762 F.3d 503
6th Cir.2014Background
- Joseph Moyer, a participant in Solvay’s ERISA-governed Long Term Disability Plan administered by MetLife, had benefits approved in 2005 but terminated in 2007; MetLife affirmed the termination on administrative appeal in a June 20, 2008 adverse benefit determination letter.
- MetLife’s adverse determination letter informed Moyer of his right to judicial review but did not state the plan’s contractual three-year limitations period for filing suit; the SPD likewise did not disclose the right or time limit.
- Moyer filed suit under 29 U.S.C. § 1132(a)(1)(B) on February 20, 2012, after the three-year contractual period elapsed; MetLife moved to dismiss as time-barred and the district court granted dismissal.
- On appeal Moyer sought equitable tolling, arguing he lacked notice of the limitations period; the Sixth Circuit reviewed whether the omission in the denial letter and related ERISA notice obligations precluded enforcement of the plan’s time bar.
- The Sixth Circuit majority held that under ERISA § 1133 and its implementing regulation (29 C.F.R. § 2560.503-1), an adverse benefit determination letter must include the time limits applicable to judicial review; MetLife’s omission meant the letter did not substantially comply and therefore did not trigger the plan’s time bar.
- The court reversed and remanded for judicial review of Moyer’s benefits claim; Judge Cook dissented, arguing the § 1133 issue was unpreserved and that the majority improperly raised and decided an unbriefed issue.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether MetLife’s adverse benefit determination triggered the plan’s contractual three-year suit limitation | Moyer: denial letter failed to give notice of the three-year judicial-review limitation, so time bar should not apply; equitable tolling warranted | MetLife: plan’s three-year limit is reasonable and enforceable; plan documents (available on request) provided constructive notice | Held: Reversed — denial letter failed to substantially comply with ERISA notice rules by omitting judicial-review time limits, so the plan’s time bar does not attach and claim may proceed |
| Whether § 1133 / 29 C.F.R. § 2560.503-1 required inclusion of judicial-review time limits in the denial letter | Moyer: adverse determination letters must include time limits for judicial action as part of required notice | MetLife: (implicitly) notice to the participant as a whole sufficed and plan documents disclosed time limit | Held: Court: the regulation requires describing time limits applicable to the claim procedures, including the right and time frame to bring a civil action; omission defeats substantial compliance |
| Whether the SPD’s omissions under 29 U.S.C. § 1022 require relief | Moyer: SPD failed to disclose right and time limit, supporting tolling | MetLife: district court relied on plan to apply the time bar | Held: Court did not decide § 1022/SPD issue because remedy based on defective denial letter sufficed |
| Whether the appellate court may decide an unpreserved § 1133 claim not argued below | MetLife (and dissent): issue was not raised below or adequately briefed; appellate court should not address it sua sponte | Moyer: argued denial letter lacked required notice (district court focused on SPD) | Held: Majority reviewed § 1133 on the merits; dissent objects that the issue was unpreserved and should have been left to the district court |
Key Cases Cited
- Fallin v. Commonwealth Indus., Inc., 695 F.3d 512 (6th Cir. 2012) (standard of review for contractual limitations in ERISA cases)
- Medical Mutual of Ohio v. K. Amalia Enterprises Inc., 548 F.3d 383 (6th Cir. 2008) (upholding reasonable three-year plan limitations)
- Rice v. Jefferson Pilot Financial Ins. Co., 578 F.3d 450 (6th Cir. 2009) (reasonableness of three-year limitations periods)
- Engleson v. Unum Life Ins. Co. of Am., 723 F.3d 611 (6th Cir. 2013) (discussing when denial-letter notice of judicial-review limits may be required)
- Wenner v. Sun Life Assurance Co. of Canada, 482 F.3d 878 (6th Cir. 2007) (substantial-compliance test for ERISA notice requirements)
- VanderKlok v. Provident Life & Acc. Ins. Co., 956 F.2d 610 (6th Cir. 1992) (remand appropriate when procedural ERISA defects constitute significant legal error)
- Burke v. Kodak Ret. Income Plan, 336 F.3d 103 (2d Cir. 2003) (notice not in substantial compliance does not trigger plan time bar)
- Ortega Candelaria v. Orthobiologics LLC, 661 F.3d 675 (1st Cir. 2011) (denial letters must include right to sue and time frame)
- White v. Sun Life Assurance Co. of Canada, 488 F.3d 240 (4th Cir. 2007) (civil action is integral to claim procedure notices)