Supreme Court Refuses to Review Decision Which Allowed ERISA Pre-Suit Appeal To Be Filed Next Business Day After a Saturday Deadline
On March 21, 2016, the Supreme Court denied an insurance company’s Petition to review a court decision that allowed an ERISA plan participant (a company employee) to file the pre-suit appeal in his disability case on Monday when the deadline fell on a Saturday. In the lower court case, Aetna Life Insurance Co. v. LeGras, 786 F.3d 1233 (9th Cir. 2015), the 9th Circuit Court of Appeals held that the ERISA regulation which governs appeals allows an appeal to be filed on the first business day after the appeal deadline if the deadline falls on a weekend. The federal regulation which requires an appeal of ERISA decision in cases like disability insurance, 29 C.F.R. Section 2560.503-1, does not specify whether filing on the next business is allowed or not. In these types of cases, a denial must be appealed back to the insurance company within 180 days, or the disabled person never gets to go to court. In LeGras, the 180th day fell on a Saturday, and Mr. LeGras filed his appeal with disability insurer, Aetna, the following Monday. The disability insurance company denied the claim saying the appeal was late. A District Judge agreed with the disability insurance company, and granted judgment to Aetna! However, the 9th Circuit Court of Appeals reversed, holding that the 180-day period was extended from the weekend to the following Monday, and Mr. LeGras filed a timely appeal.
Aetna did not like that outcome, so they appealed to the U.S. Supreme Court. Aetna filed what is called a Petition for Writ of Certiorari asking the Supreme Court to look at the case. Aetna wanted the Supreme Court to review the 9th Circuit decision and overrule it. Aetna was hoping the Supreme Court would have said that Mr. LeGras had 180 days and that was it. In other words, Aetna wanted the Court to say that LeGras had to file by the 180th day, even if that day fell on a Saturday and the disability insurance company was closed for business that day. See Disability Insurer Urges High Court To Review Decision On Internal Appeal Deadline.
However, because the Supreme Court refused to hear the case, that means that Mr. LeGras wins. The Ninth Circuit’s decision stands. In other words, Mr. LeGras filed a timely appeal, and his Long Term Disability insurance case will continue.
Aetna’s position is just another example of how ERISA administrators and insurance companies often take unreasonable positions that are in their own best interests, not those of the company employees they insure. So, for now, one Circuit Court of Appeal has held that participants and beneficiaries may file pre-suit appeals that are required under ERISA on the Monday following a weekend deadline.
See — S.Ct. —-, 2016 WL 1078937 (Mem), 84 USLW 3217 (3/21/2015).