Heimeshoff v. Hartford Life & Accident Ins. Co. (12-729)

argument 12-729

Heimeshoff v. Hartford Life & Accident Ins. Co.

Supreme Court of the United States 1h 0m 5 speakers 8 chapters transcribed 5 days ago official recording ↗

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What is the ERISA accrual provision at issue in Heimeshoff v. Hartford Life?

John G. Roberts 0:00

We'll hear argument next in case twelve seven twenty nine, Heimishoff versus Hartford Life and Accident Insurance. Mr. Wessler.

Bob Wessler 0:09

Thank you. Mr Chief Justice, and may it please the Court. This case involves an accrual provision in an ERISA plan that starts the clock running on a federal denial of benefits claim near the beginning of ERISA's mandatory internal claims process, before the federal claim ever exists or could be filed in court. This provision directly conflicts with Aris's two tiered remedial structure, which is designed to maximise the number of claims that are resolved internally without lawyers in courts. Respondents' provision undermines this goal by making it impossible for anyone to know in advance how much time will be left on the limitations clock after the internal process is complete.

Unknown 0:50

How much time was left in this case?

Bob Wessler 0:52

There was approximately one year, Your Honor. Um the

Unknown 0:55

And you would and if there were a one year limitation running from the final administrative review. uh you would be out.

Bob Wessler 1:06

Well I don't think we would be out in this case, Your Honor, because the the provision in this case was a three year from final denial. Going forward If in fact uh Arisciplins had a one year clock running from final denial, everyone would know that they would need to file their claim within one year. But if there were such

Unknown 1:22

a rule one year. from the final administrative decision. This claim would become too late.

Bob Wessler 1:31

If in fact the provision in this plan said one year for final denial, that's correct, Your Honor.

Unknown 1:35

What what accounts with the delay? The clock was running. And more than a year went by before this suit was instituted. Why was that why did that happen?

Bob Wessler 1:47

Well I think this gets us, Your Honor, to one of the core problems with this provision, which is that it's confusing. It is unclear. One of the key questions with these provisions, when they're coupled with the mandatory exhaustion requirement, is that is that is actually quite uncertain when proof of loss is due. And so below Uh one one of the key questions which actually still remains unresolved is when the clock actually started ticking. But I think there's a there's a more fundamental problem. Sorry, I thought the

Elena Kagan 2:12

court below said

Bob Wessler 2:14

that

Elena Kagan 2:14

um that was irrelevant to the resolution of this case, that even if they accepted your date. for when the uh proof of loss started that you

Bob Wessler 2:23

would still lose. In this case, Your Honor, that's true. However, the problem with these proof of loss dates, coupled with this mandatory exhaustion requirement, is that it is it is unclear from the outset uh uh w when when the when the clock w how much time after final denial will be left when you're in the middle of the process. And on this question of proof of loss

Elena Kagan 2:44

I'm a little confused because it would be the same no matter what rule we instituted. I I don't think that's right. You would never know when the administrative you really never know when the administration process is final, just like you're arguing you don't know when the proof of loss date is final. But at least the advantage of proof of loss, you know you got three years from at least the beginning of the process.

Bob Wessler 3:07

Right. Although I there there's actually quite a bit of disagreement among the lower courts about how you measure proof of loss, when that date actually triggers the limitations clock. So for instance, in the Seventh Circuit the Court has held that proof of loss starts the clock ticking the first time proof of loss is due under the plan, which is the first set of documents that a claimant actually provides to her plan supporting her claim for disability. Uh the plan, however, through this internal process can come back and ask for more documents, more evidence supporting the disability. And if the claimant then provides those additional documents, that could conceivably reset the limitations clock under proof of loss requirement.

Elena Kagan 3:46

That can only help you. That it gives you more time, but it doesn't take time away from you. That's true, Your Honor. You have three years no matter what.