Aetna Denial of ERISA disability appeal filed on day 182 is reversed by court

The Ninth Circuit ruled that if the internal deadline for a long-term disability claimant to file an administrative appeal falls on a Saturday, Sunday or holiday, the deadline is extended to the next day that is not a Saturday, Sunday or holiday.

In LeGras v. Aetna Life Ins. Co., the plaintiff’s claim for long-term disability was denied and he was informed he had 180 days to file an administrative appeal according to the plan’s terms. The 180-day time-limit ended on a Saturday, but the appeal was not mailed until the following Monday. Aetna promptly dismissed the appeal as untimely. The plaintiff followed up by filing an ERISA complaint in a federal district court in California. That court dismissed the complaint on the grounds that by filing an untimely administrative appeal, the plaintiff had failed to exhaust his administrative remedies as required by law.

The U.S. Court of Appeals for the Ninth Circuit reversed the district court’s ruling and concluded that “because the last day of the appeal period fell on a Saturday, neither that day nor Sunday count in the computation of the 180 days…”. Since LeGras mailed his appeal on the Monday following the Saturday deadline date, it should have been accepted as timely. The court commented that “this method of counting time is widely recognized… we therefore adopt it as part of ERISA’s common law.”
 
In coming to its conclusion, the Ninth Circuit noted that there is a “widespread understanding” that when a deadline falls on a Saturday, Sunday or holiday, the deadline is extended to the next business day. The court remarked that “there is nothing novel about the principle” and referenced an 1890 U.S. Supreme Court case where the court specifically held that when a deadline to do something falls on a Sunday, it is extended to the following Monday. The court mentioned various federal statutes and rules that use this method of calculating deadlines and noted that a 1988 Fifth Circuit case concluded that this “rubric has universal acceptance.”
 
The court rejected Aetna’s argument that the 180-day deadline was a contract provision and should not be controlled by the court’s method of calculation of time. According to the court, “the Plan is ultimately governed by ERISA. Any ambiguity in calculating the 180 days should be resolved to further the purposes and goals of ERISA.”

If you have questions regarding your claim for disability benefits, or if your disability claim has been denied, feel free to call Disability Attorneys Dell & Schaefer for a free consultation.

Source:
http://cdn.ca9.uscourts.gov/datastore/opinions/2015/05/28/12-56541.pdf