When an ERISA Remand Means Starting Over: Court Addresses Claim Deadlines, IME Obligations, and Attorney’s Fees After Procedural Default by Insurer

In Chalk v. Life Insurance Company of North America, No. 3:25-cv-133-RGJ, 2026 WL 1252337 (W.D. Ky. May 7, 2026), District Judge Rebecca Grady Jennings of the United States District Court for the Western District of Kentucky addressed two post-remand disputes in a long-term disability benefits case: whether Plaintiff’s motion to reopen was prematurely filed and whether Plaintiff was entitled to attorney’s fees following a court-ordered remand that the insurer had initiated. The court denied the motion to reopen, denied attorney’s fees, and awarded costs only.

The procedural background is important context. The court had previously remanded the matter to LINA after finding that LINA failed to issue any notice of its decision on Plaintiff’s LTD claim within 45 days, as required by 29 C.F.R. § 2560.503-1(f)(3). An employee’s procedural error in routing the claim caused the failure, meaning LINA never conducted an initial review of the LTD claim at all. The court ordered “a full and fair review of [Plaintiff’s] LTD claim consistent with the terms of the LTD Policy.”

Did ERISA’s initial claim deadlines or appeal deadlines govern the remand?

After remand, LINA requested an Independent Medical Evaluation and sought two 30-day extensions to the initial 45-day review period. Plaintiff moved to reopen the case on the theory that LINA’s decision was overdue under the 90-day deadline applicable to appeals following court-ordered remands. The court rejected that framing. Because LINA had never conducted an initial review at all, Plaintiff had no prior determination to appeal. The cases Plaintiff cited in support of applying appeal-stage deadlines all involved remands that came after exhaustion of administrative remedies, including an administrative appeal. Because the remand here required an initial claim review, the initial claim procedures of 29 C.F.R. § 2560.503-1(f)(3) applied: 45 days with two potential 30-day extensions.

Was LINA entitled to the extension periods?

The court found that LINA properly invoked both 30-day extensions. LINA’s December 8, 2025 letter requesting an IME, sent three days before the 45-day deadline, satisfied the regulatory requirement to notify Plaintiff of the unresolved issues preventing a decision and the standards for benefit entitlement. The January 6, 2026 follow-up scheduling the IME served as the required notice before expiration of the first 30-day extension. LINA issued its claim decision on February 6, 2026, well within the extended deadline. Plaintiff’s December 16, 2025 motion to reopen was therefore premature. The court further held that Plaintiff must exhaust her administrative appeal before the court may reopen the case, but allowed Plaintiff 180 days from the order to file that appeal.

Practitioners should note Plaintiff’s argument that the claim was no longer “pending” once LINA missed the initial 45-day deadline, such that the policy’s IME provision no longer applied. The court did not directly reach this argument in the motion-to-reopen analysis, but the framing may carry more traction in challenging LINA’s partial denial on IME non-cooperation grounds in a future appeal.

Did Plaintiff achieve the degree of success on the merits necessary for a fee award?

The court found that Plaintiff cleared the threshold eligibility requirement under Hardt v. Reliance Standard Life Insurance Co., 560 U.S. 242 (2010), notwithstanding LINA’s argument that LINA, not Plaintiff, had moved for the remand. The court relied on McKay v. Reliance Standard Life Insurance Co., 428 F. App’x 537 (6th Cir. 2011), observing that Plaintiff had persuaded the court that LINA failed to comply with ERISA’s notice requirements and that LINA denied Plaintiff the kind of review to which she was entitled. That LINA offered the remand early in litigation, and that Plaintiff initially opposed it, went to the weight of the King factors rather than to threshold eligibility.

How did the King factors resolve?

The court applied the five-factor King analysis and found the balance tipped against a fee award. On the first factor, the court found that LINA’s notice failure reflected an honest procedural mistake rather than bad faith, although it noted that unlike the plan administrator in Shelby Cnty. Health Care Corp. v. Majestic Star Casino, 581 F.3d 355 (6th Cir. 2009), LINA conducted no review at all, causing the first factor to weigh slightly in Plaintiff’s favor. The second factor, LINA’s ability to pay, also favored Plaintiff. Factors three and four, however, weighed against a fee award: a fee award would not deter other plan administrators from inadvertent procedural errors, and the remand conferred no common benefit on other plan participants or beneficiaries. The fifth factor, the relative merits of the parties’ positions, also favored LINA, as the court ultimately sided with LINA on the merits and Plaintiff’s counsel incurred the vast majority of the requested fees after LINA had correctly moved for remand. The court noted that imposing on LINA the economic burden of Plaintiff’s opposition would be unfair given the purpose of ERISA fee-shifting. The court denied Plaintiff’s request for attorney’s fees of $20,921 and granted her undisputed costs of $450.37.

The court denied the motion to reopen and granted costs only.