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PATTERSON-PRIORI v. UNUM LIFE INS. CO. OF AMERICA

March 30, 1994

EMMA PATTERSON-PRIORI, Plaintiff,
v.
UNUM LIFE INSURANCE COMPANY OF AMERICA and WESTIN HOTEL COMPANY, Defendants.



The opinion of the court was delivered by: I. LEO GLASSER

 GLASSER, United States District Judge:

 This is a motion by defendant Unum Life Insurance Company of America ("Unum") for summary judgment pursuant to Federal Rule of Civil Procedure 56 dismissing plaintiff Emma Patterson-Priori's complaint which seeks declaratory and monetary relief stemming from Unum's denial of disability benefits. Unum argues that plaintiff's cause of action is time-barred and hence the complaint must be dismissed. For the following reasons, defendant's motion is granted.

 FACTS

 Plaintiff was an employee of the Westin Hotel Company and as such was a covered employee under a long-term disability policy issued by Unum to plaintiff's employer (the "Plan"). Def.'s 3(g) Statement, P 2. *fn1" The Plan states in relevant part that "[a] claimant or the claimant's authorized representative cannot start any legal action . . . more than 3 years after the time [a] proof of claim is required." A proof of claim is required no later than 90 days after the end of the "elimination period" which is a period of consecutive days of total disability for which no benefit is payable. The Plan also provides that if it is not possible to give a proof of claim within that time limit it must be given as soon as "reasonably possible." Def.'s 3(g) Statement, Ex. A.

 On or about October 6, 1986, plaintiff filed a claim for disability benefits stemming from pain in her left leg and back and claimed a date of disability of April 8, 1986. Def.'s 3(g) Statement, P 3 and Ex. B. Unum paid benefits on this claim and then ceased paying those benefits on August 19, 1989. In a letter dated August 28, 1989, Unum notified plaintiff of the termination of her benefits and advised plaintiff of her right to appeal. Def.'s 3(g) Statement, P 4 and Ex. C. Plaintiff timely appealed this determination to Unum on or about September 22, 1989 (Def.'s 3(g) Statement, Ex. D), and in a letter dated December 1, 1989, defendant upheld its denial of benefits. Def.'s 3(g) Statement, P 5 and Ex. E. In this letter Unum stated that it "would be glad to review any additional medical information that you wish to submit, but based upon current information, we must uphold the denial of this claim."

 More than three years later, in January or February of 1993, plaintiff personally contacted Unum and requested that it reconsider its December 1, 1989 denial based on the fact that the Social Security Administration had approved her claim for disability benefits. Unum wrote to plaintiff's attorney on February 16, 1993, and reported that it was not in possession of any such information but that "if you are in receipt of any information or documentation that you would like to submit on behalf of your client, pleased do so . . . ." Def.'s 3(g) Statement, Ex. F. Therefore, plaintiff's attorney wrote to Unum on March 31, 1993, and included with his letter an April 22, 1992 letter which he had sent to Unum and which had attached to it the Social Security Administration's Award Certificate. *fn2" He requested, on behalf of plaintiff, that Unum review its December 1, 1989 denial of benefits. In a letter dated April 22, 1993, Unum acknowledged plaintiff's request, noted that a denial had been made previously, but stated that it "will review this new information within the next 60 days to determine if this will change our original decision."

 However, several weeks later, in a letter dated May 19, 1993, Unum stated that it would not reconsider its December 1, 1989 denial of benefits -- even though it acknowledged that it had invited further documentation in its February 16, 1993 letter -- because of "the length of time that has transpired since we upheld our denial of [plaintiff's] claim[.]" Def.'s 3(g) Statement, Ex. F. Furthermore, because of the Social Security Administration's favorable decision on plaintiff's claim of disability, Unum determined that it had overpaid plaintiff for the period of September 1, 1988 to August 19, 1989, and requested that she reimburse Unum in the amount of $ 8,166.40.

 Plaintiff commenced this action approximately two months later, on July 15, 1993, and seeks (i) a declaration that plaintiff is entitled to long term disability income; (ii) full benefits payable from March 1989 to the present and continuing to the date of reinstatement of benefits; and (iii) an order requiring Unum to reinstate plaintiff as a beneficiary of long term disability insurance. Complaint, "Wherefore" clause. In the complaint plaintiff states that in or about March 1989, Unum denied plaintiff's claim for continued benefits and that "upon review requested by plaintiff, defendants affirmed their denial and has not received benefits since that date." Complaint, PP 6, 7.

 Statute of Limitations

 
A. The Proper Period

 In Miles v. New York State Teamsters Conference, 698 F.2d 593 (2d Cir.), cert. denied, 464 U.S. 829, 78 L. Ed. 2d 108, 104 S. Ct. 105 (1983), the Second Circuit noted that the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. ("ERISA"), does not prescribe a statute of limitations period for actions under 29 U.S.C. § 1132, the section of ERISA pursuant to which plaintiff has brought her cause of action. The court therefore held that New York's six-year statute of limitations for contract actions, N.Y. Civ. Prac. L. & R. § 213 (McKinney 1990), is most analogous to Section 1132 actions and hence should control. Id. at 598. See also Pierce County Hotel Employees and Restaurant Employees Health Trust v. Elks Lodge, B.P.O.E., No. 1450, 827 F.2d 1324, 1328 (9th Cir. 1987) (" 29 U.S.C. § ...


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