182 F.3d 51 (1st Cir. 1999), 98-1696, I.V. Services v. Inn Development & Mgmt.
|Citation:||182 F.3d 51|
|Party Name:||I.V. SERVICES OF AMERICA, INC., Plaintiff, Appellant, v. INN DEVELOPMENT & MANAGEMENT, INC., ET AL., Defendants, Appellees.|
|Case Date:||June 28, 1999|
|Court:||United States Courts of Appeals, Court of Appeals for the First Circuit|
Heard January 5, 1999
Francis A. Miniter with whom Daniel S. Fabricant, William D. Gillis and Miniter & Associates were on brief for appellant.
Edward S. Rooney with whom Eric P. Finamore, Patrick J. Riley and Riley, Burke & Donahue were on brief for appellees.
Before Selya, Circuit Judge, Campbell, Senior Circuit Judge, and Lynch, Circuit Judge.
LEVIN H. CAMPBELL, Senior Circuit Judge.
This appeal concerns a demand for payment for medical services provided to Shelia Daly, a former employee of the Sheraton Hotel in Mansfield, Massachusetts, by Daly's medical care provider, appellant I.V. Services of America, Inc. ("I.V. Services"). I.V. Services sued Daly's employer and the administrator of its employee health benefit plan in the district court, seeking payment under the Employee Retirement Income Security Act of 1974, ("ERISA"), 29 U.S.C. § 1001 et seq. The district court dismissed on the ground that the suit was barred by the statute of limitations, finding that I.V. Services waited, without justification, over five years from the time its action accrued before bringing suit. I.V. Services appeals, claiming the district court erred by refusing to apply equitable tolling principles to the limitations period. We affirm.
During Daly's employment at the Sheraton Hotel in Mansfield, the hotel was owned and managed by Appellee Inn Development & Management, Inc. ("IDM"). In May 1988, IDM adopted a self-funded health benefit plan ("the Plan") for its employees and their dependents. Under the Plan, IDM was responsible for paying claims for medical care directly out of its own pocket and administering the Plan. Four months later, IDM contracted with Appellee Reliastar Life Insurance Company ("Reliastar")1 via an Administrative Services Only Agreement ("the ASO agreement") to have Reliastar act as the claims processor for IDM's Plan. Reliastar's duties under the ASO agreement included various claims processing functions, such as claim investigation and record keeping.
In April 1990, Daly began receiving intravenous antibiotic treatment from I.V. Services for Lyme disease. Her treating physician recommended that the treatment continue for six to eight weeks. Prior to receiving treatment from I.V. Services, Daly signed a Benefits Assignment form ("the assignment") which authorized her medical insurance benefits to be paid directly to I.V. Services.
On May 14, 1990, Daly submitted a claim to Reliastar for her treatment at I.V. Services. Over the next several months, Reliastar requested, and ultimately received, information both from I.V. Services and Daly's treating physician in order to evaluate her claim. On October 15, 1990, Reliastar advised I.V. Services by letter that its review of Daly's claim was complete. Noting that Daly's claim for treatment from April 11 to August 14, 1990 totaled $ 48,266.65, Reliastar concluded that only two weeks of treatment were "medically necessary" as defined by the Plan. Reliastar further stated that it would reconsider its decision only if it received additional written evidence contradicting its conclusion.
In November 1990, Daly's treating physician wrote to Reliastar that he believed, based on medical literature, that more than two weeks of treatment was medically necessary for Daly's case of Lyme disease. This letter caused Reliastar to reconsider
its decision and authorize payment for an additional two weeks of treatment (for a total of four weeks). Reliastar advised Daly and her treating physician of its revised decision by letter dated April 19, 1991. The letter also stated that the claim for the balance of Daly's treatments from I.V. Services were still being denied as not "medically necessary." I.V. Services received $ 9,246.66 from the IDM Plan funds for four weeks of Daly's treatment.
On May 13, 1991, Mary Lou Nicoli, a regional claims representative for Reliastar, sent another letter to Daly, her treating physician, and IDM explaining why the remainder of her claim had been denied. This letter was sent as a "follow-up" to a telephone conversation five days earlier in which Daly had called Reliastar and asked Nicoli to explain Relaistar's decision.
On August 9, 1996, I.V. Services brought suit against IDM and Reliastar, citing the enforcement provisions of ERISA. These provisions entitle an ERISA plan "participant" or "beneficiary" to bring an action "to recover benefits due him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan." 29 U.S.C. § 1132(a)(1)(B). IDM cross-claimed against Reliastar for contribution and indemnification, and moved for summary judgment against I.V. Services, arguing, among other things, that the claim was barred by the applicable limitations period. Reliastar in turn moved for summary judgment against I.V. Services and IDM.
The district court referred the motions to a magistrate judge for a report and recommendation. The magistrate recommended that I.V. Services' action be dismissed as against both IDM and Reliastar, and that Reliastar's motion for summary judgment against IDM therefore be dismissed as moot. He determined that...
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