Conn. Attorney Sees His Benefits Case Reach U.S. Supreme Court

, The Connecticut Law Tribune

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Over the holiday season, it was easy to overlook any news about U.S. Supreme Court rulings. But in a decision of interest to those in employment and insurance law practices, the justices ruled that health care insurers can legally set deadlines for when customers must file any lawsuit challenging a denial of benefits.

What may have been ever further overlooked is that the case actually originated in Connecticut. Patrick Begos, of Begos, Brown & Green in Southport, handled it every step of the way until it reached the nation's highest court.

"I never had a case go that far," said Begos. "It was the first time I have ever been to an argument at the Supreme Court in a case I was intimately involved in. That was great.

"It would've been nice to argue it, too, but when you're replaced by a former solicitor general, you really can't complain," Begos continued. Seth Waxman, now of WilmerHale in Washington, D.C., handled the Supreme Court arguments.

Begos and his firm were hired by Hartford Life & Accident Insurance Co. after the Connecticut-based insurer was sued by Julie Heimeshoff, who worked as a Walmart senior public relations manager. Heimeshoff, who complained that chronic pain and fatigue were interfering with her ability to work, filed for long-term disability benefits with The Hartford. Doctors diagnosed her with lupus and fibromyalgia in 2005, but her benefits claim was denied in 2007.

Begos explained that under the Employee Retirement Income Security Act (ERISA), an administrative review process is set up to address disputes like this before they can go to court.

Consider, for example, workers who become disabled. Begos said they must submit a claim to their health insurance provider, which then gathers information and ultimately decides whether it agrees that a person is disabled. Workers typically must turn in supporting documentation from their doctors and employers providing details of their medical condition, information about their job duties and verification they are not currently working.

If a worker disagrees with the insurance company's decision, he or she can pursue an administrative appeal, Begos explained. That appeal is usually handled by different people within the same insurance company. "Generally speaking it's only after that administrative appeal gets completed that the employee can go to court," said Begos.

In this case, Heimeshoff's claim was denied by The Hartford in 2007. In 2010, with the help of her attorney, Steven Krafchick, of the Krafchick Law Firm in Seattle, she sued in U.S. District Court in Connecticut for her benefits. Krafchick's practice focuses on representing people with fibromyalgia type disabilities.

Begos, however, said there was a provision in Heimeshoff's insurance plan stating that any lawsuit over benefits must be filed within three years of when her salary losses began. In Heimeshoff's case, that was in 2005. And so, Begos contended, her lawsuit should have been filed by 2008.

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