Jun 102015

A long-term disability claimant to whom an adverse benefit determination has been handed must mail his or her administrative appeal within 180 days of receiving the letter advising of the determination (for some other types of benefits, it is permissible for an insurer to impose a 60-day deadline).  But what happens when the appeal deadline falls on a Saturday, Sunday or holiday?

Andre LeGras received his denial letter on April 18, 2011, which meant that his appeal needed to be mailed by October 15, 2011 (a Saturday).  He waited until the following Monday (October 17) to mail his appeal, and in the district court’s view, that meant that the appeal was untimely, and that his suit should be dismissed for failure to exhaust his administrative remedies.

The Ninth Circuit, by a vote of 2-1, reversed.  Applying what it characterized as a “general understanding,” the majority held that when an appeal deadline lands on a Saturday, Sunday or holiday, claimants should have until the first business day following to file.  In the dissent’s view, the plan should be enforced as written, meaning that the 180th day is the deadline, regardless of whether it falls on a weekend or not.

LeGras v. AETNA Life Ins. Co., 786 F.3d 1233 (9th Cir. 2015)

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