This week’s notable decision is Fortier v. Hartford Life & Accident Ins. Co., No. 18-1752, __F.3d__, 2019 WL 697989 (1st Cir. Feb. 20, 2019), where the First Circuit dealt a blow to ERISA plan participants when it comes to exhausting administrative remedies.  The bottom line:  An insurer may strictly enforce the 180-day appeal deadline against a plan participant.

The facts:  Fortier received long-term disability benefits under a group disability plan insured by Hartford Life & Accident Insurance Company (“the Plan”).  The Plan only pays 24 months of benefits for disabilities caused by mental illnesses.  Hartford approved and paid Fortier’s LTD benefits before sending her notice on September 13, 2011 that her benefits would terminate in the future on November 1, 2011 due to the Plan’s Mental Illness Limitation.  The letter informed Fortier of her right to appeal within 180 days of the date that she received the letter.  Fortier retained an attorney who submitted a timely appeal and was able to get her benefits reinstated.  Shortly after reinstating her claim, Hartford explained that since it did not give Fortier prior notice of the application of the Mental Illness Limitation, it was starting the 24-month period as of September 13, 2011 and no benefits will be payable beyond September 12, 2013.  
Continue Reading First Circuit Holds that Substantial Compliance Doctrine Does Not Save Participant’s Untimely ERISA Administrative Appeal