Heimeshoff v. Hartford Life & Accident Ins. Co.

Decision Date16 December 2013
Docket NumberNo. 12–729.,12–729.
Citation571 U.S. 99,187 L.Ed.2d 529,134 S.Ct. 604
Parties Julie HEIMESHOFF, Petitioner v. HARTFORD LIFE & ACCIDENT INSURANCE CO. et al.
CourtU.S. Supreme Court

Matthew W.H. Wessler, for Petitioner.

Ginger D. Anders, for the United States as amicus curiae, by special leave of the Court, supporting the petitioner.

Catherine M.A. Carroll, Washington, DC, for Respondents.

Steven P. Krafchick, Carla Tachau Lawrence, Krafchick Law Firm, Seattle, WA, Peter K. Stris, Brendan S. Maher, Victor O'Connell, Stris & Maher LLP, Gardena, CA, Matthew W.H. Wessler, Leah M. Nicholls, Public Justice, P.C., Washington, DC, Leslie A. Brueckner, Arthur H. Bryant, Sarah E. Belton, Public Justice, P.C., Oakland, CA, for Petitioner.

Seth P. Waxman, Catherine M.A. Carroll, Counsel of Record, Weili J. Shaw, Ari Holtzblatt, Wilmer Cutler Pickering Hale and Dorr LLP, Washington, DC, for Respondents.

Justice THOMAS delivered the opinion of the Court.

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, Hartford notified Heimeshoff that it could not determine whether she was disabled because her rheumatologist had never responded 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.

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 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, 185 L.Ed.2d 810 (2013). Compare, e.g., Burke, supra, at 79–81 (plan provision requiring suit within three years after proof-of-loss deadline is enforceable); and Rice v. Jefferson Pilot Financial Ins. Co., 578 F.3d 450, 455–456 (C.A.6 2009) (same), with White v. Sun Life Assurance Co. of Canada, 488 F.3d 240, 245–248 (C.A.4 2007) (not enforceable); and Price v. Provident Life & Acc. Ins. Co., 2 F.3d 986, 988 (C.A.9 1993) (same). We now affirm.

II

Statutes of limitations establish the period of time within which a claimant must bring an action. As a general matter, a statute of limitations begins to run when the cause of action " 'accrues' "—that is, when "the plaintiff can file suit and obtain relief." Bay Area Laundry and Dry Cleaning Pension Trust Fund v. Ferbar Corp. of Cal., 522 U.S. 192, 201, 118 S.Ct. 542, 139 L.Ed.2d 553 (1997).

ERISA and its regulations require plans to provide certain presuit procedures for reviewing claims after participants submit proof of loss (internal review). See 29 U.S.C. § 1133 ; 29 C.F.R. § 2560.503–1 (2012). The courts of appeals have uniformly required that participants exhaust internal review before bringing a claim for judicial review under § 502(a)(1)(B). See LaRue v. DeWolff, Boberg & Associates, Inc., 552 U.S. 248, 258–259, 128 S.Ct. 1020, 169 L.Ed.2d 847 (2008) (ROBERTS, C.J., concurring in part and concurring in judgment). A participant's cause of action under ERISA accordingly does not accrue until the plan issues a final denial.

ERISA § 502(a)(1)(B) does not specify a statute of limitations. Instead, the parties in this case have agreed by contract to a 3–year limitations period. The contract specifies that this period begins to run at the time proof of loss is due. Because proof of loss is due before a participant can exhaust internal review, Heimeshoff contends that this limitations provision runs afoul of the general rule that statutes of limitations commence upon accrual of the cause of action.

For the reasons that follow, we reject that argument. Absent a controlling statute to the contrary, a participant and a plan may agree by contract to a particular limitations period, even one that starts to run before the cause of action accrues, as long as the period is reasonable.

A

Recognizing that Congress generally sets statutory limitations periods to begin when their associated causes of action accrue, this Court has often construed statutes of limitations to commence when the plaintiff is permitted to file suit. See, e.g., Graham County Soil & Water Conservation Dist. v. United States ex rel. Wilson, 545 U.S. 409, 418, 125 S.Ct. 2444, 162 L.Ed.2d 390 (2005) (resolving an ambiguity in light of "the 'standard rule that the limitations period commences when the plaintiff has a complete and present cause of action' " (quoting Bay Area Laundry, supra, at 201, 118 S.Ct. 542) ); Rawlings v. Ray, 312 U.S. 96, 98, 61 S.Ct. 473, 85 L.Ed. 605 (1941). At the same time, we have recognized that statutes of limitations do not inexorably commence upon accrual. See Reiter v. Cooper, 507 U.S. 258, 267, 113 S.Ct. 1213, 122 L.Ed.2d 604 (1993)(noting the possibility that a cause of action may "accru[e] at one time for the purpose of calculating when the statute of limitations begins to run, but at another time for the purpose of bringing suit"); see also Dodd v. United States, 545 U.S. 353, 358, 125 S.Ct. 2478, 162 L.Ed.2d 343 (2005) (the statute of limitations in the federal habeas statute runs from " 'the date on which the right asserted was initially recognized by the Supreme Court' " even if the right has not yet been " 'made retroactively applicable to cases on collateral review' "); McMahon v. United States, 342 U.S. 25, 26–27, 72 S.Ct. 17, 96 L.Ed. 26 (1951) (the limitations period in the Suits in Admiralty Act runs from the date of...

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