In Griffin v. United of Omaha Life Insurance Company, in the Northern District of Alabama (2014), Judge Hopkins accepted the report and recommendation of Harwell G. Davis, III, United States Magistrate Judge. He recommended that summary judgment should be entered in favor of United of Omaha.  Ms. Griffin was seeking life insurance benefits on the life of her father who had worked for Covenant Bank. Her father, Mr. Atkins, died on May 23, 2011. Prior to his death Covenant Bank had laid Mr. Atkins off on March 25, 2011 and provided him a severance package paying him salary and life insurance benefits through May 31, 2001. Accordingly, Ms. Griffin contended her father had life insurance coverage when he died, and United of Omaha contended that Mr. Atkins was no longer actively employed as of March 25, 2011.United of Omaha denied the claim on January 9, 2012 and provided 60 days to appeal that decision. Ms. Griffin however did not appeal the claim until her attorney sent a letter dated April 20, 2012 which contested the decision. The letter did not really state that it was appealing the claim. However, even if the letter was considered an appeal it was well after the 60 day time period provided by United of Omaha. United of Omaha considered the letter an appeal nonetheless and entered a final decision May 18, 2012. It provided that Ms. Griffin had exhausted all appeal rights. About three months later two affidavits from co- employees were submitted by the Ms. Griffin justifying that Mr. Atkins was actively employed at the time of his death.   United of Omaha refused to consider the affidavits.

Ms. Griffin then filed suit and the court found that the affidavits would not be considered because they were not submitted with the “appeal”. They were submitted after the claim procedure had been exhausted.

Ms. Griffin sought for the court to remand the case so that the affidavits could be considered. In support of this she cited several 11th Circuit opinions about the duties of claim administrators. She argued United of Omaha was required to consider ongoing evidence. The court stated that it did not read one 11th circuit case this way “… as requiring remand to review post-denial evidence in the absence of the finding first that the plan administrator acted arbitrarily and capriciously in denying the claim”. The court also went further and noted that neither of the affidavits established that Mr. Atkins was “actively at work”, so they still would not be sufficient.

United of Omaha won with its argument that the court should sharply adhere to the time frames required under the policy and claim procedure regulation.   It avoided paying a benefit for which it received premiums.  It would be interesting to see if this works both ways… when an insurance company fails to make a timely decision as set forth in its policy will there be sharp adherence to the times frames? And so it continues…