A federal judge has ruled that a woman who failed to adminstratively appeal the denial of her short term disabilty clain cannot now appeal the denial of her long term disabilty claim.
The court ruled that the claimant neede to satisfy the "elimination period" of 180 days in order to be eligible for long term disability benefits. Since the insurance company (Aetna) had denied her short term disabiltiy claim and the claimant had not sued Aetna over that claim, she could not pursue the more extensive long term claim. The court said that she was unable to "satisfy a threshold requirement of the plan."
The case is Downey v Aetna Life Insurance Company.
Here's our advice:
Long term disability insurance claims can be complex. On top of that you have ERISA's vast number procedural rules, most of which the insurance company never tells you about. Federal judges know them. Insurance company lawyers know them. You need to get a lawyer involved at an early stage if your claim is denied, even it it is denied for short term disability only. At least let a board certified and experienced ERISA disabilty attorney review your file. Your family will thank you.