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Monday, May 25, 2015

Appeal vs. Reconsideration: Don't Get Caught in the Trap!

One of the basic principals of ERISA benefit suits is that prior to filing suit in court, you must file an appeal with the insurer asking for the decision to be reversed.  If you don't, your case will be thrown out of court.

Sometimes, rather than filing an appeal, a claimant, or the attorney, requests that the company "reconsider" the decision, but doesn't use the word "appeal."  A request for reconsideration can be useful if you think the insurer overlooked a document, or you can submit a record was missing when the decision was made.  Since a reconsideration request is not appeal, you are not using up one of your levels of appeal.

But, make sure you still file an appeal during the 180 days following the decision even if you have filed a request for reconsideration  In the Connecticut LTD denial case of Feher v. Unum Life Ins. Co. of Am., 2014 U.S. Dist. LEXIS 174536 (D. Conn. Dec. 18, 2014) the attorney for the claimant asked for reconsideration of a benefit denial.  After denial of the reconsideration request, the attorney filed suit rather than filing an appeal with the plan.  The court dismissed the case for failure to exhaust the appeal rights with the plan, since the request for reconsideration did not count as an appeal.  

This case also shows how important it is to have attorney experienced in ERISA and employee benefits.  Without knowing about this specific issue, an attorney would have no reason to know that a request for reconsideration is not the same as an appeal.  

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