In Ruderman v. Liberty Mut. Grp., Inc., No. 21-817, 2022 WL 244086 (2d Cir. Jan. 27, 2022), the U.S. Court of Appeals for the Second Circuit ruled that reclassification of a claimant’s disability from one that is physically-based to one that is psychiatrically-based does not constitute an “adverse benefit determination” within the meaning of
Exhaustion of Administrative Remedies
Where Administrative Appeal Deadline Ends on Saturday, Monday Appeal Is Timely
In LeGras v. Aetna Life Ins. Co., 786 F.3d 1233 (9th Cir. 2015), plaintiff’s 180-day period to administratively appeal ended on a Saturday, and he mailed his appeal the following Monday. Aetna denied the appeal as untimely. Plaintiff sued, and the district court had dismissed the claim for failure to exhaust administrative remedies.…
Failure to Understand Exhaustion Requirement Does Not Excuse Compliance
Orr v. Assurant Employee Benefits, 786 F.3d 596 (7th Cir. 2015), concerned the failure to exhaust administrative remedies following the denial of a claim for AD&D benefits. The plan in question required two administrative appeals; the administrator advised plaintiffs of these two appeals, and specifically stated that the failure to complete both reviews…
ERISA Claim Accrues Upon Clear Repudiation of Claim, Even if There is No Formal Denial Letter
In Witt v. Metro. Life Ins. Co., 772 F.3d 1269 (11th Cir. 2014), the court answered the question: “what happens when the defendant says it issued a formal denial letter and the plaintiff says he never received the letter, but it is undisputed the defendant terminated benefits and did not pay the plaintiff any benefits for 12 years?”…
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Heimeshoff v. Hartford Life: Supreme Court Holds that Plan Can Start Limitation Clock Before Benefit Claim Accrues
In Heimeshoff v. Hartford Life & Acc. Ins. Co., 571 U.S. __ (Dec. 16, 2013) , the Supreme Court held that a contractual limitation provision under which the clock begins to run before administrative remedies are exhausted is enforceable under ERISA, as long as a reasonable time is left after exhaustion is expected to occur.
Julie Heimeshoff filed a claim with Hartford for benefits under a disability plan established by WalMart. The plan provided that litigation must be commenced within three years after proof of loss was due. The Court noted that, under applicable ERISA regulations, the typical ERISA claim would be fully administered in about a year, perhaps as long as 16 months. Thus, one would ordinarily expect a claimant to have 1-1/2 to 2 years to bring suit after a claim was fully administered.
When Heimeshoff’s claim was fully administered, she had about 1 year left under the limitation provision to sue. But she waited almost three years, making her suit almost 2 years late under the contractual provision. Hartford and WalMart moved to dismiss Heimeshoff’s action as untimely, and the District of Connecticut agreed, applying Second Circuit precedent enforcing an identical limitation provision. Heimeshoff appealed, and the Second Circuit affirmed on the same basis. The Supreme Court granted certiorari to resolve a split in the circuits regarding the enforceability of a contractual limitation provision that starts to run before administrative remedies are exhausted. (The District Court and the Second Circuit also found that Heimeshoff could not establish a basis for equitable tolling of the limitation period; the Supreme Court declined to grant certiorari on that question).
The Supreme Court unanimously affirmed the dismissal of Heimeshoff’s action.
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Heimeshoff v. Hartford – Oral Argument in the Supreme Court
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.
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Heimeshoff v. Hartford – Supreme Court Briefing
In petitioning for certiorari, Heimeshoff asked the Supreme Court to consider three questions:
1. When should a statute of limitations accrue for judicial review of an ERISA disability adverse benefit determination?
2. What notice regarding time limits for judicial review of an adverse benefit determination should an ERISA plan or its fiduciary give the claimant with a disability claim?
3. When an ERISA plan or its fiduciary fails to give proper notice of the time limits for filing a judicial action to review denial of disability benefits, what is the remedy?
The Supreme Court granted certiorari, but only as to the first issue, as to which there was a conflict among the Circuits.
There are several axioms and rules underlying this case that are not in dispute.
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Heimeshoff v. Hartford – Motion to Dismiss
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.
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Heimeshoff v. Hartford – Introduction
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…
Sixth Circuit Explains Why SPD is Still Important After Amara
In 2011, the Supreme Court clearly held that a summary plan description cannot trump the terms of an ERISA plan, overturning the rule in many circuits. Instead, the Amara rule provides that the plan itself governs over a summary of the plan when the two conflict.
This does not mean that an SPD is meaningless. The continued importance of preparing and distributing SPDs is nicely illustrated by Liss v. Fidelity Employer Servs. Co. LLC, 2013 WL 677280 (6th Cir. Feb. 26, 2013).…
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