Dimopoulou v. First Unum Life Insurance Company

Background

The court considered the parties’ letters about Dimitra Dimopoulou’s administrative appeal of First Unum Life Insurance Company’s claim determination. The opinion concerns the timing and handling of that appeal; it does not decide whether Dimopoulou is entitled to benefits.

Legal reasoning

The court relied on regulations governing employee benefit plans under the Employee Retirement Income Security Act. When a plan administrator makes an adverse benefit determination, the administrator must describe the plan’s review procedures and the deadlines that apply to review. The court stated that when a denial notice does not specify a deadline for administrative review, the plan’s time bar is not triggered.

The court found that First Unum’s notice did not sufficiently explain the administrative review procedures or specify a deadline for submitting an appeal. As a result, the court concluded that Dimopoulou’s appeal was not untimely.

The court also rejected First Unum’s argument that the regulations required Dimopoulou to appeal within 180 days of the denial. The court explained that the regulation requires administrators to provide claimants at least 180 days to appeal. That period is a minimum, not a maximum.

Order

Judge Andrew L. Carter, Jr. directed First Unum to decide Dimopoulou’s appeal within 60 days of the December 30, 2019 order.