You already know about the contractual limitations provision in disability policies. The provision works to bar untimely lawsuits.
So, it is no surprise that the interpretation/application of these provisions has been the subject of significant litigation.
Here’s a short new case concluding the contractual limitations provision was “unambiguous,” and dismissing the claim as untimely. Kuber v. Prudential Insurance Company of America, 2020 WL 3542308 (11th Cir. June 30, 2020).
FACTS: Kuber stopped working due to disability on September 18, 2012. Prudential paid disability benefits until January 2015, when his benefits were exhausted. After various administrative appeals, Kuber filed suit December 28, 2018, asserting a breach of contract claim. (This claim was not governed by ERISA.)
The Prudential policy stated that “[Kuber] can start legal action regarding his claim 60 days after proof of claim has been given and up to 3 years from the time proof of claim is required.” The policy also required that Kuber provide proof of claim “no later than 90 days after [his] elimination period ends.”
ISSUE: Whether Kuber’s claim was time-barred by the contractual limitations provision?
DISTRICT COURT HELD: Kuber’s claim was time-barred by the contractual limitations provision.
11th CIRCUIT COURT OF APPEALS HELD: AFFIRMED
- Choice of law: “Sitting in diversity, we apply the forum state’s choice-of-law rules to decide whether a choice of law provision applies…. We see nothing in Florida policy that conflicts with Delaware law here. So Delaware law governs our analysis of the limitation provision.” Op. at 4.
- Enforcement of the contractual limitations provision: “The policy’s limitation provision is unambiguous….[I]n a normal case (like this one) the three year clock starts running 90 days after his elimination period ends. And that time limitation is reasonable here.” Op. at 5.
- “Applying the limitation provision’s plain meaning, we reach the same conclusion as the district court. Kuber allegedly stopped working September 18, 2012. His elimination period ended 180 days later—March 17, 2013. The policy thus obligated him to provide proof of claim 90 days after that—June 15, 2013. Skip three years and you land on June 15, 2016. Kuber filed suit in December 28, 2018—over 30 months late. His claim is time-barred.” Op. at 5.