(Article from Insurance Law Alert, March 2019)
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The First Circuit dismissed a disability benefits suit against Hartford, finding that the plan participant failed to timely appeal a termination of benefits. The court rejected the participant’s argument that any untimeliness should be excused by ERISA’s substantial compliance doctrine or New Hampshire’s notice-prejudice rule. Fortier v. Hartford Life and Accident Ins. Co., 916 F.3d 74 (1st Cir. 2019).
Hartford notified Theresa Fortier that her long-term disability benefits would expire because she had not demonstrated eligibility for a continuation of those benefits. Hartford also informed Fortier that any appeal must be filed within 180 days of her receipt of notice. Fortier filed an appeal approximately two months after this deadline expired. When Hartford refused to consider her appeal, Fortier sued under ERISA, seeking benefit reinstatement. A New Hampshire federal district court ruled in Hartford’s favor, finding that Fortier had not timely appealed and thus had not exhausted her administrative remedies. The First Circuit affirmed.
The First Circuit rejected Fortier’s assertion that the 180-day time frame started at the date of termination of benefits rather than the date of notice. The court emphasized that the relevant ERISA provision states that claimants have 180 days “following receipt of a notification of an adverse benefit determination within which to appeal.”
The court also ruled that Fortier’s untimely appeal was not excused by the “substantial compliance” doctrine that applies in limited contexts. The court explained that this doctrine is intended to foster prompt review of benefits denials, not to excuse a claimant’s failure to meet exhaustion requirements.
Finally, the court rejected application of New Hampshire’s notice-prejudice rule to Fortier’s delay, noting that to do so would create inconsistency in the ERISA framework and likely result in increased costs and delays. As the court noted, its holding is consistent with the Seventh and Ninth Circuits’ rejections of the application of a common law notice-prejudice rule to ERISA appeals.