I.V. SERVICES OF AMERICA, INC. v. INN DEVELOPMENT & MANAGEMENT, INC., 1999 U.S. App. LEXIS 14226 (1st Cir. June 28, 1999)-Before Selya, Circuit Judge, Campbell, Senior Circuit Judge, and Lynch, Circuit Judge.
Claim for medical benefits originated in Massachusetts. On October 15, 1990, Defendant notified Plaintiff that it had completed its review of Plaintiff's claim for benefits. On May 13, 1991, Defendant again notified Plaintiff it was denying the benefit claim. On August 9, 1996 Plaintiff sued.
District Court dismissed case since Plaintiff did not timely sue. The Plan states that a claimant must commence legal action "within 3 years after the date proof of loss must be submitted" unless the "the Planholder's state requires longer time limits than these[.]" The magistrate further determined that, because Massachusetts law did not require a longer time period than did the Plan, the Plan's three-year internal limitations period controlled.
Plaintiff argued for equitable tolling of the statute of limitations. Plaintiff argued it had never received a copy of the plan with the three year limitation. It also argued that Defendant repeatedly ignored Plaintiff's requests for a copy of the plan. Plaintiff also argued the denial letter did not comply with the regulations. Appeals court found that Plaintiff did not establish any of these points and did not allow equitable tolling.
Plaintiff had burden of proving it did not receive a copy of the plan. Plaintiff's mere lack of recollection does not suffice to create an issue of fact over whether or not she received a Plan copy. Court agreed that Defendant did not fail to produce a copy of the plan sufficient to toll the running of the statute of limitations since Plaintiff did not request a copy until after the statute of limitations had run.
The district court found that Appellees' letters denying Daly's claim did indeed fail to comply with the Department of Labor's requirement that a denial of benefits letter provide "appropriate information as to the steps to be taken if the participant or beneficiary wishes to submit his or her claim for review." 29 C.F.R. § 2560.503-1(f)(4). In light of this deficiency, the court excused I.V. Services' failure to exhaust its administrative remedies prior to filing suit. The court, however, refused to toll the three-year limitation period on this basis, finding no genuine dispute that, by May, 1991 at the latest, both Daly and I.V. Services were aware that the claim for reimbursement had been denied, and that a cause of action had accrued. First Circuit agreed.
