Heimeshoff v. Hartford Life & Accident Ins. Co.

134 S. Ct. 604, 187 L. Ed. 2d 529, 571 U.S. 99, 24 Fla. L. Weekly Fed. S 497, 2013 WL 6569594, 57 Employee Benefits Cas. (BNA) 1265, 2013 U.S. LEXIS 9026, 82 U.S.L.W. 4035
Supreme Court of the United States·Decided December 16, 2013·No. 12–729.·Published·Cited by 349 cases

Opinion

Justice THOMAS delivered the opinion of the Court.

*102 A participant in an employee benefit plan covered by the Employee Retirement Income Security Act of 1974 (ERISA), 88 Stat. 829 , as amended, 29 U.S.C. § 1001 et seq., may bring a civil action under § 502(a)(1)(B) to recover benefits due under the terms of the plan. 29 U.S.C. § 1132 (a)(1) (B). Courts have generally required participants to exhaust the plan's administrative remedies before filing suit to recover benefits. ERISA does not, however, specify a statute of limitations for filing suit under § 502(a) (1)(B). Filling that gap, the plan at issue here requires participants to bring suit within three years after "proof of loss" is due. Because proof of loss is due before a plan's administrative process can be completed, the administrative exhaustion requirement will, in practice, shorten the contractual limitations period. The question presented is whether the contractual limitations provision is enforceable. We hold that it is.

I

In 2005, petitioner Julie Heimeshoff began to report chronic pain and fatigue that interfered with her duties as a senior public relations manager for Wal-Mart Stores, Inc. Her physician later diagnosed her with lupus and fibromyalgia. Heimeshoff stopped working on June 8.

On August 22, 2005, Heimeshoff filed a claim for long-term disability benefits with Hartford Life & Accident Insurance Co., the administrator of Wal-Mart's Group Long Term Disability Plan (Plan). Her claim form, supported by a statement from her rheumatologist, listed her symptoms as " 'extreme fatigue, significant pain, and difficulty in concentration.' " 1 App. to Pet. for Cert. 7. In November 2005, *103 Hartford notified Heimeshoff that it could not determine whether she was disabled because her rheumatologist had never responded *609 to Hartford's request for additional information. Hartford denied the claim the following month for failure to provide satisfactory proof of loss. Hartford instructed Heimeshoff that it would consider an appeal filed within 180 days, but later informed her that it would reopen her claim, without the need for an appeal, if her rheumatologist provided the requested information.

In July 2006, another physician evaluated Heimeshoff and concluded that she was disabled. Heimeshoff submitted that evaluation and additional medical evidence in October 2006. Hartford then retained a physician to review Heimeshoff's records and speak with her rheumatologist. That physician issued a report in November 2006 concluding that Heimeshoff was able to perform the activities required by her sedentary occupation. Hartford denied Heimeshoff's claim later that November.

In May 2007, Heimeshoff requested an extension of the Plan's appeal deadline until September 30, 2007, in order to provide additional evidence. Hartford granted the extension. On September 26, 2007, Heimeshoff submitted her appeal along with additional cardiopulmonary and neuropsychological evaluations. After two additional physicians retained by Hartford reviewed the claim, Hartford issued its final denial on November 26, 2007.

On November 18, 2010, almost three years later (but more than three years after proof of loss was due), Heimeshoff filed suit in District Court seeking review of her denied claim pursuant to ERISA § 502(a)(1)(B). Hartford and Wal-Mart moved to dismiss on the ground that Heimeshoff's complaint was barred by the Plan's limitations provision, which stated: "Legal action cannot be taken against The Hartford ... [more than] 3 years after the time written proof of loss is required to be furnished according to the terms of the policy." Id ., at 10.

*104 The District Court granted the motion to dismiss. Recognizing that ERISA does not provide a statute of limitations for actions under § 502(a)(1) (B), the court explained that the limitations period provided by the most nearly analogous state statute applies. See North Star Steel Co. v. Thomas, 515 U.S. 29 , 33-34, 115 S.Ct. 1927 , 132 L.Ed.2d 27 (1995). Under Connecticut law, the Plan was permitted to specify a limitations period expiring "[not] less than one year from the time when the loss insured against occurs." 2 Conn. Gen.Stat. § 38a-290 (2012); see App. to Pet. for Cert. 13. The court held that, under Circuit precedent, a 3-year limitations period set to begin when proof of loss is due is enforceable, and Heimeshoff's claim was therefore untimely. 3 Id ., at 13, 15 (citing Burke v. PriceWaterHouseCoopers LLP Long Term Disability Plan, 572 F.3d 76 , 79-81 (C.A.2 2009) ( per curiam )).

On appeal, the Second Circuit affirmed. 496 Fed.Appx. 129 (2012). Applying the precedent relied on by the District Court, the Court of Appeals concluded that it did not offend ERISA for the limitations period to commence before the plaintiff could file suit under § 502(a)(1)(B). Because the policy language unambiguously provided *610 that the 3-year limitations period ran from the time that proof of loss was due under the Plan, and because Heimeshoff filed her claim more than three years after that date, her action was time barred.

We granted certiorari to resolve a split among the Courts of Appeals on the enforceability of this common contractual limitations provision. 569 U.S. ----, 133 S.Ct. 1802

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Heimeshoff v. Hartford Life & Accident Ins. Co., 134 S. Ct. 604, 187 L. Ed. 2d 529, 571 U.S. 99, 24 Fla. L. Weekly Fed. S 497, 2013 WL 6569594, 57 Employee Benefits Cas. (BNA) 1265, 2013 U.S. LEXIS 9026, 82 U.S.L.W. 4035 (U.S. 2013).

134 S. Ct. 604 (Heimeshoff v. Hartford Life & Accident Ins. Co.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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