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The Wagner Law Group

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

  

Boston 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110


Palm Beach Gardens 

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

   

Tampa

Tel: (813) 603-2959

Fax: (813) 603-2961

101 East Kennedy Boulevard

Suite 2140
Tampa, FL  33602 

 

San Francisco

Tel: (415) 625-0002

Fax: (415) 358-8300

315 Montgomery Street

Suite 904

San Francisco, CA 94104

 

St. Louis

Tel: (314) 236-0065

Fax: (314) 236-5743
100 South 4th Street, Suite 550
St. Louis, MO  63102 

 

www.wagnerlawgroup.com

 

 

 

 

September 3, 2015

 

 Health and Welfare Law Alert

 

 

 

Federal Court Rules that Plan Must Provide Notice of Limitation Period in Benefit Denial Letter

 

 

 

 

 

The Third Circuit Court of Appeals has ruled that ERISA requires plan administrators' adverse benefit determination notices to explain any plan-imposed time limit for seeking judicial review and that any notification that fails to disclose such a time limit is noncompliant. In Mizra v. Insurance Administrator of America, Inc., the court imposed this requirement on an employer that sponsored an ERISA-covered plan that imposed a one-year time limit for judicial review of an adverse benefit determination.

 

Law. Section 502(a) of ERISA grants claimants the right to sue plan administrators in federal court to recover benefits due under the terms of the plan. However, Section 502(a) does not provide an applicable statute of limitations. In response, courts have determined that plan administrators and fiduciaries may create their own, reasonable time limit for judicial reviews. When a plan does not impose such a time limit, courts uniformly apply the statute of limitations for the most analogous state-law claim.

 

Background. In Mizra, an employer's ERISA-covered plan required claimants who received benefit denials to appeal the determination through an internal appeal process. Further, the plan provided a one-year time limit for claimants to sue for benefits following the plan administrator's final claim denial.

 

After the final denial of the plaintiff's claim, the plan administrator sent a letter to the plaintiff which explained the denial and stated that he had a right to bring a civil action under ERISA Section 502(a) if he was not satisfied with the final determination. However, the letter failed to explain to the plaintiff that he had one year from the date of final denial to file suit.

 

The plaintiff did not sue the plan administrator to recover benefits until 19 months after the final determination. As a result, the district court dismissed the plaintiff's claim, finding that it was barred by the plan's one-year limitation period. In response, the plaintiff appealed the district court's decision to the Third Circuit.

 

Third Circuit. The Third Circuit focused its analysis on whether the plan administrator had violated ERISA by failing to disclose, in the denial letter, the plan-imposed one-year time limit for seeking judicial review. Specifically, the court found that the applicable ERISA regulations required the plan administrator's adverse benefit determination to not only explain the claimant's right to sue, but also to include the time limit for bringing such a lawsuit. The court noted that both Courts of Appeals that had previously addressed the issue (i.e., the Sixth Circuit in 2014 and the First in 2011) had similarly concluded that ERISA required disclosure of the plan-imposed time limit.

 

The Third Circuit set aside the plan's one-year limitation period. Instead, it applied the applicable statute of limitations for breach of contract actions under state law, which was six years. It then ruled that the plaintiff had, therefore, filed a timely lawsuit.

  

Action Steps for Employers. Employers that sponsor ERISA-covered plans that impose a time limit for bringing a lawsuit must be sure to explain such time limit in all adverse benefit determination notices. By doing so, employers will ensure compliance with ERISA with regards to plan-imposed time limits.

 

 

 

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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.