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Another Court Adds to the Confusion Regarding Denial Letters


Currently, there is a Circuit split amongst the United States Courts of Appeals regarding whether ERISA requires a plan administrator to include the deadline for filing a lawsuit in federal court in a denial letter. The First, Third and Sixth Circuits have held that ERISA requires denial letters to contain the applicable statute of limitations for filing a lawsuit in federal court, particularly if the plan has its own deadline. However, recently the United States District Court for the District of Utah joined the Ninth and Eleventh Circuits in holding that denial letters only need to inform participants of their right to bring a lawsuit under ERISA, but not of the time limit applicable to filing suit. Accordingly, the district court rejected the plaintiff’s argument that the plan’s one-year contractual limitation was ambiguous. Although courts have not currently reached a consensus as to what is required in determination letters, plan administrators should carefully review denial letters. If a plan contains a specific statute of limitations for bringing suit, it is a best practice to include that statute of limitations in both the initial and final denial letter.

Michael C.D. v. United Health Care, No. 2:15-cv-306 (D. Utah May 17, 2016)


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