A Louisiana court recently ruled against CIGNA for imposing an unreasonable appeal deadline, finding that its refusal to accept the claimant, James Hughes, appeal of its termination of his disability benefits was wrong. CIGNA claimed that the appeal was received after the 180-day deadline mentioned in the termination letter, but nowhere in the policy did it mention the 180-day deadline.
Hughes became disabled in 1999 after an accident left him permanently paralyzed and bound to a wheelchair. Since then, CIGNA terminated his long term disability insurance benefits four different times. After each of the first three terminations, Hughes followed the guidelines for appealing the decision and CIGNA started paying him disability benefits again.
However, CIGNA claimed its fourth termination of Hughes’s disability benefits was because he did not provide documentation proving he remained disabled. Hughes’s mother called CIGNA nine months after the termination requesting an appeal. She was told because the 180-day deadline had passed, Hughes had to explain why just cause existed for the delay. Mrs. Hughes explained her son was sitting in prison and she would not be able to provide the information. Two years later, in 2012, Mrs. Hughes contacted CIGNA again appealing long term disability denial and trying to get her son disability benefits. She explained the reason for the delay was his imprisonment and the fact that his pain medication affected his mental state. CIGNA informed Hughes he could not file a lawsuit until he had exhausted his appeal rights. But they refused to consider the appeal in 2012 because the 180-day deadline passed.
Hughes filed a lawsuit against CIGNA in 2015. CIGNA then argued the lawsuit could not go forward because it was filed outside of the three year time limitation stated in the policy.
The court held CIGNA could not hold Hughes’ to the 180-day appeal deadline if this time limit was not written into the policy. Because CIGNA told Hughes as late as 2012 that he could not file a lawsuit unless he had exhausted his appeal rights, it could not argue the lawsuit was filed outside of the three-year time limit. It also found CIGNA was unreasonable in terminating the benefits of a permanently paralyzed claimant four times.
This case is a good example of when disability benefits that are governed by ERISA require special attention as many stages in the process are time sensitive. Do not try to handle your disability case alone. Contact an experienced ERISA attorney at Dabdoub Law Firm for an evaluation of your case and let us handle the complicated issues on your behalf.