Dimopoulou v. First Unum Life Insurance Company

S.D. New York

Dimopoulou v. First Unum Life Insurance Company

DecidedDecember 30, 2019

Docket1:13-cv-07159

StatusUnknown

This text of Dimopoulou v. First Unum Life Insurance Company (Dimopoulou v. First Unum Life Insurance Company) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Dimopoulou v. First Unum Life Insurance Company, (S.D.N.Y. 2019).

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| ELECTRONICALLY FILED | DOC □□□ □ . DATE FILED: 12/30/2019 UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK DIMITRA DIMOPOULOU, Plaintiff, ~against- 1:13-cv-07159 (ALC) FIRST UNUM LIFE INSURANCE ORDER COMPANY, Defendant. ANDREW L. CARTER, JR., United States District Judge: The Court is in receipt of the Parties’ letters concerning Plaintiffs administrative appeal of Defendant’s claim determination. See ECF Nos. 150-51, 53-54. After careful consideration, Defendant is directed to reach a decision on Plaintiff's appeal within 60 days of the date of this order. Pursuant to 29 C.F.R. § 2560.503-1(g)(1)(iv), upon an adverse benefit determination, a plan administrator is required to provide a claimant with “[a] description of the plan’s review procedures and the time limits applicable to such procedures.” 29 C.F.R. § 2560.503-1(g)(1)(iv). Where an administrator provides notice of a denial without specifying a time limit for administrative review of the denial, the plan’s time bar is not triggered. See Burke v. Kodak Ret. Income Plan, 336 F.3d 103, 107 (2d Cir. 2003). Here, Defendant’s notice does not sufficiently advise Plaintiff of the administrative review procedures nor does it specify any time limits by which an administrative appeal must be submitted. Accordingly, Plaintiff's appeal is not untimely. In addition, Defendant’s argument that the ERISA regulations require Plaintiff to file an administrative appeal within 180 days of a denial in unavailing. Under 29 C.F.R. § 2560.503- 1(h)(3)G), administrators are required to “[p]rovide claimants at least 180 days following receipt

of a notification of an adverse benefit determination within which to appeal the determination.” 29 CER. § 2560.503-1(h)(3)G). Not only does this requirement apply to administrators, but also it indicates that the 180-day period is the minimum amount of time to be provided to a claimant, not the maximum. SO ORDERED. 7 (La Dated: December 30, 2019 New York, New York ANDREW L. CARTER, JR. United States District Judge

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| ELECTRONICALLY FILED | DOC □□□ □ . DATE FILED: 12/30/2019 UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK DIMITRA DIMOPOULOU, Plaintiff, ~against- 1:13-cv-07159 (ALC) FIRST UNUM LIFE INSURANCE ORDER COMPANY, Defendant. ANDREW L. CARTER, JR., United States District Judge: The Court is in receipt of the Parties’ letters concerning Plaintiffs administrative appeal of Defendant’s claim determination. See ECF Nos. 150-51, 53-54. After careful consideration, Defendant is directed to reach a decision on Plaintiff's appeal within 60 days of the date of this order. Pursuant to 29 C.F.R. § 2560.503-1(g)(1)(iv), upon an adverse benefit determination, a plan administrator is required to provide a claimant with “[a] description of the plan’s review procedures and the time limits applicable to such procedures.” 29 C.F.R. § 2560.503-1(g)(1)(iv). Where an administrator provides notice of a denial without specifying a time limit for administrative review of the denial, the plan’s time bar is not triggered. See Burke v. Kodak Ret. Income Plan, 336 F.3d 103, 107 (2d Cir. 2003). Here, Defendant’s notice does not sufficiently advise Plaintiff of the administrative review procedures nor does it specify any time limits by which an administrative appeal must be submitted. Accordingly, Plaintiff's appeal is not untimely. In addition, Defendant’s argument that the ERISA regulations require Plaintiff to file an administrative appeal within 180 days of a denial in unavailing. Under 29 C.F.R. § 2560.503- 1(h)(3)G), administrators are required to “[p]rovide claimants at least 180 days following receipt

of a notification of an adverse benefit determination within which to appeal the determination.” 29 CER. § 2560.503-1(h)(3)G). Not only does this requirement apply to administrators, but also it indicates that the 180-day period is the minimum amount of time to be provided to a claimant, not the maximum. SO ORDERED. 7 (La Dated: December 30, 2019 New York, New York ANDREW L. CARTER, JR. United States District Judge

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