You already know that ERISA sets forth a 180-day time limit for internal administrative appeals of benefit denials.

And failure to pursue a timely internal administrative appeal can subject the claimant (in a later federal lawsuit) to the defense of failure to exhaust administrative remedies.

But can a claimant save an untimely administrative appeal by arguing the “substantial compliance doctrine”?  No.

Here’s the case of Fortier v. Hartford Life and Acc. Ins. Co., __ F. 3d __ (1st Cir., February 20, 2019)(Affirming dismissal of lawsuit due to untimely administrative appeal and failure to exhaust administrative remedies, concluding: “‘[To apply the substantial compliance doctrine to appeal deadlines] would render it effectively impossible for plan administrators to fix and enforce administrative deadlines while involving the courts incessantly in detailed, case-by-case determinations as to whether a given claimant’s failure to bring a timely appeal from a denial of benefits should be excused or not.’”)  

FACTS: Fortier sought ERISA-governed long term disability benefits claiming an infection had caused him memory problems. Fortier’s physician determined impairment resulted from a mood disorder, and Hartford granted benefits up to the 24 month mental/nervous limitation period. Fortier appealed the denial of benefits, and later sued.  The Court dismissed the lawsuit, and Fortier appealed.

ISSUE:  Does the “substantial compliance” doctrine excuse a claimant’s late appeal? 

1st Cir. HELD:

  1. “‘It seems consistent neither with the policies underlying the requirement of exhaustion of administrative remedies in ERISA cases nor with judicial economy to import into the exhaustion requirement the substantial compliance doctrine.’” Op. at 21 (quoting Edwards v. Briggs & Stratton Ret. Plan, 639 F.3d 355, 362 (7th Cir. 2011)).
  2. “‘[To apply the substantial compliance doctrine to appeal deadlines] would render it effectively impossible for plan administrators to fix and enforce administrative deadlines while involving the courts incessantly in detailed, case-by-case determinations as to whether a given claimant’s failure to bring a timely appeal from a denial of benefits should be excused or not.’”   Id.
  3. “[T]he Supreme Court has discussed ERISA’s ‘careful balancing’ between ensuring fair and prompt enforcement of rights under a plan and the encouragement of the creation of such plans.’”  Op. at 22.
  4. “[S]tate common law notice-prejudice rules do not apply to ERISA appeals.”  Op. at 24 (Emph. added).

 

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Photo of Mike Reilly Mike Reilly

Mike Reilly is a nationally recognized labor, employment and employee benefits attorney, named one of the “Top 100 Most Powerful Employment Attorneys in the Nation” for the past five consecutive years by Human Resource Executive®. He has decades of experience providing strategic employment…

Mike Reilly is a nationally recognized labor, employment and employee benefits attorney, named one of the “Top 100 Most Powerful Employment Attorneys in the Nation” for the past five consecutive years by Human Resource Executive®. He has decades of experience providing strategic employment advice, and has represented clients in more than 75 jury trials, arbitrations, bench trials and claims before the EEOC and Washington State Human Rights Commission.

Small and large employers retain Mike for his strategic advice and decades of experience in employment issues and litigation, business decisions and litigation avoidance. Mike provides advice in claims involving discrimination, retaliation, wrongful discharge, disability accommodation, ERISA and non-ERISA employee benefit claims, and wage/hour claims. He served as lead counsel in an employee raiding/trade secret case as reported in the Wall Street Journal, and defends employers in class action claims.

Mike’s remarks on employment issues have been quoted in NewsweekCorporate Legal TimesSeattle TimesEmployee Relations Law JournalPuget Sound Business JournalCFO.com, and other professional journals and management publications. Chambers USA’s Guide to America’s Leading Lawyers for Businessrates Mike in the top ranking (band one) for his work in labor and employment law, and has described him as “one of Seattle’s top-rate attorneys” who is “truly phenomenal [with] superb legal instincts” and “an amazingly assertive litigator.” His clients include Nordstrom, Seattle Seahawks, Home Depot, KeyBank, Starbucks, Fred Hutchinson Cancer Research Center, Red Robin and Seattle Chamber of Commerce, among others.