Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca1-15-01273/USCOURTS-ca1-15-01273-0/pdf.json

Nature of Suit Code: 790
Nature of Suit: Other Labor Litigation
Cause of Action: 

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United States Court of Appeals 

For the First Circuit 

No. 15-1273 

DIONISIO SANTANA-DÍAZ, 

Plaintiff, Appellant, 

v. 

METROPOLITAN LIFE INSURANCE COMPANY, 

Defendant, Appellee. 

APPEAL FROM THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF PUERTO RICO 

[Hon. Juan M. Pérez-Giménez, U.S. District Judge] 

Before 

Thompson, Hawkins,* and Barron, 

Circuit Judges. 

Efrain Maceira-Ortiz for appellant. 

Frank Gotay-Barquet for appellee. 

March 14, 2016 

 

* Of the Ninth Circuit, sitting by designation. 

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THOMPSON, Circuit Judge. In this appeal under the 

Employee Retirement Income Security Act of 1974 ("ERISA"), as 

amended, 29 U.S.C. §§ 1001-1461, Appellant Dionisio Santana-Díaz 

("Santana-Díaz") challenges the district court's dismissal of his 

suit as time-barred, arguing that he is entitled to equitable 

tolling, in part because the plan administrator, Appellee 

Metropolitan Life Insurance Company ("MetLife"), failed to include 

the time period for filing suit in its denial of benefits letter. 

We hold that ERISA requires a plan administrator in its denial of 

benefits letter to inform a claimant of not only his right to bring 

a civil action, but also the plan-imposed time limit for doing so. 

Because MetLife violated this regulatory obligation, the 

limitations period in this case was rendered inapplicable, and 

Santana-Díaz's suit was therefore timely filed. Accordingly, we 

reverse and remand. 

BACKGROUND 

We begin by summarizing the facts relevant to this 

appeal. Santana-Díaz was a financial analyst and ten-plus-year 

employee at Shell Chemical Yabucoa, Inc. ("Shell Chemical").1 He 

participated in Shell Chemical's employee welfare benefit plan 

(the "Plan"), which Shell Chemical provided through a group 

 1 According to the complaint, Santana-Díaz actually began his 

employment with Puerto Rico Sun Oil Company ("SUNOCO") in 1981 as 

a clerk, but SUNOCO sold its Yabucoa operations to Shell Chemical 

in 2002. 

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insurance policy issued by MetLife. Beginning in November 2007, 

Santana-Díaz, who suffered from major depression, high blood 

pressure, asthma, and various other physical and mental ailments, 

claimed and received sick leave and then short-term disability 

leave. Santana-Díaz submitted his claim for long-term disability 

benefits on April 7, 2008, and in December 2008, received his first 

long-term disability benefit payment for the period beginning on 

November 23, 2008. 

On April 5, 2010, MetLife sent Santana-Díaz a letter 

informing him that, although he was currently receiving long-term 

disability benefits, the maximum duration period for his 

particular disability was twenty-four months, and his benefits 

would therefore expire on November 22, 2010. As MetLife explained 

it, under the terms of the Plan, long-term disability benefits 

were limited to twenty-four months if the beneficiary's disability 

was the result of a "mental or nervous disorder or disease 

limitation." "[T]he primary diagnosis preventing [Santana-Díaz] 

from working [was] major depression," MetLife said, which fell 

into that category, thus Santana-Díaz was entitled to long-term 

disability benefits only for the limited duration period. MetLife 

went on to explain that in order to continue receiving benefits 

beyond November 22, 2010, Santana-Díaz would have to submit 

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additional documentation that showed his disability was not 

subject to the limitation.2

After receiving the April 5, 2010 letter, Santana-Díaz 

submitted various medical files and additional information. Upon 

reviewing the documents, MetLife denied Santana-Díaz's claim for 

an extension of benefits beyond the twenty-four-month limited 

period in a letter dated November 24, 2010. Santana-Díaz, 

proceeding pro se, filed an administrative appeal of the decision 

with the aid of his son, which MetLife likewise denied in an August 

19, 2011 letter. Now this is important for our purposes today: 

both MetLife's November 24, 2010 initial denial of benefits letter 

and its August 19, 2011 final denial letter informed Santana-Díaz 

that he could bring a civil action, but neither letter included a 

time limit for doing so or mentioned at all that the right to bring 

suit was subject to a limitations period. 

Nevertheless, the Plan -- which Santana-Díaz had 

received when Shell Chemical first became his employer at least 

ten years prior -- did contain a three-year limitations period 

that provided, in relevant part, that "[n]o legal action of any 

kind may be filed . . . more than three years after proof of 

Disability must be filed." Under the terms of the Plan, the 

 2 For example, not all disabilities resulting from "mental or 

nervous disorder or disease" were limited to twenty-four months; 

the Plan made an exception for schizophrenia, bipolar disorder, 

dementia, and organic brain disease. 

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deadline for Santana-Díaz's proof of disability had been February 

17, 2009 (and no, MetLife never mentions this start date in its 

letters either).3 According to MetLife, Santana-Díaz's time period 

for filing suit therefore expired three years thereafter. 

Alas, Santana-Díaz, finally represented by counsel, did 

not file suit until August 18, 2013. The complaint alleged a 29 

U.S.C. § 1132(a) claim for improper denial of benefits. In a 

motion for summary judgment, MetLife argued the suit was filed a 

year-and-a-half too late. The district court agreed, granting the 

motion and dismissing Santana-Díaz's complaint as time-barred. 

Santana-Díaz now appeals, arguing that the district court erred in 

dismissing his case because MetLife's failure to provide notice of 

the time limit for filing suit in its final denial letter entitled 

him to equitable tolling. 

 3 The route by which this February 17, 2009 proof-ofdisability deadline is arrived at, while undisputed by the parties, 

is labyrinthine. Under the Plan, proof of disability is due 

"within 3 months after the end of [the] Elimination Period," which, 

in turn, is defined as "360 days of continuous Disability," during 

which long-term disability benefits are not paid, beginning on the 

day the beneficiary becomes disabled. Here, the Elimination Period 

began on November 28, 2007, when Santana-Díaz became disabled, and 

ended 360 days thereafter. By our calculations, this would have 

been November 22, 2008, but the parties, without explanation, agree 

that the Elimination Period ended on November 17, 2008. Accepting 

the parties' computation, Santana-Díaz's proof of disability was 

then due three months after that November 17, 2008 date. Hence, 

February 17, 2009. 

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DISCUSSION 

We review the district court's grant of summary judgment 

de novo. Orndorf v. Paul Revere Life Ins. Co., 404 F.3d 510, 516 

(1st Cir. 2005). 

ERISA itself does not contain a statute of limitations 

for bringing a civil action, see 29 U.S.C. § 1132(a)(1)(B), so 

federal courts usually "borrow the most closely analogous statute 

of limitations in the forum state." Santaliz-Ríos v. Metro. Life 

Ins. Co., 693 F.3d 57, 59 (1st Cir. 2012), cert. denied, 133 S. 

Ct. 1726 (2013). But where the employee benefit plan "itself 

provides a shorter limitations period, that period will govern as 

long as it is reasonable." Id. at 60. In this case, the Plan 

contained a three-year limitations period that ran from the date 

proof of disability was due. MetLife included no mention of this 

time limit in its final denial letter. The issue at the heart of 

this appeal is what impact such defective notice should have on a 

contractual limitations period. Before we turn to this question, 

however, we first briefly address Santana-Díaz's argument that the 

district court applied the wrong start date to the limitations 

period.4

 4 MetLife raises a preliminary argument that we should 

summarily dismiss Santana-Díaz's appeal because his brief does not 

technically comply with Federal Rule of Appellate Procedure 

28(a)(6) in that it does not contain a statement of facts or 

citations to the record. We are none too pleased that SantanaDíaz's brief, indeed, lacks a separate statement of facts section 

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I. Limitations Period Start Date 

Santana-Díaz's argument regarding the limitations period 

start date is anything but clear. He seems to want us to conclude 

that the three-year limitations period began to run on August 19, 

2011, the date of the final denial letter, and not, as the Plan 

provides, on the date proof of disability was due. 

Santana-Díaz argues that, because he was still receiving 

benefits on February 17, 2009, when proof of disability was due, 

he "had nothing to complain about," and had no reason to file suit. 

Thus, he says, it would be "clearly erroneous, patently 

unreasonable and will result in an unfair outcome" for the 

limitations period to have begun to run before he had suffered an 

actual injury. Santana-Díaz seems to suggest that perhaps the 

limitations period would, instead, have begun to run on November 

24, 2010, when MetLife issued notice terminating his benefits. 

Except that date did not set off the limitations period either, he 

argues, because in that November 24, 2010 letter, MetLife stated: 

"In the event your appeal is denied in whole or in part, you will 

have the right to bring a civil action . . . ." Santana-Díaz 

 

and record citations, but we will not dismiss the case for these 

oversights. Although they are intermingled throughout his brief, 

Santana-Díaz provides an adequate description of the relevant 

facts, and this case is neither so fact-heavy nor record-intensive 

that we are unable to locate the relevant facts in the record. We 

therefore reject MetLife's argument that the appeal should be 

dismissed on these grounds and proceed to the merits of the appeal. 

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argues that this instruction to await the outcome of the 

administrative appeal before bringing a civil action, without any 

other mention in the letter of a time limit for filing suit, 

obscured from him the fact that the clock for filing was already 

ticking, and that, on that basis, we should conclude the 

limitations period actually only began to run on August 19, 2011, 

when his administrative appeal was denied. (Three years from 

either date, November 24, 2010, or August 19, 2011, though, would 

have rendered Santana-Díaz's August 18, 2013 complaint timely.) 

Santana-Díaz never really clarifies in his brief whether 

he is challenging the enforceability of the limitations provision, 

raising an estoppel argument, or presenting some combination 

thereof, and we are not quite persuaded that, under any of these 

theories, Santana-Díaz would be able to get around the limitations 

period start date as it is written in the Plan.5 Regardless, it 

 5 The Supreme Court has already held enforceable a contractual 

limitations period that, as in the present case, commenced when 

proof of disability was due, instead of the date of the final 

denial letter, explaining that "[a]bsent a controlling statute to 

the contrary, a participant and a plan may agree by contract to a 

particular limitations period, even one that starts to run before 

the cause of action accrues, as long as the period is reasonable." 

Heimeshoff v. Hartford Life & Accident Ins. Co., 134 S. Ct. 604, 

610 (2013). Santana-Díaz does not challenge the reasonableness of 

either the three-year period on its face or the six months that 

were left for filing suit once MetLife issued a final decision. 

Instead, he suggests his case is distinguishable because, unlike 

the plaintiff in Heimeshoff who was initially denied her claim, he 

was receiving benefits at the time the limitations period began to 

run. But Santana-Díaz cites no legal authority that explains why 

this should make a difference in our analysis, nor do we find his 

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does not matter because, as we get to in a minute, we conclude 

MetLife's regulatory violation rendered the contractual 

limitations period in this case altogether inapplicable, and we 

therefore do not need to decide when that limitations period would 

have begun to run.

II. MetLife's Regulatory Violation 

Santana-Díaz argues here, as he did below, that 

MetLife's final denial letter did not comply with 29 C.F.R. 

§ 2560.503-1(g)(1)(iv) because it failed to provide notice of the 

plan-imposed time limit for filing suit, and that, as a result, 

equitable tolling should apply.6 The district court disagreed, 

 

argument convincing. Although the plaintiff in Heimeshoff never 

received benefits, she was equally unable to file suit until her 

claim was administratively exhausted. Yet, the Supreme Court found 

it fit to hold that the limitations period continued to run during 

this time, despite the fact that her administrative appeal had not 

yet been denied and she could not have filed her action until the 

final denial. See id. at 612-13. 

As to equitable estoppel, that doctrine applies when a 

defendant makes a "definite misrepresentation," on which it has 

reason to know the plaintiff will rely, and the plaintiff 

reasonably relies on it in failing to bring suit. Ramírez-Carlo 

v. United States, 496 F.3d 41, 49 (1st Cir. 2007) (quoting Heckler 

v. Comty. Health Servs., 467 U.S. 51, 59 (1984)). While MetLife's 

November 24, 2010 letter may have been confusing, we are not 

certain that its statements would amount to a "misrepresentation," 

or that Santana-Díaz reasonably relied on it to late-file his suit. 

6 A limitations period may be equitably tolled where a 

plaintiff establishes that "extraordinary circumstances" beyond 

his control prevented a timely filing, such as where the plaintiff 

was "materially misled into missing the deadline." BarretoBarreto v. United States, 551 F.3d 95, 101 (1st Cir. 2008) 

(citations omitted). 

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concluding that, even though MetLife had failed to provide notice, 

this failure did not entitle Santana-Díaz to the "extraordinary 

measure of equitable tolling" because Santana-Díaz "was made aware 

of both the time limit for plan participants to file legal action 

and how the plan calculates time, since these matters were clearly 

and explicitly laid out in the group policy." We need not 

determine whether the district court correctly decided this 

equitable tolling issue, however, because we begin and end our 

review with the issue of MetLife's failure to note the time period 

for filing suit in its final denial letter. 

As we explain in the following sections, we conclude 

that, in failing to provide such notice, MetLife was not in 

substantial compliance with the ERISA regulations, and that this 

rendered the limitations period altogether inapplicable. Because 

this resolves the question of whether Santana-Díaz's claim was 

time-barred, we need not discuss whether the limitations period 

would otherwise have been equitably tolled.7

 7 At oral argument, counsel for MetLife argued we could not 

directly address the argument that it had violated section 

2560.503-1(g)(1)(iv) because the only question Santana-Díaz had 

raised on appeal is whether he would be entitled to equitable 

tolling as a result of the purported violation. But we are 

unpersuaded by the suggestion that Santana-Díaz has waived the 

regulatory violation argument here. To the contrary, Santana-Díaz 

explicitly argued in his brief, as he did before the district 

court, that MetLife violated section 2560.503-1(g)(1)(iv) when it 

failed to include the time period for filing suit in its final 

denial letter. Specifically, he argued: "First, the final notice 

served by MetLife did not include the statement of the time frame 

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A. Violation of Section 2560.503-1(g)(1)(iv) 

ERISA is a remedial statute intended "to 'protect . . . 

the interests of participants in employee benefit plans and their 

beneficiaries' by setting out substantive regulatory requirements 

for employee benefit plans and to 'provid[e] for appropriate 

remedies, sanctions, and ready access to the Federal courts.'" 

Aetna Health Inc. v. Davila, 542 U.S. 200, 208 (2004) (alterations 

in original) (quoting 29 U.S.C. § 1001(b)). In furtherance of 

this purpose, section 503 of ERISA, codified as 29 U.S.C. § 1133, 

provides that "every employee benefit plan shall . . . provide 

adequate notice in writing to any participant or beneficiary whose 

 

plaintiff had to file the civil action as required by ERISA 

regulations contained [in] 29 CFR 2560.503-1(g)[1](iv);" and, "The 

other issue has to do with appellee's violation [of] the notice 

requirement imposed by ERISA. According to ERISA 

regulations . . . on its final notice MetLife had the legal 

obligation to notify plaintiff of the time limit to file court 

action;" and again in his Reply Brief, "Accepting appellee's 

argument amounts to converting [to] 'dead letter' the notice 

requirement contained in 29 CFR 560.503-1(g)[1](iv)." Thus, we 

think the regulatory violation argument was sufficiently briefed. 

See United States v. Dunbar, 553 F.3d 48, 63 n.4 (1st Cir. 2009) 

(holding that, although an argument was not stated "artfully," it 

was not waived where the brief identified the relevant facts and 

law). 

Furthermore, MetLife had and took the opportunity to respond, 

albeit briefly, to this argument, indicating that it understood 

Santana-Díaz was challenging its failure to comply with section 

2560.503-1(g)(1)(iv). (We note that MetLife, moreover, was the 

defendant-appellee in Moyer v. Metropolitan Life Insurance Co., 

762 F.3d 503 (6th Cir. 2014), a nearly identical case in which, as 

we discuss later, the Sixth Circuit took a similar approach as the 

one we take here. MetLife was thus certainly aware of the way 

other circuits have treated this exact regulatory violation.) 

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claim for benefits under the plan has been denied" and "afford a 

reasonable opportunity . . . for a full and fair review by the 

appropriate named fiduciary of the decision denying the claim." 

29 U.S.C. § 1133. One of the purposes of section 1133 is to 

"enable the claimant to prepare adequately for any further 

administrative review, as well as appeal to the federal courts." 

Witt v. Metro. Life Ins. Co., 772 F.3d 1269, 1280 (11th Cir. 2014) 

(citation omitted); see also Brown v. J.B. Hunt Transp. Servs., 

Inc., 586 F.3d 1079, 1086 (8th Cir. 2009); Halpin v. W.W. Grainger, 

Inc., 962 F.2d 685, 689 (7th Cir. 1992). As such, the regulations 

promulgated under section 1133, in relevant part, require a plan 

administrator to provide "written or electronic notification of 

any adverse benefit determination" that includes a "description of 

the plan's review procedures and the time limits applicable to 

such procedures, including a statement of the claimant's right to 

bring a civil action." 29 C.F.R. § 2560.503-1(g)(1)(iv). 

The question before us is one of interpretation: the 

parties differ in their reading of this regulation, specifically, 

in their interpretation of which "time limits" must be included in 

the denial letter. Santana-Díaz argues the regulation requires 

plan administrators to include notice of not only the right to 

bring a civil action, but also the time limit for filing the 

action. MetLife disagrees. It suggests we should read the 

regulation as requiring only those time limits applicable to 

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internal administrative review procedures. In other words, 

MetLife seems to argue that the two phrases in section 2560.503-

1(g)(1)(iv) could be read separately, such that a plan 

administrator is, first, required to include in its denial letter 

a "description of the plan's review procedures and the time limits 

applicable to such procedures," and second, required to include "a 

statement of the claimant's right to bring a civil action," though 

not necessarily the time period for filing the action. 

In support of its interpretation of section 2560.503-

1(g)(1)(iv), MetLife cites an unpublished case, Wilson v. Standard 

Insurance Co., 613 F. App'x 841 (11th Cir. 2015) (per curiam), in 

which the plan administrator similarly failed to include notice of 

the time limit for filing suit in its final denial letter. But in 

Wilson the Eleventh Circuit did not decide on an interpretation of 

section 2560.503-1(g)(1)(iv). Instead, it concluded the language 

was ambiguous, and speculated the provision could be read two ways: 

either as including "civil action" as part of the plan's review 

procedures, such that notice of the time limits for both 

administrative review procedures and civil actions are required, 

or as requiring notice of the right to file suit, but not the time 

limits for doing so. Id. at 844. Rather than deciding on an 

interpretation, the court assumed, favorably to the plaintiff, 

that the plan administrator had violated section 2560.503-

1(g)(1)(iv), but declined to "simply assume unenforceability" of 

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the limitations period on the basis of the plan administrator's 

"failure to interpret the ambiguous regulation that way." Id. It 

thus resolved the case against the plaintiff on equitable tolling 

grounds instead, holding that she was not entitled to equitable 

tolling because she had not been diligent in pursuing her suit, 

and it thus concluded that the case had been properly dismissed as 

time-barred. Id. at 844-45. 

We decline to follow the Eleventh Circuit's approach 

here. Based on the plain language of the regulation, we hold that 

the correct interpretation of section 2560.503-1(g)(1)(iv) is that 

a denial of benefits letter must include notice of the plan-imposed 

time limit for filing a civil action. To repeat, the regulation 

states that the letter must contain a "description of the plan's 

review procedures and the time limits applicable to such 

procedures, including a statement of the claimant's right to bring 

a civil action." 29 C.F.R. § 2560.503-1(g)(1)(iv) (emphasis 

added). We previously noted in Ortega Candelaria v. Orthobiologics 

LLC, 661 F.3d 675, 680 n.7 (1st Cir. 2011), a case in which we 

discussed but did not decide this issue, that we think "the term 

'including' indicates that an ERISA action is considered one of 

the 'review procedures' and thus notice of the time limit must be 

provided." We further stated we would not find "compelling" the 

alternative reading, discussed in Wilson, that "notice of the right 

to sue under ERISA is in addition to, and divorced from, notice of 

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review procedures and the time frame pertaining to such 

procedures." Id. Indeed, interpreting the regulation that 

way -- as imposing two unrelated requirements -- would require us 

effectively to erase the word "including" from the sentence and to 

replace it with "and," such that the regulation would read: "The 

notification shall set forth . . . a description of the plan's 

review procedures and the time limits applicable to such 

procedures, [and] a statement of the claimant's right to bring a 

civil action . . . ." 29 C.F.R. § 2560.503-1(g)(1)(iv). It would 

then further require us to determine that a plan's time limit for 

filing, itself, could not otherwise be included as one of the 

"plan's review procedures," or alternatively, that a civil action 

could not otherwise be one of the "plan's review procedures," for 

which time limits must be included. We will not interpret the 

regulation in a way that so contravenes the text, and not even the 

Eleventh Circuit in Wilson, to which MetLife cites, has done so. 

On the other hand, both the Third and Sixth Circuits 

have interpreted section 2560.503-1(g)(1)(iv) as we do today, and 

have held that the regulation requires a plan administrator to 

provide in its final denial letter not only notice of the right to 

bring a civil action, but also of the time limit for filing the 

action. In Mirza v. Insurance Administrator of America, Inc., 800 

F.3d 129 (3d Cir. 2015), the Third Circuit reasoned that the word 

"including" was the "most important word in the sentence" for 

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purposes of interpreting the regulation, and that it signified 

that "civil actions are logically one of the review procedures 

envisioned by the Department of Labor." Id. at 134. The court 

therefore concluded that "29 C.F.R. § 2560.503–1(g)(1)(iv) 

requires that adverse benefit determinations set forth any planimposed time limit for seeking judicial review." Id. at 136. 

Likewise, in Moyer v. Metropolitan Life Insurance Co., 762 F.3d 

503 (6th Cir. 2014), the Sixth Circuit concluded, based on the 

phrase, "including a statement of the claimant's right to bring a 

civil action," 29 C.F.R. § 2560.503-1(g)(1)(iv) (emphasis added), 

that "[t]he claimant's right to bring a civil action is expressly 

included as a part of those procedures for which applicable time 

limits must be provided," and thus held that denial letters must 

include the time limit for judicial review. Id. at 505.8

 8 We note that it could feasibly be argued that section 

2560.503-1(g)(1)(iv)'s notice requirement applies only to initial 

denial of benefits letters. The regulations contain a later 

subsection that governs the "[m]anner and content of notification 

of benefit determination on review," 28 C.F.R. § 2560.503-1(j) 

(emphasis added), which appears to apply specifically to final 

denial letters. That subsection mandates that a "plan's benefit 

determination on review" must include, among other things, "a 

statement of the claimant's right to bring an action under section 

502(a) of the Act," id. § 2560.503-1(j)(4), but makes no express 

reference to the requirement to include the time limit for filing 

the action. Thus, one could make the argument that plan 

administrators are required to include notice of the time limit 

for filing suit in the initial denial of benefits letter, only. 

Here, the parties make no mention of section 2560.503-1(j)(4) in 

their briefs, and treat section 2560.503-1(g)(1)(iv) as applying 

to final denial letters, as we did in Ortega Candelaria v. 

Orthobiologics LLC, 661 F.3d 675, 677-78 (1st Cir. 2011), and as 

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Our reading of the regulation is furthermore in keeping 

with 29 U.S.C. § 1133's purpose of ensuring a fair opportunity for 

judicial review, and with ERISA's overall purpose as a remedial 

statute. Claimants are obviously more likely to read information 

stated in the final denial letter, as opposed to included (or 

possibly buried) somewhere in the plan documents, particularly 

since, as was the case here, plan documents could have been given 

to a claimant years before his claim for benefits is denied. The 

Department of Labor, recognizing this, has required that the denial 

letters themselves include certain information that the Department 

has deemed critical to ensuring a fair opportunity for review.9 

We think it clear that the Department has included the plan-imposed 

time limit for filing suit among this required information.10

 

other circuits have, see Mirza v. Ins. Admin. of Am., Inc., 800 

F.3d 129, 135-36 (3d Cir. 2015); Moyer, 762 F.3d at 504. Thus, 

for purposes of this case, we assume section 2560.503-1(g)(1)(iv) 

applies to final denial letters. (It makes no difference in this 

case because neither MetLife's November 24, 2010 initial denial of 

benefits letter nor its August 19, 2011 final denial letter was in 

compliance with section 2560.503-1(g)(1)(iv).) 

9 In addition to a description of the plan's review procedures 

and applicable time limits, which is the provision at issue here, 

the regulations also require that the final denial letters include 

the specific reasons for the adverse determination, the plan 

provisions on which the adverse determination is based, and any 

additional information necessary to perfect the claim. 29 C.F.R. 

§ 2560.503-1(g)(1)(i)-(iii). 

10 Section 2560.503-1(g)(1)(iv)'s notice requirement is made 

all the more important where an employee benefit plan contains a 

contractual limitations period that, though legally enforceable, 

seems designed to confuse. Such is the case here. The limitations 

period began to run on the proof of disability deadline -- the 

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Thus, we hold that MetLife had a regulatory obligation 

to provide notice of the time limit for filing suit in its denial 

of benefits letter, and it failed to do so. Our holding is limited 

to the circumstances of the case before us, in that it applies 

only to plan-imposed time limits for filing suit. We reserve for 

another day the question of the extent of a plan administrator's 

obligation, under section 2560.503-1(g)(1)(iv), to provide, where 

the plan itself does not contain a contractual limitations period, 

notice of the forum state's applicable statute of limitations. 

Having determined that MetLife violated section 

2560.503-1(g)(1)(iv), we turn our attention to whether SantanaDíaz was prejudiced by the violation. 

B. Prejudice 

Our case law does not always require strict technical 

compliance with the regulations -- all that is required of the 

plan administrator is "substantial compliance" with the spirit of 

 

complicated calculation for which we have already described -- 

while Santana-Díaz was still receiving benefits, and before he was 

informed he would be eligible for those benefits for only a twentyfour-month period. The period then continued to run while SantanaDíaz administratively appealed the decision to deny an extension 

of his benefits, and it expired just six months after MetLife's 

final decision. If employers are to enjoy such "large leeway" in 

designing their employee benefit plans, Black & Decker Disability 

Plan v. Nord, 538 U.S. 822, 833 (2003), the other side of the coin 

is that plan administrators have a duty, under section 1133's 

regulations, to be forthcoming about the contractual time limits 

that apply to the plan's procedures, so that claimants have a fair 

opportunity to pursue administrative and judicial review. 

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the regulations. Niebauer v. Crane & Co., Inc., 783 F.3d 914, 927 

(1st Cir. 2015). Thus, in cases involving a plan administrator's 

regulatory violation, we have tended to require the plaintiff to 

demonstrate that the violation prejudiced him by affecting review 

of his claim. In other words, a plaintiff must make some "showing 

that a precisely correct form of notice would have made a 

difference." Recupero v. New England Tel. & Tel. Co., 118 F.3d 

820, 840 (1st Cir. 1997). 

Here, we must first decide whether to remand to the 

district court for a prejudice finding in the first instance, or 

make such a determination ourselves. Generally, where a district 

court has made a prejudice determination, our case law has treated 

it as a "factual conclusion that we review only for clear error." 

DiGregorio v. Hartford Comprehensive Emp. Benefit Serv. Co., 423 

F.3d 6, 13, 15-16 (1st Cir. 2005). But where the lower court has 

made no factual finding as to prejudice, and where one could be 

made on the basis of the administrative record before us, we have, 

without remanding, made our own prejudice determination. See Bard 

v. Boston Shipping Ass'n, 471 F.3d 229, 241 & n.15 (1st Cir. 2006). 

In this case, because we conclude that a defective denial letter 

that fails to include the limitations period for filing suit is 

per se prejudicial, we see no need to remand to the district court 

for a factual finding as to prejudice. 

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As we have already noted, the Department of Labor 

requires plan administrators to give notice of the limitations 

period in the denial of benefits letter -- even when the 

information is also contained elsewhere in the plan documents, and 

regardless of when the claimant last received a copy of the plan 

documents -- because it recognizes that it is the denial of 

benefits letter that most clearly and readily provides the 

plaintiff with the information he needs to know to pursue review 

of his claim. This leaves us with but one conclusion to draw, 

which is that the regulation itself contemplates that failure to 

include this information in the denial of benefits letter is per 

se prejudicial to the plaintiff. Obviously, a plan administrator's 

compliance with its regulatory obligation to give this notice in 

its denial of benefits letters "ma[kes] a difference," Recupero, 

118 F.3d at 840, because it notifies a claimant of the pending 

deadline for filing his case.11 And ERISA's purpose of ensuring 

 11 Furthermore, we see no value in requiring lower courts to 

make an individualized factual finding of actual prejudice in cases 

involving this particular regulatory violation. Unlike in other 

notice defect cases where it might be possible for a plaintiff to 

prove actual prejudice, there is no way for a plaintiff to prove 

prejudice from a plan administrator's failure to include the 

limitations period in the final denial letter, other than by merely 

attesting that he would have timely filed had he only received 

proper notice. By contrast, in Terry v. Bayer Corp., 145 F.3d 28, 

38-39 (1st Cir. 1998), we assumed, without deciding, that the plan 

administrator had failed to comply with ERISA when it directed the 

claimant to forward "any information which may affect the decision 

to terminate [his] claim," instead of informing him of the specific 

documentation or medical reports needed to obtain a favorable 

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that claimants have a fair chance to present their cases remains 

"the lodestar in determining whether there has been substantial 

compliance with the notice provisions." Niebauer, 783 F.3d at 

927. Thus, we hold that, where a plan administrator fails, as 

MetLife did here, to include the time limit for filing suit in its 

denial of benefits letter, and it has not otherwise cured the 

defect by, for example, informing the claimant of the limitations 

period in a subsequent letter that still leaves the claimant 

sufficient time to file suit, the plan administrator can never be 

in substantial compliance with the ERISA regulations, and the 

violation is per se prejudicial to the claimant. See Moyer, 762 

F.3d at 507 ("The exclusion of the judicial review time limits 

from the adverse benefit determination letter was inconsistent 

with ensuring a fair opportunity for review and rendered the letter 

not in substantial compliance."); Mirza, 800 F.3d at 136 ("Without 

 

decision. There, the plaintiff could presumably have shown 

prejudice by showing that he actually possessed additional, unsubmitted medical documents, and that the outcome in his case might 

have been different had the letter only informed him that they 

were needed. Similarly, in Recupero v. New England Telephone & 

Telegraph Co., 118 F.3d 820, 825, 840-41 (1st Cir. 1997), where 

the claimant argued that the plan administrator failed to include 

the specific reasons for denying her claim or cite the specific 

plan provisions upon which the denial was based, the claimant could 

have presented evidence in the form of additional documents that 

she might have submitted if the letter had only made clear their 

potential relevance to the denial of her claim. Here, the 

violation is obviously and necessarily prejudicial to the 

plaintiff, and there is no such corollary evidence of prejudice 

that we might expect a plaintiff to proffer. 

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[the] time limit, a notification is not in substantial compliance 

with ERISA.").12 MetLife's defective notice therefore prejudiced 

Santana-Díaz. 

C. Remedy 

 This leaves us with the question of the appropriate 

consequence for MetLife's regulatory violation. The parties 

dispute whether equitable tolling of the limitations period should 

be the remedy for a section 2560.503-1(g)(1)(iv) violation. Our 

review today, however, does not reach the equitable tolling 

question because we conclude that MetLife's failure to include the 

time limit in the final denial letter rendered, as a matter of 

law, the contractual three-year limitations period altogether 

inapplicable. 

 Harkening back to our earlier discussion of Mirza and 

Moyer, we note that our sister courts in the Third and Sixth 

Circuits have resolved cases involving the same regulatory 

violation MetLife has committed here by concluding that the 

violation rendered the limitations period inapplicable. We think 

 12 Instead of requiring, as we do, that the plaintiff establish 

prejudice, courts in the Third and Sixth Circuits appear to apply 

a substantial compliance test in which the courts determine whether 

the communications between the administrator and participant, as 

a whole, fulfill section 1133's requirements. See, e.g., Wenner 

v. Sun Life Assurance Co. of Canada, 482 F.3d 878, 882 (6th Cir. 

2007); Morningred v. Delta Family-Care & Survivorship Plan, 790 F. 

Supp. 2d 177, 194-95, aff'd, 526 F. App'x 217 (3d Cir. 2013). 

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their approach is the correct one.13 For example, in Mirza, the 

Third Circuit focused its analysis on the plan administrator's 

regulatory violation of failing to include the plan's time limit 

in its final denial letter, and explained, "we do not find 

equitable tolling to be an obstacle, or even relevant, to [the 

plaintiff's] claim." 800 F.3d at 133. It concluded that 

"[b]ecause the denial letter [the plaintiff] received on August 

12, 2010 did not comply with the regulatory requirements, the oneyear deadline for judicial review was not triggered," id. at 137-

38 -- in other words, it would not apply. To do otherwise, the 

court reasoned, "would render hollow the important disclosure 

function of § 2560.503-1(g)(1)(iv)," as plan administrators would 

then "have no reason at all to comply with their obligation to 

include contractual time limits for judicial review in benefit 

denial letters." Id. at 137. 

Similarly, in Moyer, after concluding that "[the 

plaintiff] was denied his right to judicial review as a result of 

MetLife's failure to comply with § 1133," the Sixth Circuit 

reversed the district court's dismissal on timeliness grounds and 

 13 As we have already discussed, the Eleventh Circuit also 

encountered a similar scenario in Wilson v. Standard Insurance 

Co., 613 F. App'x 841, 843 (11th Cir. 2015) (per curiam), but 

decided the case on equitable tolling grounds. Because our reading 

of section 2560.503-1(g)(1)(iv) differs from the Eleventh 

Circuit's, and because we do not reach the equitable tolling issue 

here, we do not find much persuasive weight in this unpublished 

case. 

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remanded, reasoning that "[t]he appropriate remedy is to remand to 

the district court so that [the plaintiff] may now receive judicial 

review." 762 F.3d at 507. 

The courts' reasoning in Mirza and Moyer makes sense, 

given that plan administrators are in the best position to know 

what plan-imposed time limits apply to the very plans they are 

charged with administering, and that the requirement to include 

such information in their denial letters imposes upon them the 

most minimal of burdens. To accept that plan administrators may 

nevertheless dodge this simple regulatory obligation so long as 

claimants have received the plan documents at some point during 

their tenure as employees, would, as Santana-Díaz argues, 

effectively make section 2560.503-1(g)(1)(iv) "dead letter." 

 Furthermore, this approach, as the Third Circuit also 

discussed in Mirza, is in keeping with analogous ERISA cases in 

the administrative review context where courts have declined to 

enforce contractual limitations periods on account of a noncompliant termination of benefits letter. In those cases, the 

courts reasoned that a plan administrator's failure to comply with 

the ERISA regulations by not providing notice of the time limit 

for filing an administrative appeal rendered the limitations 

period for administrative review un-triggered. See, e.g., Burke 

v. Kodak Ret. Income Plan, 336 F.3d 103, 107 (2d Cir. 2003) ("A 

written notice of denial must be comprehensible and provide the 

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claimant with the information necessary to perfect her claim, 

including the time limits applicable to administrative review. A 

notice that fails to substantially comply with these requirements 

does not trigger a time bar contained within the plan." (citation 

omitted)), overruled on other grounds by CIGNA Corp. v. Amara, 563 

U.S. 421 (2010); Syed v. Hercules, Inc., 214 F.3d 155, 162 (3d 

Cir. 2000) (same); White v. Jacobs Eng'g Grp. Long Term Disability 

Benefit Plan, 896 F.2d 344, 350 (9th Cir. 1989) (same). This has 

been the case even where the plaintiff possessed a copy of the 

plan documents, and therefore was on notice of the time limit for 

filing an administrative appeal. See Epright v. Envtl. Res. Mgmt., 

Inc. Health & Welfare Plan, 81 F.3d 335, 342 (3d Cir. 1996) ("The 

fact that [the plaintiff's] attorney had a copy of the Plan, and 

thus the means to ascertain the proper steps for requesting review, 

in no way excuses [the defendant's] failure to comply with the 

Department of Labor's regulations."). 

Accordingly, we hold that, as a consequence of MetLife's 

failure to include the time limit for filing suit in its final 

denial letter, the limitations period in this case was rendered 

inapplicable. 

D. Statute of Limitations

 Recall that in the absence of a contractual limitations 

period within the employee benefit plan itself, the forum state's 

most closely analogous statute of limitations applies to ERISA 

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claims. Santaliz-Ríos, 693 F.3d at 59. Here, the Plan's 

limitations period was rendered inapplicable, so we look to Puerto 

Rico law for the closest statute of limitations. See Mirza, 800 

F.3d at 137-38 (borrowing state statute of limitations for contract 

claims where the plan administrator's regulatory violation 

rendered the plan's limitations period not triggered). Because an 

ERISA claim brought under 29 U.S.C. § 1132(a) to recover benefits 

arises out of a contract between an employer and its employees, 

courts in Puerto Rico have applied Puerto Rico's default fifteenyear statute of limitations for contract claims, P.R. Laws Ann. 

tit. 31 § 5294. Santaliz-Ríos, 693 F.3d at 59-60 (citing Nazario 

Martinez v. Johnson & Johnson Baby Prods., Inc., 184 F. Supp. 2d 

157, 159-62 (D.P.R. 2002)); see also Riley v. Metro. Life Ins. 

Co., 744 F.3d 241, 244 (1st Cir. 2014) (applying Massachusetts 

statute of limitations for breach of contract to a section 1132(a) 

claim), cert. denied, 135 S. Ct. 94; Drinkwater v. Metro. Life 

Ins. Co., 846 F.2d 821, 826 (1st Cir. 1988) (stating that an ERISA 

claim to enforce benefits is a "simple contract claim"), cert. 

denied, 488 U.S. 909.14 The fifteen-year statute of limitations 

 14 The circuits that have decided this issue appear to 

uniformly apply the state statute of limitations for contract 

actions. See, e.g., Santino v. Provident Life & Accident Ins. 

Co., 276 F.3d 772, 776 (6th Cir. 2001); Wetzel v. Lou Ehlers 

Cadillac Grp. Long Term Disability Ins. Program, 222 F.3d 643, 648 

(9th Cir. 2000) (en banc); Harrison v. Digital Health Plan, 183 

F.3d 1235, 1241 (11th Cir. 1999) (per curiam); Hogan v. Kraft 

Foods, 969 F.2d 142, 145 (5th Cir. 1992); Wright v. Southwestern 

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began to run on August 19, 2011 (the date of the final denial 

letter). See Riley, 744 F.3d at 244-45 (explaining that "[w]hile 

state law governs the length of the limitations period, federal 

common law determines when an ERISA claim accrues," which is 

"ordinarily . . . when a fiduciary denies a participant benefits" 

(citations omitted)). 

Santana-Díaz filed suit on August 18, 2013, which is 

well within the fifteen years. Thus, this case was timely filed. 

CONCLUSION 

For the reasons we explain above, we reverse and remand 

for further proceedings consistent with this opinion. Costs to 

appellant. 

 

Bell Tel. Co., 925 F.2d 1288, 1291 (10th Cir. 1991); Johnson v. 

State Mut. Life Assurance Co. of Am., 942 F.2d 1260, 1263 (8th 

Cir. 1991) (en banc). 

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