When Confusing Appeal Instructions Backfire: Southern District of New York Denies Hartford Summary Judgment in ERISA Disability Exhaustion Fight

In Lucas v. Hartford Life and Accident Insurance Company, No. 24-CV-7561 (VEC), 2026 WL 1759034 (S.D.N.Y. June 18, 2026), United States District Judge Valerie Caproni denied Hartford’s motion for summary judgment on the question of whether Plaintiff exhausted her administrative remedies before filing suit under ERISA. The decision shows how an insurer’s own post-denial communications can create a fact question about where a claimant was required to send an appeal, defeating an exhaustion defense that might otherwise have ended the case.

What does ERISA require before a claimant can sue over a denied disability claim?

Before filing suit to challenge a coverage determination under ERISA, a claimant must exhaust the internal review and appeal procedures the insurer provides. Plaintiff received long-term disability benefits beginning in 2021. In January 2024, Hartford required her to attend an independent medical examination as a condition of continued benefits. Plaintiff attended but left before the exam was complete after refusing to provide photo identification or sign paperwork. On February 28, 2024, Hartford sent a denial letter terminating her benefits. The letter explained the appeal procedure, instructed Plaintiff to send her appeal to a P.O. Box in Lexington, Kentucky, and stated that any appeal had to be submitted within 180 days.

Was the appeal mandatory even though the plan used the word “may”?

Yes. Plaintiff argued that the plan’s statement that she “may appeal” made the internal process optional. The court rejected that argument, following a consistent line of Second Circuit authority holding that “may appeal” language is sufficiently clear to require an insured to file an appeal before suing. Exhaustion was therefore mandatory under the plan.

Did sending the appeal to the claims adjuster instead of the P.O. Box defeat exhaustion?

Not as a matter of law. After the denial, Plaintiff’s counsel exchanged emails with the claims adjuster who signed the denial letter and with another member of Hartford’s claims department. Those employees repeatedly told counsel to “submit the formal appeal,” and stated that “once it is received, it will be sent to the appeal department for handling” and that the claim “will be forwarded to the appeal department for further handling.” On August 20, 2024, 174 days after the denial letter, Plaintiff’s counsel emailed an appeal to the adjuster, attaching a letter addressed to the Kentucky P.O. Box, but never mailed the letter.

The court held that Plaintiff’s decision to send the appeal directly to the adjuster was not unreasonable as a matter of law. Drawing on Israel v. Unum Life Insurance Co. of America, the court reasoned that Hartford’s own messages implied a two-step process in which an employee would “receive” the appeal and then “forward” it to the Appeals Department. Because ERISA places the burden on the plan administrator to establish reasonable appeal procedures and clearly inform participants of them, a reasonable factfinder could conclude that Hartford’s communications created enough ambiguity to make Plaintiff’s approach appropriate.

What happens if the appeal was properly submitted?

If a factfinder concludes Plaintiff appealed within the 180-day window, then Hartford failed to decide the appeal within the 45 days ERISA’s regulations require. Under McQuillin v. Hartford Life & Accident Insurance Co., that failure would mean Plaintiff was deemed to have exhausted her plan remedies and could sue. The court therefore found summary judgment for Hartford on exhaustion inappropriate and denied the motion.

The court was careful to note that denying the motion was not an endorsement of how Plaintiff’s counsel handled the appeal. In footnote 4, the court called it “unfathomable” that a represented party, knowing the appeal ultimately needed to reach the Kentucky P.O. Box, would not have simply dropped the letter in the mail. The court set the matter for a conference to discuss a bench trial and directed Plaintiff to address her repeated refusals of Hartford’s remand offers, warning that she or her counsel may be required to pay Hartford’s accrued fees if the court finds no good-faith basis for those refusals.