If You Don't Exhaust Your Administrative Remedies in Your Long Term Disability Insurance Claim Your Lawsuit May be DOA

Administrative remedies must be timely complied with in long term disability insurance claims.

In Swanson v. Hearst Corporation the insured lost her long term disability insurance claims case on summary judgment for failing to exhaust her administrative remedies prior to bringing suit.  The insured had coverage under a long term disability benefits policy issued by Hartford Life Insurance Company which was governed by the Employee Retirement Income Security Act (ERISA).  After having received benefits for a period of time, the insurer notified the insured that benefits would be terminated since the insured was cleared to return to work.  The policy allowed the insured to appeal within 180 days.  The insured hired an attorney who wrote a letter stating that insured ‘intended" to appeal the termination of benefits and requested various documents in hopes of supplementing the record.  The insurer did not consider this letter a formal appeal and treated it as such.

Some three and half years later, the attorney submitted a formal appeals package including medical records, vocational expert's reports, etc.  Since this appeal arrived past the 180 days appealable period, the insurer rejected the appeal.  The insured filed suit and shortly thereafter summary judgment was ruled in favor of the insurer.  The insured then appealed the decision and the appelate court ruled in favor of the insurance company.  To read the entire decision, please go here.

This case highligts the importance of deadlines in the world of long term disability insurance claims.

The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability insurance benefits denied, delayed or terminated.

You can reach Miami Long Term Disability Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email J.P. directly at [email protected].

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