We all know that texting while driving is a bad idea and has been the cause of countless accidents. But what about texting after an accident? Texting shortly after an accident might be very wise, especially when it serves as prompt notice of work-related injuries in writing to your employer.
Policies occasionally cover work-related injuries, and sometimes those policies clearly read that specific forms must be submitted for the claim to be paid. However, if the policy does not clearly require specific submission of forms, but more generally requires notice of the claim in writing, is texting enough? May an insurance company interpret that general provision so as to require submission of specific forms and reject texting?
A magistrate judge in Cervantes v. 3NT LLC, No. EP-19-CV-00383-DCG (W.D. Tex. May 2, 2022) had occasion to review that issue and make a recommendation.
Facts of the Case:
- In Texas, 3NT, LLC, provided its employees with an insurance policy to cover work-related injuries when they were not covered by the Texas Worker's Compensation Act. This policy was governed by ERISA, and the employer served as the plan administrator. The insurance company served as the claims administrator.
- Ms. Brenda Cervantes was an over-the-road truck driver.
- While working, her tractor-trailer had a blowout and mechanical issue, which resulted in a collision and injuries.
- Within hours, she called her supervisor, and she was instructed to undergo a drug test.
- She sent a text message to her supervisor and to the owner of the company about the accident and her injuries. She took photographs of the accident scene and submitted those by text message.
- She was later provided a form to sign, but it contained inaccurate and incomplete information about the incident. Furthermore, the form contained agreements for arbitration, subrogation, and release of medical records. There were also blank spaces requesting a description of the accident and how it occurred.
- Because of the incorrect information listed on the form, Ms. Cervantes did not sign. The employer, through its supervisor, asked her to fill in some blanks and sign the form, but she refused. Ms. Cervantes wanted to revise the form, but that was not allowed.
- Ms. Cervantes sought treatment for her injuries, but the insurance company refused to pay the claims.
- First, the insurance company said the treatment was not authorized. In a second letter, the claim was rejected because Ms. Cervantes failed to satisfy the plan's writing requirement by completing the injury report form.
- Ms. Cervantes appealed the refusal to provide coverage, but the appeals committee refused to change the decision because she did not meet the form submission requirement.
- Ms. Cervantes filed a lawsuit contending that her employer interfered with her right to benefits by requiring her to sign a form that was inaccurate and misleading. She made a claim for interference with benefits under section 510 of ERISA, a claim for benefits, and a claim for breach of fiduciary duty.
- A motion for summary judgment was filed by the defendant seeking dismissal of all claims.
- The court recommended granting part of the motion but rejected part thus allowing the case to continue. The court first noted that the section 510 interference claim was based on the refusal to allow Ms. Cervantes to revise the form which had false and inaccurate information. The parties disputed whether she was allowed to revise the form, leaving a question of fact.
- Next, the court considered whether the motion for summary judgment should be granted as to the benefits claim. The motion was predicated on the defendant's interpretation that the form was required, i.e. notification by text was not sufficient.
- The court found that the insurance policy only required notice in writing and did not require submission of the specific form. Text messages are electronic writing, and the plan did not preclude consideration of electronic writing. Adequate notice of the cause of the accident and the injuries had been received.
- In the end, the court allowed both the section 510 interference with benefits claim and the benefits claim to proceed. The magistrate judge recommended dismissal of the breach of fiduciary duty claim.
Ultimately, texting (and thus perhaps emailing) a notice of claim is adequate if the policy requires the notice to be in writing. Thus, texting after an accident – not while driving – is a good thing to do. If you have been injured in a work-related accident and have filed an ERISA claim that was later denied, contact the ERISA long term disability attorneys at The Martin Law Group today.