Don L. Witt v. Metropolitan Life Insurance Co.
772 F.3d 1269
| 11th Cir. | 2014Background
- Don Witt, a former Shell employee, received long-term disability benefits through a Shell Plan administered by MetLife; he sought benefits dating from Dec. 29, 1995.
- Witt filed for benefits in Jan. 1997; MetLife approved retroactive benefits through April 30, 1997 but terminated payments effective May 1, 1997 for failure to provide proof of continued disability. MetLife’s 1997 termination letter cannot be produced; Witt denies receiving it.
- Witt did not challenge the termination or contact MetLife for 12 years. In 2009 his attorney reopened the file; MetLife performed a “courtesy” review and repeatedly requested medical records to support benefits beyond May 1, 1997.
- MetLife ultimately denied reinstatement after administrative review (final denial dated May 4, 2012) and advised Witt of his right to sue under ERISA §502(a); MetLife did not assert a statute-of-limitations defense in its denial letters.
- Witt sued in June 2012 seeking benefits from May 1997 forward. Defendants asserted a six-year statute of limitations defense; the district court granted summary judgment for defendants as time-barred. Witt appealed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| When did the ERISA limitations period begin? | Limitations began with MetLife’s final denial (May 4, 2012); Witt never received the 1997 letter. | Limitations began when benefits stopped and Witt had reason to know his claim was repudiated (by May 1998 at the latest). | Court: accrual when claimant had reason to know of clear repudiation; here nonpayment put Witt on notice (no later than May 1, 1998). |
| Whether MetLife’s 2009–2012 courtesy review restarted the limitations clock | The 2010–2012 review treated the matter as a new claim, so the clock should start from the final denial in 2012. | The correspondence was a review of the old claim (possible reinstatement), not a new claim, so limitations were not restarted. | Court: review was a courtesy review of the original claim and did not restart the statutory period. |
| Whether MetLife waived the statute-of-limitations defense by not raising it during administrative review | Failure to mention timeliness in denial letters waived the defense. | No waiver: waiver requires intentional relinquishment; no express waiver, no consideration exchanged, and reopening a stale claim does not revive it. | Court: no waiver; implied waiver not proven. |
| Whether Witt’s filing in 2012 was timely under Alabama’s six-year limit (as applied federally) | The suit was timely because accrual occurred in 2012 after final denial. | The suit was time-barred because accrual occurred when Witt had reason to know claim was denied (late 1990s). | Court: action barred by the six-year limit; filed too late. |
Key Cases Cited
- Paris v. Profit Sharing Plan for Emps. of Howard B. Wolf, Inc., 637 F.2d 357 (5th Cir. 1981) (ERISA cause of action does not accrue until an application for benefits is denied)
- Heimeshoff v. Hartford Life & Accident Ins. Co., 134 S. Ct. 604 (U.S. 2013) (a cause of action accrues when plaintiff can file suit; statute of limitations begins to run at accrual)
- In re Managed Care Litig., 756 F.3d 1222 (11th Cir. 2014) (ERISA claims based on denial or underpayment do not accrue absent a denial or underpayment)
- Riley v. Metro. Life Ins. Co., 744 F.3d 241 (1st Cir. 2014) (accrual when plan repudiates claim or sum sought and beneficiary knows of repudiation)
- Miller v. Fortis Benefits Ins. Co., 475 F.3d 516 (3d Cir. 2007) (formal denial unnecessary where fiduciary’s repudiation was clear and known to beneficiary)
- Gordon v. Deloitte & Touche, LLP Grp. Long Term Disability Plan, 749 F.3d 746 (9th Cir. 2014) (limitations run when benefits are denied or insured has reason to know claim denied; clear continuing repudiation starts accrual)
- Glass v. United of Omaha Life Ins. Co., 33 F.3d 1341 (11th Cir. 1994) (discussing waiver, estoppel, forfeiture principles in ERISA context)
- Lozano v. Montoya Alvarez, 134 S. Ct. 1224 (U.S. 2014) (policy rationale for statutes of limitations: repose and elimination of stale claims)
- Harrison v. Digital Health Plan, 183 F.3d 1235 (11th Cir. 1999) (federal law governs accrual date though state law supplies limitations period)