Gordon v. Deloitte & Touche, LLP Group Long Term Disability Plan
749 F.3d 746
| 9th Cir. | 2014Background
- Gordon, a former Deloitte employee, received MetLife long-term disability (LTD) benefits from March 3, 2001; MetLife terminated payments in a Jan. 2, 2003 letter for lack of continuing proof.
- Gordon appealed Jan. 9, 2003; MetLife denied the appeal on Mar. 17, 2003. Gordon again appealed on Oct. 15, 2003.
- MetLife’s Nov. 4, 2003 letter approved benefits only for Jan. 1–Mar. 2, 2003 and stated the Plan limits mental-illness benefits to 24 months; the letter characterized the last payment as full and final and notified her of a 180‑day appeal right.
- Gordon did not appeal within 180 days and took no action until contacting MetLife in Nov. 2007; her file was administratively reopened after a 2009 complaint to the California Department of Insurance.
- MetLife reaffirmed its denial in a Dec. 8, 2009 letter, informed Gordon of appeal rights and that she could bring an ERISA suit if the appeal were denied; Gordon appealed administratively but filed an ERISA §502(a) suit Jan. 31, 2011.
- The district court granted summary judgment for the Plan, holding Gordon’s suit time‑barred by California’s four‑year statute for written contracts; the Ninth Circuit affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Accrual / statute of limitations start date for ERISA claim | Gordon: Nov. 4, 2003 letter wasn’t final because appeals remained; accrual occurred later | MetLife: Claim was finally repudiated no later than Nov. 4, 2003 and, at the latest, when the 180‑day appeal period expired (~May 4, 2004) | Accrual occurred by May 4, 2004; four‑year California limitations bar applied to Gordon’s 2011 suit (affirmed) |
| Whether reopening in 2009 revived the limitations period | Gordon: Reopening and reconsideration revived the limitations period under CA acknowledgment/renewal doctrines | MetLife: Reopening does not restart federal accrual or revive state limitations for ERISA claims | Reopening did not revive the limitations period under Ninth Circuit precedent (Martin) |
| Estoppel based on MetLife’s Dec. 8, 2009 representations | Gordon: MetLife’s statements that she could sue induced her to delay and should estop statute of limitations defense | MetLife: Any such statements came after the limitations period had already run; no detrimental reliance | No estoppel — no showing that MetLife’s conduct caused Gordon to miss the deadline |
| Waiver of limitations defense by MetLife | Gordon: MetLife waived the defense by reopening and by representations in 2009 | MetLife: Waiver requires intentional relinquishment plus detrimental reliance or consideration; no such facts here | No waiver — court requires detrimental reliance or misconduct to find waiver in ERISA context; absent here |
Key Cases Cited
- Coszalter v. City of Salem, 320 F.3d 968 (9th Cir. 2003) (summary judgment standard and favoring nonmoving party review)
- Wetzel v. Lou Ehlers Cadillac Grp. Long Term Disability Ins. Program, 222 F.3d 643 (9th Cir. 2000) (use state statute of limitations and ERISA accrual rule)
- Chuck v. Hewlett Packard Co., 455 F.3d 1026 (9th Cir. 2006) (definition of ‘‘reason to know’’ and clear repudiation accrual rule)
- Martin v. Construction Laborer’s Pension Trust, 947 F.2d 1381 (9th Cir. 1991) (reopening claim after final denial does not restart limitations period)
- LaMantia v. Voluntary Plan Admin’rs, Inc., 401 F.3d 1114 (9th Cir. 2005) (estoppel prevents limitations defense where defendant’s conduct caused plaintiff to miss deadline)
- Aceves v. Allstate Ins. Co., 68 F.3d 1160 (9th Cir. 1995) (limits on insurer waiver of statute of limitations after the limitations period has run)
- Mitchell v. CB Richard Ellis Long Term Disability Plan, 611 F.3d 1192 (9th Cir. 2010) (insurer must state basis and policy provision when denying claim)
- Harlick v. Blue Shield of California, 686 F.3d 699 (9th Cir. 2012) (insurer cannot switch denial grounds at litigation that were not relied on administratively)
- Intel Corp. v. Hartford Accident & Indem. Co., 952 F.2d 1551 (9th Cir. 1991) (waiver requires intentional relinquishment of a known right)
- Prudential-LMI Com. Ins. v. Superior Court, 51 Cal.3d 674 (Cal. 1990) (California insurance waiver/estoppel doctrines and equitable tolling principles)