Tibble v. Edison Int’l, — F.3d –, 2016 WL 1445220 (9th Cir. Apr. 13, 2016) (“Tibble II”), marks the Ninth Circuit’s second review of the case after its earlier decision was vacated by the Supreme Court. Tibble v. Edison Int’l, 135 S.Ct. 1823 (2015) (“Tibble I”). Tibble I concerns the commencement of the statute of limitations for breach of fiduciary duty under 29 U.S.C. § 1113, which provides that an action must be brought within six years of “the last action which constituted a part of the breach or violation.”
Continue Reading On Tibble remand, court finds plaintiffs forfeited continuing-duty-to-monitor argument
Failure to disclose contractual limitation in ERISA claim denial letter is per se prejudicial
In Santana-Diaz v. Metro. Life Ins. Co., 816 F.3d 172 (1st Cir. 2016), the court held “that ERISA requires a plan administrator in its denial of benefits letter to inform a claimant of not only his right to bring a civil action, but also the plan-imposed time limit for doing so. Because MetLife violated this regulatory obligation, the limitations period in this case was rendered inapplicable[.]” The First Circuit thus reversed the district court, which had held that the failure to provide notice was not dispositive because plaintiff was aware of the limitation through the group policy.
Continue Reading Failure to disclose contractual limitation in ERISA claim denial letter is per se prejudicial
Third Circuit rules that claim denial letters must disclose contractual limitation period
In Mirza v. Ins. Administrator of Amer., Inc., 800 F.3d 129 (3d Cir. 2015), the court held that the failure to disclose a contractual limitation period in a denial letter precluded enforcement of that limitation, and required application of the most analogous state limitation period.
The district court had ruled, in granting summary judgment for defendant, that a lack of notice was irrelevant, because the plaintiff had knowledge of the limitation, and therefore could not benefit from the equitable tolling that might otherwise flow from a lack of required disclosure. The Third Circuit held “we do not find equitable tolling to be an obstacle, or even relevant, to Mirza’s claim.”
Continue Reading Third Circuit rules that claim denial letters must disclose contractual limitation period
Disability Benefit Underpayment Claim Accrues When Benefit Calculated
Long-term disability plans typically pay benefits on a monthly basis. When there is a dispute about the calculation of benefits, when does that claim accrue? And does each new underpayment give rise to a new claim? The First Circuit answered those questions in Riley v. Met Life Ins. Co., — F.3d –, 2014 WL
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.
Continue Reading Heimeshoff v. Hartford – Supreme Court Briefing
Statute of Limitations Can Start Running Before Claim Accrues
ERISA claim practitioners generally have the concept of exhaustion of administrative remedies engrained in our thought process. They know well that claimants are required to exhaust their administrative remedies before they can sue over a benefit determination. Given the focus on this exhaustion requirement, it may surprise some to know that, in many circuits, the statute of limitations clock can begin to run well before administrative remedies are exhausted.
Continue Reading Statute of Limitations Can Start Running Before Claim Accrues