ERISA 180-day time limit

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).