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Gordon v. Deloitte & Touche, LLP Group Long Term Disability Plan

United States Court of Appeals, Ninth Circuit

April 11, 2014

BRIDGET GORDON, Plaintiff-Appellant,
v.
DELOITTE & TOUCHE, LLP GROUP LONG TERM DISABILITY PLAN, Defendant-Appellee

Argued and Submitted, Pasadena, California October 10, 2013

Page 747

Appeal from the United States District Court for the Central District of California. D.C. No. 2:11-cv-00913-R-JCG. Manuel L. Real, District Judge, Presiding.

Robert J. Rosati (argued), ERISA Law Group LLP, Fresno, California, for Plaintiff-Appellant.

Ian Seth Linker (argued), Metropolitan Life Insurance Company, New York, New York; Robert Kevin Renner, Barger & Wolen, LLP, Irvine, California, for Defendant-Appellee.

Before: Stephen Reinhardt and Morgan Christen, Circuit Judges, and John W. Sedwick, District Judge.[*] Dissent by Judge Reinhardt.

OPINION

Page 748

SEDWICK, District Judge

Plaintiff-Appellant Bridget Gordon (" Gordon" ) appeals the district court's

Page 749

summary judgment in favor of Defendant-Appellee Deloitte & Touche, LLP Group Long Term Disability Plan ( the " Plan" ), which is insured by Metropolitan Life Insurance Company (" MetLife" ), based on her failure to file the action within the applicable limitation period. The Plan is subject to the Employee Retirement Income Security Act of 1974, 29 U.S.C. § § 1001-1461 (" ERISA" ). We have jurisdiction over the appeal pursuant to 28 U.S.C. § 1291.

I. BACKGROUND

Deloitte & Touche USA LLP (" Deloitte" ) offers employees long-term disability insurance through the Plan. The Plan's claims administrator, MetLife, has broad discretionary authority to make eligibility determinations. Under the Plan, an employee is entitled to long-term disability benefits if she is otherwise qualified and meets the Plan's definition of " disabled." Benefit payments for disabilities due to mental illness are limited to twenty-four months under the Plan.

Gordon worked for Deloitte until October of 2000. Around that time, Gordon learned that she was HIV positive and claimed she could no longer work due to depression. MetLife determined that she was eligible for disability benefits under the Plan and began paying benefits effective March 3, 2001. MetLife paid benefits through December of 2002, but gave notice that it had terminated further payments in a January 2, 2003 letter. The letter recounted that Gordon's treating physician had advised on December 19, 2002 that Gordon had not been seen in over three months and had failed to appear for her last scheduled appointment. The letter also indicated that Gordon had not responded to calls from MetLife personnel. The letter then explained that the benefits were terminated because Gordon had failed to furnish continuing proof of disability as required by the Plan. The letter gave Gordon 180 days from receipt of the letter in which to send a written appeal to MetLife.

On January 9, 2003, Gordon appealed the termination. After reviewing the medical information submitted in support of her continuing claim for disability benefits, MetLife denied her claim in a letter dated March 17, 2003. The letter reviewed the supporting information at length before concluding that Gordon did not meet the definition of disabled under the Plan, because the documentation did not substantiate the proposition that she was unable to perform the essential duties of her job. The letter informed Gordon that she had 180 days to appeal the decision.

On October 15, 2003, Gordon appealed, arguing that she was disabled due to severe and debilitating depression. In a November 4, 2003 letter, following MetLife's review of the information submitted and a review by an independent physician consultant, MetLife informed Gordon that additional benefits had been approved for the limited period of January 1, 2003 through March 2, 2003, because she was disabled during that period by her major depression. The letter explained that under the Plan Gordon's benefits were limited to twenty-four months because her disability stemmed from a mental illness, and noted her twenty-four months ended on March 2, 2003. Once again Gordon was advised that she could appeal the decision within 180 days.

Gordon failed to appeal. Indeed, she took no action for more than four years. On November 26, 2007, she called MetLife to ask whether her claim could be reopened, and MetLife informed her that her appeal deadline had passed. ...


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