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One-Year Contractual Limitation Provision Bars Claim for Death Benefits under ERISA Plan

One-Year Contractual Limitation Provision Bars Claim for Death Benefits under ERISA Plan

Webb v. Liberty Life Assurance Co. of Boston, 2016 WL 3087455 (N.D. Ga. June 1, 2016)


ERISA and Life Insurance News
(November, 2016)

Webb was a participant in an ERISA-governed plan sponsored by his employer, Adobe. He was insured under a group policy issued by Liberty, providing basic and optional life and accidental death insurance benefits. On December 27, 2013, Mr. Webb died from a self-inflicted gunshot wound to the head. 

By December 31, 2013, Adobe provided Liberty with the information it was required to submit and noted that the cause of Webb’s death was a “possible suicide.” On January 24, 2014, Liberty received Mrs. Webb’s completed claim form and the death certificate, which stated that the cause of death was suicide. 

On January 27, 2014, Liberty paid the basic life benefit to Mrs. Webb but denied the other benefits based on suicide exclusions. On March 26, 2014, Mrs. Webb, through an attorney, appealed the claim decision and provided additional proof. On June 23, 2014, Liberty upheld its decision. 

Mrs. Webb filed suit on June 12, 2015. Liberty moved for summary judgment based on the contractual limitations provision.

Under the group policy, a legal action could not be commenced “more than one year after the time Proof of claim is required.” The “proof of claim” provision stated: “Satisfactory Proof of loss must be given to Liberty no later than 30 days after the date of loss. Failure to furnish such Proof within such time shall not invalidate or reduce any claim if it was not reasonably possible to furnish such Proof within such time. Such Proof must be furnished as soon as reasonably possible, and in no event, except in the absence of legal capacity of the claimant, later than one year from the time Proof is otherwise required.” 

Citing Harrison v. Liberty Life Assurance Co. of Boston, 2011 WL 2118954, at *2 (N.D. Fla. May 27, 2011), the court construed the contractual limitation provision to mean that a legal action could not be filed “more than one year plus 30 days from the date of loss,” unless it was not “reasonably possible” for the claimant to submit proof within 30 days of the date of loss, in which case the legal action could not be filed more than two years plus 30 days from the date of loss.  

Because Mrs. Webb could, and did, submit the required proof of loss within 30 days of the loss, the court concluded the applicable limitations period was one year and 30 days from the date of loss, or January 27, 2015. Mrs. Webb did not file suit until June 12, 2015. The court found “no reason not to enforce the contractual limitations period” and granted judgment in favor of Liberty.

Click here to view the full November 2016 Edition of the ERISA and Life Insurance News.

Authors
H. Sanders Carter
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Andrea K. Cataland
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Kenton J. Coppage
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Mary B. Ramsay
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Jennifer Noland Rathman
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