Gordon v. Deloitte & Touche, LLP

• Decision Date: 11 April 2014
• Docket Number: No. 12–55114.,12–55114.
• Citation: 749 F.3d 746
• Parties: Bridget GORDON, Plaintiff–Appellant, v. DELOITTE & TOUCHE, LLP GROUP LONG TERM DISABILITY PLAN, Defendant–Appellee.
• Court: U.S. Court of Appeals — Ninth Circuit

749 F.3d 746

Bridget GORDON, Plaintiff–Appellant,

v.DELOITTE & TOUCHE, LLP GROUP LONG TERM DISABILITY PLAN, Defendant–Appellee.

No. 12–55114.

United States Court of Appeals, Ninth Circuit.

Argued and Submitted Oct. 10, 2013.

Filed April 11, 2014.

Robert J. Rosati (argued), ERISA Law Group LLP, Fresno, CA, for Plaintiff–Appellant.

Ian Seth Linker (argued), Metropolitan Life Insurance Company, New York, NY; Robert Kevin Renner, Barger & Wolen, LLP, Irvine, CA, for Defendant–Appellee.

Appeal from the United States District Court for the Central District of California, Manuel L. Real, District Judge, Presiding. D.C. No. 2:11–cv–00913–R–JCG.

Before: STEPHEN REINHARDT and MORGAN CHRISTEN, Circuit Judges, and JOHN W. SEDWICK, District Judge.^*

Opinion by Judge SEDWICK; Dissent by Judge REINHARDT.

OPINION

SEDWICK, District Judge:

Plaintiff–Appellant Bridget Gordon (“Gordon”) appeals the district court's summary judgment in favor of Defendant–Appellee Deloitte & Touche, LLP Group Long Term Disability Plan (the “Plan”), which is insured by Metropolitan Life Insurance Company (“MetLife”), based on her failure to file the action within the applicable limitation period. The Plan is subject to the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001–1461 (“ERISA”). We have jurisdiction over the appeal pursuant to 28 U.S.C. § 1291.

I. BACKGROUND

Deloitte & Touche USA LLP (“Deloitte”) offers employees long-term disability insurance through the Plan. The Plan's claims administrator, MetLife, has broad discretionary authority to make eligibility determinations. Under the Plan, an employee is entitled to long-term disability benefits if she is otherwise qualified and meets the Plan's definition of “disabled.” Benefit payments for disabilities due to mental illness are limited to twenty-four months under the Plan.

Gordon worked for Deloitte until October of 2000. Around that time, Gordon learned that she was HIV positive and claimed she could no longer work due to depression. MetLife determined that she was eligible for disability benefits under the Plan and began paying benefits effective March 3, 2001. MetLife paid benefits through December of 2002, but gave notice that it had terminated further payments in a January 2, 2003 letter. The letter recounted that Gordon's treating physician had advised on December 19, 2002 that Gordon had not been seen in over three months and had failed to appear for her last scheduled appointment. The letter also indicated that Gordon had not responded to calls from MetLife personnel. The letter then explained that the benefits were terminated because Gordon had failed to furnish continuing proof of disability as required by the Plan. The letter gave Gordon 180 days from receipt of the letter in which to send a written appeal to MetLife.

On January 9, 2003, Gordon appealed the termination. After reviewing the medical information submitted in support of her continuing claim for disability benefits, MetLife denied her claim in a letter dated March 17, 2003. The letter reviewed the supporting information at length before concluding that Gordon did not meet the definition of disabled under the Plan, because the documentation did not substantiate the proposition that she was unable to perform the essential duties of her job. The letter informed Gordon that she had 180 days to appeal the decision.

On October 15, 2003, Gordon appealed, arguing that she was disabled due to severe and debilitating depression. In a November 4, 2003 letter, following MetLife's review of the information submitted and a review by an independent physician consultant, MetLife informed Gordon that additional benefits had been approved for the limited period of January 1, 2003 through March 2, 2003, because she was disabled during that period by her major depression. The letter explained that under the Plan Gordon's benefits were limited to twenty-four months because her disability stemmed from a mental illness, and noted her twenty-four months ended on March 2, 2003. Once again Gordon was advised that she could appeal the decision within 180 days.

Gordon failed to appeal. Indeed, she took no action for more than four years. On November 26, 2007, she called MetLife to ask whether her claim could be reopened, and MetLife informed her that her appeal deadline had passed. Gordon took no further action for an additional year and a half.

In April of 2009, MetLife received a letter from California's Department of Insurance indicating that Gordon had filed a complaint on April 12, 2009. It asked MetLife to reevaluate the issues raised by Gordon in her complaint. MetLife informed Gordon that it would reopen her claim for further review and allowed Gordon to submit any additional information that she wanted MetLife to consider.

On December 8, 2009, after reviewing Gordon's file and the additional information available, MetLife informed Gordon in writing that it was upholding its original decision to terminate her benefits based on the Plan's 24–month limitation for disabilities resulting from mental illness. The letter set forth MetLife's analysis of the medical information and explained why MetLife had decided to maintain its original decision. The letter advised Gordon of her appeal rights, saying that she could appeal the decision within 180 days and that any appeal would be concluded within 45 days unless otherwise notified in writing. Of significance at this point, the letter also stated that if the administrative appeal were to be denied, Gordon would have the right to bring a civil action under § 502(a) of ERISA. Gordon timely appealed with a 74–page appeal letter and more than 480 pages of exhibits. MetLife wrote to Gordon's counsel on July 6, 2010, advising that it was continuing to review the file. However, on January 31, 2011, before MetLife's review was completed, Gordon filed a complaint pursuant to § 502(a) of ERISA in the district court.

The district court granted the Plan's motion for summary judgment. It concluded that Gordon's ERISA action was barred by the applicable four-year statute of limitation, as well as by the three-year contractual limitation period contained in the Plan itself. The trial court rejected Gordon's arguments that the reopening of her file in 2009 reset the statute of limitation and that the Plan waived its limitation defense or was estopped from asserting it. The district court entered judgment in favor of the Plan. This appeal followed.

II. DISCUSSION

The standard of review applicable here is well known. We examine orders granting summary judgment de novo, viewing the evidence in the light most favorable to the nonmoving party to determine whether any genuine issue of material fact remains. Coszalter v. City of Salem, 320 F.3d 968, 973 (9th Cir.2003).

A. Statute of limitation

There is no federal statute of limitation applicable to lawsuits seeking benefits under ERISA. Wetzel v. Lou Ehlers Cadillac Grp. Long Term Disability Ins. Program, 222 F.3d 643, 646 (9th Cir.2000). We therefore “look to the most analogous state statute” in the state where the claim for benefits arose. Id. Here, the state is California, and the most analogous statute is its four-year statute of limitation governing actions involving written contracts. Id. at 648. The district court concluded that Gordon's cause of action accrued on November 4, 2003, and thus that the four-year statute of limitation barred her suit.

While the statute of limitation is borrowed from state law, accrual of an ERISA cause of action is determined by federal law. Id. at 649. Under federal law, “an ERISA cause of action accrues either at the time benefits are actually denied or when the insured has reason to know that the claim has been denied.” Id. (internal citation omitted). A claimant has reason to know that the claim has been denied where there has been “a clear and continuing repudiation of a claimant's rights under a plan such that the claimant could not have reasonably believed but that his benefits had been finally denied.” Chuck v. Hewlett Packard Co., 455 F.3d 1026, 1031 (9th Cir.2006) (internal quotation marks and citation omitted).

Gordon's claim was denied in the November 4, 2003 MetLife letter which advised Gordon that no disability benefits would be available to her after March 2, 2003, and that she would receive one final payment covering the period of January 2, 2003 through March 2, 2003. The letter explicitly stated that the last payment was made in a full and final settlement of her claim for disability benefits under the Plan. Gordon argues that the November 4, 2003 letter did not constitute a final denial because the letter also informed her of her appeal rights, suggesting that she had further administrative remedies and that the matter was therefore not final. Assuming arguendo that the November 4 letter was not a final denial, because Gordon still had an administrative appeal option, the letter also stated that the right to appeal would expire 180 days from November 4, 2003, which meant on or about May 4, 2004.

We conclude that Gordon's right to file an ERISA action accrued no later than May 4, 2004. Gordon did not file the pending complaint until January 31, 2011. The district court correctly concluded that Gordon's ERISA action was barred by the four-year statute of limitation. That being so, it is unnecessary to consider whether her complaint is also time barred under the shorter three-year limitation period set out in the Plan.

B. Revival of the limitations period

Gordon argues that we should apply California law regarding acknowledgment of debts to conclude that MetLife's reconsideration of her claim in 2009 revived the statute of limitation. Under California law, “[t]he acknowledgment of a debt already barred by the statute [of limitation] gives rise to a new contract and a new cause of action dating from the acknowledgment.” Eilke v. Rice, 45 Cal.2d 66, 286 P.2d 349, 352 (1955) (en banc)....