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ERISA claimants must sue quickly or risk being thrown out of court.

By Jeffrey Herman

 

I’ve written before about the significant problems ERISA claimants face, especially when they try to handle claims themselves. Here’s another to add to the list: If you don’t file a lawsuit quickly, you may not ever get the chance. 

 

Most employer-sponsored insurance plans—whether they are disability plans, health plans, pension plans, or life plans—are, in the end, just contracts between your employer and an insurance company. And your rights are, to a large extent, determined by that contract.

 

So what if that contract says you have to file your lawsuit within 3 years after making a claim for benefits? And, after you make the claim, it takes two years to be denied and go through the appeal, leaving you only one year to file the lawsuit? But you file it just after that?

 

Well, tough. In the 2013 case of Heimeshoff v. Hartford Life & Accident Ins. Co., the Supreme Court dealt with that exact situation. The Court emphasized that ERISA plans are contracts, and contracts are allowed to have reasonable limitations for filing lawsuits. So, too, then, should ERISA plans. And because the claimant didn't file his lawsuit within the 3 year period, it was thrown out of court.

 

It would be different, the Supreme Court said, if the time period for filing the lawsuit were “unreasonably short,” or if a statute required otherwise. But barring that, you have to do what the plan says.

 

But how short is too short? What can ERISA plans get away with?

 

The federal court in St. Louis recently held that 2 years from the date of the decision on appeal is okay. Munro-Kienstra v. Carpenters' Health & Welfare Trust Fund of St. Louis, 2014 U.S. Dist. LEXIS 18156  (E.D. Mo. Feb. 13, 2014).

 

Another federal court held that a 3 year limitation that left the claimant with just 9 months after the final denial was okay. Tuminello v. Aetna Life Ins. Co., 2014 U.S. Dist. LEXIS 20964 (S.D.N.Y. Feb. 14, 2014).

                                                   

Another court held that a claimant left with less than 7 months to file suit was reasonable. Russell v. Catholic Healthcare Partners Emple. Long Term Disability Plan, 577 Fed. Appx. 390 (6th Cir. 2014).

 

But leaving a person with barely more than 3 months to file suit after the denial, just about 100 days? That is not reasonable. A federal court refused to approve of such a short timeframe. Nelson v. Std. Ins. Co., 2014 U.S. Dist. LEXIS 119179, 14 (S.D. Cal. Aug. 26, 2014).

 

And how can a claimant comply with an insurance provision if she is never given a copy of the insurance contract? In that case, missing a deadline that was never disclosed in the first place is excusable. Walden v. Metro. Life Ins. Co. of Am., Inc., 2014 U.S. Dist. LEXIS 173221 (D. Colo. Dec. 16, 2014).

 

Bottom line: You have to be really careful when it comes to your ERISA appeal. After the Supreme Court’s 2013 decision, time limitations in ERISA plans will spread like wildfire. And if you miss a deadline, you may be out of luck.

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