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March 31, 2005

CA5 ERISA administrative review and denial notices

Lacy v. Fulbright & Jaworkski LLP is an appeal from a grant of summary judgment for the defendants in a suit over an ERISA medical claim denial.  The employer and plan obtained a summary judgment based on the employee's failure to exhaust administrative review rights; after she got a notice of denial, she had failed to make a timely administrative appeal.  Her response was that the notice was defective and therefore did not  begin the running of the appeal time.  Without explaining how the notice was not in "strict compliance," the court held that a notice that substantially complies with statutory and regulatory notice requirements would suffice.  The summary judgment was affirmed.

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