by Steve Fields | August 25th, 2022
August 25, 2022, U.S. Court of Appeals – 11th Circuit – Unpublished Decision
Bakos’ claim for Long Term Disability benefits was originally approved by Unum in 2014. In 2015, Unum terminated her claim for Long Term Disability benefits. Bakos appealed that denial, which was upheld by Unum after their administrative review on June 27, 2016. Bakos did not further pursue this claim until 2020. In March of 2020, Bakos was approved Social Security Disability (SSD) benefits. Bakos then sought to re-open her Long Term Disability claim with Unum based on the SSD approval. Unum denied that request stating that the administrative review was completed already. Bakos proceeded to file suit against Unum in 2021, almost five years after the last denial. Bakos’ claim was dismissed by the district court because the policy contained a three-year time limit to file a civil lawsuit against Unum.
Bakos appealed that denial, and the 11th Circuit upheld the dismissal. The Court of Appeals rejected Bakos’ equitable tolling argument as well as the argument that she lacked notice of the time limitation. This case highlights that the policies and the terms within them are vitally important to know and understand. It is also important to note how important the administrative appeal process is and how difficult it can be, if not impossible, to add to your file after that is complete. While it seems harsh, the terms of the policy can and often are strictly enforced. If you are dealing with a denial on a Long Term Disability claim, the sooner you reach out for help, the more likely it is that our attorneys can help you.
