Moyer v. Metro. Life Ins. Co.

• Decision Date: 24 October 2014
• Docket Number: No. 13–1396.,13–1396.
• Citation: 762 F.3d 503
• Parties: Joseph MOYER, Plaintiff–Appellant, v. METROPOLITAN LIFE INSURANCE COMPANY, Defendant–Appellee.
• Court: U.S. Court of Appeals — Sixth Circuit

762 F.3d 503

Joseph MOYER, Plaintiff–Appellant,

v.METROPOLITAN LIFE INSURANCE COMPANY, Defendant–Appellee.

No. 13–1396.

United States Court of Appeals, Sixth Circuit.

Aug. 7, 2014.

Rehearing En Banc Denied Oct. 24, 2014.^*

ON BRIEF:David B. Grant, Grant Busch & Kirschner, Southfield, Michigan, for Appellant. David M. Davis, Hardy, Lewis & Page, P.C., Birmingham, Michigan, for Appellee.

Before: COOK and STRANCH, Circuit Judges; CARR, District Judge. ^**

STRANCH, J., delivered the opinion of the court, in which CARR, D.J., joined. COOK, J. (pp. 507–09), delivered a separate dissenting opinion.

OPINION

STRANCH, Circuit Judge.

Joseph Moyer, an ERISA plan participant, appeals the district court's dismissal for untimeliness of his action against the plan's claim administrator, Metropolitan Life Insurance Company (MetLife), seeking recovery of unpaid ERISA plan benefits. Because MetLife failed to include notice of the time limits for judicial review in its adverse benefit determination letter, we REVERSE.

I. Background

As an employee of Solvay America, Inc., Moyer participated in Solvay's ERISA-governed Long Term Disability Plan. When Moyer applied for disability benefits in 2005, MetLife initially approved his claim, but reversed its decision in 2007 after determining that Moyer retained the physical capacity to perform work other than his former job. Moyer filed an administrative appeal, and MetLife affirmed the revocation of benefits on June 20, 2008. Moyer's adverse benefit determination letter included notice of the right to judicial review but failed to include notice that a three-year contractual time limit applied to judicial review. The Summary Plan Description (SPD) failed to provide notice of either Moyer's right to judicial review or the applicable time limit for initiating judicial review.

On February 20, 2012, Moyer sued MetLife, seeking recovery of unpaid plan benefits under 29 U.S.C. § 1132(a)(1)(B). MetLife moved to dismiss, arguing that the plan's three-year limitations period barred Moyer's claim. The district court agreed, noting that the plan documents—which were not sent to plan participants unless requested—stated in the Claims Procedure section of the plan that there was a three-year limitations period for filing suit. It concluded that MetLife provided Moyer with constructive notice of the contractual time limit for judicial review. Moyer now appeals, requesting equitable tolling.

II. Analysis

We review de novo the district court's holding that the plan's contractual limitations period barred Moyer's claim under § 1132(a)(1)(B). See Fallin v. Commonwealth Indus., Inc., 695 F.3d 512, 515 (6th Cir.2012).

Courts uphold contractual limitations periods embodied in ERISA plans as long as the period qualifies as “reasonable.” Med. Mut. of Ohio v. K. Amalia Enters. Inc., 548 F.3d 383, 390 (6th Cir.2008). Here, the administrative record contains a plan document of approximately 50 pages that includes a section on Claims Procedure providing that “[n]o lawsuit may be started more than 3 years after the time proof [of a claim] must be given.” R. 12–4, Long Term Disability Plan, Page ID 1065. Past decisions of this court have upheld as reasonable similar three-year limitations periods. See Rice v. Jefferson Pilot Fin. Ins. Co., 578 F.3d 450, 454 (6th Cir.2009); Med. Mut. of Ohio, 548 F.3d at 390–91; Morrison v. Marsh & McLennan Cos., 439 F.3d 295, 301–02 (6th Cir.2006). This time limit for seeking judicial review was not provided to Moyer in the correspondence revoking his benefits or in the SPD.

A. Adverse Benefit Determination Letter

Being unaware of the contractual time limit, Moyer filed his complaint late. He asks us to toll the filing deadline, alleging that MetLife breached its obligations under ERISA by failing to include in his benefit revocation letter the time limit for seeking judicial review. We agree with Moyer that on the date his revocation letter was sent, it was required to include the time limit for judicial review. We turn to the ERISA “Claims procedure” statute, 29 U.S.C. § 1133, to explain why.

The dissent argues that we may not examine the requirements for claim-denial letters because Moyer's arguments failed to specifically reference that statute and that regulation. We do not see our review as so narrowly circumscribed. Moyer argues in his brief, as he did before the district court, that MetLife's correspondence with him—including specifically the adverse benefit determination letter—was required to include the time limits for judicial review. The issue, therefore, was properly raised and we may consider the relevant arguments, including application of the appropriate ERISA provisions.

ERISA § 1133 governs adverse benefit determination letters. It explicitly authorizes the Secretary of Labor to establish regulations explaining the meaning of the statute and requires that the statute be applied “[i]n accordance with regulations of the Secretary.” 29 U.S.C. § 1133; see Kent v. United of Omaha Life Ins. Co., 96 F.3d 803, 806 (6th Cir.1996). The regulations require that benefit denial letters provide: “[a] description of the plan's review procedures and the time limits applicable to such procedures, including a statement of the claimant's right to bring a civil action ... following an adverse benefit determination on review.” 29 C.F.R. § 2560.503–1 (emphasis added). The claimant's right to bring a civil action is expressly included as a part of those procedures for which applicable time limits must be provided.

Cases of and in our sister circuits support this conclusion. See Ortega Candelaria v. Orthobiologics LLC, 661 F.3d 675, 680 (1st Cir.2011) (“[The employer] was required by [29 C.F.R. § 2560.503–1(g)(1)(iv) ] to provide [the employee] with notice of his right to bring suit under ERISA, and the time frame for doing so, when it denied his request for benefits.” (emphasis added)); McGowan v. New Orleans Empl'rs Int'l Longshoremen's Ass'n, 538 Fed.Appx. 495, 498 (5th Cir.2013) (finding that a benefit termination letter substantially complied with 29 C.F.R. § 2560.503–1(g)(1)(iv) because, in addition to enclosing the benefit booklet and specifying the pages containing the review procedures and time limits, the letter “mentionedMcGowan's right to file suit under § 502(a) of ERISA, as well as the one-year time limit”); White v. Sun Life Assurance Co. of Canada, 488 F.3d 240, 247 n. 2 (4th Cir.2007) (emphasizing that the right to bring a civil action is an integral part of a full and fair benefit review and that the adverse benefit determination letter must include the relevant information related to that right) (abrogated on other grounds by Heimeshoff v. Hartford Life & Acc. Ins. Co., ––– U.S. ––––, 134 S.Ct. 604, 612, 187 L.Ed.2d 529 (2013)); see also Novick v. Metropolitan Life Ins. Co., 764 F.Supp.2d 653, 660–64 (S.D.N.Y.2011) (concluding that 29 CFR § 2560.503–1(g) requires that the adverse benefit determination letter include the time limits for judicial review); Solien v. Raytheon Long Term Disability Plan # 590, No. CV07–456 TUC DCB, 2008 WL 2323915, at *8 (D.Ariz. June 2, 2008) (holding that “[j]udicial review is an appeal procedure for an adverse benefit determination and is therefore a part of the claim procedures covered by these regulations, especially when the time limit for filing a judicial action is established contractually by the Plan”).

Our recent opinion in Engleson v. Unum Life Insurance Company of America supports this conclusion as well. 723 F.3d 611 (6th Cir.2013). In Engleson, the plaintiff claimed that the insurance company “was required to disclose his right to seek review in federal court and the contractual time limitation attached to that right in its claim denial letters.” Id. at 617. Engleson held that such notice was not required for that plaintiff but added that the regulations were different now, and “[h]ad these events transpired a year later, [the plaintiff] would have a colorable ERISA violation.” Id. at 618. The version of the regulations that Engleson held would have given rise to a colorable ERISA violation claim is the version in force in this case. Engleson also noted that the Fourth Circuit's opinion in White, 488 F.3d at 247 n. 2, suggests this same conclusion—that “the scope of § 1133 and the notice derived therefrom includes both internal and judicial mechanisms for review.” Engleson, 723 F.3d at 618–19. Engleson did not follow White, however, because “Unum was under no regulatory obligation” at that time. Id.

MetLife was subject to the regulatory obligation recognized in Engleson and White when it revoked Moyer's benefits; its failure to include the judicial review time limits in the adverse benefit determination letter renders the letter not in substantial compliance with § 1133. As part of our substantial compliance analysis, we consider whether the adverse benefit determination letter fails to fulfill the purposes of § 1133 “that the claimant be notified of the reasons for the denial of the claim and have a fair opportunity for review.” Kent, 96 F.3d at 807.

Relying on language from Wenner v. Sun Life Assurance Co. of Canada, 482 F.3d 878, 882 (6th Cir.2007), the dissent contends that the purpose of § 1133 is limited to assuring review by the plan fiduciary. But that statement in Wenner was bound to its facts—that the adverse benefit determination letter failed to provide the plaintiff information on his right to have the benefit decision reviewed by the named fiduciary. Id. It does not discount the statutory and regulatory language that applies to judicial review. Wenner, moreover, also properly stated the general purpose of § 1133 by noting, “[a]s this court has repeatedly said, the purpose of § 1133 is to ‘notify [ ] Plaintiff of [the plan administrator's] reasons for denying his claims and affording him a fair opportunity for review.’ ” Id. (quoting Moore v. Lafayette Life Ins. Co., 458 F.3d 416, 436 (6th Cir.2006)...