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Reopening of Claim Does Not Waive Issues Regarding Timeliness of Appeal

Reopening of Claim Does Not Waive Issues Regarding Timeliness of Appeal

Witt v. Metropolitan Life Ins. Co., 2014 WL 769285 (N.D. Ala. Feb. 25, 2014)


ERISA and Life Insurance News
(May 30, 2014)

Witt was paid disability benefits until May 1997, when his claim was denied on the grounds that he had failed to provide adequate medical records in support of the claim. The denial letter – which Witt denied having received – provided a 60-day time limit to request an administrative appeal. Witt submitted no appeal of the claim decision.

Twelve years later, in May 2009, Witt’s attorney contacted MetLife and requested the status of the claim, stating that Witt had received an approval letter but no payment. MetLife stated that it would pull the archived file once the attorney submitted a copy of the approval letter and a letter of representation. These documents were not provided until December 2009. Thereafter, MetLife reviewed the file and informed Witt’s attorney that the claim had been terminated. MetLife offered, however, to review additional supporting medical records if submitted.

In February 2011, Witt submitted additional documents through his attorney. The following month, MetLife informed Witt that, upon review of the medical information, the claim would remain terminated. The letter also informed Witt that he could appeal within 180 days. Witt’s attorney stated in September 2011 that he was appealing. After several extensions of time, the attorney submitted additional documents in November 2011.

MetLife issued a final denial in May 2012. In June 2012, Witt filed suit.

MetLife argued that Witt missed two deadlines which barred his lawsuit. First, Witt failed to submit an appeal within 60 days of the original claim decision. Additionally, he did not file suit within the six-year statute of limitation generally applied in Alabama for ERISA claims. Witt argued in response that MetLife had waived its timeliness arguments by failing to assert them during the reopened administrative proceedings.

First, the court determined that the six-year statute had begun to run “at the latest” by June 1997. Even if Witt had not received the denial letter, “he should have known about his termination when he realized he was no longer receiving the money that MetLife had been paying to him on a monthly basis,” the court reasoned. As a result, Witt filed his suit “long after the statute had run – and many years after the 60 day time period under the Plan.”

The court also rejected Witt’s waiver arguments. Although the parties cited case law on both sides of the issue, the court found the cases cited by MetLife to be more persuasive. The court noted that “it stretches credulity ... to argue that a plaintiff who allows his claim to lie dormant for twelve years and is in no rush to provide the needed documentation when he finally gets around to reasserting his claim, should be able to accuse the defendants of waiving their statute of limitations defense by reviewing the medical documentation that he finally provides nearly fourteen years later.”

To conclude otherwise, the court wrote, would create negative incentives for ERISA plan administrators. “If courts were to hold that the provision of any extra review would prevent plan administrators from invoking the statute of limitations, then plan administrators would be forced to invoke a strict policy of no review outside of the strict time periods provided by the plan,” the court reasoned.

Click here to view the full May 2014 Edition of the ERISA and Life Insurance News.

Authors
H. Sanders Carter
T (404) 962-1015
F (404) 962-1220
Kenton J. Coppage
T (404) 962-1065
F (404) 962-1256
Dorothy H. Cornwell
T (404) 962-1096
F (404) 962-1246
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