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
- A timely appeal is a prerequisite to filing an action in federal court; Op. at 4.
- The December 2008 letter merely requested medical records.
- 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.