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Mental incapacity not a defense to ERISA’s exhaustion requirement

| Sep 1, 2020 | ERISA Benefits Claims Litigation

Mental incapacity can be used as a defense for many legal issues. However, a recent federal court ruled that in cannot be used as a defense to the administrative remedy exhaustion requirements in the Employee Retirement Income Security Act of 1974.

The background of the case

Originally, the plaintiff was on short-term disability from the defendant, Hartford Life and Accident Insurance Company, for depression. This was later transitioned to long-term disability. However, the Hartford terminated those long-term benefits in early 2017 because depression benefits were limited to 4 months.

Prior to the termination, the Hartford sent the plaintiff a benefit determination letter. This letter included information about her appeal options, but stated she had to appeal within 180 days of receiving the letter. It further explained that if her appeal was denied, she could then bring an ERISA civil action.

Over 18 months later, the plaintiff sent a letter to the Hartford stating that she wished to appeal her termination. She then initiated her case in federal court.

The mental incapacity argument

After she initiated her case, the Hartford moved to have it dismissed because she failed to exhaust all of her administrative remedies, prior to filing. Generally, in ERISA cases, plaintiffs must exhaust all administrative remedies before filing in court. In this case, the Hartford argued that because she failed to appeal the Hartford’s decision in time (i.e., exhaust that administrative remedy), she could not now file in federal court. However, the plaintiff, among a few other arguments, contended that she had a mental incapacity that made her not competent to understand the appeal deadline.

Unfortunately for plaintiffs hoping to use this argument, the judge did not allow the mental incapacity argument against the ERISA exhaustion requirements. Instead, he stated that the only allowable defenses are futility or inadequate remedy.

Consequences

Many courts have a strict adherence policy for ERISA exhaustion requirements. Luckily, as this case comes from the 11th District, which Washington, D.C., is not part of, this case is not mandatory law for locals. Though, it can persuade local judges to find the same. This is why it is so important to contact legal counsel early in the process.

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