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Tetreault v. Reliance Std. Life Ins. Co.

United States Court of Appeals, First Circuit

October 6, 2014

MICHELE C. TETREAULT, Plaintiff, Appellant,
v.
RELIANCE STANDARD LIFE INSURANCE COMPANY; THE LIMITED LONG TERM DISABILITY PROGRAM, Defendants, Appellees

As Corrected October 27, 2014.

Page 50

APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MASSACHUSETTS. Hon. Joseph L. Tauro, U.S. District Judge.

Jonathan M. Feigenbaum, for appellant.

Joshua Bachrach, with whom Wilson, Elser, Moskowitz, Edelman & Dicker LLP was on brief, for appellees.

Before Thompson, Kayatta and Barron, Circuit Judges.

OPINION

Page 51

BARRON, Circuit Judge.

The Employee Retirement Income Security Act of 1974 (ERISA) governs employee benefit plans. 29 U.S.C. § 1001 et seq. Among other things, the statute permits beneficiaries to go to court to challenge their plan's decision to deny or cut off their benefits. Id. § 1132(a)(1)(B). Before filing suit, however, beneficiaries must first use -- or, as it is often put, " exhaust" -- their

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plan's procedures for making claims. Madera v. Marsh USA, Inc., 426 F.3d 56, 61 (1st Cir. 2005). The main question for us concerns which document a benefit plan must use to set forth those procedures.

The beneficiary who brings this appeal, Michele Tetreault, argues that ERISA requires a benefit plan to use one particular type of document, which the statute calls the " written instrument." 29 U.S.C. § 1102(a)(1). And she further argues that we should excuse her failure to comply with what her benefit plan contends was one of its claims procedures -- a 180-day deadline for filing an internal appeal of an adverse benefits decision -- because the benefit plan's written instrument did not mention it. But Tetreault is mistaken on that point. That is because the written instrument in this case expressly incorporated a document that clearly sets forth the appeals deadline. For that reason, we affirm the District Court's decision to dismiss Tetreault's benefits challenge. We also affirm the District Court's dismissal of Tetreault's two other ERISA claims, which, respectively, are for statutory penalties and for breach of fiduciary duty.

I.

Michele Tetreault injured her back in 2000 while working as a store manager at The Limited, a nationwide clothing retailer. She then filed a claim under The Limited's long-term disability benefit plan, which is called The Limited Long Term Disability Program. The benefit plan initially denied Tetreault's claim but then, in 2004, reversed course after Tetreault successfully challenged the denial in court.

The situation changed yet again in 2008. By then, Reliance Standard Life Insurance Company had started administering claims for The Limited Long Term Disability Program. In that role, Reliance Standard informed Tetreault on December 18 that, after reviewing her medical records, it had determined she could perform " sedentary" work and thus was no longer eligible for the benefits she had been receiving. Reliance Standard also informed Tetreault at that time that she could appeal the decision in writing to Reliance Standard, but that she would have to do so " within 180 days of your receipt of this letter or the last date to which we have paid, whichever is later."

On January 14, 2009, Tetreault's counsel wrote to Reliance Standard and requested " [t]he Summary Plan Description and the Plan documents for the LTD plan." Tetreault's counsel also requested that Reliance Standard provide " [a] complete copy of Ms. Tetreault's file in Reliance's possession."

Nine days later, Reliance Standard responded. It sent Tetreault's counsel the requested file, which contained certain of her medical records as well as other documents that related to her claim for benefits. Reliance Standard also sent the document that established the 1998 version of the benefit plan. That document made no reference to an appeals deadline.

Reliance Standard did not at that time send the " Summary Plan Description" Tetreault's counsel had requested. Reliance Standard also did not send some other documents that, though not then in its possession, are relevant to the merits of Tetreault's arguments to this Court. These documents concerned a 2005 version of The Limited Long Term Disability Program. They included both the document that established that version of the benefit plan and another document that described its terms. This last document, which identified itself as the " summary plan description," set forth the 180-day deadline for

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making an internal appeal of an adverse benefit decision.

On June 15, 2009 -- four days before the 180-day period was set to run out -- Tetreault's counsel sent a letter to Reliance Standard stating that Tetreault " w[ould] be appealing" the termination decision to Reliance Standard and that she expected to complete that appeal within 30 days. Reliance Standard responded by letter faxed to Tetreault's counsel on June 17. The letter reminded Tetreault's counsel that the 180-day period was about to expire. The letter also stated that Reliance Standard would not accept an appeal filed after that period. Finally, the letter warned Tetreault's counsel that if he filed Tetreault's appeal late, the " 'failure to exhaust' defense" would bar her from challenging the decision to terminate her benefits.

The appeals deadline expired on June 19, 2009. Tetreault did not file an appeal with Reliance Standard until nearly a year later, on May 27, 2010. Reliance Standard then denied the appeal ...


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