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Exhausting Administrative Remedies: Why You Need an ERISA Lawyer for Your Long-Term Disability Appeal

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Exhausting Administrative Remedies: Why You Need an ERISA Lawyer for Your Long-Term Disability Appeal

19 Mar, 2021
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If you live in Chicago and you have been denied a long-term disability claim under your employer’s group long-term disability insurance policy, you may have wondered whether you need an ERISA attorney to handle the appeal. I have heard from prospective clients that insurers have even told them they do not need an attorney until they file a lawsuit. You should have an attorney advising and handling the appeal for many reasons. One of the biggest reasons is to ensure you properly exhausted administrative remedies. If you do not properly exhaust administrative remedies, your lawsuit could be dismissed, and you lose your rights under the policy. One such example happened just recently.

In Ruderman v. Liberty Mutual Group, Inc., No. 1:20-cv-945, 2021 WL 827693 (N.D.N.Y. Mar. 4, 2021), Liberty terminated Ruderman’s long-term disability benefits once based on neuropsychological testing results. Ruderman appealed, and Liberty overturned the benefit termination. Bu the next day, Liberty terminated benefits again, contending Ruderman was not disabled due to the most recent neuropsychological assessment. Rather than appeal again, Ruderman filed a breach of contract claim in state court. Liberty removed it to federal court under ERISA and the court dismissed the case for failing to appeal the second benefit termination. Ruderman argued Liberty was likely to maintain the denial in light of its past actions, but that was not enough to be excused from pursuing the appeal.

Ruderman’s case should be a lesson for all. The worst part of learning that lesson for Ruderman is that she does not get to go back and do the appeal. Insurance policies and ERISA regulations provide 180 days to complete that appeal. By the time the court dismissed Ruderman’s case, she was out of time to complete that appeal.

If you have a denied or terminated long-term disability claim, consult with an ERISA long-term disability attorney immediately so you do not fall into the trap of failing to properly exhaust administrative remedies.

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