In this 2023 ERISA case, a participant in an employee benefit plan governed by ERISA was not required to exhaust administrative remedies before challenging a denial of benefits in court when the written plan documents made no mention of any review process or administrative remedies that could be exhausted.
The plain language of the administrator’s intentionally self-inflicted injury exclusion did not apply to unintended injuries like the participant’s husband’s heroin overdose. The administrator’s denial of the participant’s claim for accidental death benefits based on that exclusion was erroneous. Judgment of the lower court was affirmed.
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.