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.”
The court reviewed 29 C.F.R. § 2560.503-1(g), and held that it required disclosure of contractual limitations by stating that denial letters were required to include a “description of the plan’s review procedures and the time limits applicable to such procedures, including a statement of the claimant’s right to bring a civil action … following an adverse benefit determination.” The court held that the word “including” meant that “civil actions are logically one of the review procedures envisioned by the Department of Labor. And as with any other review procedure, the administrator must disclose the plan’s applicable time limits.” The court did not address subsection 1(j), which applies to decisions on administrative appeal, and which does not require disclosure of any time limits.
The court held that its interpretation was limited to “plan-imposed time limits on the right to bring a civil action,” and would not require administrators to research and disclose applicable statutes of limitation. The court did not explain how it read that limitation into the regulation.
The court also rejected defendant’s argument that the lack of disclosure was irrelevant when plaintiff had knowledge of the limitation provision: “the doctrine of equitable tolling should not bear on Mirza’s case. If we allowed plan administrators in these circumstances to respond to untimely suits by arguing that claimants were either on notice of the contractual deadline or otherwise failed to exercise reasonable diligence, plan administrators would have no reason at all to comply with their obligation to include contractual time limits for judicial review in benefit denial letters. Instead, they could almost invariably argue that the contractual deadline was in the plan documents and that claimants are charged with knowledge of this fact.”