Chapman v. Choicecare Long Island Term Disability Plan

In this 2002 case, due to a mental disability, the claimant submitted a long term disability benefits application to an insurance company that was under contract with the plan to pay the plan’s benefits. The insurance company denied the claimant’s claim as untimely filed and informed the claimant that a written request for review of a claims denial had to be sent within 60 days of the receipt of the notice of denial. The claimant’s attorney’s letter asking for review was 10 days late, and the insurance company denied the appeal. The appellate court found that the plan itself was a proper defendant in the action and the plan could be held liable in its own name for a money judgment under 29 U.S.C.S. § 1132(a)(1)(B). The difficulties that the claimant’s counsel encountered because of the claimant’s inability to participate in her representation due to her mental illness, and the brevity of the 10 day delay provided a basis for finding that counsel acted with due diligence. Thus, on remand, the proof proffered by the claimant’s counsel was sufficient to warrant an evidentiary hearing as to whether the claimant’s mental illness impaired counsel’s efforts to file a timely request for review.

Outcome: The judgment of the district court was vacated and the case was remanded to the district court for further proceedings to address the issue of whether the 60-day time limit was enforceable given that such limitation was not mentioned in either the policy or the plan’s summary plan description.

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.