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Administratorís Reconsideration of Claim Did Not Waive Statute of Limitations . . .

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  • Administratorís Reconsideration of Claim Did Not Waive Statute of Limitations . . .

    Administratorís Reconsideration of Claim Did Not Waive Statute of Limitations Argument - C.D. Cal.

    In Gordon v. Deloitte & Touche, LLP Group Long Term Disability Plan, plaintiff seeks long term disability benefits from her employerís self-funded plan which is administered by MetLife. Plaintiffís claim was ultimately approved and she was paid benefits consistent with a mental/nervous limitation. The claim was approved in 2003 on that basis and plaintiff was advised that she could appeal the application of the mental/nervous limitation. She did not do so. In late 2007, plaintiff contacted MetLife and asked if her claim could be reopened. Plaintiff was advised that it would not be. In 2009, plaintiff filed a complaint with the California Department of Insurance and MetLife agreed to review her claim again and did so. In late 2009, MetLife advised the plaintiff that its 2003 determination was upheld. Plaintiff filed suit. The plan moved to dismiss based upon the statute of limitations. Plaintiff argued that MetLifeís voluntary review of her claim in 2009 waived the statute of limitations argument. The court disagrees.

    13. Therefore, these authorities buttress the Plan's position that Plaintiff's action is barred by the applicable statute and contractual limitations periods, because she was required to file her lawsuit by November 4, 2007 at the very latest. Significantly, both the statute of limitations and the contractual limitations periods had expired long before Plaintiff ever sought reconsideration.

    14. MetLife's later voluntary reconsideration and subsequent decision to uphold the prior determination (on the same basis that Plaintiff had received all benefits to which she was entitled pursuant to the Plan's Mental Illness Limitation) did not reset the already-passed statute and contractual limitations periods, for the reasons cited above. If the law were otherwise, MetLife and other insurers would be discouraged from voluntarily and benevolently reconsidering an otherwise time barred claim.
    [*21] See Martin, 947 F.2d at 1386-87. See also Stafford, 2002 U.S. App. LEXIS 1039, at *6-7. Indeed, there would be absolutely no reason for a plan's claims fiduciary to ever reconsider a claim that is time barred as MetLife did here. Accordingly, Plaintiff's claim is time barred and cannot be revived by MetLife's reconsideration thereof.

    15. Plaintiff's arguments that Defendant has waived its right to assert either of the defenses of statute of limitations or contractual limitations are without merit. The reconsideration of Plaintiff's claim does not revive already passed statutes and contractual limitation periods. See
    Folk v. Federal Insurance Administration, 1981 U.S. Dist. LEXIS 10168 (N.D. Cal. 1981); Martin v. Constr. Laborer's Pension Trust, 947 F.2d 1381 (9th Cir. 1991); Stafford v. Eli Dupont De Nemours, 27 Fed. Appx. 137 (3d Cir. 2002); Dameron v. Sinai Hospital of Baltimore, 595 F. Supp. 1404 (D. Md. 1991) ("a tenacious plaintiff should not be allowed to renew stale claims merely by requesting reconsideration of 'final' decisions."). Defendant did not agree to be sued when MetLife once again determined that the Plaintiff's claims were baseless for the same reasons already explained [*22] to Plaintiff on numerous occasions previously. Therefore, Defendant did not waive the defenses of statute of limitations or contractual limitations.

    16. Plaintiff's arguments that Defendant should be estopped from asserting either of the defenses of statute of limitations or contractual limitations is without merit. "As a general rule, a defendant will be estopped from setting up a statute-of-limitations defense when its own prior representations or conduct have caused the plaintiff to run afoul of the statute and it is equitable to hold the defendant responsible for that result."
    Lamantia v. Voluntary Plan Adm'rs, Inc., 401 F.3d 1114, 1119 (9th Cir. 2005); see also Doe v. Blue Cross & Blue Shield United, 112 F.3d 869, 875 (7th Cir. 1997) (stating that "if the defendant through representations or otherwise prevents the plaintiff from suing within the limitations period, the plaintiff may add to the remaining limitations period the entire period during which the defendant's action was effective in delaying the suit"). Here, there is absolutely no evidence indicating that MetLife did anything to cause Plaintiff to not file her Complaint within the proscribed time periods.


    A copy of the decision is attached.
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