The Ugly Truth About ERISA Plans And Contractual Limitations Period
When Does The Meter Run On Your ERISA Disability Claim?
In Heimeshoff v. Hartford Life and Accident Insurance Company, U.S.#12-729(December 16, 2013) the United State Supreme Court found that “absent the controlling statute to the contrary a participant and a plan may agree by contract for particular limitations., even when it starts to run before the cause of action approves, as long as the period is reasonable.” That is bad news for an ERISA policy holder whose claim has been denied.
The Contractual Limitations In An ERISA Disability Plan
The Hartford Life and Accident Plan in the Heimeshoff case included a provision that “any litigation challenging an adverse benefit determination had to be brought within 3 years after time “proof of loss” was to be submitted to the plan administrator.
What’s the Problem? When Did The 3 Years Start and End?
Many ERISA Plans require the policy holder to exhaust their administrative remedies before filing suit. The practical problem is that the time to file a lawsuit may expire before the Plan Administrator issues a final benefits determination.
This can cause a problem for a policy holder who is trying to exhaust their administrative remedies under the ERISA plan, while the time in which to file suit is potentially expiring. For example, the policy in dispute provided that no action can be brought more then 3 years after the time written proof of loss is to be required to be furnished according to the terms of the policy.
Proof of loss had to be submitted within “90 days after the start of the period from which Hartford owes the payment.” What does that mean?
Ms. Heimeshoff had fibromyalgia and chronic pain and filed a claim in 2005 for long term disability benefits which was denied in December of 2005. After an informal appeal, the last denial letter was issued by Hartford on November 25, 2007.
When Does The Statute Of Limitations Run In This Case?
According to the Supreme Court, Heimeshoff, lawsuit challenging Hartford’s decision which was filed on November 28, 2010 was late. According to Hartford, “Heimeshoff was to file suit no later than December 8, 2008, 3 years after proof of loss was due to Hartford.”
This is a trap that many policy holders need to be aware of or they can be barred from filing a lawsuit. Ms. Heimeshoff lost all of her rights to her benefits because her lawsuit was filed late.
What Should I Do If My Disability Claim Has Been Denied?
You need to immediately retain a experienced ERISA disability attorney who understands how to ready the policy and determine when the statute and limitations expires! Don’t get caught short or delay! You can learn more about your rights in filing an ERISA appeal and what to do if your claim has been denied by contacting Nancy L. Cavey, an ERISA attorney, who can help you with your benefits regardless of where you live in the United States.
Call (727) 894-3188 for a complimentary consultation today!