After submission of an ERISA disability appeal, when can I file an ERISA disability lawsuit?

Federal law governing ERISA disability lawsuits requires claimants to submit an administrative appeal of the denial of benefits before they can file a lawsuit in the federal district court. In the recent case of Lewis-Burroughs v. The Prudential Insurance of America, et al., the plaintiff filed an administrative appeal and, according to Prudential’s own rules, consistent with federal law, the insurer had a maximum of 90 days to render its decision.

When Prudential failed to render a decision on the administrative appeal by the 90 day deadline, the claimant filed her disability lawsuit in the New Jersey federal district court just 91 days after the date upon which she had filed her administrative appeal. Despite Prudential’s attempt to have the lawsuit dismissed on the grounds that the statute had been tolled and the lawsuit was filed prematurely, the court agreed with the claimant and allowed the lawsuit to proceed. In ruling for the plaintiff, the federal court made two important findings in response to Prudential’s claims and the time for filing an ERISA disability lawsuit.

The Statute of Limitiations Does Not Restart When Claimants Submit New Evidence

The court strongly disagreed with Prudential’s claim that the statute of limitations started all over again when the claimant submitted additional supportive medical evidence after filing her appeal. The court found the language of the relevant statute controlling and specifically held that the deadline for deciding an appeal begins on the date the “appeal is filed,” not on the date that the insurer determines it has all the information necessary for making its decision. Any other interpretation would deter claimants from providing additional information when such an act would restart the time for the required decision. In this case, Lewis-Burroughs lawsuit was filed after the expiration of the required 90 days without a decision by Prudential. The appeal was deemed denied and the lawsuit was properly filed in the district court.

The Statute is Tolled Only if Specific Requirements Are Met

The statute is only tolled if the insurer gives the claimant notice that more information is necessary in order for it to make a decision. The notice must include the specific information deemed necessary and a date upon which the insurer expects to have a decision. If, in response to the notice, the claimant provides the requested evidence, the statute is tolled during the time beginning when the notice is given until the information is provided.

In this case, the insurer did not send a notice requesting necessary information so the statute was not tolled. Prudential failed to issue its decision within the required time limit and the plaintiff was entitled to pursue her lawsuit in the district court.

Attorneys Dell & Schaefer did not represent Lewis-Burroughs in this action, but if you are in a similar situation, feel free to contact us to discuss how we may be able to assist you.

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