Jerry Isaacs v. Metropolitan Life Insurance Company, 2008 U.S. App. LEXIS 12584 (4th Cir. 2008) – decided June 13, 2008 – United States Court of Appeals for the Fourth Circuit – Robert E. Hoskins

In this case, I represented the plaintiff.  This is a case that I lost, but as the introduction to this case log points out, the purpose of this log is not just to list the firm’s victories, but to provide cases that are of interest to the firm’s clients.  I post this case because it exemplifies and underscores a very important point under ERISA.  This case demonstrates what can happen if a claimant does not timely provide all of the paperwork that an insurer asks for during claim processing.  In this ERISA case, my client, timely filed a short term disability (STD) clam.  According to MetLife, the insurer of the long term disability (LTD) plan, the client was required to provide LTD claim forms separately from the STD forms which were submitted.  MetLife contends that the LTD claim forms were due within 90 days from the date of disability.  MetLife contends that it never received any LTD claim forms from the client.  I became involved about 9 months after my client went out on disability and I wrote several letters to MetLife asking if my client needed to fill out any additional claim forms to perfect his long term disability claim.  MetLife never responded to my letters so I filed a lawsuit.  I argued that my client had essentially submitted all of the information needed to perfect his LTD claim in a timely manner even if he did not submit claim forms that MetLife contended were necessary to perfect the claim.  MetLife filed a motion for summary judgment asking the court to throw the case out because it asserted no long term disability claim had been filed and because it was too late to file one.  The District Court agreed and granted the defendant’s motion for summary judgment.  (Click here to see a copy of the District Court order dismissing my client’s claim.)  The District Court held:

 “It is also clear that plaintiff cannot “bootstrap” his LTD claim onto his properly made short-term disability claim. The LTD plan was separate and distinct from the short-term disability plan. The LTD plan and the short-term disability plans have different plan documents, and one was covered by ERISA while the other was not. As outlined above, the uncontroverted evidence is that plaintiff did not strictly comply with the procedures outlined in the plan document for filing an LTD claim.

 

Plaintiff asserts the exhaustion requirement is excused in this case by the doctrine of futility. Under the doctrine of futility, a claimant is not required to exhaust administrative remedies if doing so would have been futile, which a plaintiff can demonstrate by showing he was denied access to the procedures outlined in the plan.  See Makar v. Health Care Corp. of Mid-Atlantic (Carefirst), 872 F.2d 80, 83 (4th Cir. 1989).  Plaintiff argues his counsel’s communications with defendant demonstrate the futility of pursuing administrative remedies in this case. Importantly, however, all of those communications occurred well after the 90-day claim period ended. Plaintiff has not offered any evidence that pursuing his administrative remedies was futile at the time he was able to file an LTD claim. Thus, plaintiff has not made a “clear and positive” showing of futility so as to excuse his failure to file a timely claim for LTD benefits.  See Makar, 872 F.2d at 83.”

“Isaacs also argues that his receipt, completion, and return of the forms Woods gave him on June 6, 2005 was the functional equivalent of filing a claim under the LTD Plan. We disagree.  Aside from the February 18, 2005 claim discussed above, Isaacs has never properly initiated any other claim for benefits with MetLife.  Moreover, the documents faxed by Isaacs’s doctor referenced either the STD and FMLA claims or no claim at all. We therefore hold that the faxed forms were insufficient to initiate a claim under the LTD Plan.  Isaacs’s attorney’s subsequent letters were likewise insufficient either to initiate an LTD claim or to put MetLife on notice that Isaacs believed that such a claim existed separate and apart from his STD claim.”  (Click here to see a copy of the Fourth Circuit's order.)

I felt that the outcome of this case was so unjust that I actually petitioned the US Supreme Court to hear the matter raising a technical issue about my client’s right to do discovery before his case was dismissed.  I knew it was a long shot when I filed the petition with the Supreme Court and, as I expected, the Supreme Court denied our petition for writ of certiorari (our request to have the court consider the case) on December 1, 2008.  Of the many, many cases I have handled over the years, this case had one of the most unjust and unfair outcomes of any I have ever handled in my opinion.  But, the outcome does stress that a claimant needs to do everything that an insurer requests of it during the claim process and this case demonstrates that the failure to do can, by itself, destroy a claim.