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Unum Disability Claim Dismissed For Failure To File a Timely Claim

In Wilson v. Provident Life and Accident Insurance Company, Woodrow K. Wilson, a shareholder of the Woodrow Wilson Construction Company, Inc., purchased an individual disability insurance policy from Provident in 1993. On April 18, 2013, for the first time, Wilson filed a claim for disability stating he had been unable to work since October 13, 2008, due to osteoarthritis pain in his shoulder, left knee and low back. Provident denied his claim finding that, based on the information it had available, the plaintiff was not disabled on that date. Provident noted the tardiness of the claim made it difficult to evaluate and impossible to have an independent medical exam. After exhausting his administrative appeals, the plaintiff filed this lawsuit.

Provident moved to have the lawsuit dismissed on the grounds that:
1) Wilson failed to provide timely proof of loss which was required to be filed within 90 days of his alleged disability date; and,
2) he failed to file the lawsuit within the three-year time frame established by the contractual terms of the policy. The court agreed with Provident and found that its contractual terms establishing time limits was “in conformance with law.” The court determined there was no exception to the 90-day filing requirement that would excuse Wilson’s tardy claim. The court also determined Wilson’s lawsuit was filed beyond the three-year statute of limitations and accordingly dismissed the lawsuit.

Wilson’s Claim for Benefits Was Untimely

Wilson admitted that October 13, 2008, was the date upon which he claimed he became disabled. He failed to file proof of his disability until April 18, 2013. The contract allowed for a late claim to be filed beyond the 90 day deadline if plaintiff could submit proof that it was legally impossible to file a claim within the time limit or at least not reasonably possible to file one. The only reason Wilson gave for his late filing was that he “hoped” he would get better. The court found that “Wilson’s explanation does not demonstrate that it was not reasonably possible for him to file his notice and proof of loss timely.”

Wilson’s Lawsuit Was Also Untimely

The clear language of the policy allowed a lawsuit to be filed three years from the time proof of loss was required, not from the time the claim was denied. In this case, considering all time frames in the light most favorable to the plaintiff, the very latest he was required to file proof of loss was May 13, 2010. Three years from that date would be May 13, 2013. He did not file his lawsuit until August 11, 2014. Since this was beyond the filing date required by the statute of limitations, the court dismissed his lawsuit as untimely.

This case was not handled by our office, but it may provide claimants guidance in the importance of filing a timely claim for disability benefits and in complying with the applicable statute of limitations for filing a lawsuit. If you need assistance with a similar matter, or for any other question concerning your claim for disability benefits, please contact any of our lawyers for a free consultation.

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Do you help Provident claimants nationwide?

We represent Provident 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 Provident disability insurance policy?

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

How do you help Provident claimants?

Our lawyers help individuals that have either purchased a Provident 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 Provident:

  • 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   *****

J.P., ESQ.

Dell & Schaefer saved my life. After receiving disability payments from CIGNA for 10 years, CIGNA decided that their initial determination had been in error. This was based on an evaluation of the file – with no personal interview of any kind – from a psychiatrist who new less about bipolar disease than I do.

With a wife and four children to provide for, I was distraught. Dell & Schaefer took charge of the mater. Although no lawyer can guarantee an outcome, as a former attorney I was very impressed with their professionalism and efficiency. On a personal level, they were very reassuring. They understood the embarrassment that comes from disclosing a mental disease, and dealt with me with courtesy and encouragement.

We prevailed over CIGNA, and I continued to have financial security until my benefits were paid in full.

I would recommend Dell & Schaefer, without reservation, to anyone who has to go up against the insurance giants.

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