Unum Disability Claim Dismissed For Failure To File a Timely Claim
Author: Attorney Gregory Dell
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.