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LTD Claimant’s Failure to Submit Timely Appeal Was Fatal to His Disability Insurance Claim

In a recent Florida case not handled by our law firm a claimant’s untimely submission of his ERISA appeal proves fatal to his claim. The case was decided by the United States District Court in the Middle District of Florida and reminds us of the importance of properly submitting an appeal in ERISA governed cases.

Mr. Applegate had received benefits for 24 months for his inability to perform the material duties of his own occupation before receiving a denial letter from his employer’s group disability plan issued by Liberty Life Assurance Company of Boston. Like in many group disability policies, after receiving benefits for 24 months, Mr. Applegate would be considered disabled if he was unable to perform his own occupation or any occupation for which he was reasonably qualified. Liberty found Mr. Applegate was not disabled under the terms of the policy beyond the 24 month mark.

Pursuant to ERISA guidelines, a claimant must be given 180 days to submit an appeal following an initial denial of benefits. Mr. Applegate submitted his appeal within the required timeframe; however, the appeal denial letter set forth procedures for review of a second appeal option which Mr. Applegate had 60 days to submit. On the sixtieth day, Mr. Applegate faxed a letter to Liberty Life requesting an additional 10 days to submit evidence from a treating physician in support of the appeal.

The letter stated:

“This letter is in response to your denial letter dated November 5, 2015. The Letter provides that additional information pertinent to review may be submitted within 60 days of the denial letter. I would like to request [an] additional 10 days to submit additional evidence from Mr. Applegate’s treating physician, Richard Hood, M.D.”

Nine days later, Liberty Life denied the request stating:

“Mr. Applegate has failed to properly exhaust his administrative right of appeal. Therefore, Liberty is unable to accept or review any additional documentation with regard to his claim.”

Although the additional evidence from Dr. Hood was eventually submitted to Liberty, they refused to accept it or review it in conjunction with any appeal. Mr. Applegate filed a lawsuit against Liberty Life following receipt of Liberty’s decision to decline the request for an appeal.

Upon review, the court pointed out the errors in Mr. Applegate’s requests. The most important had to do with the absence of an actual request for a review. While insurance carriers may sometimes give additional time to submit more evidence in support of an appeal the actual appeal request must be submitted within the required timeframe. The court concluded that Mr. Applegate’s faxed letter was insufficient to initiate an administrative review because while it may have suggested a future intention to file a request for review or appeal upon Mr. Applegate’s receipt of additional evidence, the letter did not “facially purport to initiate or otherwise constitute the initiation of a review or appeal.”

The court found that Mr. Applegate failed to exhaust his administrative remedies and that there were no exceptional circumstances to excuse his failure to do so.

What we learn from this case?

The obvious points are you must submit your appeal timely and ERISA is very strict when it comes to these timeframes.

The other take away from this case is if you have to request more time do not wait until the day the appeal is due before simply asking for more time. If you find yourself running out of time to submit an appeal some insurance carriers may give more time but you should submit the request, in writing, well before the due date to allow time for the carrier to respond with a yes or no. Also, an appeal letter must specifically ask for an appeal to be opened. In other words, the request must be clear that it is intended to serve as an appeal and if you would like more time to submit additional information then additional time can be requested in the same letter. Whether more time will be provided is up to the carrier.

The approach will obviously always depend on the circumstances and time left to submit an appeal but the most important take away from this case should be that an experienced ERISA attorney should always be consulted in a timely fashion before submitting an appeal. Do not wait until the day before the appeal is due to contact an attorney.

If you need assistance with your disability insurance appeal or have questions regarding your disability insurance denial, please contact the law office of Attorneys Dell & Schaefer for a Free Consultation.

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Questions About Hiring Us

Do you help Liberty Mutual claimants nationwide?

We represent Liberty Mutual clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Liberty Mutual disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Liberty Mutual. 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 Liberty Mutual.

How do you help Liberty Mutual claimants?

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

Our experienced lawyers can assist with Liberty Mutual:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

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 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 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.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer 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.

Dell & Schaefer Client Reviews   *****

Brett C.

I have been on LTD, since Aug 2016, and Cigna is my LTD Insurance Company. I received a couple of payments from Cigna, without any issues, but then the payments stopped in Oct, at which time I was informed by Cigna that they were “looking into” my claim. Cigna stopped contacting me, would not even return calls or emails, but finally contacted me in mid-December to inform me that they would not be continuing with my claim.

I contacted Dell & Schaefer in January, at which time I began working with Attorney Alex Palamara, Disability Appeal Specialist Randa Escayg, and Legal Assistant Kathy Bordes. These folks were always kind, professional, understanding, did a great job of explaining everything to me, and most importantly I could tell that they truly cared about the situation my wife and I had unfortunately found ourselves in.

I fully understand the feeling of being overwhelmed, when you are first denied, that David vs Goliath feeling of you against some huge conglomerate, that powerless and helpless feeling that overcomes you when you are sick and injured and at your most vulnerable. The only things that you are able to focus on are saving your family’s home, doing whatever you can to take care of them, all while you should be focusing your energy on getting better, as much as you are able, so that you can recover your life to what it once was, returning your current life of overwhelming stress and chaos to some semblance of normalcy. Well, as soon as I began working with Alex, Randa, and Kathy, I immediately felt better, like I finally had someone in my corner fighting for me, somebody who cared, and somebody who would stand up to that giant corporation, and make things right.

Alex won my appeal for me, and Cigna is in the process of restoring my full benefits, retro back to October. I cannot describe to you the feeling of joy and elation the moment my wife and I were notified we had won. To those currently dealing with a LTD company, and all of the madness that entails, just know that there is a light at the end of the long dark tunnel. You do still have hope, and you can certainly do no better than to have the wonderful folks at Dell & Schaefer in your corner fighting for you!!!!

***** 5 stars based on 202 reviews

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