In this 2022 case, the question is whether the beneficiary of the plan timely brought suit in federal court – whether or not he had exhausted his plan remedies. The lower court determined that he had not exhausted his remedies and dismissed his suit, from which the beneficiary appealed. The beneficiary argued that the remedies should have been deemed exhausted because the insurer, in violation of the applicable ERISA regulation, failed to provide a final decision on his benefits within 45 days of the administrative appeal. The Court notes that the appropriate ERISA statute requires that the insurer “strictly adhere” to the 45 day window in which to render its decision, absent extraordinary circumstances. Here, there were no extraordinary circumstances as contemplated by the statute, so the insurer did not strictly comply with the 45 day deadline, and the beneficiary’s remedies were exhausted, and he timely filed suit. Therefore, the lower court is reversed and the suit is reinstated.
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.