OPINION
Thе question presented in this case is whether the contractual time limitation has expired on an insured’s action against his insurer for disability benefits. The long-term disability policy at issue is gоverned by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq. We conclude that the insurer, in its correspondence to the insured, did not utilize language from its own policy which would inform the insured that the contractual time limitation for legal proceedings would begin to run. Therefore, we reverse the judgment of the district court and. remand for further proceedings.
BACKGROUND
A. The Claimant
Kenneth Mogck (“Mogck”) was injured in a car accident on March 25, 1993. In October 1993, Mogck submitted a claim for long-term disability benefits under his employer’s policy undеrwritten by Unum Life Insurance Company of America (“Unum”). Under the policy terms, a qualified claimant is provided approximately 66 percent of his basic monthly earnings, following a 91 dаy elimination period. Unum began
B. The Insurance Policy
The policy defines “disability” during the first two years of a claim as the insured’s inability to perform each of the material duties of the participant’s regular occupation, and thereafter as the insured’s inability to perform each of the material duties of “any gainful occupation for which he is reasonably fitted by training, education, or experience.”
The policy’s time limitation on legal proceedings is set forth in a section entitled “Legal Proceedings.” The policy provides: “A claimant or the claimant’s representative cannot start any legal action: (1) until 60 days after proof of claim has been given; nor (2) more than 3 years after thе time proof of claim is required.”
In a section entitled “Notice and Proof of Claim,” the policy provides that “[p]roof of continued disability and regular attendancе of a physician must be given to the Company within 30 days of the request for the proof.”
C. The Correspondence
By letter dated February 3, 1995, Unum wrote to Mogck to remind him of the policy definition of disability applicable after two years. Unum advised Mogck that “based on information we have, we find that you will not be disabled from any occupation and you will therefore not be eligiblе for benefits beyond June 25,1995.”
By letter dated June 1, 1995, _ Unum informed Mogck that “we are unable to extend benefits past June 25, 1995.” The letter reviewed the policy definitions of disability, cited the dоctors’ reports in its possession, and stated,”[y]ou no longer meet the above definition of disability, we must deny any further liability on your claim.” The letter then informed Mogck that “[i]f you have new additional information to support your request for disability benefits, please send it to my attention at the above address,” and “[i]f you do not agree with our decision, you mаy have it reviewed. Should you desire a review, you must send a written request, within 60 days of your receipt of this notice” [to a given address].
By letter dated July 8, 1995, Mogck requested “a review оf the decision to deny me further benefits at this time,” requested copies of his medical records in Unum’s file, and stated that he would send additional medical records. By letter dated August 3, 1995, Mogck enclosed additional medical records.
By letter dated September 29, 1995, Unum informed Mogck that it had reviewed the medical information recently provided and • concluded that, “[w]hile it does support the fact that you have various medical conditions, none of those conditions support medical restrictions that would impair your ability to perform any gainful occupation.” The letter stated that Unum’s prior decision to terminate benefits as of June 25; 1995, would be upheld.
D.The Legal Proceedings
■ Mogck filed this action under ERISA, 29 U.S.C. § 1132(a),. on Fеbruary 5, 1999. Unum moved for summary judgment on the grounds that the action was untimely. The district court determined that Mogck’s ERISA action was filed within the four-year statute of limitations for ERISA claims in California, but was contractually barred by the three-year time limitation in the policy.’ Judgment was entered and Mogck timely appealed. We have jurisdiction pursuant to 28 U.S.C. § 1291.
ANALYSIS
A. The ERISA Four Year Statute of Limitations
In Wetzel v. Lou Ehlers Cadillac Group Long Term Disability Ins. Program, 222
In the present сase, the district court did not decide, and we need not decide, whether Unum’s June 1,1995, letter or the September 29, 1995, letter to Mogck constituted the accrual point for Mogck’s ERISA cause of action, because, in either event, Mogck’s action, filed on February 5, 1999, was filed within the applicable four-year ERISA statute of limitations.
B. The Contractual Three Year Limitation
The policy prоvides that a legal action cannot be started “(1) until 60 days after proof of claim has been given; nor (2) more than three years after the time proof of claim is required” (emphasis added). In the policy section entitled “Notice and Proof of Claim,” the policy provides that “[p]roof of continued disability and regular attendance of a physician must be given to the Company within 30 days of the request for the proof” (emphasis added). It is undisputed that Mogck is seeking continued disability benefits, not initial disability benefits. Therefore, in order to determine when the contractuаl limitation period began, we must first determine when Unum asked Mogck for a “request for the proof,” or a “proof of claim.”
The district court determined that Unum’s June 1, 1995, letter constituted an adequate “request for proof.” We disagree. The June 1, 1995, letter (and the September 29, 1995, letter) informed Mogck of Unum’s decision to discontinue the disability payments past June 25, 1995. However, nowhere in either letter are the terms “proof,” “request for the proof,” or “proof of claim” utilized. Without an adequate request for the proof of clаim, Unum never took the steps necessary to trigger the running of the contractual time limitation under the policy.
The insurance policy at issue was drafted entirely by Unum and is therefоre a contract of adhesion. See Carrington Estate Planning Servs. v. Reliance Standard Life Ins. Co.,
In conclusion,, because Unum drafted certain terms regarding the time limits on legal actions, but did not utilize those terms at all in its correspondence with Mogck, the pоlicy’s time limitation provision was never rendered operative. Mogck’s action filed on February 9, 1999, therefore was not time-barred. The judgment of the district court is reversed аnd the case is remanded for further proceedings.
REVERSED AND REMANDED.
Notes
. We note that, subsequent to the filing of this action, California Administrative Code, Title 10 § 2695.7 was amended, effective May 10, 1997, adding the follоwing subsection, which provides in relevant part:
(f) Except where a claim has been settled by payment, every insurer shall provide written notice of any statute of limitation or other time period requirement upon which the insurer may rely to deny a timely claim.... This subsection shall not apply to a claimant represented by counsel on the clаim matter.
Failure to give notice pursuant to California's insurance code regulations may estop an insurer from asserting a statute of limitations defense. See Spray, Gould & Bowers v. Associated Int'l. Ins. Co.,
We need not decide whether the amended California rеgulations clarified an existing duly of the insurer to provide notice of a contractual statute of limitation, or whether a new duty to provide written notice was created, because, in any event, Unum's correspondence was ineffective to trigger the policy's time limitation provision.