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Sarah Smith

Abstract

The circuit courts are split as to how a plan administrator of an ERISA-governed employee benefit plan must notify a claimant of a time limitation placed on a claimant’s ability to seek judicial review of an adverse benefit decision. Some courts indicate that inclusion of this time limitation in the Summary Plan Description is sufficient to notify a claimant. Other courts have held that the time period must specifically be included in adverse determination notices, which are documents notifying claimants of the denial of their claim and the right to judicial review. Much of the debate among courts concerns the requirement of 29 C.F.R. §2560.503-1(g)(1)(iv) that a benefits determination include a“description of the plan’s review procedures and the time limits applicable to such procedures.”

In this Article, I argue that the meaning of 29 C.F.R. § 2560.503-1(g)(1)(iv) is clear: the Plan-provided limitations period must be included in a final adverse benefits determination notice. Failure to disclose this information cannot be said to be in strict—or even substantial—compliance with the statute because such a failure would burden a claimant with no way to adequately remedy this burden. While claimants who have actual knowledge of the time limitation should be subject to the Plan’s period of limitation even if it was not contained in the benefits determination, a claimant that has simply received a Summary Plan Description should not be said to have constructive knowledge of the limitation period. The courts should treat a failure to disclose a limitation period in an adverse benefits determination notice as a waiver of the time limitation described in the Plan and instead apply an analogous state law statute of limitations, instead of tolling the limitations period set forth by the noncompliant Plan.

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