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?”
The facts are suitably odd, but the decision is useful. The plaintiff filed a claim in 1997 for a 1995 disability. Met Life approved the claim, paid benefits (mostly) retroactively for two years, and then closed the claim for failure to submit proof of continuing disability. Met Life says it sent a letter regarding the decision, but by the time the litigation was filed in 2012, it could not locate a copy; plaintiff said he never received it.
Plaintiff’s attorney contacted Met Life in 2009 about the claim, and Met Life offered to consider any new evidence plaintiff submitted. Plaintiff submitted documents a year later; Met Life considered them, denied the claim, and upheld the decision on appeal. Plaintiff sued, and the district court found his claim was barred by Alabama’s six-year statute of limitations (which both parties agreed applied). The 11th Circuit affirmed.
The court held that, even though state law supplied the limitation period, federal law specifies the date on which that period begins. The court noted that it had never addressed accrual when plaintiff disputes receiving a formal denial.
It observed that the 1st, 3rd and 9th Circuits had “squarely concluded that [in the absence of a formal denial] an ERISA cause of action accrues – and the limitations period begins to run, when the claimant has reason to know that the claim administrator has clearly repudiated the claim or amount sought.” It also observed that the 2nd, 6th and 8th Circuits “have applied a clear-repudiation accrual rule, although under distinguishable fact patterns, and concluded that an ERISA cause of action may accrue prior to a final or formal denial of the plaintiff’s claim.”
With that authority, the court ruled that Met Life’s conduct in not paying benefits after April 1997 “demonstrated a clear and continuing repudiation of Witt’s rights[.]” It held that twelve months of non-payment clearly suffices as a repudiation, and left open “the exact number of missing monthly benefits payments that were required to put Witt on notice that his claim had been clearly repudiated and thus denied.”
The court also “reject[ed] Witt’s attempt to exploit MetLife’s failure to locate a 12–year–old document where Witt had reason to know of the acts giving rise to his cause of action, regardless of whether he received the 1997 letter. Adopting Witt’s position would undermine the very purpose of statutes of limitations, which ‘characteristically embody a policy of repose, designed to protect defendants’ and ‘foster the elimination of stale claims, and certainty about … a defendant’s potential liabilities.’”
Finally, the court rejected plaintiff’s argument that Met Life had waived the statute of limitations defense, ruling that “MetLife’s voluntary reconsideration of Witt’s benefit claim cannot revive or resurrect that already-time-barred claim.” Similarly, the failure to include a reservation of the statute of limitations defense in its 2010 “courtesy review” letters could not be a waiver.