The U.S. Court of Appeals for the Ninth Circuit has reversed a district court’s dismissal of an action regarding a Plan Participant’s application for continued long-term disability (LTD) benefits. The issue involved whether a deadline for filing an appeal could be on a Saturday.
The case is Legras v. Aetna Life Insurance Company.
The Plan Participant, Andre LeGras, was an employee of FedEx and a member of FedEx’s LTD Plan. In October 2008, LeGras seriously injured himself while working as a ramp transport driver for FedEx, a job he had held for twenty-three years. LeGras suffered a serious back injury that caused severe and sustained pain. In May 2009, he began receiving disability benefits under the Plan.
Aetna, the insurer, notified LeGras that his benefits would terminate on May 24, 2011 unless he could establish that his disability qualified as a total disability as defined by the Plan.
LeGras filed a claim to qualify, in which Aetna denied on April 18, 2011. The denial letter advised LeGras he had 180 days to appeal the decision. After LeGras attempted to make the required showing, Aetna sent LeGras a letter explaining that the evidence he submitted did not establish that he suffered from a total disability.
LeGras received the letter at 1:23 p.m. on April 18, 2011. The letter stated, “If you disagree with the above determination, in whole or in part, you may file a request to appeal this decision within 180 days of receipt of this notice.”
The 180 day appeal period ended on October 15, 2011, which was a Saturday. LeGras mailed his appeal on October 17, 2011, a Monday. On January 17, 2012, Aetna denied LeGras’ appeal and labeled it as untimely.
LeGras filed an action in district court regarding his denial of benefits. In court Aetna argued that he was unable to reinstate LTD benefits because he mailed his appeal after the 180 day period that was written in the denial letter. The district court sided with Aetna and LeGras appealed.
In the appeal process, the court of appeals sided with LeGras. The court explained that the DOL Regulation 29 C.F.R. 2560.503-1(h) states that a reasonable opportunity for a full and fair review is “at least 180 days” after receiving a notification of an adverse benefit determination.
a reasonable opportunity for a full and fair review is “at least 180 days” after receiving a notification of an adverse benefit determination.
The court stated that although the 180-day appeal period specified in the April 18, 2011 denial letter ended on Saturday, October 15, 2011, ERISA Federal common law requires that Aetna accept LeGras’s appeal as timely as he mailed it on the first business day following the weekend. It was an error for Aetna and the district court to concluPde that LeGras’s administrative appeal as untimely.
Employers and others involved in benefit Plan Administration should follow the Federal common law and construe deadlines that would otherwise fall on a weekend as being the first business day after the weekend.