How does an ERISA claimant start an administrative appeal?

Can a mere request for medical records, and a reference to an “appeal in the future tense,” trigger the appeal?  No.

Here’s the case of Reindl v. Hartford Life and Accident Insurance Co., –F.3d __, 2013 WL 425356 ( 8th Cir. February 5, 2013) [PDF].

FACTS.  Reindl participated in an ERISA governed employee benefit plan and sought and obtained disability benefits. Hartford later reassessed her claim and discontinued benefits.  On November 25, 2008, Hartford sent a letter informing Reindl she had 180 days to file an administrative appeal. On December 12, 2008, Reindl’s lawyer sent a letter requesting medical records and stating: “We will be reviewing the records and obtaining additional medical information for my client’s appeal of the decision to terminate [benefits].”  On July 8, 2009 Reindl’s attorney expressed disagreement with the benefits termination decision and stated: “I would appreciate your reversal of the decision to terminate [Reindl’s benefit claim].”

ISSUE: Whether a request for medical records, and a reference to an appeal sometime in the future constitute an “appeal.”

TRIAL COURT HELD: Plaintiff had failed to file a timely appeal.

EIGHTH CIRCUIT:  AFFIRMS

  1. A timely appeal is a prerequisite to filing an action in federal court;  Op. at 4.
  2. The December 2008 letter merely requested medical records.
  3. It was reasonable for Hartford to conclude Reindl’s December 2008 letter was not an appeal because it merely made “reference to an appeal [in] the future tense”.  Op. at 4.
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Photo of Mike Reilly Mike Reilly

Mike Reilly is a nationally recognized labor, employment and employee benefits attorney, named one of the “Top 100 Most Powerful Employment Attorneys in the Nation” for the past five consecutive years by Human Resource Executive®. He has decades of experience providing strategic employment…

Mike Reilly is a nationally recognized labor, employment and employee benefits attorney, named one of the “Top 100 Most Powerful Employment Attorneys in the Nation” for the past five consecutive years by Human Resource Executive®. He has decades of experience providing strategic employment advice, and has represented clients in more than 75 jury trials, arbitrations, bench trials and claims before the EEOC and Washington State Human Rights Commission.

Small and large employers retain Mike for his strategic advice and decades of experience in employment issues and litigation, business decisions and litigation avoidance. Mike provides advice in claims involving discrimination, retaliation, wrongful discharge, disability accommodation, ERISA and non-ERISA employee benefit claims, and wage/hour claims. He served as lead counsel in an employee raiding/trade secret case as reported in the Wall Street Journal, and defends employers in class action claims.

Mike’s remarks on employment issues have been quoted in NewsweekCorporate Legal TimesSeattle TimesEmployee Relations Law JournalPuget Sound Business JournalCFO.com, and other professional journals and management publications. Chambers USA’s Guide to America’s Leading Lawyers for Businessrates Mike in the top ranking (band one) for his work in labor and employment law, and has described him as “one of Seattle’s top-rate attorneys” who is “truly phenomenal [with] superb legal instincts” and “an amazingly assertive litigator.” His clients include Nordstrom, Seattle Seahawks, Home Depot, KeyBank, Starbucks, Fred Hutchinson Cancer Research Center, Red Robin and Seattle Chamber of Commerce, among others.