Engleson v. Unum Life Insurance Co. of America
723 F.3d 611
6th Cir.2013Background
- Jerry Engleson, former VP at Seibert-Keck, filed for long-term disability in 2001; Unum denied the claim after two internal appeals that year.
- Engleson made limited follow-up, moved to Florida, then returned to Ohio and filed a new disability claim in 2008; Unum granted benefits effective August 5, 2008 but refused to backdate to 2001.
- Engleson sued in federal court on December 22, 2009 under 29 U.S.C. § 1132(a)(1)(B) and for equitable relief, challenging procedural compliance and alleging fiduciary breach.
- The plan contained a contractual 3-year limitations provision (running from the date proof of claim was required); the district court concluded Engleson’s claim based on the 2001 disability was time-barred and dismissed; appeal followed.
- On appeal the Sixth Circuit treated the district court’s dismissal as the functional equivalent of summary judgment and reviewed de novo.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Unum’s 2001 denial letters were required to disclose right and deadline for judicial review under 29 C.F.R. §2560.503-1(f) (2000) | Engleson: denial should have told him about right to sue and the contractual time limit, so nondisclosure excuses lateness | Unum: regulation required notice of internal-review steps only, not judicial-review deadlines | Held: Regulation in effect then covered internal appeals only; no obligation to disclose judicial-review time limits in 2001 denial letters. |
| Whether Unum’s 2008 grant/letters operated as a new adverse determination or waived enforcement of the 2001 limitations clause | Engleson: 2008 grant and follow-up correspondence functioned as adverse determinations or implied waiver of the time bar | Unum: 2008 claim was a separate claim; any reconsideration offer was not an unequivocal waiver of the limitations clause | Held: 2008 letter addressed a new claim; any offer to reconsider was mere reconsideration, not the clear, decisive act required to waive the limitations period. |
| Whether the SPD failed to disclose “applicable time limits” (29 C.F.R. §2520.102-3(s)) so as to bar enforcement of the contractual limitations period | Engleson: SPD’s silence about judicial-review time limits violated the regulation and misled him | Unum: SPD complied by describing internal appeal timing and remedies; SPD is a summary and does not supplant plan language | Held: Court reads “applicable time limits” as referring to claim-processing time limits; SPD complied and does not render plan limitation unenforceable. |
| Whether equitable tolling applies (due to lack of notice, failure to receive plan documents, and Unum’s conduct) | Engleson: Unum’s conduct and lack of plan documents prevented timely filing; Amara supports relaxation of equitable doctrines | Unum: Engleson was not diligent, failed to request plan earlier, and bears burden to prove tolling elements | Held: Amara does not alter Sixth Circuit equitable-tolling test; Engleson failed the diligence/knowledge prongs, so equitable tolling not warranted. |
Key Cases Cited
- Chappel v. Laboratory Corp. of America, 232 F.3d 719 (9th Cir. 2000) (plan fiduciary must disclose mandatory internal arbitration steps; distinguishes internal requirements from judicial review)
- White v. Sun Life Assurance Co. of Canada, 488 F.3d 240 (4th Cir. 2007) (discusses relation between administrative notice rules and civil action notice under later regulations)
- CIGNA Corp. v. Amara, 131 S. Ct. 1866 (2011) (SPDs serve the summary/communication function; SPD language not necessarily controlling over plan terms)
- Lipker v. AK Steel Corp., 698 F.3d 923 (6th Cir. 2012) (SPD silence about a term does not create a conflict that overrides plan language)
- Ortega Candelaria v. Orthobiologics LLC, 661 F.3d 675 (1st Cir. 2011) (equitable tolling applied where participant repeatedly sought plan documents and administrator failed to disclose new limitations period)
- Hounshell v. American States Insurance Co., 424 N.E.2d 311 (Ohio 1981) (insurer’s mere reconsideration of a claim does not waive contractual limitations unless insurer’s conduct caused insured to delay filing)