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Witt v. Metropolitan Life Insurance Co.

United States Court of Appeals, Eleventh Circuit

November 25, 2014

DON L. WITT, Plaintiff-Appellant,
v.
METROPOLITAN LIFE INSURANCE CO., SHELL OIL LONG TERM DISABILITY TRUST PLAN, Defendants-Appellees

Page 1270

Appeal fro the United States District Court for the Northern District of Alabama. D.C. Docket No. 4:12-cv-02157-KOB.

For Don L. Witt, Plaintiff - Appellant: Ralph Kenneth Strawn Jr., Joshua Blake Sullivan, Henslee Robertson Strawn & Sullivan, LLC, Gadsden, AL.

For Metropolitan Life Insurance Company, Shell Oil Long Term Disability Trust Plan, Defendants - Appellees: Brittlynn H. Burns, MetLife, New York, NY; Scott Burnett Smith, Bradley Arant Boult Cummings, LLP, Huntsville, AL; Summer A. Davis, Thomas Matthew Miller, Bradley Arant Boult Cummings, LLP, Birmingham, AL.

Before HULL, MARCUS and DUBINA, Circuit Judges.

OPINION

Page 1271

HULL, Circuit Judge:

In this case, we must determine whether plaintiff Don Witt's lawsuit seeking to recover disability benefits allegedly due from May 1997 to the present is barred by the applicable statute of limitations and, if so, whether the defendants waived that statute-of-limitations defense. After careful review of the record and the briefs, and with the benefit of oral argument, we affirm the district court's grant of summary judgment in favor of the defendants.

I. BACKGROUND

The facts of this case are largely undisputed. From May 18, 1972, until December 29, 1994, Witt worked as a senior operations specialist with Shell Oil Company. In connection with his employment, Witt gained access to short-term and long-term disability insurance through the Shell Oil Long Term Disability Plan (the " Plan" ),[1] whose long-term disability claims are administered by Metropolitan Life (" MetLife" ). The Plan is subject to the Employee Retirement Income Security Act of 1974, 29 U.S.C. § § 1001-1461 (" ERISA" ). This lawsuit stems from a claim for disability benefits originally filed in 1997.

A. Approval of Witt's Claim for Benefits in 1995-97

On January 3, 1997, Witt filed a claim for disability benefits based on anterior cervical fusion and a herniated lumbar disc. On January 17, 1997, Witt updated his claim, reporting that he was also suffering from secondary asbestosis, coronary artery disease, and hypertension. Although his claim was not made until 1997, Witt sought benefits from December 29, 1995. According to MetLife's files, Witt also complained of neck, shoulder, and back pain; dizziness; and severe headaches.

Although Witt's 1997 claim for 1995-96 benefits was untimely under the Plan's provisions, MetLife approved the claim and granted him retroactive benefits, effective December 29, 1995. On March 7, 1997, MetLife sent Witt a Notice of Approval, stating that it had awarded him a monthly benefit of $3,125.00, which would be reduced by any worker's compensation or social security benefits Witt received. After accounting for the deductions, MetLife estimated it would make monthly payments of $514.41 to Witt for the remainder of his life. The Notice of Approval included the following provision immediately above MetLife's estimated contributions: " Providing reductions remain as listed above, and you remain totally disabled as defined in your group plan, your benefit schedule will be as follows . . . ."

Witt's Plan advised that the participant may be requested to submit periodic proof of continuing disability and those benefits will be paid only " if proper proof of continued disability is provided." Additionally, the Plan's Summary Plan Description specified that it " does not provide benefits for any disability . . . from the date you fail to furnish due proof of continued disability."

MetLife paid benefits to Witt through April 30, 1997.

B. May 1997 Termination of Benefits

On May 22, 1997, MetLife terminated Witt's claim effective May 1, 1997, for failure

Page 1272

to provide adequate supporting medical records. Pursuant to his disability policy, Witt had the " right to request a review of any denied claim by writing . . . within 60 days after receiving the denial notice." MetLife's internal records indicate that it sent Witt a letter that day, informing him that his claim was terminated for failure to support.

In this 2012 litigation, however, MetLife has been unable to produce a copy of the 1997 letter. Witt denies ever receiving such a letter. In any event, MetLife did not pay benefits to Witt in May 1997, or in any month thereafter.

C. 1997-2009

Although Witt stopped receiving benefits in 1997, Witt did not challenge the termination of his benefits. Notably, Witt did not make any inquiries of MetLife for the 12 years that passed between benefits termination on May 22, 1997, and May 29, 2009.

D. Events in 2009-2012

On May 29, 2009, Witt's attorney, Joshua Sullivan, contacted MetLife by telephone, requesting a status update on Witt's claim. Sullivan indicated that Witt had received an approval letter but no payments.

On June 3, 2009, MetLife informed Sullivan that it would review Witt's file once Sullivan sent MetLife a copy of the Notice of Approval and a letter of representation. Sullivan sent MetLife the Notice of Approval on December 23, 2009, and the letter of representation on December 31, 2009.

Once it received both documents, MetLife reviewed Witt's previously-archived file from 1997.

On January 26, 2010, MetLife sent a letter to Sullivan, stating that Witt's claim " was paid for the period December 29, 1997 [sic] through April 30, 1997 and Terminated effective May 1, 1997 for failure to provide proof of continued Disability." MetLife characterized Witt's request for benefits as an attempted revival of his old claim, rather than a new claim for benefits. Specifically, MetLife stated that if attorney Sullivan wished to have his " clients [sic] claim . . . reviewed for Benefits beyond May 1, 1997[,] we require supporting medical documentation." MetLife's 2010 letter also told Sullivan to " submit evidence of any abnormal clinical exam findings from the health care providers who treated your client from May 1, 1997 through the date that you are claiming Disability benefits for your client. The information provided should include office visit notes[,] objective test results and any other relevant medical information which was not previously submitted for review." MetLife's letter reflects that it understood Witt was seeking back benefits from May 1997 forward.

Over the next 12 months (January 2010--February 2011), MetLife received no letters, phone calls, or other correspondence from either Witt or Sullivan.

On February 17, 2011--more than a year after MetLife requested medical documentation--attorney Sullivan sent MetLife a letter with attachments from eight sources, for a total of 10 documents in support of Witt's claim. The attachments included a receipt for Witt's claim of his Social Security benefits, along with notes from seven doctors: three written in 1995; one written in 1998; one written in 2002; one written in 2005; one written in 2006; and two written in 2010. In 2011, Witt again was seeking back benefits from May 1, 1997 forward.

MetLife subsequently reviewed Witt's claim with the supporting documentation. During the review, ...


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