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Motion to Stay Pending Exhaustion of Administrative Remedies: M.D. La.

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  • Motion to Stay Pending Exhaustion of Administrative Remedies: M.D. La.

    In a recent case from Louisiana, the court rules on a motion to stay, and ultimately grants it. By way of background, the Plaintiff applied for and was awarded LTD benefits in 2010. Subsequently, those benefits were terminated in 2017 and the Plaintiff was informed of his right to appeal the decision in the denial letter. The Plaintiff submitted a letter captioned "Administrative Appeal" and requested copies of documents relevant to his claim. The Defendant provided him with these copies, and without submitting any additional information, the Plaintiff filed suit in October of 2017.

    In ruling, the court reasoned as follows:

    The Court further finds that Prudential has demonstrated that its procedural error was for good cause. Although the May 9, 2017 letter expressed Green's intention to appeal the denial of his claim for LTD benefits, it also included a lengthy and detailed request for additional information relevant to Green's claim. In its May 16, 2017 response, it appears Prudential clearly, albeit mistakenly, interpreted Green's letter as a request for more information in order to prepare a "complete appeal" that would be "due no later than November 7, 2017." As Prudential correctly notes, it was not unreasonable for the Defendant to believe that, after reviewing the relevant plan documents and claim file, Green would want to submit more information in support of his administrative appeal. Therefore, the court finds that the May 16, 2017 correspondence shows Prudential was, for good cause, waiting on Green to submit his complete appeal.
    Ultimately, the court granted the motion. The opinion is attached below.
    Attached Files