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When must I file suit against my insurer for denial of my long-term disability benefits?

When your long-term disability benefits carrier gives you final notice of denial, the next step is to file suit in federal court. The deadline for filing suit is not always clear because the Employee Retirement Income Security Act of 1974 ("ERISA") contains no statute of limitations. The usual practice in that instance is to borrow the limitations period of the most closely analogous state or federal statute. The analogous limitations period under Wisconsin contract law is six (6) years. However, the federal courts have also held that a shorter limitations period in the Plan document, if reasonable, is enforceable in suits under ERISA, regardless of state law. In one recent case, for example, the court deemed the seventeen month period reasonable in general and under the circumstances of the plaintiff's case. The court reasoned that, "[e]ven though the internal appeals process was protracted, the employee, who was represented by counsel throughout the process, still had seventeen months in which to bring the suit before the period expired. . . . A seventeen month period was therefore more than sufficient to meet the standard of reasonableness."

When figuring out your deadline to file suit under ERISA, it is important to look at the specific circumstances of your case. For example, some long-term disability Plans require a participant to file suit no later than three years from the time proof of Disability was required to be filed. The Plan, in turn, may require that proof of Disability be filed no later than three months after the Elimination Period. The Elimination Period is the ninety days of continuous Disability following the onset of the Disability. Under this scenario one district court calculated that the claimant's Elimination Period ended on August 15, 2000. The claimant was required to submit his proof of Disability by November 15, 2000, and should have filed any law suit by November 15, 2003. Because the claimant did not file the suit until April 17, 2006, the suit was not timely. The court noted that MetLife did not complete the internal appeals process until April 16, 2003, but the claimant still had seven months in which to file suit before the November 15, 2003 contractual deadline. The district court reasoned that seven months was a reasonable amount of time in which to file the suit, and granted summary judgment in favor of the defendants. These cases state that a limitations period of only 17 months and 7 months, respectively, from the end of the internal appeal would be reasonable. Such strict standards may not be reasonable however in a situation where benefits have been paid and then terminated, in contrast to a benefits claim that was denied from the outset.

Application of the shorter contractual limitations provision would not be reasonable, for example, if the employer paid the claim for three or more years and then terminated payments. It would be unreasonable to enforce a limitations period that ended before the claim could have even accrued. Or if the appeals process was so protracted that the claimant was unable to file suit within the contractual period, the application of this provision would not be reasonable.

The lesson we glean from these court rulings is the importance of immediately calculating the filing deadline set forth in the long-term disability plan document. In doing so, you err to the side of caution by filing suit pursuant to the shorter contractual deadline instead of relying on the longer six year common law limitations period.

Alan Olson writes this web-log to provide helpful information regarding long-term disability cases. He practices long-term disability law throughout the United States from his offices in New Berlin, Wisconsin. Attorney Olson may be contacted at [email protected] with questions about the information posted here or for advice on specific disability benefit claims.

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