North Carolina Federal Appeals Court Dismisses Disability Lawsuit Against Prudential As Untimely

In a case not handled by Attorneys Dell & Schaefer, a Prudential Claimant has lost her right to sue after being denied disability benefits. In a recent decision by a Circuit Court Judge in the United States District Court for the Western District of North Carolina, a disabled woman’s lawsuit against Prudential was dismissed because she unfortunately waited too long to file a lawsuit.

The claimant was previously employed by Thermo Fisher Scientific. As an employee of Thermo Fisher Scientific, she was covered under Thermo Fisher’s short term disability (STD) and long term disability (LTD) plans. These plans were administered by Prudential Life Insurance Company of America.

On March 16, 2010, the claimant became disabled and applied for and was ultimately approved for STD benefits through April 20, 2010. On June 21, 2010, Prudential denied both STD and LTD eligibility after May 25, 2010. The claimant filed a timely appeal on July 10, 2010, but that appeal was denied on August 9, 2010. A second appeal was filed on September 1, 2010, but this appeal was also denied by way of a letter dated February 2, 2011.

Unfortunately for the claimant, with the administrative remedies exhausted, her only remaining avenue to seek compensation under the STD and LTD plans was to file an ERISA lawsuit in federal court.

For unknown reasons, the former Thermo Fisher employer waited until February 11, 2014 to file her lawsuit.

Shortly after the lawsuit was filed, Prudential filed a Motion to Dismiss the Plaintiff’s (claimant’s) Complaint. In its motion, Prudential argued that the claimant’s lawsuit was untimely as she waited beyond the time limit under the STD and LTD plans to file a lawsuit.

Long Term Disability Claim

The Long Term Disability Plan stated that “(w)ritten notice of a claim should be sent within 30 days after the date your disability begins. However, you must send Prudential written proof of your claim no later than 90 days after your elimination period ends.” Additionally, the LTD Plan states that you “can start legal action regarding your claim 60 days after proof of claim has been given and up to 3 years from the time proof of claim is required…”. It must be noted that the elimination period under Thermo Fisher’s LTD Plan is 180 days.

After receiving the Motion to Dismiss, the Court noted that “a reasonable contractual limitations period for a suit under ERISA may start to run even during a period when the claimant must still be pursuing administrative remedies prior to filing suit.” The Judge seems to find this fair as the “parties contracted for a three-year limitations period for filing suit under ERISA with regard to long-term disability.” The Court found this three-year period reasonable.

The Court then found that “the three year contractual limitations period applicable to the Plaintiff’s filing suit for LTD benefits under ERISA commenced to run at the end of the 90” day period to provide proof of loss. The Court continued that the “last day of the 90 day period for the Plaintiff to offer proof of claim for LTD benefits was December 11, 2010.” This date was calculated using the 180 day elimination period plus the 90 day period to provide proof of loss. The Court therefore concluded that “the three-year contractual limitations period for the Plaintiff to file suit under ERISA for LTD benefits expired on December 11, 2013.” The Court noted that the Claimant did not file this lawsuit until February 11, 2014. Therefore, the Court held that the claimant was time barred by the contractual limitations period from claiming LTD benefits in this case.

Short Term Disability Claim

The Short Term Disability Plan stated that “(n)otice of a claim should be sent within 30 days after the date your disability begins. However, you must send written proof of your claim no later than 90 days after your elimination period.” The STD Plan did not provide time limits for legal proceedings as the LTD Plan did.

With regards to the STD claim, because the policy offered no time limit to bring legal proceedings, the Court ultimately made a similar finding to the LTD claim, albeit through a different reasoning process.

The Court first noted that there “is no particular statute of limitations for a cause of action under ERISA.” Thus the Court “must look to the most analogous state statute of limitations.” Since this case was brought in North Carolina where the Plaintiff resided, the Court applied “North Carolina’s three year breach of contract statute of limitations to the STD claim.” The Court further noted that a “claimant for benefits under ERISA ‘must both pursue and exhaust plan remedies before gaining access to the federal courts.'” The court also noted that “the statute of limitations… does not ordinarily begin to run until the statutorily mandated internal appeals process is exhausted.”

The Court found that the North Carolina three-year statute of limitations did not begin running until the second (and final) appeal was denied on February 2, 2011 when the claimant’s administrative remedies were finally exhausted. Thus, the statute of limitations for the STD claim expired on February 2, 2014. As the claimant did not file suit until February 11, 2014 (9 days after that time limit), the Court ruled that the claimant was “barred by the statutory limitations period from filing suit to obtain STD benefits in this case.”

Why Does This Decision Matter?

This decision can serve as an educational tool for those needing to sue Prudential or any disability insurance provider. Calculating the time period in which a claimant has a right to sue over a denial of disability benefits is a very meticulous and confusing process. It is often better to file the lawsuit as soon as possible rather than let a Court play a calculation game to see if you are allowed to proceed.

If you have been denied Long Term Disability benefits by Prudential or any disability insurance provider and you need to sue, please do not wait any longer and please contact Attorney Alexander Palamara or any attorney at Dell & Schaefer. We are always available for a free consultation.

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Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

Jeff P. (Oklahoma)

After a very long and frustrating ordeal to keep my LTD payments coming I decided to seek assistance from and attorney. After much research and asking those in the legal profession Dell & Schaefer seemed to be the top choice. I reached out and Alex Palamara was the attorney assigned to my case. All I can say is the experience was outstanding. Both Alex and his Paralegal, Danielle Lauria were excellent to work with. They were very kind, concerned, understanding of my frustrations and treated me with the utmost respect. Communication was excellent with regular updates and telling me what I could expect in each stage of the process.

Alex was also very straight forward with what to expect and no pie in the sky promises or expectations were made. In the end we won our case and I believe it was solely due to their experience and knowledge of not only the laws but the insurance companies as a whole. I would highly recommend them and am very grateful for the help they afforded to me.

Chad B. (Illinois)

I originally spoke with 3 other long term disability lawyers about my case before contacting Dell and Schaefer. None of those law firms would take it. They said the chances of me winning was not good. After finding Dell and Schaefer online I spoke with one of the attorneys that has since left. He did take my case but later it was picked up by Rachel Alters. Rachel is amazing and a very intelligent attorney. She not only won my case but also was able to get my back pay for 6 months.

I also cannot say enough about Sonia Nogueira. Sonia was always quick to answer any of my questions. I would usually hear back from her within hours of sending her a email. I do not know where I would be if I hadn’t contacted them. My family and I cannot thank them enough. Don’t let an insurance company tell you they are not responsible for paying you. I paid them for 20 years monthly and they looked for any reason they could not to have to pay me when I needed my benefit. Thank you Rachel and Sonia for all you guys do.

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