Hartford wins long-term disability case, court rules that claimant failed to exhaust administrative remedies

It is vital that you hire the right long-term disability firm to represent you. Debra Swanson had to learn this the hard way, as a recent ruling in the Fifth Circuit court of Appeals in the Southern District of Texas demonstrates. How did Swanson’s attorney fail her? Her counsel failed to file a proper appeal.

Swanson’s story begins in January of 2002, when she was approved for long-term disability benefits through her employer’s plan with Hartford Life Insurance Co. (“Hartford”). The following year, on April 4, 2003, Hartford notified Swanson that her benefits would be terminated because she had been cleared to return to full-time work. She had 180 days to appeal this determination.

Swanson sought the assistance of an attorney. Her attorney sent a letter to Hartford on August 25, 2003, informing the insurer that the firm was representing her “in her efforts to reinstate her unlawfully terminated disability and health insurance benefits.” The letter went on to inform Hartford that the letter was notice “of Debra Swanson’s intention to appeal” Hartford’s “decision terminating her benefits.”

The attorney stated that once “we have had adequate time to review and supplement the record, we will notify you in writing to proceed with Debra Swanson’s administrative appeal under the terms of the Plan.” Various documents from the Plan and notice of further deadlines were requested.

While the attorney may have considered this an appeal, neither Hartford nor the Court did. When nothing further was received, Hartford closed the file after the 180-day deadline passed.

This same firm submitted an ERISA appeal with accompanying evidence to Hartford on February 23, 2007, almost four years from the time that Swanson had been notified that her benefits would be terminated, three and a half years after her right to appeal expired. Hartford rejected her appeal on April 21, 2007 stating that the 180 day window to appeal had expired.

Swanson responded by filing suit in the Texas district court. Hartford asserted that she had failed to exhaust her administrative remedies prior to bringing her suit.

The court ruled in Hartford’s favor based on two factors. First, the court ruled that because Swanson’s attorney did not submit evidence to refute Hartford’s claim that Swanson had been approved to return to full-time work, there was no evidence that the August 25 letter was an appeal. Instead, the wording demonstrated to the court that it was merely a letter indicating intent to file an appeal.

Swanson’s attorney argued that Swanson had filed her appeal within 180 days and that Hartford did not issue its decision within 45 days of receiving that appeal. The court found that even if the court could consider the letter an appeal, the statute of limitations would not have extended more than 90 days beyond August 25, 2003. In either case, because Swanson filed suit more than four years later, the case was time-barred.

Swanson lost out, primarily because someone in the firm representing her failed to follow through and make sure that deadlines were met. The failure to file a timely appeal cost her long-term disability insurance benefits.

Don’t find yourself in a similar situation. Hire a disability insurance attorney who pays attention to the details. It could make the difference between securing your rightful long-term disability insurance benefits and losing your rights.

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Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Hartford. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Hartford.

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Our lawyers help individuals that have either purchased a Hartford long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

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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.

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No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. 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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I did a lot of research on disability attorneys before hiring Dell & Schaefer. Many firms do real estate, legal defense and disability on the side. I wanted a firm that specialized in and only did disability claims. I chose Dell & Schaefer after many conversations with Steven Dell. Mr. Dell was very professional giving me all pluses and minuses of my claim. It was an extraordinary amount of paperwork but this was all made easy by Merlin Bryan. Merlin walked me through all the steps and was on top of everything needed. My initial claim was denied but Mr. Dell assured me I still had a good case and suggested an appeal. The appeal attorney, Stephen Jessup, was also very professional and very assuring. Bottom line, my disability was approved. I couldn’t be more happy with the firm.

One of the best things about the firm was how accessible everyone is. Mr. Dell and Mr. Jessup always returned my phone calls the same day. If I emailed Merlin Bryan something I received an answer within minutes. Mr. Jessup even replied to my emails on weekends.

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