In Fortier v. Hartford Life & Accident Ins. Co., 916 F.3d 74 (1st Cir. 2019) the U.S. Court of Appeals for the First Circuit clarified ERISA's timing requirements with respect to appealing an adverse benefits determination and rejected a claimant's attempts to salvage an untimely appeal under equitable doctrines.

Specifically, the court held that a claimant's 180-day appeal period commences upon notification of the benefits decision, not when benefits terminate, as the plaintiff ("Fortier") had argued. In addition, the court held that the doctrines of "substantial compliance" and the notice-prejudice rule, both of which ERISA plaintiffs sometimes invoke to excuse late appeals, were inapplicable.

The dispute in Fortier arose from Hartford Life & Accident Insurance Company's ("Hartford") notification to the claimant that her LTD benefits would terminate after 24 months, pursuant to the plan's Mental Illness Limitation. Under 29 C.F.R. § 2560.503-1(h)(3)(i), a group health plan must provide a claimant 180 days after notification of an adverse benefit determination to file an appeal. Hartford, whose plan incorporated the 180 day period, declined to consider the Fortier claimant's appeal because it was filed two months late.

Fortier filed a complaint in district court under ERISA Section 502(a) and argued that her appeal was timely filed because Hartford received it within 180 days of the benefit termination date or, in the alternative, that equitable doctrines required Hartford to process her appeal. The court rejected both arguments.

With respect to timing, the court held that the plain language of § 2560.503-1(h)(3)(i) establishes that notice—not the termination of benefits—is the key event triggering ERISA's appeal deadline. Fortier's equitable arguments fared no better. The court held that the "substantial compliance" doctrine only applies to an insurer's failure to comply precisely with notice requirements. According to the court, applying the doctrine to a claimant's late appeal would render it virtually impossible for plan administrators to enforce administrative deadlines.

Furthermore, the court held that New Hampshire's notice-prejudice rule was inapplicable in the context of ERISA appeals. "Indeed, no federal court has applied any state's common law notice-prejudice rule to excuse a late administrative appeal."

Ultimately, the court affirmed the district court's granting of Hartford's motion to dismiss on the grounds that the claimant had failed to exhaust her administrative remedies. The case is potentially significant to plan administrators because of its strict enforcement of ERISA's timing requirements regarding appeals.

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