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[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
No. 16-14565
________________________
D.C. Docket No. 1:15-cv-02508-TWT
MELINDA WEBB,
Plaintiff-Appellant,
versus
LIBERTY MUTUAL INSURANCE COMPANY,
Defendant,
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON,
Defendant-Appellee.
________________________
Appeal from the United States District Court
for the Northern District of Georgia
________________________
(May 25, 2017)
Before MARTIN, JILL PRYOR, and ANDERSON, Circuit Judges.
MARTIN, Circuit Judge:
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Melinda Webb brought suit against Liberty Life Assurance Company of
Boston (“Liberty”) seeking to recover optional life insurance benefits and an
accidental death insurance benefit under the Employee Retirement Income Security
Act (“ERISA”), 29 U.S.C. § 1001. The District Court granted Liberty summary
judgment after finding the action was not within the contractual limitations period.
After careful review, we vacate the District Court’s order and remand for the court
to decide in the first instance the factual question of whether Ms. Webb reasonably
relied upon Liberty’s statement that “further review will be conducted.”
I.
On December 27, 2013, Ronald Webb sustained a gunshot wound to the
head in the home he and Ms. Webb shared. Ms. Webb was home at the time of the
incident, and immediately called the police. Mr. Webb was transported to a
hospital, where he died later that night. The coroner concluded Mr. Webb’s death
was a result of suicide.
Mr. Webb was an employee of Adobe Systems Incorporated (“Adobe”).
Through Adobe, Mr. Webb enrolled in coverage under a life insurance and
accidental death benefits plan in compliance with the ERISA. Mr. Webb’s
coverage included basic life insurance of $250,000; optional life insurance of $1
million; basic accidental death insurance of $250,000; and optional accidental
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death insurance of $1 million. Ms. Webb was a beneficiary under each of these
policies.
On December 28, 2013, Adobe emailed Liberty that Mr. Webb had died.
Adobe then sent Liberty a completed Employee Proof of Death form on December
30, 2013. On January 2, 2014, Liberty’s claims examiner spoke to Ms. Webb and
informed her that because Mr. Webb’s death had been ruled a suicide, Liberty
would not pay the optional life insurance benefits or accidental death benefit. On
January 6, 2014, Liberty sent Ms. Webb a claim form and asked for a copy of Mr.
Webb’s death certificate. Ms. Webb provided this additional information required
for proof of loss to Liberty on January 24, 2014. Liberty then sent Ms. Webb a
letter on January 27, 2014, informing her she would receive basic life insurance
benefits. The letter included a check for that sum plus interest. It also explained
again that she would not receive the optional benefits, and that she had the right to
appeal the decision under the ERISA.
On March 26, 2014, Ms. Webb asked Liberty to review its decision. After
review, Liberty did not change its decision, and sent another letter to Ms. Webb to
tell her this on June 23, 2014. However, Liberty’s June 23 letter said: “At this
time, the appeal process has been exhausted and further review will be conducted
by Liberty.” On May 5, 2015, Ms. Webb’s lawyer sent Liberty a letter inquiring
about this further review and providing additional evidence to support Ms. Webb’s
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claim that the death was not suicide, but instead accidental. Ten days later, on
May 15, 2015, Liberty responded, thanking Ms. Webb’s attorney for “pointing out
the typo in [its] letter.” Liberty said it had meant no further review would be
conducted.
Ms. Webb then filed this action on June 12, 2015. Liberty removed the case
to federal court and moved for summary judgment based on contractual time
limitations in the policy and based on the administrative record. The District Court
granted summary judgment in favor of Liberty based on the contractual limitations
period of Mr. Webb’s policy. The court did not rule on the administrative record
because it was not necessary in light of the grant of summary judgment.
II.
We review de novo the grant of summary judgment. Byars v. Coca-Cola
Co., 517 F.3d 1256, 1263 (11th Cir. 2008). Summary judgment is appropriate only
“if the movant shows that there is no genuine dispute as to any material fact and
the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). 1
This Court has held “contractual limitations periods on ERISA actions are
enforceable, regardless of state law, provided they are reasonable.” Northlake
Reg’l Med. Ctr. v. Waffle House Sys. Emp. Benefit Plan, 160 F.3d 1301, 1303
1
Liberty argues the standard of review for summary judgment is different in ERISA
cases. Liberty points to no binding precedent from this Court to support this claim, and in any
event, the cases Liberty cites show this only for ERISA benefit denial cases reviewing an
administrator’s denial, not cases interpreting a contract.
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(11th Cir. 1998); see also Heimeshoff v. Hartford Life & Accident Ins. Co., 571
U.S. ___, 134 S. Ct. 604, 611–12 (2013) (“The principle that contractual
limitations provisions ordinarily should be enforced as written is especially
appropriate when enforcing an ERISA plan.”).
Liberty’s Group Life Insurance Policy (the “Policy”) contains two relevant
provisions. First, the Policy sets a time limit after which lawsuits cannot be
brought:
Legal Proceedings
A claimant or the claimant’s authorized representative cannot start
any legal action:
...
2. more than one year after the time Proof of claim is required.
Second, the Policy defines when Proof of claim is required:
Proof
a. Satisfactory Proof of loss must be given to Liberty no later than 30
days after the date of loss.
b. Failure to furnish such Proof within such time shall not invalidate
or reduce any claim if it was not reasonably possible to furnish such
Proof within such time. Such Proof must be furnished as soon as
reasonably possible, and in no event, except in the absence of legal
capacity of the claimant, later than one year from the time Proof is
otherwise required.
The District Court construed this language to mean a claimant ordinarily has
thirty days to furnish proof of loss, and then one year after that to bring suit—
resulting in a total contractual limitations period of one year and thirty days. The
court said when “proof cannot reasonably be furnished within 30 days, [then] an
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additional year would be added to the contractual limitations period.” Because Ms.
Webb submitted proof within thirty days, the District Court concluded her
contractual limitations period was one year and thirty days instead of two years and
thirty days. Therefore, the District Court found her suit barred by the contract’s
limitations period and granted summary judgment in favor of Liberty.
On appeal, Ms. Webb argues her action was timely filed because the District
Court erred in its interpretation of the contractual limitations period. She says at
the very least, the Policy is ambiguous and should therefore be construed against
the drafter, Liberty. Alternatively, Ms. Webb argues that if this Court agrees with
the District Court’s interpretation of the contractual limitations period, that period
was unreasonable.
A.
Ms. Webb first argues the District Court erred by interpreting the term
“required” to change its meaning based on when proof of loss is filed. She says,
under the Policy, proof is not absolutely required until one year and thirty days.
Therefore, Ms. Webb asserts the contractual time limit is one year after that (a total
of two years and thirty days) for all claimants. She points to Harrison v. Liberty
Life Assurance Co. of Boston, No. 5:11-cv-60, 2011 WL 2118954 (N.D. Fla. May
7, 2011), for support of her interpretation. At the very least, Ms. Webb says, the
Policy is ambiguous on this point and should be construed against Liberty.
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This Court interprets ERISA contracts, like the Policy, according to federal
common law. Alexandra H. v. Oxford Health Ins. Inc. Freedom Access Plan, 833
F.3d 1299, 1306–07 (11th Cir. 2016). “We first look to the plain and ordinary
meaning of the policy terms to interpret the contract.” Id. at 1307. When a term is
ambiguous—that is, it is “susceptible to two or more reasonable interpretations that
can be fairly made”—we “construe any ambiguities against the drafter.” Id.
Because Ms. Webb filed sufficient proof of loss on January 24, 2014, within
thirty days of the loss on December 27, 2013, the thirty-day provision for when
proof was required under the Policy applied. The additional-year provision that
Ms. Webb seeks to apply goes only to claims for which proof of loss could not be
filed within thirty days. By the Policy’s own terms, this additional year is
reserved exclusively for instances in which “it was not reasonably possible to
furnish such Proof” within thirty days. That was not the case here. Not only was it
possible for Ms. Webb to furnish sufficient proof of loss within thirty days, but she
actually did.
This interpretation of the Policy follows its plain language to determine
when proof of loss is required based on when that proof can reasonably be
furnished. And this interpretation does not conflict with Harrison, which arrived at
the same conclusion. Notably, the District Court in Ms. Webb’s case adopted
Harrison’s reasoning. See Harrison, 2011 WL 2118954, at *2 (finding the extra
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year applied only “[i]n certain circumstances [where] the policy grants additional
time . . . if it is not ‘reasonably possibl[e]’ to meet . . . . the normal [thirty-day]
requirement”). As a result, the Policy’s plain meaning was not ambiguous and Ms.
Webb brought her action after its contractual limitations period.
B.
Next, Ms. Webb says the Policy’s limitations period is unreasonable and
fundamentally unfair. She points out that Liberty did not tell her it was no longer
conducting review until May 15, 2015—four months after the contractual
limitations period expired.
Liberty says Ms. Webb had seven months to bring her suit after Liberty
upheld its decision to deny optional benefits on June 23, 2014. Liberty argues Ms.
Webb was mistaken, and that “this is not a case in which Liberty’s conduct
prevented Webb from filing suit.” And in any event, it says, because Ms. Webb
“did not diligently pursue her claim” by following up about the typo, she should be
time barred from bringing suit.
This Court has not established a clear test for whether a contractual
limitations period under ERISA is reasonable, but instead has relied on several
instructive factors. In Northlake, this Court looked to (1) whether there was any
“subterfuge” to prevent lawsuits; (2) whether the limitations period was
commensurate with other provisions in the plan that are designed to process claims
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with dispatch; and (3) whether an ERISA-required internal appeals process was
completed. 160 F.3d at 1304. In analyzing the second factor, this Court stressed
the importance of the plan provider completing review with ample time left for the
claimant to file suit. See id.; see also Heimeshoff, 134 S. Ct. at 612–13 (noting the
importance of time “in which to file suit” after the end of the ERISA internal
review process when evaluating whether a limitations period is reasonable).
Applying this precedent, we conclude the contractual limitations period
would be unreasonable in Ms. Webb’s case if Ms. Webb reasonably relied upon
Liberty’s written statement that it was conducting further review. If Ms. Webb
believed the administrative review process was incomplete based on Liberty’s
statement, and if an objectively reasonable person in her place would have believed
as much, the limitations period in this case would be unreasonable because Ms.
Webb could not bring suit until the administrative review process finished. See
Heimeshoff, 134 S. Ct. at 612–13; Northlake, 160 F.3d at 1304.
Ms. Webb argues that she did, in fact, reasonably rely upon this statement.
She points out that she retained new counsel and conducted further investigation to
produce evidence to support her claim. And once Liberty told Ms. Webb that its
letter stating it would be undertaking further review was a typo, she filed suit
within thirty days. On the other hand, Liberty argues Ms. Webb did not reasonably
rely upon its statement. It says Ms. Webb did not diligently pursue her claim
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because she did not communicate with the insurance company until May 5, 2015,
which was after the limitations period had expired. Because this is a factual
question the District Court did not evaluate, we vacate the District Court’s order
and remand for the court to make this determination in the first instance. See, e.g.,
Williams v. Wright, 927 F.2d 1540, 1551 (11th Cir. 1991) (“These factual issues
were not addressed by the district court, and we therefore decline to address them
here, preferring that they be addressed in the first instance by the district court.”).2
VACATED AND REMANDED.
2
Liberty asks us to look beyond the District Court’s reason for granting summary
judgment and evaluate its benefits denial decision based on the administrative record. However,
the District Court’s order evaluated only the contractual limitations period and not the
administrative record. We also remand for the District Court to evaluate the administrative
record in the first instance, if necessary.
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