Your employer-provided insurance is supposed to be there for you in your time of need. Whether you must undergo surgery to repair a life-threatening condition or you need medications to manage a chronic, long-standing issue, your insurance benefits exist to make these necessary expenditures more affordable.
That is why having a claim you submit for payment denied by your insurer can be such a shock. An ERISA claim may be the vehicle you need to get the benefits you are entitled to receive and enforce your insurance agreement. Like any other legal right, your ability to file an ERISA claim does not last indefinitely. You only have a limited time to file an ERISA claim, and you might have less time than you think.
ERISA’s Statute of Limitations Generally
The federal ERISA statute has a statute of limitations clause describing the amount of time that someone has to file a lawsuit if they believe their employer’s insurance company wrongfully denied them benefits. The statute of limitations serves to encourage you and others with claims to bring them in a timely manner or risk losing your right to sue altogether.
In general, an ERISA claim should be brought within six years of the breach or violation, of the agreement or the date on which the insurance company could have done something to fix the breach. There is a shorter statute of limitations, though, that may apply as well. This statute of limitations is three years from the date you acquire “actual knowledge” of the breach.
“Actual Knowledge” Defined
ERISA does not define what constitutes having “actual knowledge” of the breach or violation. It fell to the U.S. Supreme Court in a 2020 decision, Intel Corp. Investment Policy Committee v. Sulyma, 589 U.S. ___ (2020). In this decision, a unanimous Court held that for the three-year statute of limitations to apply, the plaintiff must actually know and be aware of the breach or violation and not just have been provided information about it.
Sulyma dealt with a claim that a fiduciary tasked with investing retirement contributions did not properly diversify the portfolio, but its holding can apply in other contexts under ERISA, too.
The Court was careful to limit its holding by saying that the need for a plaintiff to have “actual knowledge” and thus trigger the three-year statute of limitations may not allow a plaintiff to become willfully blind to information being provided to them. Thus, in the future, a plaintiff who receives information about a denial in the mail but refuses to read it may still be found to have “actual knowledge” of the breach.
File Your ERISA Claim Sooner Rather Than Later
When it comes to your rights and the benefits you need, the best practice is to file your ERISA claim as soon as possible. In the San Francisco area, this begins by contacting Unruh Law and having your case evaluated. If you have an ERISA claim, we will help you file your case and will see it through to the end.
If you believe your employer’s health insurer unfairly denied your claim for benefits or otherwise acted inappropriately, Unruh Law would like to speak with you. Contact us at 833-753-5168 or through our website to schedule your consultation.