FI L ED

U.S. COURT OF APPEAL S

EL EVENTH CI RCUI T

J UNE 17, 2010

J OHN L EY

CL ERK [DO NOT PUBLISH]

IN THE UN ITED STATES COURT OF APPEALS

FOR THE ELE VENTH CIRCUIT

__ __ __ __ __ __ __ __ __ __ __ __

No. 0 9- 16 12 7

Non -Arg um en t Ca le nd ar

__ __ __ __ __ __ __ __ __ __ __ __

D.C. Dock et No. 0 8- 02 09 2- CV-T-2 3- MAP

DAVID BENNET T,

Pl ai nt iff -Ap pe ll an t,

ve rs us

METROPOLITAN LIFE INSURANCE COMP ANY,

Defen da nt -Ap pe ll ee.

__ __ __ __ __ __ __ __ __ __ __ __

App eal fro m

th e Uni te d S ta te s Di st ric t Co ur t

fo r th e Mi dd le Dis tri ct of F lo rid a

__ __ __ __ __ __ __ __ __ __ __ __

(J un e 1 7, 2 01 0)

Befo re BARKETT, HULL and COX, Circ ui t J ud ge s.

PER CURI AM:

Pl ai nt iff Dav id Ben ne tt w or ke d as a refr ig erat io n te ch ni ci an fo r In ge rs ol l-R an d

Co m pa ny, whi ch pr ov id es lo ng -te rm di sa bi li ty be ne fit s to it s em pl oyees th ro ug h apl an ad m in is te red by Defen da nt Met ro po li ta n Life In su ran ce Co m pa ny (“ Met Life ”).

The p l a n p ro vi de s a m on th ly be ne fit to an em pl oyee who su ffer s fro m a lo ng -te rm

di sa bi li ty. An em

pl oyee is di sa bl ed un de r th e pl an if he or sh e req ui res t h e reg ul ar

care of a do ct or du e to an in jury or si ck ne ss an d is un ab l e t o p e rfo rm th e m at eri al

du ti es of an y ga in fu l wor k fo r whi ch he or sh e is reas on ab ly qu al ifi ed

. Afte r twen tyfo ur m on th s of pa y

m en ts

, an em

pl oyee wil l no lo ng er be co ns id ered di sa bl ed if he or

sh e ha s no t be en ap pr ov ed to rece iv e So ci al Secu rit y Adm in is tra ti on be ne fit s du e to

di sa bi li ty or ag e. The pl an al so pr o v i d e s, “ [i]f y ou do no t rece iv e So ci al Secu rit y

Ben efi ts aft er 30 m on th s fo ll owi ng y o u r d is ab il it y

, y ou r Lon g Term Dis ab il it y

Ben efi ts wil l end

. Howev er, y ou ha ve on e ad di ti on al y ear to ob ta in So ci al Secu rit y

Ben efi ts

. If su ch So ci al Secu rit y Ben efi ts are ap pr ov ed an d rece iv ed wit hi n 12

m on th s, your Lon g Ter m Dis ab il it y

Ben efi ts are re in st at ed .” (R.1 -1 Ex. A at 16 .)

To rece iv e be ne fit s, an em pl oyee m us t su bm it a writ te n c l a i m du rin g th e

“ el im in at io n pe rio d,” de fin e d a s th e 18 0 da y s aft er th e fir st da y of di sa bi li ty. The

em pl oyee m us t pr ov id e pr oo f o f t he cl ai m wit hi n ni ne ty da y s aft er th e en d of th e

el im in at io n pe rio d. “ If no ti ce or pr oo f is no t gi ve n on ti m e, th e de la y wil l no t cau se

a cl ai m to be de ni ed or red uc ed as l o n g as th e no ti ce or pr oo f is gi ve n as so on as

po ss ib le .” (

Id

. at 15 .) Bu t, “ [n ]o la wsu it m ay be st art ed m or e th an 3 y ears aft er th e

ti m e p ro of

m us t b e g iv en .” (

Id

. )

2I n Sep te m be r 20 02

, Ben ne tt su st ai ne d an on -th e-jo b in jury an d st op pe d

wor ki ng fo r In ge rs ol l-R an d. He su bm it te d a cl ai m fo r lo ng -te rm di sa bi li ty be ne fit s,

whi ch Met Life ap pr ov ed

. Met Life pa id be ne fit s to Ben ne tt fo r twen ty-fou r m on th s,

be gi nn in g on Mar ch 29

, 20 03

, an d en di ng on Mar ch 28

, 2 0 05

. It st op pe d pa y in g

be ne fit s be cau se Ben ne tt ha d no t be en ap pr ov ed to rece iv e So ci al Secu rit y di sa bi li ty

be ne fit s w i th in twen ty-fou r m on th s aft er fir st rece iv in g pa y m en ts

. On Aug us t 15

,

20 05

, Ben ne tt fil ed an ad m in is tra ti ve ap pe al of th e de ni al of be ne fit s. On Sep te m be r

8, 20 05

, Met Life affi rm ed th e de ni al o f b e ne fit s an d ex pl ai ne d in a le tt er: (1 ) th at

Ben ne tt ’s m ed ic al hi st or y fai le d to su pp or t a fin di ng th at he was di sa bl ed be cau se he

co ul d p e r f

or m a se de nt ary-to- li gh t oc cu pa ti on ; (2 ) th at Ben ne tt fai le d to m eet th e

pl an ’s de fin it io n of di sa bl ed be cau se he ha d no t b e e n a pp ro ve d to rece iv e So ci al

Secu rit y Dis ab il it y be ne fit s; an d (3 ) th at he ha d ex ha us te d ad m in is tra ti ve rem ed ie s

an d co ul d pu rs ue a ci vi l act io n un de r th e Em pl oyee Ret ire m en t In co m e Secu rit y Act

of 19 74 (“ ERISA”) if he so de si red

. On Ju ne 6, 20 08

, Ben ne tt su bm it te d to Met Life

a “ Req ue st fo r Cas e Rei ns ta te m en t,” whi ch st at ed th at he ha d rece nt ly be en ap pr ov ed

to rece iv e So ci al Secu rit y di sa bi li ty be ne fit s. On Ju ne 27

, 20 08

, Met Life de ni ed th e

req ue st fo r rei ns ta te m en t in a le tt e r

, w h i c h ex pl ai ne d th at Met Life ha d pr ev io us ly

rev ie wed an d pr op erl y de ni ed hi s cl ai m

. On Octo b e r 2 0

, 20 08

, Ben ne tt fil ed th is

3act io n in th e Uni te d St at es Dis tri ct Co ur t fo r th e Mi dd le Dis tri ct of Fl or id a to reco ve r

lo ng -te rm di sa bi li ty ben efi ts un de r ERISA.

Met Life m ov ed fo r su m

m ary jud gm en t, whi ch th e di st ric t co ur t gr an te d. The

co ur t he ld th at Ben ne tt ’s cl ai m was ba rred by a reas on ab le th ree- y ear co nt ract ua l

l i mita ti on pe rio d co nt ai ne d in th e pl an an d th at Met Life co rrec tl y de ni ed Ben ne tt ’s

cl ai m fo r be ne fit s. Ben ne tt ap pe al s; he arg ue s th at th e co ur t erre d in co nc lu di ng th at

hi s cl ai m is t i me b arre d un de r th e pl an ’s li m it at io n pe rio d. In th e al te rn at iv e, he

arg ue s th at ev en if hi s cl ai m is ba rred by th e pl an ’s li m it at io ns pe rio d, th at pr ov is io n

is un reas on ab le an d/ or un co ns ci on ab le

.

ERISA do es no t pr ov id e it s own st at ut e of li m it at io ns

. Co ur ts ei th er bo rro w a

cl os el y an al og ou s st at e li m it at io ns pe rio d, or th ey ap pl y a co nt ract ua ll y ag reed up on

pe rio d, pr ov id ed it is reas on ab le

. No rt hl ak e Reg ’l Med

. Ct r

. v

. Wa

f f l e Hou se Sy s.

Empl oy ee Ben ef

it Pla n

, 16 0 F.3 d 13 01

, 13 03 (1 1t h Ci r. 19 98 ). The po li cy in th is cas e

pr ov id ed fo r a th ree- y ear li m it at io ns pe rio d, whi ch is reas on ab le un de r ou r pr eced en t.

Se e id

. at 13 04 (h ol di ng th at a ni ne ty-day li mi t at io n pr ov is io n was en fo rcea bl e). It

ba rs an y la wsu it fil ed m o r e t h a n t hr ee y ears aft er “ th e ti m e pr oo f m us t be gi ve n.”

App lying th e pl ai n la ng ua ge of th e p l a n

, t he li m it at io ns pe rio d ba rs an y act io n by

4Ben ne tt fil ed aft er J un e 2 7, 2 00 6. (R.1 -1 Ex. A at 15 .) Ben ne tt fil ed th is act io n o n 1

Octo be r 20

, 20 08

, m or e th an two y ears aft er th e li m it at io ns pe rio d ex pi red

. Ben ne tt

arg ue s th a t h is cl ai m is no t ba rred be cau se : (1 ) th e el im in at io n pe rio d be ga n on th e

da te Met Life fir st de ni ed hi s cl ai m , Marc h 2 8, 2 00 5, an d h is cla im accr ue d o n J un e

27 , 20 08 , when Met Life de ni ed th e cl ai m fo r th e la st ti m e; (2 ) th e pl an pe rm it s l at e

no ti ce of a pr oo f of

a cl ai m if i t i s g iv en “ as so on as po ss ib le ” an d Ben ne tt sa ti sf ie d

th is pr ov is io n by pr ov id in g Met Li f e n ot ic e th at he ha d be en ap pr ov ed to rece iv e

So ci al Secu rit y be ne fit s so on aft er r e c ei vi ng a fav or ab le So ci al Secu rit y Dis ab il it y

de ci si on ; an d (3 ) a rid er am en de d th e pl an to di sp la ce th e c o n t r a ct ua l li m it at io ns

pe rio d. Afte r r e v i e w o f th e reco rd

, we ag ree wit h th e di st ric t co ur t’s an al y si s

co nc lu di ng th at th es e arg um en ts co nf li ct wit h th e un am

bi gu ou s la ng ua ge of th e pl an

a nd th at Ben ne tt ’s c la im is ba rred by t he co nt ract ua l li m it at io ns pe rio d. ( R

. 1

- 2 8 a t

3 n .1; 6-7 .)

Ben ne tt al so arg ue s th at th e co nt ract ua l li m it at io ns pe rio d is un reas on a b le

an d/ or un co ns ci on ab le be cau se it ru ns whi le be ne fit s are be in g pa id an d whi le th e

So ci al Se cu

ri ty A dm ini str at ion co ns id ers a cl ai m an t’ s So ci al Se cu ri ty dis ab ili ty cl ai m

.

Be nnett’s disability and the 180-day elimination period beg an on September 30, 2002. The 1

elimination period ended on Marc h 29, 2003. The plan states that p ro o f of a claim must be

submitt ed within ninety day s following the end of the elimination period, n o l ater than J une 27,

2003, in Be nnett’s case

. The limit ations p er i od bars actions filed more than three y ear s afte r this

date.

5Acco rd in g t o B en ne tt , th e d is tri ct co ur t’s i nt erp ret at io n o f th e p la n p erm it s a d en ia l

of be ne fit s to Ben ne tt “ on th e ba si s th at th e So ci al Secu rit y Adm in is tra ti on to ok to o

lo ng to m ak e it s de te rm in at io n th at he was di sa bl ed .” W e co ns id e r w h e t h e r th e

li m it at io ns pe rio d is un reas on ab le an d/ or un co ns ci on ab le in li gh t of th e fact s an d

ci rcu m st an ces of Ben ne tt ’s cas e. Ben ne tt su st ai ne d hi s in jury in Sep te m

be r 20 02

, bu t

di d no t su bm it a cl ai m fo r So ci al Secu rit y di sa bi li ty be ne fit s un ti l Apr il 20 05

. Giv en

Ben ne t’s de la y in se ek in g So ci al Secu rit y di sa bi li ty be ne fit s, we ag ree wi t h t he

di st ric t co ur t’s an al y si s co nc l u d i n g th at th e pl an is ne it he r un reas on ab le no r

un co ns ci on ab le as ap pl ie d to th e fact s of th is cas e. (R.1 -2 8 at 9- 10 .) The refo re, we

ho ld th at th e di st ric t co ur t di d no t err in ho ld in g th at Ben ne tt ’s cl ai m is ba rred by th e

pl an ’s th ree- y ear c on tra ct ua l l im it at io n.

AFFIR MED.

6