News & Resources

When is an Appeal Too Late?

By Amar Raval February 26, 2019 Posted in Blog

At Berg Plummer Johnson & Raval, we often get involved in our clients’ cases at an early stage. The following highlights the risks of waiting too long to get a lawyer involved in your disability claim.

On February 20, the First Court of Appeals issued an opinion that changes the way many disability appeal deadlines are calculated. In Fortier v. Hartford Life & Accident Ins. Co., __F.3d__, 2019 WL 697989 (1st Cir. Feb. 20, 2019), the Court held that the 180-day time limit to appeal an adverse benefit determination began to run from the date of the notice of the determination, not the date the benefits would be terminated. Here’s how the Court reached its conclusion.

Ms. Fortier received long-term disability benefits under a group disability plan insured by Hartford Life & Accident Insurance Company. The policy provided a limited 24 month period of benefits for disabilities caused by mental illness. Hartford approved Fortier’s LTD claim. In September 2011, it advised that her benefits would terminate in the future on November 1, 2011 due to the policy’s limited pay period for disabilities caused by mental illness. Fortier hired a lawyer who filed an appeal on her behalf. The appeal was approved, and Hartford reinstated her benefits. But in a letter dated July 13, 2013, Hartford again advised that it would terminate her claim due to the same limited disability provision. Now benefits would terminate after September 12, 2013. 

Fortier did not appeal within 180 days, although she sent an appeal letter 2 months after the deadline. Hartford decided that the appeal was too late and refused to review it. Fortier filed suit, and Hartford argued that Fortier’s claims should be dismissed because she failed to timely appeal. Fortier responded that the 180 day appeal deadline should run from the date of the termination of benefits, not from the date of notice. The First Circuit disagreed, ruling that the 180-day time limit to appeal an adverse benefit determination starts from the date notice is given. The court also explained that nothing in the ERISA regulations is undermined by insurance companies applying deadlines strictly against claimants.

What’s the takeaway lesson? Don’t rely only on the date that the insurance company tells you benefits will terminate. You may have to appeal even before that termination takes effect. ERISA is full of potholes for the unwary. 

Contact a Houston Disability Insurance Lawyer Today

If you have had your legitimate disability insurance claim wrongfully denied by an insurer, undervalued, or unreasonably delayed, then it’s important to get in touch with an experienced Texas disability insurance attorney here at Berg Plummer Johnson & Raval, LLP for assistance.  With the aid of a qualified attorney, you can effectively and timely appeal the denial of benefits.

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