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08-1611-c v B ur k e v . P r i c e W at e rH o u s e C o o p e r s LLP

U N IT E D S T A T E S C O U R T O F A P P E A LS F O R T H E S E C O N D C IR C U IT

________________ August Term, 2008 (Argued: April 30, 2009 Dec ided: J uly 9, 2009) Docke t No. 08-1611-c v

__________________ PATRI CI A A. B URKE,

Plaintif f-Appellant , v. P R IC E W A T E R H O U S E C O O P E R S LLP L ONG TERM DI SABI L I TY PL AN, THE HARTF ORD L I FE A ND ACCI DENT I NSURANCE COMPANY,

Defendants-A

ppellees
.

_________________ B e f o r e : B.D . PARKER, W ESL EY, Circuit Judges , and MURTHA, District Judge
. *

_________________________ Th e Ho no ra

ble J. Ga rv an M ur tha , Unit e d St ate s D istri c t Judg e , D istri c t of Ve rm ont, * sitti ngby desig nation.2 _____________________ Appea l from the judg ment of the United States District Court for the Southern District of New Y ork (Chin, J .) ente red on Ma rch 6, 2008, dismissing plaintiff’ s complaint broug ht pursuant to 29 U.S.C. § 1132, finding the cla im tim e-ba rre d. Affir

med.
STE PHA NE M. MO NT AS, De Ha an B us se , L L P, Hauppa ug e, N.Y., for Plainti

ff-Appellant
. MI CHAEL

H. B ERNSTEI

N (John T. S ey

bert, of counsel ), Se dgwi c k D e te rt

Mo ra n & Ar no ld, L L P, New Y ork, N.Y., for Defendants-Appe llees
.

______________________ PER CU RIAM : Plaintiff-Appellant Patricia Bur ke appe als from a

J udg ment enter ed Mar ch 6, 2008 in the Un ite d St ate s D istri c t Co ur t f or the Southe rn

Di str ic t of

Ne w Y or k ( Chi n, J.), dis mis sin gwi th pr e jud ic e he r E RI SA c la im a g a ins t Pr ic e wate rh ou se Coo pe rs L L P ( “ PwC ” ) L on gTe rm Di sa bil ity P l anan d th e H art f o r d L i f e an d A c c i d e n tIn s ur an c e C o mp any ( “ H art f o r d ” ) ( c o l l e c t i v e l y, “De fenda nts”). F or the re asons stated be low, we a ffirm the district c ourt’s dismissal of Bur ke’s 29 U.S.C. § 1132 claim beca use it is tim e-ba

rre d under the written terms of the plan. In Jun e 20 02 , f

oll ow ingkn e e surg e ry , B ur ke , a fo rm e r P wC e mpl oye e , a pp lie d f or sh ortterm disability

benef its under the PwC Hea lth and Welfare Be nefits Plan (the “ Plan”). She wa s g rante d and re ceive d benef its unti l they

wer e exhausted. On Septembe r 17, 2002, B urke a pplied for long -term disability

(“L TD”) benef

its which were approve d to commence at the expiration of her shor t-term bene fits on October 20, 2002. On Marc h 28, 2003, Har

tford, the Plan administrator, r equeste d Proof of L oss, including
an e va luatio n to be c omp le te d b y he r d oc tor . T he Pla

n r e qu ir e d Pr oo f o f L os s b e pr ov ide d w ith in3

thirty day s of the re quest. Bur

ke’s doc tor submitted the evaluation on Apr il 25, 2003. Hartfor d reque sted furthe r information be submitt ed by May 5, 2003, beca

use it viewed the doctor’s conclusions that B urke w as per manently disabled, but that she could wor k for e ight hour s per da

y as contra dictory . When Hartfor d did not rece ive a r esponse by May 12, 2003, it notified Burke her L TD bene fits were terminated a s of April 30, 2003 bec ause “ the weight of medica l evidence ” did not support continuing the be nefits. On June 10, 2003, Burke appea led the ter mination and submitt ed additional information. Hartfor d denied the a ppeal on Oc tober 1, 2003 a nd informed Bur ke she c ould bringa civil ac tion. On September

25, 2006, Bur

ke filed a suit in federa l court cha lleng ing the termination of he r L TD be ne fi ts. 29 U. S.C. § 1 13 2( a )( 1) (B ) ( c re atin ga c a us e of a c tio n f or a pla n b e ne fi c iary

to
rec over be nefits due unde r an e mploy ee be nefit plan). T he district cour t held a summary

trial on a stipulated administrative re cord. Judge Chin dism issed Bur ke’s c laim as time-bar

red unde r the Plan in a well-re asoned Me morandum De cision dated F ebrua ry 29, 2008. Bur

ke v. PricewaterhouseCoope rs L L P, L ongTerm Disa bility Plan, 537 F. Supp. 2d 546 (S.D.N.Y. 2008). We r e vie w the dis tr ic t c ourt ’s jud g me nt d e no vo be c a us e the so le iss ue on

a pp e a l is a question of law; the f

acts a re undisputed. Gr ace v. Corbis-Syg ma, 487 F.3d 113, 118 ( 2d Cir. 2007) (statingthat conclusions of laware revie wed de novo). B urke’ s appea l hinge s on whether the applica

ble limitations period be g an to run be fore she could bringa § 1132 cla im. I f yes, her appea l is unti mely ; if no, her a ppeal is timely
. Th e sta rt ing po int is the a pp lic a ble lim ita tio ns pe ri od . T he Em

plo y e e Re tir e me nt I

nc ome Security Act of 1974 ( ERI SA), codified at 29 U.S.C. §§ 1001-1461, does not prescr ibe a limit ations period for

29 U.S.C. § 1132 actions, the section under which B urke br oug ht herSignifica ntly , this three-year

limit ations period is long er tha n the per iod provided under 1 N.Y. Ins. L aw § 3221, whic h require s g roup hea lth insurance policie s to state “no ac tion at law or in equity shall be brought to recove r on the policy prior to the expiration of six ty day s after

proof of loss has bee n filed in ac corda nce w ith the require ments of the policy and that no such a ction shall be brought after

the expiration of two y ear s following the time such proof of loss is required by the policy .” I d. § 3221(a) (14). The Plan’s limit ations period is permitted bec ause it is “more favor able” than the statute re quires. I d. § 3221(a)
. The Miles Court addre ssed when a n ERI SA cause of ac tion accr ues but the policy 2 contra ct at issue did not contain a limitations period. See Miles, 698 F .2d at 598 (holdingan ERI SA cause of ac tion beg ins to accr ue “when ther e has be en a r epudiation by the fiducia

ry which is clea

r and ma de known to the be nefic iar[y]”) (interna l quotation marks and citation omitted). 4 claim. See Miles v. N.Y. State T eamster s Confere nce Pension & Ret. Fund Employ ee Pension B e ne fi t Pla

n, 69 8 F .2 d 5 93 , 5 98 (2 d Ci r. 19 83 ). Th e re fo re , th e a pp lic a ble lim itatio ns pe ri od

is

“ th at s p e c if

ie d in th e mo s t n e ar ly

an a lo g o u s s tate li mi tati o n s s tatute . ” I d
. H e r e , N e wY o r k ’ s s ixy e ar l imi tatio ns pe ri od

fo r c ontr a c t a c tio ns , N .Y . C. P.L .R. 21 3, a pp lie s a s it

is m os t ana log ou s to § 1132 actions. Miles, 698 F.2d at 598. New Yor k permits contra ctingparties to shorten a l i m i t at i o n s p e r i o d , h o w e v e r , i f th e a g r e e m e n ti s m e m o r i a l i z e d i nw r i t i n g . N
. Y
. C
. P
. L. R
. 2 0 1
. In this case, the thr ee- y ear

limit ations period in the Plan controls, a c onclusion the parties do not dispute. 1 Di str ic t c ourt s in

thi s Ci rc uit

have us e d tw o me tho ds to d e te rm ine wh e n a n E RI SA § 1132 claim ac crue s when the policy contra ct contains a

limit ations provision : (1) whe n 2 benef its are initially

denied, Patter son-Priori v. Unum L ife Ins. Co. of Am., 846 F. Supp. 1102, 1108 (E.D.N.Y . 1994), or ( 2) whe n administrative re medies have been e x hausted, Mitchell v. Shearson L ehman B ros., No. 97 CIV. 0526, 1997 WL277381, at *3 (S.D.N.Y. Ma y 27, 1997). Under Patterson-Priori, B urke’ s claim “a ccr ued” on Ma

y 12, 2003. Since she filed this ac tion on Se pte mbe r 2 5, 20 06 , h e r s uit is unti me ly

un de r t his sta nd ard . I f w e we re to a

pp ly the Mit c he ll5

standard, by

contra st, we would dee m Burke ’s claim to have “ac crue d” on Oc tober 1, 2003 -- when he r appe al was de nied -- a nd her suit would be timely . J udg e Chin did not reac h the issue of the unre solved ac crua l date for § 1132 actions, B urke, 537 F . Supp. 2d at 549 n.2, and we ha ve previously

declined to do so a s well, see V eltri v. Bldg . Serv. 32B -J P ension Fund, 393 F .3d 318, 325 (2d Cir. 2004). He re , w ith out r e fe re nc e to a n a c c ru a l date , th e Pla

n’ s li mit atio ns pe ri od

pr oh ibi ts a
c la ima nt f ro m br ing ingle g a l a c tio n mo re tha n “ thr e e y e ars a ft e r t

he tim e wr itt e n Pr oo f o f L os s is require d to be furnishe d.” B urke, 537 F . Supp. 2d. at 547 (internal quotation mar ks omitt ed). New Y ork law pe rmits the Plan to begin the limitations period bef ore a plan bene ficiar

y can bringsuit by

permitting pa

rties to alter “ the time within which an ac tion mustbe commenc ed.” N.Y. C.P.L .R. 203(a). The rule fur ther provide s: “The time within which an a ction must be
c omm e nc e d, e xce pt a s o the rw ise e xpre ssl y pr e sc ri be d, sh a ll b e c omp ute d f ro m th e tim e the c a

us e of ac tion accr

ued to the time the cla im is i nterposed.” I d. (empha sis added). The Supreme Court has stated “it is theore tically possible for a statute to cre ate a cause of action that ac crue s at one time for the purpose of

calc ulating when the statute of limit ations be g ins to r

un , b ut at ano the r t ime fo r t he purp os e of

br ing ingsu it. ” Re ite r v . Co op e r, 50 7 U .S. 258, 267 (1993). Though in that case the Court did not “infer suc h an odd re sult in t he abse nce of any such indication in the statute,” id., he re, a s allowed unde r Ne w York la w, the Plan sp e c if ie s th e lim itatio ns pe ri od

wi ll b e g in t o r

un at a dif fe re nt t ime tha

n whe n a c la ima nt c ou ld bringa fe dera l action. Ther efor e, ther e is rea son to “infer the odd re sult” that the limit ations pe ri od be g an to ru

n p ri or to t he tim e B ur

ke c ou ld f

ile su it i n f

e de ra l c ourt . B e c a

us e an E RI SAERI SA d oe s n ot c onta in a n e xplic it e xha

us tio n o f r e me die s r e qu ir e me nt, but th is C ir c uit 3 has infer red suc h a re quirement. See Kenne dy v. Empire B lue Cross & B lue Shield, 989 F.2d 588, 594 (2d Cir. 1993). B ur ke fa ils to c ounte r t

he argume nt t

hat “ [a]b se nt a

fi nd ingof

un c on sc ion a

bil ity
. . . , it 4 would be anoma lous . . . to allow [ a] plaintiff to maintain an ac tion to recove r a be nefit which wa s c re ate d b y

and e xists so le ly

be c a us e of the [te rm s] of

the Pla n, wh ile at th e same tim e to deny eff ect to the c onditions t hose same [terms] place upon r ece ipt of that benefit.” PattersonPriori, 846 F. Supp. at 1105. 6 action may

not be brought in feder al cour t until admini strative re medies ar e exhausted, 3 enfor cinga policy -pre scribed limitations period that runs fr om a time differ ent than whe n the
cause of ac tion accr

ued could r esult in a shorteningof the e ffe ctive limitations period. 4 De fe nd ants a sse rt

that th e Plan “ e xpre ssl y

pr e sc ri be s” the lim itatio ns pe ri od wi ll
commence thirty

day s after

proof of loss is due, thereby

alteringthe g ener al rule that a limitations pe ri od ru ns fr om t he date a c a us e of a c tio n a c c ru e s. Th e ir

a sse rt ion is i n d ir e c t c ontr a dic tio n w ith Mitchell, where the cour

t held the limitations period did not beg in to run until pl aintiff’s f inal
a p p e a l w a s d e n ie d

d e s p it e a c o n tr a c t t e r

m i d e n ti c a l t o th e o n e at i s s u e h e r e . M it c h e ll , 1 9 9 7 WL 277381, at * 6. The Mitche ll court was motivated by fairne ss conce rns, noting that if a limit ations period beg an bef ore a plaintiff had e x hausted a dminist rative r emedies through the pla n, wh ic h c on se qu e ntl y

wo uld pr e ve nt h e r f

ro m br ing ingan a c tio n in c ourt , th e “ re su lt w ou ld be unfa ir bec ause a

plaintiff would be de prived of the full benef it of the limit ations period.” I d. at *5. More w orrisome wa s the possibili ty that an “insure r [could] simply bury a denia l of
cover ag e and w ait for the statute of limitations t o run.” I d. at *2 (interna l quotation marks omitted). J udg e Chin distinguished Mitchell and de clined to follow its holding bec ause the U.S. Depar

tment of L abor ( DOL ) ena cted r egulations applicable to be nefit cla ims made under7

ERI SA p lans a ft e r Janu ary 1, 20 02 , whic h in c lud e de a dli ne s r e qu ir ingpla n a dmi nis tr ator s to conclude appea ls in a timely manner . Bur

ke, 537 F . Supp. 2d at 550-51. The r egulations require a plan a dminist rator to de cide a n initial claim within 45 day s of re ceipt, with two 30-da y extensions allowed. 29 C.F.R. § 2560.503-1(f) (3). I f the c laim is denied, the cla imant has 180 day s to appea l. I d. § 2560.503-1(h) (3)( i). The plan a dminist rator must dec ide the appe al within 45 day s, with one 45-day extension allowed. I d. § 2560.503-1(i)( 3). Unde r the DOL timeline, “a c laimant would still have ne arly two y ear s to bring le g al ac tion under the Plan’s limit ations provision.” Bur ke, 537 F . Supp. 2d at 551. I f the plan a dminist rator misses any of the de adlines, the c laim is deemed de nied with administrative re medies exhausted there by permitting a

claimant to immediately

bringan ac tion in federa l court. See N ichols v. Prudential Ins . Co . o f Am., 40 6 F .3 d 9 8, 10 6- 07 (2 d Ci r. 20 05 ). Mo re ov e r, on c e a de e me d d e nie d c la im i s in fede ral c ourt, it is not s ubject to a de fer ential re view, but ra ther to de novo r eview. I d. at 109. J udg e Chin found that, in light of the se re gulations, the fairne ss conce rns ra ised in Mitchell were no longe r a f

actor . Bur

ke, 537 F . Supp. 2d at 550-51. This Circuit has not addresse d the implications of the DOL regulations on the enfor cea bility of a policy-pre scribed limitations period that beg ins when proof of loss is due. See B urke, 537 F . Supp. 2d at 551. J udg e Chin rea soned this Circuit’s “strict adhe renc e to the DO Lre gulatio ns thu s atte nu ate s th e [Mitc he ll c ourt ’s ] re a so nin g .” I d. We a g re e . T he tim e
re ma ini nga ft e r t

he a dmi nis tr ativ e a

pp e a l pr oc e ss h a s r

un its c ours e un de r t

he DO Lre gulatio ns , as we ll as the protec tions provided should the plan administrator be dilator y , support enfor cing the contra ctual limitations provisi on in this case.Rece ntly , the Four th Circuit refuse d to enforc e a policy-pre scribed limitations period that 5 would beg in to run befor e a c laimant may bringsuit. W hite v. Sun L ife Assura nce Co. of Ca

n., 48 8 F .3 d 2 40 , 2 47 (4 th C ir . 2 00 7) . T he Whit e c ourt ’s c on c e rn , a s in Mit c he ll, wa s th e po ssi bil ity a pla n a dmi nis tr ator

wo uld us e the a dmi nis tr ativ e pr oc e ss t o “ un de rm ine [] an d p ote nti a lly eliminate[] the ERI SA civil right of a ction.” I d. The F ourth Circuit considere d the DOL re gulatio ns but c on c lud e d, de pe nd ingon the pla n li mit atio ns pe ri od , a

pla n a dmi nis tr ator

c ou ld “eat up the entire limitations period.” I d. at 251. In light of a court’s a uthority to determine the rea sonablene ss of a policy -pre scribed limitations period, howeve r, and its authority to toll t hat pe ri od sh ou ld t he fa c ts o f a

g ive n c a se re qu ir e su c h a re su lt, that po ssi bil ity

do e s n ot t

ro ub le us . Th e F ourt h Ci rc uit wa s c onvin c e d a

“ re a so na ble ne ss” fa c t- de pe nd ant s tand ard is unwo rk a ble a s it wo uld “ ru n c ounte r t o th e va lue s o f c e rt a int y and pr e dic ta bil ity
. . . o f m os t acc rual a nd limit ations rules,” a

nd “be pa rticularly incompatible with ERI SA, give n its written plan re quirement.” Whit e, 488 F .3d at 250. Our holdingenfor ces the written plan re quirement in its entirety . Contrary

to the Four

th Circuit’s positi on, enfor cinga policy -pre scribed limitations pe ri od a s wri tte n, inc lud ingthe date up on wh ic h it wi ll b e g in t o r

un , w ill pr ov ide c le ar n oti c e to plan par ticipants of the time in which they must bring suit: for e x ample, in this case, thr ee year s fr om t he date B ur

ke wa s r e qu ir e d to pr ov ide De fe nd ants wi th P ro of of L os s. 8 F ina lly , b e c a

us e we a pp ly ru le s o f c ontr a c t la

w t o E RI SA p lans , L if

so n v . I NAL if e Ins . Co. of N.Y., 333 F .3d 349, 353 (2d Cir. 2003), a c ourt must not “rewr ite, under the guise of interpre tation, a term of the contra ct when the term is clea r and una mbiguous,” Cruden v. B ank of N.Y., 957 F .2d 961, 976 (2d Cir. 1992), as is the policy -pre scribed limitations period at issue he re . T he pa

rt ie s, sp e c if

ic a lly the pla n a dmi nis tr ator , c an a

nti c ipate su it w ill be br ou g ht w ith in the limitations period -- an expectation base d on a ter m in Burke ’s plan. We j oin the F if th, Sixth, Se ve nth , a

nd Ei g hth Cir c uit s in

up ho ldi ngwr itt e n p lan te rm s including limitations periods which may beg in to run befor e a c laimant can br ing le g al ac tion. See Abe na v. Metro. L ife Ins. Co., 544 F.3d 880 (7th Cir. 2008); Har ris Methodist Fort Worth v. Sales Support Servs. Inc. Employ ee H ealth Care Plan, 426 F.3d 330 (5th Cir. 2005); Clark v. NB D B ank, N.A., 3 F . App’x 500 (6th Ci r. 2001); B laske v. UNUM L ife Ins. Co. of Am., 131 F.3d 763 ( 8th Cir. 1997). Furthe r, the va st majority of states, includingNew Y ork, re quire insurance contra cts to include the proof of loss limi tations languag e such a s that at issue here
. 59

See Wetzel v. L ou Ehlers Cadillac Group L ongTerm Disa bility Ins. Progr am, 222 F.3d 643, 647 n.5 (9th Cir. 2000) (listing statutes)
. Bur ke had a mple time within which to bring he r cla im: following exhaustion of her
a dmi nis tr ativ e a

pp e a l, t wo y e ars and

fi ve months of

the lim itatio ns pe ri od

re ma ine d. We h old th e d i s tr i c tc o urtw a s c o r

r e c tt o e n f

o r c e th e p o l i c y- p r e s c r i b e d l i m i t at i o n s p e r i o d

i ni t s e n t i r e ty, including its pre scribed sta rt date, a nd to dismi ss Burke ’s claim as time-ba rre d beca use it was br ou g ht a ft e r t

he e xpir atio n o f t

he lim itatio ns pe ri od . Und e r t he te rm s o f t

he Pla n, B ur ke ’s c la im
was re quired to be f

iled by April 27, 2006 -- thre e year s from the date proof of loss was due. Acc ording ly , her f

iling on September

25, 2006 was late by

almost five months. F or the fo re g oin gre a so ns , th e jud g me nt o f t he dis tr ic t c ourt

dis mis sin gB ur

ke ’s 29 U. S.C. § 1132 claim is AFF I RMED.