Ninth Circuit Says Disability Plan Participant’s Claim Is Time-Barred
The Ninth Circuit in Gordon v. Deloitte & Touche, LLP Group Long Term Disability Plan, 2014 WL 1394962 (9th Cir. Apr. 11, 2014) affirmed summary judgment in favor of a long term disability plan on the ground that the participant, Bridget Gordon, failed to file her action within the applicable limitations period. Gordon had been eligible for disability benefits due to depression. After paying benefits for about twenty-two months, the plan stopped paying benefits upon finding that Gordon had failed to furnish continuing proof of disability. Gordon’s appeal was at first denied but then, in a November 4, 2003 letter, the claims administrator approved benefits for an additional two months, which brought Gordon to the maximum amount of benefits permitted under the plan. Over four years later, Gordon called the claims administrator to ask whether her claim could be reopened, but was told that her appeal deadline had passed. Gordon took no action for another year and a half.
Applying California’s four-year statute of limitation governing actions involving written contracts, the Court determined that Gordon’s right to file an ERISA action accrued no later than May 4, 2004, because the November 4, 2003 letter stated that her right to appeal would expire 180 days from the date of the letter. Since Gordon did not file a complaint until January 31, 2011, her claim was barred by the four-year statute of limitation. In so ruling, the Court rejected several arguments advanced by Gordon. First, it held that the statute of limitations was not revived when Gordon asked that her claim be re-opened because to hold otherwise would discourage reconsideration by insurers. Second, it held that defendant was not estopped from asserting a statute of limitations defense because Gordon did not detrimentally rely on any representation by the claims administrator. Third, it held that defendant had not waived its statute of limitations defense because an insurance company cannot waive the defense after the limitations period has run and, in any event, there was no evidence that Gordon reasonably relied on statements by the claims administrator that would result in a waiver.