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Seibert–Keck had a group plan for long-term disability benefits, managed by the Unum Life Insurance Company of America (Unum).

But by August 1, 2008, his medical condition became too much to bear once more—Engleson filed another claim for disability benefits on that day, claiming that he was unable to work as of the day before. The Amara Court made clear that SPDs have a singular purpose: “clear, simple communication.” Amara, 131 S. Menasha Corp., 690 F.3d 444, 455–56 (6th Cir.2012) (citing Amara, 131 S. Further undermining the Richards rationale is our subsequent decision in Lipker v. In Lipker, we held that “[s]ilence in the SPD regarding a term the plan defines more explicitly does not make out a ‘conflict[,]’ “ id. Neither Hounshell nor the general waiver rule bodes well for Engleson's argument; in some sense, he has fashioned a choose-your-own-adventure for himself in which both choices lead to disappointment. By proposing the alternative standard, Engleson indicates that he already knew his argument would be futile under Hounshell; therefore, we turn to the general waiver rule.When Care Source Will NOT Automatically Adjust a Denied COB Claim: If the updated coverage was received after 90 days from the denial for COB, the provider still needs to notify Care Source within 365 days of date of service that the claim is COB.OR, the provider still needs to notify Care Source within 90 days from the date of the primary EOB denial, whichever is greater.From Unum's perspective, nothing in the file suggested that Engleson had been “continuously disabled.”But Unum also offered an internal appeal, which Engleson took advantage of on August 28, 2001.In doing so, he asked for his claim file, stating: “I would appreciate it very much if you would provide me with the documents contained in your claim file which were pertinent to your denial decision.” Unum sent the file.

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