Salisbury v. Hartford Life & Accident Insurance

583 F.3d 1245, 47 Employee Benefits Cas. (BNA) 2580, 2009 U.S. App. LEXIS 21455
CourtCourt of Appeals for the Tenth Circuit
DecidedSeptember 30, 2009
Docket18-1356
StatusPublished
Cited by22 cases

This text of 583 F.3d 1245 (Salisbury v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Tenth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Salisbury v. Hartford Life & Accident Insurance, 583 F.3d 1245, 47 Employee Benefits Cas. (BNA) 2580, 2009 U.S. App. LEXIS 21455 (10th Cir. 2009).

Opinion

HARTZ, Circuit Judge.

Arguing that the limitations period in her long-term-disability plan is unenforceable, Carol Ann Salisbury appeals the district court’s decision that she untimely filed her lawsuit under the Employee Retirement Income Security Act of 1974 (ERISA). See 29 U.S.C. § 1132(a)(1)(B). We have jurisdiction under 28 U.S.C. § 1291. We hold that the plan’s limitations period is enforceable and therefore affirm the summary judgment in favor of Hartford Life and Accident Insurance Company.

I.

Mrs. Salisbury is a participant in a group long-term-disability insurance plan (the Plan) issued and administered by Hartford. Mrs. Salisbury was injured at work in 2000 and became disabled under the terms of the Plan. She did not file for benefits, however, until the summer of 2002.

On October 15, 2002, Hartford approved and paid her benefits for the period from August 3, 2000, to August 2, 2002, because she was unable to perform one or more essential duties of her occupation. But because the Plan’s definition of disabled was more restrictive for periods after the first two years of disability, Hartford denied benefits for any time after August 2, 2002. After the first two years, a claimant was entitled to benefits only if she could not perform the essential duties of any occupation, not just her own occupation, and Hartford believed that Mrs. Salisbury did not meet the any-occupation requirement.

On March 29, 2003, Mrs. Salisbury administratively appealed the denial of further benefits. Hartford rejected the appeal by letter dated September 19, 2003. Mrs. Salisbury did not file her ERISA lawsuit, however, until March 7, 2008. Upholding the Plan’s three-year limitation on legal actions, the district court determined that the suit was time-barred and granted Hartford’s motion for summary judgment. Mrs. Salisbury appeals.

II.

We review the district court’s decision de novo. See Lang v. Aetna Life Ins. Co., 196 F.3d 1102, 1104 (10th Cir. 1999). ERISA does not contain a limitations provision for private enforcement actions under 29 U.S.C. § 1132. See Lang, 196 F.3d at 1104. Thus, we generally “apply the most closely analogous statute of limitations under state law.” Id. (internal quotations marks omitted). “Choosing which state statute to borrow is unnecessary, however, where the parties have contractually agreed upon a limitations period.” Northlake Regional Med. Ctr. v. Waffle House Sys. Employee Benefit Plan, 160 F.3d 1301, 1303 (11th Cir.1998). “An ERISA plan is nothing more than a contract, in which parties as a general rule are free to include whatever limitations they desire.” Id. Thus, several circuit courts have held that reasonable ERISA-plan limitations periods are enforceable. See id.; Morrison v. Marsh & McLennan Cos., 439 F.3d 295, 302 (6th Cir.2006); Harris Methodist Fort Worth v. Sales Support Servs. Inc. Employee Health Care Plan, 426 F.3d 330, 337 (5th Cir.2005); Wilkins v. Hartford Life & Accident Ins. Co., 299 F.3d 945, 948 (8th Cir.2002); Doe v. Blue Cross & Blue Shield United of Wis., 112 F.3d 869, 875 (7th Cir.1997). We *1248 agree with these decisions, and accordingly we must determine whether the Plan’s limitations period is reasonable.

In relevant part the Plan provides: “Legal action cannot be taken against us: 1. sooner than 60 days after due Proof of Loss has been furnished; or 2. three years after the time written Proof of Loss is required to be furnished according to the terms of the Policy.” ApltApp. at 152. In turn, the section regarding Proof of Loss provides: “Written Proof of Loss must be sent to us within 90 days after the start of the period for which we owe payment.” Id. at 150. Mrs. Salisbury does not contend that three years is not a reasonable period, but she argues that the Plan’s limitations period is not enforceable because it is ambiguous, circular, and confusing. In particular, she says that a participant whose claim has been denied could not determine when the limitations period commences because (1) that depends on when a proof of loss is due; (2) the proof of loss is not due before “the start of the period for which [Hartford] owe[s] payment”; and (3) Hartford’s decision that it owes no payment means that the period for which it owes payment never commenced.

We disagree. “In order to determine whether a plan is ambiguous, we consider the common and ordinary meaning as a reasonable person in the position of the plan participant, not the actual participant, would have understood the words to mean.” Miller v. Monumental Life Ins. Co., 502 F.3d 1245, 1250 (10th Cir.2007) (alteration and internal quotation marks omitted). The Proof of Loss provision is not ambiguous, because a reasonable person would understand “the period for which [Hartford] owe[s] payment” as referring to the period for which the applicant seeks benefits. That period is easily determinable; for example, in this case Mrs. Salisbury claims benefits dating back to August 3, 2002. Thus, the deadline for submitting her Proof of Loss was October 31, 2002, and the contractual limitations period ran through October 31, 2005.

Mrs. Salisbury also contends that the Plan’s limitations period is unenforceable because it is triggered by the Proof of Loss due-date, not by the date of exhaustion of the process for administrative review by Hartford. This court has held that “exhaustion of administrative ... remedies is an implicit prerequisite to seeking judicial relief’ under ERISA. Held v. Mfrs. Hanover Leasing Corp., 912 F.2d 1197, 1206 (10th Cir.1990). A divided panel of the Fourth Circuit refused to uphold an ERISA-plan limitations provision because under that plan, the cause of action accrued before the plan administrator made a final decision on the claim. See White v. Sun Life Assur. Co. of Can., 488 F.3d 240, 247 (4th Cir.2007) (“Th[e] interlocking remedial structure [of administrative review and the court system] does not permit an ERISA plan to start the clock ticking on civil claims while the plan is still considering internal appeals.”). In contrast, the Seventh Circuit enforced a contractual limitations period commencing when proof of disability had to be submitted, because the claimant still had a reasonable period of time to file suit after exhausting his administrative remedies. See Abena v. Metro. Life Ins. Co.,

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Bluebook (online)
583 F.3d 1245, 47 Employee Benefits Cas. (BNA) 2580, 2009 U.S. App. LEXIS 21455, Counsel Stack Legal Research, https://law.counselstack.com/opinion/salisbury-v-hartford-life-accident-insurance-ca10-2009.