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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 23 attorneys engaged exclusively in employee benefits, estate planning and employment law. Seven 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

 

 

 

 

January 9, 2014

 

 State and Federal Law Alert

 

 

 

Supreme Court Rules ERISA Plan's Limitations Period for Filing Lawsuit is Enforceable

 

 

 

The Supreme Court recently determined the extent to which the terms of an ERISA-covered plan can establish when the statute of limitations to file a lawsuit related to the denial of benefits begins to run. In deciding Heimeshoff v. Hartford Life & Accident Insurance Company, the Court unanimously held that a participant and plan may agree by contract to a particular limitations period as long as the period is reasonable and is not contrary to a controlling statute

 

Background

 

In August of 2005, the plaintiff submitted a claim for benefits under her employer's ERISA-covered long-term disability plan. The applicable insurance policy required the plaintiff to submit proof of the claim by December 8, 2005, and provided that the applicable three-year statute of limitations to file a lawsuit related to the denial of benefits began on the date proof of the claim was due.

 

During the claim evaluation process, the plaintiff failed to respond to the insurer's requests for information and, consequently, her benefit claim was denied. The plaintiff filed an informal appeal with the insurer and, in November of 2007, her claim was again denied.

 

In November of 2010, the plaintiff filed a lawsuit in federal district court to challenge the insurer's denial of benefits. The insurer moved to dismiss the lawsuit asserting that it was barred by the plan's limitation period, which required the lawsuit to be filed no later than December 8, 2008 (i.e., three years after proof of the claim was due). The United States District Court for Connecticut agreed with the insurer and dismissed the lawsuit. On appeal, the Second Circuit affirmed the decision. The plaintiff next appealed to the Supreme Court, which granted certiorari to resolve a split among the circuits on the enforceability of this provision.

 

Supreme Court Ruling

 

The plaintiff's primary argument before the Court was that the plan's limitation period ran afoul of the general rule that statutes of limitation must begin on accrual of the relevant cause of action. Under ERISA, a participant's cause of action does not accrue until the plan issues a final decision. Thus, because proof of loss was due before the plan's administrative process could be completed, the administrative exhaustion requirement shortened the three-year limitation period.

 

The Court disagreed with the plaintiff, ruling that a plan's limitations provision was enforceable and that the statute of limitations provides only a default rule that permit parties to agree to a shorter limitation period. In reaching this decision, the Court acknowledged that parties can not only agree to the length of the limitations period but also the time at which it commences.

 

The Court concluded that the plan's limitations provision must be give effect unless (1) the period is unreasonably short or (2) a controlling statute prevents the limitations period from taking effect. The court determined that the plan's three-year limitations period was not unreasonable because it provided the plaintiff with over a year to file suit after the conclusion of the administrative review process. The Court also rejected the plaintiff's contention that ERISA was a controlling statute contrary to the limitations provision by finding that it was highly doubtful the plan's limitation period would undermine ERISA's remedial scheme. Accordingly, the Court affirmed the Second Circuit and the plaintiff's lawsuit was dismissed.

 

Impact of Heimeshoff on ERISA-Covered Plans

 

The practical effect of the Supreme Court's decision in Heimeshoff is that limitations provisions of the kind found in the employer's long-term disability plan are enforceable so long as the limitation period is reasonable in length and there is no controlling statute to the contrary.

 

The full text of the Supreme Court's Heimeshoff opinion can be accessed at: http://www.supremecourt.gov/opinions/13pdf/12-729_q8l1.pdf

 

 

 

 

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Pursuant to Internal Revenue Service Circular 230, we hereby inform you that any advice set forth herein with respect to US federal tax issues is not intended or written by The Wagner Law Group to be used and cannot be used, by you or any taxpayer, for the purpose of avoiding penalties that may be imposed on you or any other person under the Internal Revenue Code.

 

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.