In a recent case, Civil Action No. 19-1939, a ruling by Judge Feldman of the United States District Court for the Eastern District of Louisiana in New Orleans showed the importance of filing for long-term disability while appealing a short-term disability denial. In this case, the plaintiff filed for short-term disability with the defendant, was denied, and filed suit; however, the defendant filed a motion to dismiss the plaintiff’s claim for long-term disability benefits for failure to exhaust administrative remedies because she had never actually filed an application for long-term disability benefits.

The original denial of her claim for short-term disability benefits caused the plaintiff to view filing for long-term disability benefits to be patently futile because the claim would be evaluated on the same, if not a more stringent, basis than her short-term disability claim. The plaintiff did not file a separate claim form for long-term disability, resulting in the defendant’s motion to dismiss her case.

The Court agreed with both sides of the argument, in part. The Court found that the plaintiff did exhaust her administrative remedies for her claim for short-term disability benefits. Although the definition of disabled for the purposes of short-term disability benefits is similar to that for long-term disability benefits, the plaintiff still had to file her claim for long-term disability. The Court though acknowledged the likelihood of the plaintiff having her long-term disability declined akin to the denial of her short-term disability. Fortunately for the plaintiff, the Court dismissed her claim for long-term disability benefits without prejudice and stayed the proceedings until she could properly exhaust her administrative remedies. If long-term benefits are not paid, the Court will have a complete administrative record to review to re-evaluate the decision. However, if the claim is approved, many issues in the case may be rendered moot.            

Failing to file a separate for long-term disability in the first place caused a delay in this case, and ultimately caused a delay in plaintiff being able to present her case for benefits. There is a lesson in this for claimants. Even if claimants are instructed by low-level claim analysts that the transition to long-term benefits is automatic or that there is no reason to apply for long-term benefits in the face of a short-term disability denial, it almost always makes sense to send in the long-term claim form and cover all bases before bringing the case to court.