Heimeshoff v. Hartford Life & Accident Ins. Co.
Heimeshoff v. Hartford Life & Accident Ins. Co.
Opinion
*102
A participant in an employee benefit plan covered by the Employee Retirement Income Security Act of 1974 (ERISA),
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, *103 Hartford notified Heimeshoff that it could not determine whether she was disabled because her rheumatologist had never responded *609 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.
*104
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,
On appeal, the Second Circuit affirmed.
We granted certiorari to resolve a split among the Courts of Appeals on the enforceability of this common contractual limitations provision. 569 U.S. ----,
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.,
ERISA and its regulations require plans to provide certain presuit procedures for reviewing claims after participants submit proof of loss (internal review). See
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 *106 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,
*611
(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,
None of those decisions, however, addresses the critical aspect of this case: the parties have agreed by contract to commence the limitations period at a particular time. For that reason, we find more appropriate guidance in precedent confronting whether to enforce the terms of a contractual limitations provision. Those cases provide a well-established *107 framework suitable for resolving the question in this case:
"[I]n the absence of a controlling statute to the contrary, a provision in a contract may validly limit, between the parties, the time for bringing an action on such contract to a period less than that prescribed in the general statute of limitations, provided that the shorter period itself shall be a reasonable period." Order of United Commercial Travelers of America v. Wolfe,331 U.S. 586 , 608,67 S.Ct. 1355 ,91 L.Ed. 1687 (1947).
We have recognized that some statutes of limitations do not permit parties to choose a shorter period by contract. See,
e.g.,
Louisiana & Western R. Co. v. Gardiner,
The
Wolfe
rule necessarily allows parties to agree not only to the length of a limitations period but also to its commencement. The duration of a limitations period can be measured only by reference to its start date. Each is therefore an integral part of the limitations provision, and there is no
*108
basis for categorically preventing parties from agreeing on one aspect but not the other. See
Electrical Workers v. Robbins & Myers, Inc.,
B
The principle that contractual limitations provisions ordinarily should be enforced as written is especially appropriate
*612
when enforcing an ERISA plan. "The plan, in short, is at the center of ERISA."
US Airways, Inc. v. McCutchen,
569 U.S. ----, ----,
Heimeshoff's cause of action for benefits is likewise bound up with the written instrument. ERISA § 502(a)(1)(B) authorizes a plan participant to bring suit "to recover benefits due to him
under the terms of his plan,
to enforce his rights
under the terms of the plan,
or to clarify his rights to future benefits
under the terms of the plan.
"
*109
Kennedy v. Plan Administrator for DuPont Sav. and Investment Plan,
III
We must give effect to the Plan's limitations provision unless we determine either that the period is unreasonably short, or that a "controlling statute" prevents the limitations provision from taking effect.
Wolfe,
A
Neither Heimeshoff nor the United States claims that the Plan's 3-year limitations provision is unreasonably short on its face. And with good reason: the United States acknowledges that the regulations governing internal review mean for "mainstream" claims to be resolved in about one year, Tr. of Oral Arg. 22, leaving the participant with two years to file suit. 4 Even in this case, where the administrative review process required more time than usual, Heimeshoff was left with approximately one year in which to file suit. Heimeshoff does not dispute that a hypothetical 1-year limitations period commencing at the conclusion of internal review would be reasonable. Id., at 4. We cannot fault a limitations provision that would leave the same *613 amount of time in a case with an unusually long internal review process while providing for a significantly longer period in most cases.
Heimeshoff's reliance on
Occidental Life Ins. Co. of Cal. v. EEOC,
B
Heimeshoff and the United States contend that even if the Plan's limitations provision is reasonable, ERISA is a "controlling statute to the contrary."
Wolfe,
1
The first tier of ERISA's remedial scheme is the internal review process required for all ERISA disability-benefit plans.
Following denial, the plan must provide the participant with "at least 180 days ... within which to appeal the determination." §§ 2560.503-1(h)(3)(i), (h)(4). The plan has 45 days to resolve that appeal, with one 45-day extension available for "special circumstances (such as the need to hold a hearing)." §§ 2560.503-1(i)(1)(i), (i)(3)(i). The plan's time for resolving an appeal can be tolled again if the participant fails to submit necessary information. § 2560.503-1(i)(4). In the ordinary course, the regulations contemplate an internal review process lasting about one year. Tr. of Oral Arg. 22. If the plan fails to meet its own deadlines under these procedures, the participant "shall be deemed to have exhausted the administrative remedies." § 2560.503-1( l ). Upon exhaustion of the internal review process, the participant is entitled to proceed immediately to judicial review, the second tier of ERISA's remedial scheme.
2
Heimeshoff and the United States first claim that the Plan's limitations provision will undermine the foregoing internal review process. They contend that participants will shortchange their own rights during that process in order to have more time in which to seek judicial review. Their premise-that participants will sacrifice *614 the benefits of internal review to preserve additional time for filing suit-is highly dubious in light of the consequences of that course of action.
First, to the extent participants fail to develop evidence during internal review, they risk forfeiting the use of that evidence in district court. The Courts of Appeals have generally limited the record for judicial review to the administrative record compiled during internal review. See,
e.g.,
Foster v. PPG Industries, Inc.,
*112
McCartha v. National City Corp.,
3
Heimeshoff and the United States next warn that it will endanger judicial review to allow plans to set limitations periods that begin to run before internal review is complete. The United States suggests that administrators may attempt to prevent judicial review by delaying the resolution of claims in bad faith. Brief for United States as
Amicus Curiae
19; see also
White,
The United States suggests that even good-faith administration of internal review will significantly diminish the availability of judicial review if this limitations provision is enforced. Forty years of ERISA administration suggest otherwise. The limitations provision at issue is quite common; the vast majority of States require certain insurance policies to include 3-year limitations periods that run from
*113
the date proof of loss is due.
5
BUT THERE IS
*615
no significant evidence that limitations provisions like the one here have similarly thwarted judicial review. As explained above, see
supra,
at 10-11, ERISA regulations structure internal review to proceed in an expeditious manner. It stands to reason that the cases in which internal review leaves participants with less than one year to file suit are rare. Heimeshoff identifies only a handful of cases in which § 502(a)(1)(B) plaintiffs are actually time barred as a result of this 3-year limitations provision. See
Abena v. Metropolitan Life Ins. Co.,
Moreover, even in the rare cases where internal review prevents participants from bringing § 502(a)(1)(B) actions within the contractual period, courts are well equipped to apply traditional doctrines that may nevertheless allow participants to proceed. If the administrator's conduct causes a participant to miss the deadline for judicial review, waiver or estoppel may prevent the administrator from invoking the limitations provision as a defense. See,
e.g.,
Thompson v. Phenix Ins. Co.,
C
Two additional arguments warrant mention. First, Heimeshoff argues-for the first time in this litigation-that the limitations period should be tolled as a matter of course during internal review. By effectively delaying the commencement of the limitations period until the conclusion of internal review, however, this approach reconstitutes the contractual revision we declined to make. As we explained, the parties' agreement should be enforced unless the limitations period is unreasonably short or foreclosed by ERISA. The limitations period here is neither. See supra, at 612 - 613, 613 - 615, and this page.
Nor do the ERISA regulations require tolling during internal review. A plan must agree to toll the limitations provision only in one particular circumstance: when a plan offers voluntary internal appeals beyond what is permitted by regulation. § 2560.503-1(c)(3)(ii). Even then, the limitations period is tolled only during that specific portion of internal review. This limited tolling requirement would be superfluous if the regulations contemplated tolling throughout the process.
Finally, relying on our decision in
Hardin v. Straub,
IV
We hold that the Plan's limitations provision is enforceable. The judgment is, accordingly, affirmed.
It is so ordered.
The insurance policy provides: " 'Written proof of loss must be sent to The Hartford within 90 days after the start of the period for which The Hartford owes payment. After that, The Hartford may require further written proof that you are still Disabled.' " App. to Pet. for Cert. 10.
The parties do not dispute that Connecticut provides the relevant state law governing the limitations period in this case.
Heimeshoff also argued before the District Court that even if the Plan's limitations provision were enforceable, her suit was still timely because Hartford had granted her request for an extension until September 30, 2007. Even crediting the contention that proof of loss was not due until that date, the court held that the Plan's limitations provision barred her from bringing legal action any later than September 30, 2010. Heimeshoff did not file suit until November 18, 2010.
Heimeshoff, drawing on a study by the American Council of Life Insurers of recent § 502(a)(1)(B) cases where timeliness was at issue, states that exhaustion can take 15 to 16 months in a typical case. Reply Brief 17-18, n. 3 (citing Brief for American Council of Life Insurers et al. as Amici Curiae 29). In our view, that still leaves ample time for filing suit.
See Ala.Code §§ 27-19-14, 27-20-5(7) (2007) ;
Whether the Court of Appeals properly declined to apply those doctrines in this case is not before us. 569 U.S. ----, ----,
Reference
- Full Case Name
- Julie HEIMESHOFF, Petitioner v. HARTFORD LIFE & ACCIDENT INSURANCE CO. Et Al.
- Cited By
- 349 cases
- Status
- Published