Prior to filing for disability our client worked as a registered nurse in a hospital setting, suffering from multiple chronic medical conditions that resulted in ever worsening pain throughout her back, neck and extremities. When her conditions began to limit her ability to safely and effectively perform her occupational duties she, on her own, filed a claim for disability benefits under her employer’s group long term disability policy with Hartford.
Hartford initially approved her disability claim and began issuing monthly disability benefits after determining that her medical conditions would prevent her from performing the material duties of a registered nurse. As required by the policy she filed for Social Security Disability and shortly thereafter was also approved for benefits by the Social Security Administration. Although she had successfully secured her Hartford and SSDI benefits she would soon find out that being approved for disability benefits by Hartford, as well as through the Social Security Administration, did not mean that Hartford would continue to pay her disability claim indefinitely. As is the case with all disability insurance companies, Hartford required updated information from our client in order to establish that she was still entitled to disability benefits under her policy.
In pain, focusing on her medical conditions, and without anyone to assist her in keeping up with Hartford’s constant requests for information, our client failed to respond to repeated requests by Hartford for updated information. Hartford notified her in various letters that if the requested medical information was not received her claim would be terminated. After several attempts to obtain information from our client Hartford finally terminated her disability claim by way of a formal denial letter and as required by ERISA advised her of her right to appeal its decision to terminate her claim.
The 180 Day Deadline
Under ERISA, an insured has 180 days to file an administrative appeal contesting the denial of a claim for disability benefits. In most cases this 180 day period a very strict deadline and failure to comply with the deadline can result in an insured being forever barred from bringing a lawsuit to secure disability benefits against his or her insurance company. By the time our client contacted our office and spoke to Attorney Stephen Jessup, her 180 day deadline had already passed.
In reviewing the information provided, Attorney Jessup realized that our client had mistakenly thought she had filed her disability appeal by way of an email to her claims manager. However, review of the communications between Hartford and our client made it clear to Attorney Jessup that Hartford did not consider her communication to have been an appeal. Attorney Jessup advised our client that her ability to file a formal appeal and in turn, pursue any legal recourse against Hartford, could be in jeopardy and that action needed to be taken immediately to have any shot of securing benefits. Knowing that time was of the absolute essence she hired Attorney Jessup to take over the handling of her claim.
The Review Process
Attorney Jessup immediately sent a letter to Hartford detailing our client’s position that she had previously filed what she believed to be an administrative appeal and that given her medical condition and her unfamiliarity with the law it would be unfair to penalize her for failing to formally appeal within the 180 day timeframe. Hartford contacted Attorney Jessup to advise that it would consider an appeal on our client’s behalf, which although a victory did not mean our client would receive additional benefits as she still had to establish that she remained disabled under the terms and conditions of the policy.
Attorney Jessup gathered all of our client’s outstanding medical records and received detailed updates from her treatment providers with which to supply to Hartford in support of her claim. Upon review of the information, after a period of time, Hartford notified Attorney Jessup that our client’s claim for benefits had been reinstated. However, in approving the benefits Hartford notified us that they were only approving her claim through the remainder of her own occupation period and denying her claim into the any occupation period, prompting the need to file yet another appeal.
Do not wait too long to submit your appeal.
Attorney Jessup is in the process of preparing our client’s formal appeal of Hartford’s denial. The outcome of this claim could have been much different had Hartford refused to review our client’s claim in light of her failure to submit a timely appeal. Our client went from potentially losing all legal rights to pursue benefits to being awarded back benefits owed and the possibility of securing continued disability benefits into the future. Not everyone is this fortunate. As such, it is imperative that if your claim has been denied you speak with an attorney as soon as possible to discuss the preparation and filing of your administrative appeal.
If your claim for disability benefits has been denied please feel free to contact our office to speak to Attorney Jessup or one of our other disability insurance attorneys to discuss how we can assist you in securing your disability benefits.