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The Wagner Law Group Description 

The Wagner Law Group, A Professional Corporation, is a nationally recognized ERISA & employee benefits, estate planning, employment, labor & human resources practice. 

 

Established in 1996, The Wagner Law Group has 22 attorneys engaged exclusively in employee benefits, estate planning and employment law. Six of our attorneys are AV rated by Martindale-Hubbell as having very high to preeminent legal abilities and ethical standards. The firm is among the largest ERISA boutiques in the country. Our practice is national in scope, with clients in more than 40 states and several foreign countries.

 

 

 

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Massachusetts Office 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110


Florida Office 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418

   

San Francisco Office

Tel: (415) 625-0002

Fax: (415) 358-8300

315 Montgomery Street

Suite 904

San Francisco, CA 94104

 

www.wagnerlawgroup.com

 

 

 

 

August 14, 2014

 

 Health and Welfare Law Alert

 

 

 

Plan Must Inform Participant of Time Limitation on Initiating Lawsuit

 

 

 

A federal appeals court has ruled that an employee can proceed with a lawsuit against an insurer despite the expiration of the contractual limitations period contained in his employer's long-term disability ("LTD") plan because the insurer did not include the deadline for initiating a lawsuit in its benefit denial letter. In Moyer v. Metropolitan Life Insurance Company, the Sixth Circuit Court of Appeals held that the letter did not satisfy ERISA's requirements because it did not specify the time limit for judicial review.

 

ERISA Requirements. ERISA requires benefit denial letters 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 sue following an adverse benefit determination.

 

Background. The plaintiff was a participant in his employer's LTD plan that was administered by the defendant. The plaintiff had applied for, and was approved, for LTD benefits. However, the defendant later revoked its approval after it determined the plaintiff could perform his job. The plaintiff contested this decision under the plan's internal appeals process, and the defendant affirmed the denial. However, neither the benefit denial letter nor the summary plan description mentioned that a three-year contractual time limit applied to judicial review of an adverse benefit determination.

 

The plaintiff sued the defendant in federal district court to contest the adverse benefit determination, unaware that the three-year contractual period had expired. The defendant moved to dismiss the case, asserting that the plan's three-year limitations period barred the claim. The district court agreed, finding that the plan document stated that the three-year limitations period was violated. The plaintiff then appealed this decision to the Sixth Circuit Court of Appeals.

 

Analysis. The Sixth Circuit ruled that the defendant's failure to directly notify the plaintiff of the contractual time limit violated ERISA. The court noted that other Circuit Courts had made similar rulings stating that plan administrators must include any time limits for judicial review in adverse benefit determination letters. Furthermore, the court ruled the defendant had failed to substantially comply with ERISA and applicable DOL regulations because exclusion of the judicial review time limit was inconsistent with ensuring a fair opportunity for review. Accordingly, the Sixth Circuit reversed the lower court's holding and remanded the claim (to the lower court) to consider the plaintiff's appeal of the adverse benefit determination.

   

 

 

 

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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.