Witt v. Metropolitan Life Insurance Co et al

Filing 24

MEMORANDUM OPINION Signed by Chief Judge Karon O Bowdre on 2/25/14. (SAC )

FILED
2014 Feb-25 PM 01:15
U.S. DISTRICT COURT
N.D. OF ALABAMA

IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
MIDDLE DIVISION
DON L WITT,
Plaintiff,
v.
METROPOLITAN LIFE INSURANCE
CO, ET AL.,
Defendants.

]
]
]
]
]
]
]
]
]
]

4:12-cv-02157-KOB

MEMORANDUM OPINION
This ERISA case is before the court on “Defendants’ Motion for Judgment as a Matter of
Law” (doc. 19) and “Plaintiff’s Brief in Support of Judgment on the Record” (doc. 21). Plaintiff
Don L. Witt filed suit against Defendants Metropolitan Life Insurance Company (“MetLife”) and
Shell Long Term Disability Plan (“Plan”) seeking recovery of past, present, and future benefits
under the Plan. Although Plaintiff does not call his “Brief” (doc. 21) a “motion,” the court will
consider it to be a motion for judgment on the record because the Plaintiff requests that the court
reverse the termination of his disability benefits. These cross motions have received thorough
briefing. For the reasons stated in this Memorandum Opinion, the court DENIES Plaintiff’s
motion for judgment in his favor and GRANTS Defendants’ motion for judgment.
I.

BACKGROUND
Plaintiff Don L. Witt worked as a Senior Operations Specialist with Shell Oil Company

from May 18, 1972 until December 29, 1994. (Doc. 12-7, pg. 216). In connection with his
employment with Shell Oil Company, Mr. Witt gained access to a short-term and long-term

1

disability insurance policy. (Doc. 12-5). On January 3, 1997, Mr. Witt made his initial claim of
long-term disability based on anterior cervical fusion, herniated lumbar disc, secondary
asbestosis, coronary artery disease, and hypertension. (Doc. 12-6, pgs. 102, 106). Although the
claim was late, MetLife approved the claim and granted Mr. Witt retroactive benefits back to
December 29, 1995. (Doc. 12-6, pg. 123). The Notice of Approval Mr. Witt received, dated
March 7, 1997, indicated the amount of the monthly payments he would receive for the rest of
his life, “providing reductions remain as listed above, and you remain totally disabled as defined
in your group plan . . .” (Doc. 12-9, pg. 472).
MetLife continued to provide benefits to Mr. Witt through April 30, 1997, but the record
shows that in a May 22, 1997 letter, MetLife terminated his benefits effective May 1, 1997
because he had failed to provide adequate medical records to sustain his claim. (Doc. 12-6, pg.
111). Although the May 22, 1997 letter is documented in MetLife’s claim activity, an actual copy
of the letter is not part of the record and Mr. Witt denies ever receiving such a letter. (Doc. 21,
pg. 6). Under the Plan, Mr. Witt had 60 days to request a review of his claim termination. (Doc.
12-5, pg. 86).
No record exists of any challenge by Mr. Witt of the termination or any inquiry by him as
to why Mr. Witt was no longer receiving benefits until May 29, 2009. On that date, over twelve
years after the termination of benefits, Mr. Witt’s counsel in the current action—Josh
Sullivan—contacted MetLife asking about the status of Mr. Witt’s claim and stating that Mr.
Witt had received an approval letter but no payment. (Doc. 12-6, pg. 112-13). Representatives of
MetLife told Mr. Sullivan that once he submitted a letter of representation and a copy of the
approval letter, they would retrieve the archived file and review it. (Doc. 12-6, pg. 114). Despite
2

further inquiries from MetLife, Plaintiff and his counsel did not send the requested information
until December 31, 2009. (Doc. 12-6, pg. 114-22). At that point, MetLife reviewed Mr. Witt’s
file and, on January 26, 2010, informed him that although his claim had initially been approved,
it had been terminated “effective May 1, 1997 for failure to provide proof of continued
[d]isability.” Representatives from MetLife told Mr. Sullivan that “[i]f you wish your clients [sic]
claim to be reviewed for [b]enefits beyond May 1, 1997 we require supporting medical
documentation” and gave him details about the type of documentation required. (Doc. 12-6, pg.
124-25).
On February 17, 2011, Mr. Witt and his counsel submitted additional medical
documentation to MetLife, noting that “[d]ue to the long time period, it has taken some time to
gather some of this documentation.” (Doc. 12-15, pg. 1046-47). Upon receipt of this
documentation, MetLife reviewed the merits of the claim to determine whether the medical
documentation supported a continued disability from May 1, 1997 through the current date at the
time. (Doc. 12-6, pg. 128). During the course of this review, the claim was referred to MetLife’s
legal department, which noted that “[a]ppeal request 14 yrs later is outside of ERISA timeframe”
but decided “to allow submission of medical since 1997 to present for review, since claim had
been terminated for [failure to support].” (Doc. 12-6, pgs. 137, 140-41).
On March 21, 2011, MetLife notified Mr. Witt and his counsel that after a review of the
medical information provided, the claim would remain terminated. The letter, which outlined the
reasons MetLIfe found Mr. Witt’s claim deficient, informed Mr. Sullivan and Mr. Witt how to
proceed with an appeal of the determination within 180 days of receipt of the letter. (Doc. 12-15,
pgs. 1041-44). On September 16, 2011, Mr. Sullivan advised MetLife that Mr. Witt was
3

appealing the March 21, 2011 denial of his claim and requested an extension of time to gather
additional documentation. (Doc. 12-15, pg. 1024). MetLife granted this extension request, along
with several other extension requests during the fall of 2011. (Doc. 12-15, pgs. 1017, 1009). On
November 15, 2011, Mr. Sullivan submitted a letter and additional documentation to support Mr.
Witt’s appeal. (Doc. 12-15, pgs. 111-14).
On May 4, 2012, after additional review of Mr. Witt’s claim, which included inquiries
into Mr. Witt’s job description and Social Security benefits, contact with his doctors, and
requests for additional information (doc. 12-6, pgs. 163-204), MetLife notified Mr. Sullivan that
it was “upholding the termination of Mr. Witt’s claim” because “he has not demonstrated that
beyond April 30, 1997 and thereafter, that [he] was unable to perform his own job or any job due
to illness or injury.” After thoroughly explaining the reasons for rejecting Mr. Witt’s claim,
MetLife concluded the letter by stating: “You have exhausted your client’s administrative
remedies under the plan, and no further appeal will be considered.” (Doc. 12-7, pgs. 215-22). Mr.
Witt filed this action on June 13, 2012. (Doc. 1).
II.

DISCUSSION
The court must first address the preliminary—but outcome determinative—issue in this

case: whether the suit is time-barred. Defendants argue that Mr. Witt missed two key deadlines,
both of which make this suit untimely. First, he failed to submit a written request for review
within 60 days of the original termination, as required under the Plan. Second, he did not file suit
within the six-year statute of limitations used in the state of Alabama for ERISA claims. (Doc.
20, pg. 20). Mr. Witt counters by arguing that Defendants have waived any timeliness argument
they may have had by failing to assert it during the administrative proceedings, and that this
4

appeal is timely because Mr. Witt filed it June 13, 2012, only 40 days after the “final”
determination on May 4, 2012. (Doc. 21, pg. 30).
The only law either of the parties have cited on this issue that comes from the Eleventh
Circuit is Blue Cross & Blue Shield of Alabama v. Sanders, 138 F.3d 1347 (11th Cir. 1998). In
Blue Cross, the Eleventh Circuit noted that “[i]n an ERISA action with no congressionally
mandated limitations period, the district court ‘must define the essential nature of the ERISA
action and apply the forum state’s statute of limitations for the most closely analogous action.’”
Id. at 1356 (quoting Byrd v. MacPapers, 961 F.2d 157, 159 (11th Cir. 1992)). The Court held
that a fiduciary’s action to enforce a reimbursement provision under ERISA is most closely
analogous to a simple contract action under Alabama law, with a six-year statute of limitations.
Id. at 1357.
Although this case is not a fiduciary reimbursement action, another Eleventh Circuit case
has applied the similar Georgia statute of limitations for breach of contract—also for six
years—to an employee’s action seeking to enforce an ERISA plan. Harrison v. Digital Health
Plan, 183 F.3d 1235, 1241 (11th Cir. 1999). Based on this case law, and Mr. Witt’s failure to
dispute the six-year statute as the applicable statute of limitations in this case, the court will apply
Alabama’s six-year statute for breach of contract to this ERISA action.
In applying a breach of contract statute of limitations to an ERISA case, the Eleventh
Circuit has held that “a cause of action accrues when the plaintiff knew or should have known of
the injury.” Warren v. Schwerman, 155 F. App’x 416, 419 (11th Cir. 2005) (citing Bowling v.
Founders Title Co., 773 F.2d 1175, 1178 (11th Cir. 1985)). Even if Mr. Witt never received the
May 22, 1997 termination letter, he should have known about his termination when he realized
5

he was no longer receiving the money that MetLife had been paying to him on a monthly basis.
The court finds that the six-year statute began to run by June 1997 at the latest; therefore, Mr.
Witt filed his suit long after the statute had run—and many years after the 60 day time period
under the Plan.
The court must now decide whether Defendants waived their ability to challenge the
timeliness of the appeal by proceeding to review the case on its merits. Neither party cites, and
the court cannot find, any applicable Eleventh Circuit law on this topic. Both parties, however,
cite law from other circuits, which the court will review briefly as persuasive, but not controlling,
authority.
Mr. Witt cites a Second Circuit Case, O’Hara v. National Union Fire Insurance Co. of
Pittsburgh, PA, which summarizes the lower court’s conclusion that “because [the Defendant]
‘never objected to the timeliness of [Plaintiff’s] claim, or suggested anywhere that her notice of
claim had not be filed ‘as soon as [was] reasonably possible’ in light of the nature and
progression of [Plaintiff’s] disability,’ it has waived that defense.” 642 F.3d 110, 115 (2d Cir.
2011) (citing O’Hara v. Nat’l Union Fire Ins. Co. of Pittsburgh, PA, 697 F.Supp.2d 474
(W.D.N.Y. 2010)). The Second Circuit opinion did not actually address whether the district
court’s conclusion on this matter was correct, but simply noted the ruling.
Mr. Witt also cites the opinion of a district court within the Second Circuit. In Haisley v.
Sedgwick Claims Management Services, Inc., the court found that “[h]aving declined to invoke
the ninety-day limitations period as a basis for denying [the plaintiff’s] LTD claim during the
course of administrative proceedings, [the Defendants] cannot turn around and rely on it as a
basis for defeating [the plaintiff’s] claims under the ERISA.” 776 F. Supp. 2d 33, 48 (W.D. Penn.
6

2011).
Finally, Mr. Witt cites other law and cases that do not directly address the waiver issue,
but require that an ERISA notice of denial communicate the specific reasons for the denial. See
29 U.S.C. § 1133; 29 C.F.R. § 2560.503-1(g)(1); Reich v. Ladish Co., 306 F.3d 519, 524 n. 1
(7th Cir. 2002); Haplin v. W.W. Grainger, Inc., 962 F.2d 685, 688-90 (7th Cir. 1992); Haisley,
776 F. Supp. 2d at 53; Zuckerman v. United of Omaha Life Ins. Co., 2011 WL 2173623, at *3-4
(N.D. Ill. 2011). According to Mr. Witt, because MetLife did not list “untimeliness” as a reason
for denial in the March 21, 2011 notice or the May 4, 2012 notice, it is precluded from now
asserting such a defense.
Defendants cite Stafford v. E.I. Dupont De Nemours for the proposition that the reopening
of a case does not prevent a defendant from asserting a timeliness defense. 27 F. App’x 137 (3rd
Cir. 2002). In Stafford, the plaintiff employee requested an additional review of his ERISA claim
approximately two-and-a-half years after the conclusion of his appeal of the original denial of his
application. The ERISA plan administrator accepted and reviewed new medical records, but
ultimately determined that it would not reopen his application. The plaintiff argued that because
the plan administrator’s procedure “allows employees to attempt to reopen their cases, his
administrative remedies were never exhausted and the statute of limitations [had] not begun to
run.” Id. at 140.
The court addressed this argument, stating
[Plaintiff]’s position defies all logic. If this Court adopted [Plaintiff]’s theory,
there would never be repose for an employer that procedurally allows for the
reopening of a case. A decade-old finding of non-disability could then be
judicially challenged simply by a plaintiff seeking to reopen the administrative
process. Allowing this would in turn create incentives for an employer not to
7

allow any reopening of the administrative process, lest it face a perpetual risk of
litigation. . . . ERISA does not demand that an employer allow for reopening of
closed cases. In providing such a procedure, [the plan administrator] acts
benevolently, and we do not intend to discourage such benevolence.
Id. Defendants also cited a number of other cases that reach similar conclusions. See Mason v.
Aetna Life Ins. Co., 901 F.2d 662 (8th Cir. 1990) (affirming the district court’s decision that
“informal reexamination is to be encouraged and will not renew a claimant’s cause of action for
statute of limitations purposes”); Engleson v. Unum Life Ins. Co. of America, 723 F.3d 611 (6th
Cir. 2013) (finding that “neither the law nor principles of equity allow us to excuse the tardiness”
of an ERISA suit filed over eight years after the claim was denied); Martin v. Constr. Laborer’s
Pension Trust, 947 F.2d 1381, 1386-87 (9th Cir. 1991) (holding that a 1987 hearing on new
evidence regarding plaintiff’s alleged disability “did not alter the Appeals Committee’s 1982
repudiation of [the plaintiff]’s claim”).
Finally, Defendants also briefly address Mr. Witt’s argument that an ERISA notice of
denial must communicate the specific reasons for the denial; they argue that “[a] statute of
limitations defines when litigation must commence and, as such, need not be, and would not be,
asserted outside of litigation, in a courtesy review.” (Doc. 23, pg. 2).
In a situation such as this one, where no controlling authority exists and the parties have
cited relevant persuasive authority to support both positions, the court must truly decide which
outcome makes the most sense and will set the best precedent for future decisions. Ultimately,
the court finds the cases cited by Mr. Witt unpersuasive and determines that the ruling of the
Third Circuit in Stafford—also supported by rulings of the Sixth and Ninth Circuits—should be
the law in this situation.

8

The circumstances addressed in Mr. Witt’s cases, O’Hara and Haisley, both involved an
employee who had sought ERISA benefits outside of the window for claims that were specified
in the plans—twenty days and ninety days, respectively. They did not involve the appeal of a
determination outside of a six-year statute of limitations.
The court finds that it stretches credulity in this case for Mr. Witt to argue that a plaintiff
who allows his claim to lie dormant for twelve years and is in no rush to provide the needed
documentation when he finally gets around to reasserting his claim, should be able to accuse the
defendants of waiving their statute of limitations defense by reviewing the medical
documentation that he finally provides nearly fourteen years later. Even if the court were inclined
to allow such an outcome, it would refrain from doing so based on the negative incentives such a
decision would provide for ERISA plan administrators.
As the Second Circuit explained in Stafford, allowing plan administrators the flexibility
to voluntarily review an otherwise time-barred claim can only result in more deserving people
receiving disability benefits. If courts were to hold that the provision of any extra review would
prevent plan administrators from invoking the statute of limitations, then plan administrators
would be forced to invoke a strict policy of no review outside of the strict time periods provided
by the plan. Not only would such a policy disadvantage employees suffering from disabilities, but
it would likely create needless litigation over disputes that could otherwise be resolved outside of
court.
Mr. Witt’s final argument that the court needs to address here is that the statute of
limitations did not begin to run until MetLife made its final determination on May 4, 2012.
Although this is technically a different argument from Mr. Witt’s claim that the 2009-2012
9

review waived Defendants’ timeliness defense, Mr. Witt did not provide any additional support
for the theory that the statute of limitations was restarted in 2012 other than his waiver
arguments. Therefore, the court will reject both arguments for the same reasons. If the court were
to find that any “courtesy” review—regardless whether it is termed as such—starts the running of
a whole new statute of limitations period, plan administrators would never allow for any
untimely review and it would be disabled individuals who would suffer as a result.
As such, Mr. Witt’s claim is barred by the six-year statute of limitations applied to
ERISA under Alabama law. Judgment is due in favor of the Defendants and the court will not
proceed to evaluate any of the parties substantive arguments as to Mr. Witt’s disability claims.
III.

CONCLUSION
For these reasons, the court DENIES Plaintiff’s motion for judgment in his favor and

GRANTS Defendants’ motion for judgment. The court ENTERS JUDGMENT in favor of the
Defendants.
DONE and ORDERED this 25th day of February, 2014.

____________________________________
KARON OWEN BOWDRE
CHIEF UNITED STATES DISTRICT JUDGE

10