HEIMESHOFF v. HARTFORD LIFE & ACCIDENT INSURANCE CO. ET AL.
No. 12-729
SUPREME COURT OF THE UNITED STATES
December 16, 2013
571 U. S. ____ (2013)
THOMAS, J.
CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT. Argued October 15, 2013-Decided December 16, 2013
NOTE: Where it is feasible, a syllabus (headnote) will be released, as is being done in connection with this case, at the time the opinion is issued. The syllabus constitutes no part of the opinion of the Court but has been prepared by the Reporter of Decisions for the convenience of the reader. See United States v. Detroit Timber & Lumber Co., 200 U. S. 321, 337.
Syllabus
Respondent Hartford Life & Accident Insurance Co. (Hartford) is the administrator of Wal-Mart Stores, Inc.‘s (Wal-Mart) Group Long Term Disability Plan (Plan), an employee benefit plan covered by the Employee Retirement Income Security Act of 1974 (ERISA). The Plan‘s insurance policy requires any suit to recover benefits pursuant to the judicial review provision in
Held: The Plan‘s limitations provision is enforceable. Pp. 4-16.
(a) The courts of appeals require participants in an employee benefit plan covered by ERISA to exhaust the plan‘s administrative remedies before filing suit to recover benefits. A plan participant‘s cause of action under
(1) The rule set forth in Order of United Commercial Travelers of America v. Wolfe, 331 U. S. 586, 608, provides that a contractual limitations provision is enforceable so long as the limitations period is of reasonable length and there is no controlling statute to the contrary. That is the appropriate framework for determining the enforceability of the Plan‘s limitations provision. The Wolfe approach necessarily allows parties to agree both to the length of a limitations period and to its commencement. Pp. 5-7.
(2) The principle that contractual limitations provisions should ordinarily be enforced as written is especially appropriate in the context of an ERISA plan. Heimeshoff‘s cause of action is bound up with the written terms of the Plan, and ERISA authorizes a participant to bring suit “to enforce his rights under the terms of the plan.”
(b) Unless the limitations period is unreasonably short or there is a “controlling statute to the contrary,” Wolfe, supra, at 608, the Plan‘s limitations provision must be given effect. Pp. 8-16.
(1) The Plan‘s period is not unreasonably short. Applicable regulations mean for mainstream claims to be resolved by plans in about one year. Here, the Plan‘s administrative review process (“internal review“) required more time than usual but still left Heimeshoff with approximately one year to file suit. Her reliance on Occidental Life Ins. Co. of Cal. v. EEOC, 432 U. S. 355, in which this Court declined to enforce a 12-month statute of limitations applied to Title VII employment discrimination actions where the Equal Employment Opportunity Commission faced an 18- to 24-month backlog, is unavailing in the absence of any evidence that similar obstacles exist to bringing a timely
(2) This Court rejects the contentions of Heimeshoff and the United States that the limitations provision is unenforceable because it will undermine ERISA‘s two-tiered remedial scheme. Pp. 10-15.
(i) Enforcement of the Plan‘s limitation provision is unlikely to cause participants to shortchange the internal review process. The record for judicial review generally has been limited to the administrative record, so participants who fail to develop evidence during internal review risk forfeiting the use of that evidence in district court. In addition, many plans vest discretion over benefits determinations in the plan administrator, and courts ordinarily review such determinations only for abuse of discretion. Pp. 11-12.
(ii) It is also unlikely that enforcing limitations periods that begin to run before the internal review process is exhausted will en
(3) Heimeshoff‘s additional arguments are unpersuasive. The limitations period need not be tolled as a matter of course during internal review because that would be inconsistent with the text of the limitations provision, which is enforceable. And federal courts need not inquire whether state law would toll the limitations period during internal review because the limitations period is set by contract, not borrowed from state law. Pp. 15-16.
496 Fed. Appx. 129, affirmed.
THOMAS, J., delivered the opinion for a unanimous Court.
NOTICE: This opinion is subject to formal revision before publication in the preliminary print of the United States Reports. Readers are requested to notify the Reporter of Decisions, Supreme Court of the United States, Washington, D. C. 20543, of any typographical or other formal errors, in order that corrections may be made before the preliminary print goes to press.
JUSTICE THOMAS delivered the opinion of the Court.
A participant in an employee benefit plan covered by the Employee Retirement Income Security Act of 1974 (ERISA), 88 Stat. 829, as amended,
I
In 2005, petitioner Julie Heimeshoff began to report chronic pain and fatigue that interfered with her duties as
On August 22, 2005, Heimeshoff filed a claim for long-term disability benefits with Hartford Life & Accident Insurance Co., the administrator of Wal-Mart‘s Group Long Term Disability Plan (Plan). Her claim form, supported by a statement from her rheumatologist, listed her symptoms as “extreme fatigue, significant pain, and difficulty in concentration.”1 App. to Pet. for Cert. 7. In November 2005, Hartford notified Heimeshoff that it could not determine whether she was disabled because her rheumatologist had never responded to Hartford‘s request for additional information. Hartford denied the claim the following month for failure to provide satisfactory proof of loss. Hartford instructed Heimeshoff that it would consider an appeal filed within 180 days, but later informed her that it would reopen her claim, without the need for an appeal, if her rheumatologist provided the requested information.
In July 2006, another physician evaluated Heimeshoff and concluded that she was disabled. Heimeshoff submitted that evaluation and additional medical evidence in October 2006. Hartford then retained a physician to review Heimeshoff‘s records and speak with her rheumatologist. That physician issued a report in November 2006 concluding that Heimeshoff was able to perform the activities required by her sedentary occupation. Hartford denied Heimeshoff‘s claim later that November.
In May 2007, Heimeshoff requested an extension of the Plan‘s appeal deadline until September 30, 2007, in order
On November 18, 2010, almost three years later (but more than three years after proof of loss was due), Heimeshoff filed suit in District Court seeking review of her denied claim pursuant to
The District Court granted the motion to dismiss. Recognizing that ERISA does not provide a statute of limitations for actions under
On appeal, the Second Circuit affirmed. 496 Fed. Appx. 129 (2012). Applying the precedent relied on by the District Court, the Court of Appeals concluded that it did not offend ERISA for the limitations period to commence before the plaintiff could file suit under
We granted certiorari to resolve a split among the Courts of Appeals on the enforceability of this common contractual limitations provision. 569 U. S. 946 (2013). Compare, e.g., Burke, supra, at 79–81 (plan provision requiring suit within three years after proof-of-loss deadline is enforceable); and Rice v. Jefferson Pilot Financial Ins. Co., 578 F. 3d 450, 455-456 (CA6 2009) (same), with White v. Sun Life Assurance Co. of Canada, 488 F. 3d 240, 245-248 (CA4 2007) (not enforceable); and Price v. Provident Life & Acc. Ins. Co., 2 F. 3d 986, 988 (CA9 1993) (same). We now affirm.
II
Statutes of limitations establish the period of time within which a claimant must bring an action. As a general matter, a statute of limitations begins to run when the cause of action “accrues“—that is, when “the plaintiff can file suit and obtain relief.” Bay Area Laundry and Dry Cleaning Pension Trust Fund v. Ferbar Corp. of Cal., 522 U. S. 192, 201 (1997).
For the reasons that follow, we reject that argument. Absent a controlling statute to the contrary, a participant and a plan may agree by contract to a particular limitations period, even one that starts to run before the cause of action accrues, as long as the period is reasonable.
A
Recognizing that Congress generally sets statutory limitations periods to begin when their associated causes of action accrue, this Court has often construed statutes of limitations to commence when the plaintiff is permitted to file suit. See, e.g., Graham County Soil & Water Conservation Dist. v. United States ex rel. Wilson, 545 U. S. 409, 418 (2005) (resolving an ambiguity in light of “the ‘standard rule that the limitations period commences when the plaintiff has a complete and present cause of action‘”
None of those decisions, however, addresses the critical aspect of this case: the parties have agreed by contract to commence the limitations period at a particular time. For that reason, we find more appropriate guidance in precedent confronting whether to enforce the terms of a contractual limitations provision. Those cases provide a well-established framework suitable for resolving the question in this case:
“[I]n the absence of a controlling statute to the contrary, a provision in a contract may validly limit, between the parties, the time for bringing an action on such contract to a period less than that prescribed in the general statute of limitations, provided that the shorter period itself shall be a reasonable period.” Order of United Commercial Travelers of America v. Wolfe, 331 U. S. 586, 608 (1947).
We have recognized that some statutes of limitations do not permit parties to choose a shorter period by contract.
The Wolfe rule necessarily allows parties to agree not only to the length of a limitations period but also to its commencement. The duration of a limitations period can be measured only by reference to its start date. Each is therefore an integral part of the limitations provision, and there is no basis for categorically preventing parties from agreeing on one aspect but not the other. See Electrical Workers v. Robbins & Myers, Inc., 429 U. S. 229, 234 (1976) (noting that “the parties could conceivably have agreed to a contract” specifying the “occurrence” that commenced the statutory limitations period).
B
The principle that contractual limitations provisions ordinarily should be enforced as written is especially appropriate when enforcing an ERISA plan. “The plan, in short, is at the center of ERISA.” US Airways, Inc. v. McCutchen, 569 U. S. 88, 101 (2013). “[E]mployers have large leeway to design disability and other welfare plans as they see fit.” Black & Decker Disability Plan v. Nord, 538 U. S. 822, 833 (2003). And once a plan is established, the administrator‘s duty is to see that the plan is “maintained pursuant to [that] written instrument.”
Heimeshoff‘s cause of action for benefits is likewise bound up with the written instrument.
III
We must give effect to the Plan‘s limitations provision
A
Neither Heimeshoff nor the United States claims that the Plan‘s 3-year limitations provision is unreasonably short on its face. And with good reason: the United States acknowledges that the regulations governing internal review mean for “mainstream” claims to be resolved in about one year, Tr. of Oral Arg. 22, leaving the participant with two years to file suit.4 Even in this case, where the administrative review process required more time than usual, Heimeshoff was left with approximately one year in which to file suit. Heimeshoff does not dispute that a hypothetical 1-year limitations period commencing at the conclusion of internal review would be reasonable. Id., at 4. We cannot fault a limitations provision that would leave the same amount of time in a case with an unusually long internal review process while providing for a significantly longer period in most cases.
Heimeshoff‘s reliance on Occidental Life Ins. Co. of Cal. v. EEOC, 432 U. S. 355 (1977), is therefore misplaced. There, we declined to enforce a State‘s 1-year statute of limitations as applied to Title VII employment discrimination actions where the limitations period commenced before accrual. We concluded that “[i]t would hardly be reasonable” to suppose that Congress intended to enforce state statutes of limitations as short as 12 months where
B
Heimeshoff and the United States contend that even if the Plan‘s limitations provision is reasonable, ERISA is a “controlling statute to the contrary.” Wolfe, supra, at 608. But they do not contend that ERISA‘s statute of limitations for claims of breach of fiduciary duty controls this action to recover benefits. See
1
The first tier of ERISA‘s remedial scheme is the internal review process required for all ERISA disability-benefit plans.
Following denial, the plan must provide the participant with “at least 180 days . . . within which to appeal the determination.”
2
Heimeshoff and the United States first claim that the Plan‘s limitations provision will undermine the foregoing internal review process. They contend that participants will shortchange their own rights during that process in order to have more time in which to seek judicial review. Their premise—that participants will sacrifice the benefits of internal review to preserve additional time for filing suit—is highly dubious in light of the consequences of that course of action.
First, to the extent participants fail to develop evidence during internal review, they risk forfeiting the use of that evidence in district court. The Courts of Appeals have generally limited the record for judicial review to the administrative record compiled during internal review. See, e.g., Foster v. PPG Industries, Inc., 693 F. 3d 1226, 1231 (CA10 2012); Fleisher v. Standard Ins. Co., 679 F. 3d 116, 121 (CA3 2012); McCartha v. National City Corp., 419 F. 3d 437, 441 (CA6 2005). Second, participants are not likely to value judicial review of plan determinations over internal review. Many plans (including this Plan)
3
Heimeshoff and the United States next warn that it will endanger judicial review to allow plans to set limitations periods that begin to run before internal review is complete. The United States suggests that administrators may attempt to prevent judicial review by delaying the resolution of claims in bad faith. Brief for United States as Amicus Curiae 19; see also White, 488 F. 3d, at 247-248. But administrators are required by the regulations governing the internal review process to take prompt action, see supra, at 10–11, and the penalty for failure to meet those deadlines is immediate access to judicial review for the participant.
The United States suggests that even good-faith administration of internal review will significantly diminish the availability of judicial review if this limitations provision is enforced. Forty years of ERISA administration suggest otherwise. The limitations provision at issue is quite common; the vast majority of States require certain insurance policies to include 3-year limitations periods that run
Moreover, even in the rare cases where internal review prevents participants from bringing
C
Two additional arguments warrant mention. First, Heimeshoff argues—for the first time in this litigation—that the limitations period should be tolled as a matter of course during internal review. By effectively delaying the commencement of the limitations period until the conclusion of internal review, however, this approach reconstitutes the contractual revision we declined to make. As we explained, the parties’ agreement should be enforced unless the limitations period is unreasonably short or foreclosed by ERISA. The limitations period here is neither. See supra, at 9–10, 11–14, and this page.
Nor do the ERISA regulations require tolling during internal review. A plan must agree to toll the limitations provision only in one particular circumstance: when a plan offers voluntary internal appeals beyond what is permitted by regulation.
IV
We hold that the Plan‘s limitations provision is enforceable. The judgment is, accordingly, affirmed.
It is so ordered.
