Faciane v. Sun Life Assur. Co., ERISA and Long Term Disability

This ERISA case, decided in 2019, is a case dealing with a contractual limitations period under a policy for long term disabiliity.

The Plaintiff/Insured filed an action under ERISA claiming that the plan administrator had miscalculated his long term disability benefits payment. The lower court granted summary judgment in the case because the contractual limitations period had lapsed and the Plaintiff failed to demonstrate that the plan’s limitations provision left him an unreasonably short period to file suit from the time his claim accrued in 2008 when the administrator sent him a letter explaining his monthly benefit calculation. The Court found that the 2008 letter contained enough information for the miscalculation claim to accrue because the disputed figure was displayed prominently on the first page, and the alleged discrepancy was so large and concerned a matter so fundamental to any working person that the letter clearly repudiated the beneficiary’s entitled to greater benefits. Therefore, the Court affirmed the lower court.

This case is a great example of the fact that if you see a problem with the amount being paid to you for your long term disability benefits, or any problem under your policy, you need to do something about that problem immediately. Here, the Plaintiff got shut out because of a provision in the policy that limited the time he has to do something. You cannot sit around after you see a problem thinking that you will get it taken care of eventually. You have to get proactive with any problem you see and, if necessary, bring in an attorney to advocate for you and get these problems resolved, or you could forever lose the right to do so, like the Plaintiff did here.

If you need assistance navigating your claim for short term or long term disability benefits under ERISA, or it is time to sue the insurance company, please do not hesitate to give Cody Allison & Associates, PLLC a call (844) LTD-CODY, (615) 234-6000. or send us an e-mail Cody@codyallison.com.  We provide representation nationwide and have successfully sued all the major insurance companies in many states. Our headquarters are located in Nashville, Tennessee.  We offer a free consultation and would love to speak with you.