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.
Heimeshoff alleged that she became disabled on June 6, 2005, and submitted her claim on August 22, 2005. She did not provide all of the documentation required to evaluate her claim, and, after giving her several notices, Hartford denied the claim on December 8, 2005 because Heimeshoff had “failed to provide satisfactory Proof of Loss[.]”
Heimeshoff retained attorney Steven Krafchick in May 2006 “to assist her in acquiring the ‘satisfactory Proof of Loss’ the Hartford was requesting.” Krafchick wrote to Hartford on May 18, 2006, to request, among other things, a copy of the Policy “[s]o that we can fully understand the claim and advise our client[.]” Hartford sent the Policy to Krafchick on May 31, 2006, and stated that it would reopen the claim if it received the information it had previously requested.
Krafchick submitted additional information in October 2006. Hartford reopened the claim, evaluated the new information, and denied the claim on November 29, 2006 because Heimeshoff had not established her inability to perform the essential duties of her occupation. The November 29, 2006 letter contained a description of the plan’s review procedures and the time limits applicable to such procedures:
If you do not agree with our denial, in whole or in part, and you wish to appeal our decision, you or your authorized representative must write to us within one hundred eighty (180) days from your receipt of this letter. Your appeal letter should be signed, dated and clearly state your position. Along with your appeal letter, you may submit written comments, documents, records and other information related to your claim.
On May 24, 2007 (four days before Heimeshoff’s deadline to administratively appeal), Krafchick requested that Hartford give him until September 30, 2007 to submit additional materials. Hartford agreed to that request, and told him: “If we do not receive additional information by that time, we will evaluate your appeal using the information currently in our file.” On September 26, 2007, just before the expiration of the extended deadline, Krafchick submitted new information.
Hartford conducted an appellate review, and, on November 26, 2007, denied the administrative appeal. In its decision letter, Hartford stated: “This is our final decision and the file remains closed. … You may bring a civil action under Section 502(a) of the Employee Retirement Income Security Act of 1974 (‘ERISA’).”
Based on the terms of the plan, Heimeshoff’s deadline to file suit was December 8, 2008 (a couple of extra days were added to the Elimination Period due to Wal-Mart’s payment of Heimeshoff’s salary). Heimeshoff and Krafchick waited until November 18, 2010 – almost five years after her proof of loss was due, and almost three years after Hartford issued its final denial – to sue. Oddly, though Heimeshoff lived and worked in Arkansas, and though Krafchick was located in Seattle, they chose to sue Hartford and Wal-Mart in Connecticut. They gave no reason why they waited almost three years after the final claim determination to sue. (Indeed, throughout the litigation, Heimeshoff has never given any reason for her delay.