In Wilson v. Standard Ins. Co. (U.S. Ct. Apps., 11th Cir.) the claimant filed her lawsuit claiming long term disability benefits thirty-four months after the three-year contractual limitations period. The claimant argued that equitable tolling should apply because the insurer’s denial letter did not give notice of the time limit and therefore was in violation of the ERISA regulations. The Eleventh Circuit found that the “claims procedure” regulation, 29 CFR 2560.503-1(g)(1)(iv), clearly required notice of the administrative review procedures and those time limits, as well as the fact that the claimant has a right to bring an action, but found that whether it requires notice of the time limits applicable to filing a civil action was “anything but clear.” “Faced with that ambiguity, for purposes of this appeal only, we will construe the regulation in [the claimant’s] favor and assume that the correct interpretation of it is that a claim denial letter must notify the claimant of her time limit for filing a lawsuit under ERISA §502(a).”
The court then held that the insurer’s failure to correctly interpret the requirements of the ERISA regulation did not render the contractual limitations period unenforceable. The court noted but was not persuaded by the contradictory Sixth Circuit case law. The court concluded that the claimant had not exercised even minimal diligence in discovering the terms of the policy, which included the contractual limitations period, when despite being advised twice of her right to bring a civil action and where the insurer offered to provide all documents relating to her claim free of charge, she failed to timely request any such information.