ERISA-Second Circuit Rules That Plaintiff’s Claim For Long-Term Disability Benefits Is Not Time-Barred By A Plan Provision

In Epstein v. Hartford Life and Accident Insurance Company, No. 10-3852-cv. (2nd Cir. 2011) (Summary Order), the plaintiff, Howard Epstein (“Epstein”) was appealing the district court’s grant of summary judgment for the defendant , Hartford Life and Accident Insurance Company (“Hartford”), on Epstein’s claim for long-term disability (“LTD”) benefits. Hartford had denied Epstein’s claim for the benefits, and this suit ensued. The issue for appeal is whether Epstein’s claim for the LTD benefits, which challenged the denial by Hartford, was time-barred by a limitation-of-actions clause in Hartford’s long-term disability plan (the “Plan”).

In analyzing the case, the Court noted that ERISA does not prescribe a limitations period within which claimants can challenge benefit denials in federal court. The applicable limitations period is that specified in the most nearly analogous state limitations statute, which in this case is New York’s six-year limitations period for contract actions. However, New York permits contracting parties to shorten a limitations period if, as here, their agreement is memorialized in writing. In this case, the Plan provides that a claimant may not bring a legal action more than three years after the time written Proof of Loss is required to be furnished. Further, the Plan states that Proof of Loss must be sent to Hartford within 90 days after the start of the period for which Hartford owes payment. Also, the Plan provides for an “Elimination Period” of 182 consecutive days, which is the period for which a claimant must be disabled before benefits become payable.

In this case, Hartford calculated that Epstein exhausted the Plan’s Elimination Period on October 22, 2005. That is the same date that Epstein, in his complaint, said that he originally became eligible for LTD benefits. Under the terms of the Plan, then, Proof of Loss for Epstein’s LTD benefits claim was due on January 20, 2006, ninety days after the end of the Elimination Period on October 22, 2005. Thus, the limitations period would normally have begun to run on January 20, 2006. However, on November 20, 2006, Hartford made a post-denial request for additional Proof of Loss regarding Epstein’s LTD benefits claim. This request extended the starting date of the limitations period to December 20, 2006, when-according to the request- such Proof of Loss was due. Epstein filed suit in the district court on June 18, 2009. That date was within 3 years of December 20, 2006. As such, the Court concluded that Epstein’s claim was timely filed under the Plan’s provisions, and it overturned the summary judgment granted by the district court to Hartford.

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