Long COVID LTD Claim Survives Summary Judgment: Hartford’s Flawed Tolling Calculation Triggers ERISA Deemed Exhaustion Rule

In Bianchini v. The Hartford Life and Accident Insurance Company, No. 24-CV-6535 (JGLC), 2026 WL 810303 (S.D.N.Y. Mar. 24, 2026), Plaintiff Bianchini, a former director of digital marketing at Blackstone Administrative Services Partnership, L.P., appealed Hartford’s denial of her long-term disability benefits claim under her employer’s Group Long Term Disability Plan, asserting breach of contract under ERISA § 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B). Hartford moved for summary judgment on the sole ground that Bianchini failed to exhaust administrative remedies. The court denied Hartford’s motion, holding that Hartford’s procedural violations of 29 C.F.R. § 2560.503-1 deemed Bianchini’s administrative remedies exhausted. The court simultaneously denied Bianchini’s motion to supplement the administrative record with live trial testimony.

Bianchini tested positive for COVID-19 in March 2020 and April 2022 and thereafter developed long COVID symptoms including extreme fatigue, brain fog, post-exertion malaise, headaches, blurred vision, heart palpitations, and cognitive impairment. Hartford denied her November 2023 LTD claim in December 2023, concluding there were no restrictions preventing sedentary work. Bianchini timely appealed in June 2024, submitting personal statements and a neuropsychological evaluation. Hartford requested additional information — specifically the raw neuropsychological testing data — by July 7, 2024. On July 3, Bianchini’s counsel responded, provided mental health records from two other providers, and advised that the neuropsychological data could only be released directly to another licensed psychologist, suggesting Hartford arrange the transfer directly. Hartford then contacted Bianchini’s neuropsychologist directly, and on July 22 sent Bianchini a notice stating it required a 45-day extension due to the outstanding physician data, that it would continue review by August 1 at the latest, and that it would issue a decision no later than 45 days after receiving the requested information. The neuropsychologist provided the data on July 31. Hartford upheld its denial on September 16, 2024 — after Bianchini had filed this action on August 29.

The court addressed two independent procedural violations. First, on tolling, the court applied McFarlane v. First Unum Life Ins. Co., 274 F. Supp. 3d 150 (S.D.N.Y. 2017), which held that Section 503-1(i)(4) permits tolling only upon a claimant’s — not a third party’s — failure to submit necessary information. Because Bianchini’s counsel responded on July 3, the tolling period ran only from June 27 through July 3 — six days. After that response, Hartford was awaiting information exclusively from Bianchini’s neuropsychologist, a third party, and had itself reached out to him directly. Hartford’s argument that its July 22 letter placed responsibility on Bianchini to ensure receipt of the data was unavailing; the court found that letter’s own language confirmed Hartford was waiting on the physician, not the claimant. Second, on the extension, the court held that while Hartford’s July 22 notice was not facially invalid — it provided a definite outer date of September 15, distinguishing it from the wholly open-ended notice in McFarlane — it nonetheless exceeded the single permissible 45-day extension. With only six days of valid tolling, the maximum permissible determination deadline was September 11, 2024, or 96 days after the appeal was filed (45 initial days + 6 tolling days + 45 extension days). Hartford’s September 16 determination came five days late.

The court then considered whether Hartford’s violations were excusable under Section 503-1(l)(2)(ii)’s exception for de minimis violations occurring in good faith that are not for good cause or due to matters beyond the plan’s control. Hartford argued that waiting on the neuropsychologist’s data constituted a matter beyond its control. The court disagreed, noting that ERISA’s own regulations require that the determination period run “without regard to whether all the information necessary to make a benefit determination on review accompanies the filing,” and that Hartford’s July 22 letter had itself confirmed it would resume review by August 1 regardless of whether the data had arrived — effectively conceding the data was not necessary to proceed. Waiting on third-party medical records, the court held, is commonplace in insurance claims administration and does not justify the violations.

On Bianchini’s motion to supplement, the court denied relief on both asserted grounds. Hartford’s structural conflict as both administrator and payor, standing alone, was insufficient without specific allegations that the conflict adversely affected the record’s development. Hartford’s procedural violations likewise did not warrant supplementation because the deadline failure had no effect on what evidence was admitted — Bianchini identified no evidence that would have been in the record but for the untimely determination, and the live testimony she sought would, by her own admission, contextualize existing record evidence rather than introduce new material. The court directed the parties to submit a joint briefing schedule by April 7, 2026 for a bench trial on the papers on the merits of Bianchini’s disability claim.