ERISA-First Circuit Rules That The Plaintiff’s Long-Term Disability Benefits May Be Terminated

In Fortier v. Hartford Life & Accident Insurance Co., No. 18-1752 (1st Cir. 2019), a disability insurer, Hartford Life & Accident Insurance Company (“Hartford”), gave notice to Theresa Fortier that the long-term disability (“LTD”) benefits it had provided her under the Dartmouth Hitchcock Clinic Company Long Term Disability Plan (the “Plan”) would expire because she had not shown she was eligible for a continuation of those benefits. The notice informed her she must file any appeal within 180 days of receipt of the notice. She did not do so, filing her appeal about two months after this deadline.

In this ERISA suit, Fortier first argued that her appeal was timely under the Plan. She then argued that even if untimely, that untimeliness should be excused under either of two doctrines: the ERISA substantial compliance doctrine or a state law notice prejudice rule. The district court rejected these arguments and granted a motion for judgment on the administrative record for Hartford and the Plan. Upon review of the case, the First Circuit Court of Appeals (the “Court”) likewise rejected all these arguments and affirmed the district court’s decision.

In so affirming the district court’s decision, the Court held that:

— the ERISA regulation defining an “adverse benefit determination” requires that the 180-day time limit start at the date of the date of notice of the termination of benefits, and not from the date of the termination itself;

–Hartford properly followed the terms of the Plan, which met the ERISA requirements;

–the ERISA substantial compliance doctrine did not excuse Plaintiff’s untimely ERISA administrative appeal; and

–the New Hampshire notice-prejudice rule (where an insurer must show prejudice in order to deny certain limited types of untimely insurance claims) did not apply to Plaintiff’s situation, which involves an ERISA appeal.