Case Study: When Is Your Appeal Actually Due?

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By Scott E. Davis, Disability Attorney

In the recent Ninth Circuit case of LeGras v. Aetna Life Ins. Co., 786 F.3d 1233 (9th Cir. 2015), the issue at hand was –  when is an ERISA disability appeal actually due when the 180 day deadline to appeal falls on a weekend or holiday?

After working 23 years as a loyal employee for Federal Express Corporation, Andre LeGras seriously injured himself and filed a claim for long term disability benefits.  Aetna Insurance (Federal Express’s Claim Administrator) initially denied the claim and informed LeGras that he could file an appeal within 180 days – but this was a Saturday.

After working 23 years as a loyal employee for Federal Express Corporation, Andre LeGras seriously injured himself and filed a claim for long term disability benefits.  Aetna Insurance (Federal Express’s Claim Administrator) initially denied the claim and informed LeGras that he could file an appeal within 180 days – but this was a Saturday.

LeGras mailed his appeal the following Monday but Aetna denied it as untimely.  LeGras filed a lawsuit under ERISA but the district court dismissed his claim.  LeGras then appealed to the 9th Circuit court of appeal who reversed the lower court decision by clarifying when an appeal is due under ERISA (at least for those employees who live in the 9th circuit).

In saving LeGras’ claim, the 9th Circuit held that because the last day of the appeal period fell on a Saturday, neither that day, nor Sunday, counted in the compilation of the 180 days.  As a result, the court found LeGras’ appeal was timely.  The court’s important holding is that if the 180th day to appeal falls on a weekend or holiday, the appeal is due on the next business day.

In saving LeGras’ claim, the 9th Circuit held that because the last day of the appeal period fell on a Saturday, neither that day, nor Sunday, counted in the compilation of the 180 days. As a result, the court found LeGras’ appeal was timely. The court’s important holding is that if the 180th day to appeal falls on a weekend or holiday, the appeal is due on the next business day.

Practice Tip:  It is important to understand that under ERISA you have 180 days from the date of the denial to appeal or your claim is forever lost.  LeGras’ first mistake was waiting 180 days to appeal the claim.  Once his claim was denied and he needed to appeal, LeGras should have immediately sought representation by an experienced ERISA attorney.  LeGras fell into that trap, don’t let it happen to you.

It is not clear whether LeGras initially sought counsel but the lesson is please do not wait too long to find an ERISA attorney or appeal your claim.  My experience is similar to what occurred in LeGras, insurance companies are often look for ways to deny claims, even when you have worked for a  company for 23 years!

Please retain an ERISA attorney once your claim is denied and they will be able to guide you on when the appropriate time is to appeal your claim – assuming you have sufficient time on the 180 days, this will generally be when you have accumulated all the evidence you need in order to prove that you are disabled.

© 2015  Scott E. Davis, Disability Attorney