Supreme Court justices say they want to resolve a long-term disability (LTD) insurance case without accidentally wiping out Employee Retirement Income Security Act (ERISA) plans.
The concern came up today during oral arguments on Heimeshoff vs. Hartford Life and Wal-Mart Stores Inc. (Case Number 12-729).
Julie Heimeshoff, the benefits claimant in the case, says the “statute of limitations” period that governs when claimants can sue should start after claimants have completed the insurer’s own internal appeal process and are legally able to sue.
Hartford Life, a unit of Hartford Financial Services Group Inc. (NYSE:HIG), says an insurer should be able to set reasonable statute of limitations rules in the plan policy, and that, in the real world, most claimants have at least a year after internal appeals are exhausted to sue.
Justice Stephen Breyer asked Catherine Carroll, a lawyer for Hartford Life, what problems insurers would face if the court held that claimants must be able to exhaust the internal appeals process before the statute of limitations period on suits can start.
Breyer later said the court is “trying to work out a system with the exhaustion thing that will not destroy ERISA plans or something.”
Carroll said that, if the Supreme Court required a statute of limitations period to start after the internal appeals process was exhausted, the court would undermine Congress’s goal of wanting to assure employers that the courts will respect ERISA plan terms.
“Since ERISA’s enactment, this court has never held that, in a suit to enforce the terms of an ERISA plan, those terms can be thrown out the window,” Carroll said.
Matthew Wessler, a lawyer for Heimeshoff, said going with Hartford Life’s interpretation would get the courts too heavily involved in determining whether internal appeals processes were reasonable.
The private benefit resolution process “turns into a process in which lawyers get involved early, in which courts get involved early,” Wessler said.
Heimeshoff worked in public relations at Wal-Mart. In August 2005, she filed a group long-term disability (LTD) insurance claim, saying that lupus and pain from fibromyalgia kept her from working.
Hartford denied the claim in November 2006. Heimeshoff appealed in September 2007. She said Hartford denied the claim again in November 2007.
Heimeshoff filed a suit against her employer and the insurer in November 2010 in the U.S. District Court in Connecticut.
Hartford Life said the LTD policy required Heimeshoff to file her suit under a Connecticut statute of limitations. In Connecticut, claimants must start any legal actions within three years after the date when they are supposed to give the company proof of loss, rather than three after the date when the claim accrued.