ERISA And Statute Of Limitations

Parker County lawyers know that insurance policy’s have to be read.  Otherwise the result in a U.S. Eastern District of Texas case, can be the result.  The case is styled, Rita Jones v. Hartford Life and Accident Insurance Company et al.

This was a Rule 12(b)(6) Motion to Dismiss filed by Hartford.  The Court granted the motion.

Jones filed suit under ERISA, Section 1132 arising from Hartford’s decision to terminate long-term disability insurance benefits.

Jones alleges she suffers from severe depression, fibromyalgia, and spondyloarthropathy and became disabled on June 9, 2011.  Hartford denied Jones claim for long-term disability benefits on December 6, 2011, and issued its final written decision affirming the benefit denial on August 24, 2012.  On March 30, 2016, Jones filed her complaint in this case seeking review of Hartford’s denial of her claim.

Hartford contends Jones complaint seeking long-term disability benefits is time barred by the limitations period set forth in the Plan and must be dismissed pursuant to Rule 12(b)(6).  Section 1132 does not specify a statute of limitations.  Instead the Plan contains a 3-year limitations period that begins to run at the time “proof of loss” is due.  The Plan defines “proof of loss” as documentation of items such as the date the participant’s disability began, the cause of disability, the participant’s pre-disability income, and evidence that the participant is under the regular care of a physician.  The Plan required that proof of loss must be sent to Hartford “within 90 days after the start of the period for which we are liable for payment.”

It is undisputed that, based on the Plan’s terms and Jones allegations, proof of loss was due on March 5, 2012 (90 days after the start of the period for which Hartford would have been liable for payment).  Accordingly, the last day that Jones could have sued for benefits under the Plan was March 5, 2015.  Jones did not file until March 30, 2016 — more than a year after the limitations period expired.

Rather than contest the fact that Jones claims are time-barred, Jones argues that dismissal is improper under Rule 12(b)(6) because the Court must necessarily look to documents outside the pleadings.  To be sure, in calculating the applicable limitations period the Court reviewed the terms of the Plan and the denial letters sent to Jones by Hartford.  Though not attached to the complaint, these documents were referred to in the complaint and are central to the claims at issue, and therefore are properly considered part of the pleadings.  A plaintiff seeking to enforce ERISA benefits cannot circumvent a contractual limitations period by merely omitting the underlying agreement and relevant dates from the pleadings.

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