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An Example of what NOT to do: M.D. Fla

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  • An Example of what NOT to do: M.D. Fla

    Every once in awhile, my boss will put one of these cases on my desk with the caveat that it's a great example of what not to do. Frankly, given how dry this subject matter can be at times, they're my favorite to post about.

    This is a recent case out of Florida where the Plaintiff, without exhausting administrative remedies, filed suit to recover AD&D benefits. Both the Report and Recommendation, and Opinion are attached, but in relevant part, the court's reasoning is as follows:

    Here, the Court recommends Plaintiff’s Complaint fails on all three arguments made by Defendant. First, Plaintiff admits in the Complaint that he failed to exhaust his administrative remedies. See Doc. 1 ¶ 22. The Policy gives Plaintiff 60 days from the date of the denial of the claim to request administrative review and Plaintiff failed to do so. See Doc. 7-1 at 124. Further, Plaintiff fails to show that “resort to administrative remedies would be futile” or that Plaintiff was denied “meaningful access” to administrative review of his claim. See Perrino, 209 F.3d at 1315-16. Thus, Plaintiff’s Complaint may be dismissed on this ground alone. See Bickley v. Caremark RX, Inc., 461 F.3d 1325, 1329 (11th Cir. 2006). Next, the Policy provided that any legal action related to the Policy must be filed within three years after proof of loss is filed. Doc. 7-1 at 27. Plaintiff faxed his claim form and proof of loss on June 7, 2013, and filed this case on April 23, 2018, thus Plaintiff failed to comply with the limitation provision and the Complaint should be dismissed on that ground as well. See Docs. 1, 7-2; Heimeshoff, 571 U.S. at 108. Finally, Hulett was the sponsor of the Plan, but not the claims administrator, and thus is an improper party. See Garren, 114 F.3d at 187; Doc. 1 ¶ 8. Thus, the Complaint may be dismissed as to Hulett for this additional reason. See Garren, 114 F.3d at 187.
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