McQuillin v. Hartford Life and Accident Insurance Co., No. 21-1514 (2d Cir. 2022)Annotate this Case
Plaintiff appealed the dismissal of his lawsuit seeking long-term disability benefits under the Employee Retirement Income Security Act of 1974 (“ERISA”) from Hartford Life and Accident Insurance Company. The district court concluded that Plaintiff had failed to exhaust his disability plan’s administrative remedies. Plaintiff asserted that his administrative remedies should have been deemed exhausted because Hartford, in violation of the applicable ERISA regulation, failed to provide a final decision on his benefits within 45 days of his administrative appeal.
The Second Circuit reversed the district court’s dismissal of Plaintiff’s. The dispositive question on appeal was whether a valid benefit determination on review must determine whether a claimant is entitled to benefits. Based on the regulation’s plain language, structure, and purpose, the court held that it must. The court further held that, because Hartford did not extend the benefit determination period, duty to exhaust had ceased by the 46th day, the day he filed his federal case.
The court further explained that the text of the Sec 503-1 supports Plaintiff’s argument that he did not receive a timely benefit determination on review. Finally, Section 503-1’s text, structure, history, and purpose are fully consistent. A “benefit determination on review” must finally decide the claimant’s benefits within 45 days, assuming the absence of special circumstances that require an extension. By the 46th day after his appeal, Hartford had not determined Plaintiff’s benefits nor extended its review time. So, Plaintiff was deemed to have exhausted his plan remedies and could bring suit in federal court.