The latest ERISA case to go to the Supreme Court is Heimeshoff v. Hartford Life & Accident Ins. Co., 2012 WL 171325 (D. Conn. Jan. 2012), aff’d, 496 Fed. Appx. 129 (2d Cir. Sep. 13, 2012), cert. granted in part, 133 S.Ct. 1802 (Apr. 15, 2013). The issue to be addressed by the Supreme Court is: When should a statute of limitations accrue for judicial review of an ERISA disability adverse benefit determination?
This firm successfully argued, at the District Court and Second Circuit, that Heimeshoff’s lawsuit was untimely under the limitations period set forth in the disability plan under which she sought benefits. The case will be argued in the Supreme Court on October 15, 2013, with Wilmer Cutler Pickering Hale and Dorr LLP representing defendants. We will provide, in a series of posts, a summary of the facts and issues, the lower court decisions, and the arguments raised in the Supreme Court briefing. We will also provide reports on the oral argument and the ultimate decision.
Every so often a bit of legal synchronicity seems to occur. Sometimes its personal, like when you have several cases with the same uncommon issue, or multiple cases in the same rarely visited court. In 2013, there appears to be a larger force at work that has caused three circuits to address the question whether a plan that requires proof to be satisfactory to the insurer confers discretion.
It has long been clear that a plan document must give discretionary authority to an insurer in order to require courts to conduct an arbitrary and capricious review. It is also well-established that no “magic words” are required to give discretion. However, the vast majority of plans intending to grant discretion use the magic words anyway, and say that the insurer has “discretionary authority to determine claims and construe the plan” or some variant.
The Supreme Court heard arguments yesterday in this case, which involved the question whether a contractual limitations period in an ERISA benefit plan could begin to run before administrative remedies were exhausted. Continue reading →
At the District Court, Heimeshoff also argued that the limitation period in the plan should be equitably tolled because, she claimed the applicable ERISA regulation required Hartford to disclose the limitation period in its denial letter, and it failed to do so. Hartford argued that it was irrelevant whether the regulation required disclosure because Heimeshoff and her attorney knew what the plan said, and their knowledge precluded them from seeking equitable tolling. Hartford also argued that the regulation did not require disclosure. Continue reading →
Hartford moved to dismiss the action because it was filed after the expiration of the policy’s contractual limitation period. The plain language of the Policy gave her until December 8, 2005 to submit proof of loss: she alleged that her disability began on June 6, 2005; the ninety-day Elimination Period would ordinarily end on September 6, 2005, but her Elimination Period lasted two days longer because Wal-Mart made salary continuation payments to her until September 8, 2005; the start of the period for which Hartford would owe payment (if Heimeshoff had proven disability) was September 9, 2005; proof of loss was due ninety days later, or December 8, 2005. The deadline for taking legal action was therefore three years after that, or December 8, 2008. Continue reading →
Wal-Mart established an employee benefit plan to provide disability benefits to its employees, which it funded through a group disability policy issued by Hartford. The policy contained a contractual limitation provision specifying the deadline for lawsuits: “Legal actions cannot be taken against the Hartford … after … 3 years after the time written proof of loss is required to be furnished according to the terms of the policy.” Written proof of loss was due 90 days after the end of the Elimination Period; since the Elimination Period was 90 days, proof of loss was due 180 days after the claimed date of disability, and the deadline for any suit would be roughly 3-1/2 years after the claimed date of disability. Continue reading →
Any ERISA claim practitioner knows that a claimant is entitled to get a copy of the documents relevant to her claim on request and without charge. But when does the claimant’s right to this access become effective? More particularly, can the claim administrator defer production until after the claimant files an administrative appeal? A recent case in the Second Circuit suggests that it is sufficient to provide the claim file promptly after the appeal is filed. James v. Unum Life Ins. Co. of America, 2012 WL 4471541 (S.D.N.Y. 2012), aff’d, 2013 WL 4516424 (2d Cir. Aug. 27, 2013). Continue reading →
In a post from last year, I reported on how the Fifth Circuit had issued a decision In ACS Recovery Servs., Inc. v. Griffin, 676 F.3d 512, 514 (5th Cir. 2012), in which it held that an ERISA plan beneficiary and his lawyer had created a perfect settlement structure in which no one ever had enough possession or control over the substantial settlement proceeds to support an equitable remedy.
The Fifth Circuit decided that the shell game issue was “enbancworthy” and, in a May 7, 2013 decision, reversed the panel’s decision. Continue reading →