Summary
holding a claim was time-barred and that a period of nine months for claimant to file suit after a final denial of benefits was not unreasonably short
Summary of this case from Park Ave. Aesthetic Surgery, P.C. v. Empire Blue Cross Blue ShieldOpinion
13 Civ. 938 (KBF)
02-14-2014
JOSEPH TUMINELLO, Plaintiff, v. AETNA LIFE INSURANCE COMPANY, Defendant.
MEMORANDUM DECISION & ORDER
:
Before the Court is defendant Aetna Life Insurance Company's motion for summary judgment arguing that plaintiff's claim for long-term disability benefits under a plan governed by the Employee Retirement Income Security Act of 1974 ("ERISA") is time-barred. (ECF No. 13.) For the following reasons, defendant's motion is GRANTED.
I. BACKGROUND
In February 2009, Joseph Tuminello, an employee of Bank of America ("BOA"), requested a short-term disability ("STD") leave starting on February 6, 2009. (Def.'s Rule 56.1 Statement ("Def.'s 56.1") ¶¶ 1, 7-11, ECF No. 20; Pl.'s Rule 56.1 Statement ("Pl.'s 56.1") ¶ 1, ECF No. 27.) Defendant, as the claim administrator for BOA's STD plan, approved plaintiff's claim for STD benefits effective February 6, 2009. (Id. ¶ 11.) BOA's STD plan provides STD benefits to eligible employees for up to 26 weeks from the date of the employee's disability, or 182 days, which in this case would extend to August 7, 2009. (See id. ¶ 8.)
In November 2010, plaintiff applied for long-term disability ("LTD") benefits under BOA's employee welfare benefit plan ("the Plan"). (Id. ¶ 12.) On December 21, 2010, defendant determined that plaintiff did not meet the Plan's definition of disability. (Id. ¶ 22.) Plaintiff administratively appealed defendant's adverse determination, after which defendant upheld its initial adverse benefit determination in a letter dated February 9, 2012. (Id. ¶ 25.) In that letter, defendant advised plaintiff that its decision was final and not subject to further appeal, but that he had the right to file a civil action under ERISA. (Id.)
One year later, on February 8, 2013, plaintiff Joseph Tuminello filed the complaint in this action, in which he alleged entitlement to LTD benefits. (Id. ¶ 27; see Compl., ECF No. 1.)
LTD benefits under the Plan are only payable after the expiration of an "elimination period." (Def.'s 56.1 ¶¶ 14-15.) The Plan defines the elimination period to be the greater of (1) the "first 180 days of a period of disability" or (2) "the period of time when disability benefits are payable from any short term disability benefits with the exception of any statutory disability benefits, accumulated sick time or salary continuation program sponsored by your Employer"—in this case, 182 days, a period that ended on August 7, 2009. (See id. ¶ 15.)
Pursuant to the Plan, the "deadline for filing a claim for benefits is 90 days after the end of the elimination period"—here, November 5, 2009. (See id. ¶ 16.) The Plan states, "No legal action can be brought to recover under any benefit after 3 years from the deadline for filing claims"—or November 5, 2012. (See id. ¶ 17.)
II. DISCUSSION
Plaintiff's action is time-barred: his deadline to bring legal action was November 5, 2012, but he brought his action on February 8, 2013. As set forth above, plaintiff's disability period began on February 6, 2009. (Def.'s 56.1 ¶¶ 3-4, 7.) He was eligible to receive STD benefits under the BOA STD plan for a maximum of 182 days, i.e., until August 7, 2009. (Id. ¶¶ 18-19.) That period is also the applicable "elimination period" under the Plan. (See id. ¶ 14-15.) Accordingly, plaintiff's deadline to file a claim for benefits was 90 days later, or November 5, 2009. (See id. ¶ 16.) Thus, his deadline for filing a lawsuit with respect to his denied benefit claim was three years later, or November 5, 2012. (See id. ¶ 17.) Plaintiff's complaint was filed on February 8, 2013 and is therefore time-barred. (Id. ¶ 27.)
These plan provisions are enforceable as written, even though the time for plaintiff to bring his lawsuit began to run on November 9, 2009, well before his claim accrued on February 9, 2012. In Heimeshoff v. Hartford Life & Acc. Ins. Co., 134 S. Ct. 604 (2013), the Supreme Court unanimously held that a contractual limitations provision limiting the time for claimants to seek judicial review of denied claims must be enforced as long as it is reasonable, even if the limitations period commences before the claimant's cause of action accrues. See id. at 610. As in the instant case, the plaintiff in Heimeshoff had commenced a civil action over three years after the deadline furnished by her benefit plan. See id. at 609-10. In upholding the written provisions of the plan at issue and dismissing plaintiff's claim as time-barred, the Supreme Court explained, "The principle that contractual limitations provisions ordinarily should be enforced as written is especially appropriate when enforcing an ERISA plan. The plan, in short, is at the center of ERISA." Id. at 611 (internal quotation marks omitted).
Under Heimeshoff, this Court "must give effect to the Plan's limitations provision unless . . . the period is unreasonably short." Id. at 612. Plaintiff here was left with approximately nine months—from February 9, 2012 to November 5, 2012—to file suit. (See Def.'s 56.1 ¶¶ 14-17.) That is not an unreasonably short period of time within which to file suit. Plaintiff does not contend that it is. See Heimeshoff, 134 S. Ct. at 612 (explaining that a period of "approximately one year" was not unreasonably short, particularly because the defendant's internal review process would allow for "a significantly longer period in most case").
In Heimeshoff, the Supreme Court also stated that, notwithstanding its holding, traditional equitable doctrines of waiver or estoppel may nonetheless allow participants to proceed in cases where "the administrator's conduct causes a participant to miss the deadline for judicial review." 134 S. Ct. at 615. "To the extent the participant has diligently pursued both internal review and judicial review but was prevented from filing suit by extraordinary circumstances, equitable tolling may apply." Id.
Plaintiff invokes these principles in arguing that he relied to his detriment on defendant's letter dated March 19, 2009. In that letter, defendant initially denied plaintiff's claim for STD benefits, and communicated to him that he "must file the action in court within one year of the date of the final denial of [his] claim." (See Pl.'s Resp. in Opp. to Def.'s Supp. Mem. of L. ("Pl.'s Opp.") 3, ECF No. 38.) Accordingly, plaintiff argues that this action—filed within one year of his final LTD denial letter, dated February 9, 2012—is timely.
Plaintiff's argument fails. That letter, by its own terms, applies only to plaintiff's STD benefits, not LTD benefits. Plaintiff argues that the STD letter is relevant because his complaint aims to "secure all disability benefits, whether they be described as short term or long term." (Compl. ¶ 1.) Be that as it may, claiming LTD disability benefits on the basis of the terms of an STD letter is unreasonable, given that the March 19, 2009 letter explicitly pertains only to STD benefits; in fact, plaintiff had not even submitted a claim for LTD benefits until November 2010, after the date of that letter. (Def.'s 56.1 ¶ 12.) The STD letter simply has no bearing on the enforceability of the LTD Plan's provisions limiting the time for filing actions. At no point during the administration of plaintiff's claim for LTD benefits did defendant advise plaintiff that he had one year from the date of its final adverse determination of his LTD claim to commence a civil action.
This situation is thus a far cry from the "extraordinary circumstances" described by Heimeshoff, in which "the administrator's conduct," such as delays in the administrative review process, "causes a participant to miss a deadline." 134 S. Ct. at 615. Plaintiff's failure to consult the provisions of his plan and to file his complaint within the nine months after final denial of his LTD claim does not constitute such extraordinary circumstances. It certainly does not meet the requirement expressed by the Heimeshoff Court that equitable tolling applies "[t]o the extent the participant has pursued both internal review and judicial review." Id. (emphasis added). "Equitable tolling requires a party to pass with reasonable diligence through the period it seeks to have tolled." Johnson v. Nyack Hosp., 86 F.3d 8, 12 (2006). Here, reliance on a letter unrelated to his LTD claim—mailed in March 2009, over a year before plaintiff even applied for LTD benefits—is not diligent pursuit of judicial review of defendant's denial of his claims that can toll the statute of limitations.
III. CONCLUSION
For these reasons, defendant's motion for summary judgment is GRANTED. The Clerk of Court shall terminate this action.
SO ORDERED. Dated: New York, New York
February 14, 2014
/s/_________
KATHERINE R. FORREST
United States District Judge