do my Appeal.

    Then in letter to me regarding the Appeal that they are going to do it, the head person of the Adminstrative Review Board/ Panel whatever, writes that I can continue to pursue providing my Appeal reasons and providing documents in support, “when ever I decide to that their is no time limit for me to do it”.

    Then I was un-able to do anything further for maybe 9-years have passed with me un-able to further pursue Appeal, because of major health problems of which suffered a couple of major heart attacks, and my Doctor told me I need to quit doing anything stressful as it was dangerous to my health and actual life as surely was at least partial cause of my heart problems as well as required ongoing treatment for major anxiety and depression, and on top of that I have over the years also additional times had to have stents put in, had to have defibrulator pacemaker put in and then had to have it replaced, and in addition to heart surgeries, major low back surgery, other health problems.

    So in light of all that would the toll for me to file ERISA lawsuit still be open to me, as I am now going to force myself to again pickup on my Appeal and Pursue it to now either be provided my entitled benefits, or to finally exhaust all administrative remedies that are still pending per the written letter that I can continue my Appeal without a deadline to do whenever I want?

    Also I just learned that the Company has changed my life insurance death benefit that was originally set at a certain amount, but they simply changed the amount and never informed me as I just learned about that yesterday getting on the Verizon Benefit Connection, and isn’t that a new ERISA violation and I can as well legally now pursue?

    Please reply to me, realize long questions but extremely important for me. Please reply.

    John E. Simmons Sr.Mar 28, 2014  #5

  • YMS,

    You send a letter via certified mail with return receipt and you fax and call the disability carrier asking for an extension of at least 45 days to submit your appeal. In the abundance of caution you send them the names of your doctors and any new medical records with your request.

    Gregory DellApr 2, 2013  #4

  • How do I request an extension of the appeal deadline for my long term disability from my insurance company? Do you have any examples? Thanks.

    YMSApr 1, 2013  #3

  • Ms. Bell,

    It is always in your best interest to have an attorney file your appeal, but you are not required to have an attorney. Please watch some of our videos in which we discuss the disability appeal process and the importance of having an attorney assist with the appeal process.

    Gregory DellMar 1, 2013  #2

  • My long term disability benefits are being terminated by Hartford Insurance. Do I need to have an attorney to file an appeal?

    Geraldine V. BellFeb 28, 2013  #1