The US Supreme Court heard oral arguments yesterday in the Heimeshoff v Hartford Life case. The question considered by the Court was when does the statute of limitations start to run? Ms. Heimeshoff (and the Department of Labor who filed an amicus brief) argued that the limitations period should not commence until after her LTD claim was denied because she could not bring suit until she had exhausted her administrative remedies.
This case presents an interesting issue of whether an insurance company has the contractual right to require the statute of limitations to start running well before a claimant has the ability to bring a lawsuit. It would seem that issues of fundamental fairness would dictate that a limitations period cannot start to run before a claimant has the ability to seek court review.
The questions posed by the various Justices were interesting to the extent that, in their view that the administrative appeals should be non-adversarial and that a claimant really might not need legal counsel to receive a full and fair review. As an attorney working in the trenches on these kind of case this is a little surprising-more of a Rose colored glasses view than what is really taking place. Many of the claims decisions I have reviewed and appealed demonstrate a concerted effort to manufacture an excuse to deny a claim. It also seems that the larger the claim value the more intense the effort.
If you take the emotion out of it and simply think about it in terms of money, it makes perfect sense for a profit driven entity (the LTD insurance company) to spend a few thousand dollars hiring reliable paid paper reviewers, medical examiners or conducting surveillance to provide a colorably logical rationale to save hundred’s of thousands of dollars.