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.