First Unum Cannot Extend Disability Appeal Review Indefinitely
Following the submission of an ERISA disability appeal an insurance company is allotted 45 days under the law with which to render a decision on the appeal. ERISA also allows the insurance carrier a single 45 day extension to complete the review so long as the extension is for good cause. It is common for an insured to receive a letter from their disability carrier during the initial 45 day timeframe that the insurance company is exercising its right to the 45 day extension. Quite often there is limited ability for an insured to challenge the extension, but as seen in the recent case, McFarlane v. First Unum Life Insurance Company, there are limits to the application of the extension by the insurance company.
Prior to the filing of any lawsuit under ERISA against an insurance company for the denial of benefits an insured must exhaust his or her administrative remedies. The administrative remedy is the formal administrative appeal of the denial of benefits. If an insured does not file an appeal of the insurance company denial within the 180 day deadline imposed by ERISA then the insured can be barred from bringing legal action against the insurance carrier. In turn, when an insurance company fails to render a decision within the statutorily allotted timeline imposed by ERISA an insured is entitled to file a lawsuit for the failure to render a timely decision.
In McFarlane, First Unum (a company under the Unum umbrella) denied McFarlane’s claim for disability benefits shortly after initially approving her claim. Through counsel, McFarlane filed an appeal of First Unum’s denial. After the initial 45 day deadline had ended, McFarlane’s counsel contacted First Unum to notify them that the time to render a decision on the appeal had expired. In response, Unum request a 45 day extension to complete its review of the appeal due to a failure to receive requested documentation from one of McFarlane’s treating doctors. Unum additionally note that the start date of the 45 extension would be tolled until such time that the information was received from McFarlane’s doctor. After waiting nearly two months McFarlane filed a lawsuit against First Unum for failure to render a timely review of her claim. Unum in turn filed a motion with the court to have the lawsuit dismissed for failure to exhaust administrative remedies (complete the appeal process). As set forth below, the Court denied First Unum’s motion and allowed the case to proceed.
In denying First Unum’s motion the court notes that ERISA regulations specify that an “extension notice” needs to indicate a date on which a determination will be rendered, but First Unum had failed to provide such a date when notify McFarlane of the extension. The court stated that First Unum’s failure to provide a date the review of the appeal would end was in violation of ERISA regulations; and that the fact First Unum was tolling the start date of the extension was inappropriate as said start date was dependent on receipt of information from a third party (her doctor) beyond McFarlane’s control.
Unum attempted to argue that the timeframe for which the extension was to begin could be tolled for McFarlane’s failure to provide information necessary to render a decision on the claim. The court disagreed with First Unum’s interpretation of the law, as according to the court there was no indication that McFarlane failed to provide requested information, but rather a third party failed to provide information. As such the Court rejected Unum’s position it could toll the period that the 45 day extension would begin until it received information requested of a third party.
The importance of providing all pertinent information during the ERISA administrative appeal process.
Even though the Court allowed McFarlane’s lawsuit to stand that does not mean that the Court has decided in McFarlane’s favor as to First Unum’s denial of her claim for benefits. Although the Court holds that a plaintiff would not be liable for actions of the third parties in providing information as it relates to appeal reviews, it is still very important to note that it is often in the best interest of the insured to provide an insurance carrier with all pertinent information during the appeal process as failure to provide the information could bar the insured from presenting potentially helpful information at trial.
In situations where an insurance company requests records from an insured’s doctors, we at Dell & Schaefer work to secure any requested information that is helpful to our client’s claim for benefits and that ensures the most timely review of an appeal. Although the above case is being allowed to proceed at trial it does not mean that the plaintiff did not hurt their case by failing to try to obtain the information from their doctor. It is also worth noting that the Court indicates that McFarlane is not to be held responsible for the failure of a third party to respond to a request for information- but this still leaves the question, what if First Unum asked McFarlane directly to obtain the information from her doctors to provide as part of the review? This difference in semantics could have changed the outcome of the court’s ruling dramatically.
Resources to Help You Win Disability Benefits
Get Your Unum Disability Application Approved
Prevent a Unum Disability Benefit Denial
Negotiate a Unum Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
Q: Does UNUM periodically review Group Long Term Disability Insurance claims/payments? For example, do they verify medical eligibility every five or ten years?
Q: My group long term disability insurance allows me to work part time up to 20% of my pre-disability earnings without affecting my benefit. If I take advantage of this, will Unum use this to deny my benefit?
After appeal filed by Attorney Jay Symonds, UNUM overturned previous denial of long term disability benefits for South Carolina Nurse
Unum Overturns Original Decision to Deny Benefits to Disabled Account Manager Following Appeal Submitted by Dell Disability Lawyers Appeals Team
After appeal filed by Attorney Jay Symonds, UNUM overturned its previous denial of long term disability benefits for Colorado Plumber
Court Rules Plaintiff's Medical Records Was Replete With Evidence Supporting Claim of MS & Was Not A Pre-Existing Condition
After paying for 13 years Unum Denies Disability Benefits to Woman with Lyme Disease and Endometriosis
Inexperienced Lawyer Handles Unum Disability Lawsuit and Fails to Provide Evidence to Support Occupational Argument
Massachusetts court overturns Unum's decision to terminate disability benefits after paying for nearly ten years
Reviews from Our Clients
Very satisfied with the work of this team. Took well care of my case and took all the necessary time to be responsive and attentive when I had questions. Guided me through recovery and returning to normalcy. All thanks to Jason & Tabitha, thank you!
I’m extremely satisfied with the experience I have had with this firm from day one. The lawyer who has handled my case, Alex, is very efficient and attentive to all my questions and concerns. They are always aware of how my case has gone and they care about my health. I feel optimistic with them because they are very attentive during the process of my claim. I would not hesitate to recommend families and friends if in any situation they need their services. Kathleen as well has been very well and assisted me with this case. I highly appreciate everything they have done for me.
It’s unfortunate when disability insurance companies come after older disabled policyholders just to help their bottom line. It can be a living nightmare the damage they can do to a family. Dell Disability Lawyers are polite, understanding and knowledgeable. They call you back and answer any question you have no matter how unimportant it can be. The amount of stress they took off of myself and family was incalculable. I recommend them highly to take care of any disability case whether it be filing for benefits or reversing a claim decision. They are outstanding.
I could not have been happier or more appreciative of the hard work they performed on my behalf. I was well briefed on my case and it was closed in a timely manner with a financially successful resolution.
Mr. Symonds and Sonia as well as everyone else we have worked with throughout this process have been very helpful, professional and caring to our situation. We are very thankful to have this great team on our side.
Without them my LTD company was dropping my plan with me still suffering from my accident, even with doctor’s statements I’m still disabled. The LTD company didn’t want to advance my policy to the next stage of years of pay. Dell Disability Lawyers saved my policy, and helped to enforce the LTD company’s own policy (for its policy holder, me) that I would be covered still under the LTD policy I had paid for at my previous job, when my accident occurred. These lawyers know what they are doing and can help you too. LTD companies will try to drop you when you still need coverage just because they don’t want to pay on your policy anymore. Don’t let them break contract with ya because they are trying to get out of it. Hit em with legal action to ensure the continuation of your policy you paid for. Dell Disability worked very well for me and continue to do so.
I was denied long term disability benefits from The Hartford after being on it for years. I found Dell Disability Lawyers after doing research online. In a matter of days they responded and explained to me everything that would be done. Dell Disability Lawyers were able to settle my suit against The Hartford very quickly and responded to me quickly. I would definitely recommend this team of lawyers for anyone that is fighting for their disability insurance.
I have had nothing but a great experience with Dell Disability Law Firm. Mr. Alex Palamara and his team went above and beyond my expectations. They will respond to emails and phone calls in a timely manner. Thank you once again for taking my case.
This law firm is the best so far. MetLife denied me two times, they appealed two times for me and they won of course. So if you are on disability and want a chance at winning your case use this firm Dell disability lawyers, kind courteous understanding and they get the job done. You won’t be disappointed.