United Healthcare not required to give time limits notice

A judge has granted United Healthcare’s motion to partially dismiss a participant's claim to recover benefits under the Employee Retirement Income Security Act (ERISA) because regulations don't require United to provide any time limits for review procedures in the final letter denying benefits to participants, reported BNA.

The U.S. District Court for Utah Judge Dale A. Kimball granted United's motion to deny benefits to Michael C.D.'s son for residential healthcare treatment at two medical facilities. Judge Kimball said that although providing time limits in denial letters for bringing a lawsuit under ERISA may be a good idea and helpful to claimants, it isn't required under the governing regulations.

They had informed Michael C.D. of his right to file a lawsuit under ERISA, but didn't specify the time limit for doing so. United ERISA regulations only require initial denial letters to include time limits applicable to an administrator's internal review procedures and under these regulations there is no requirement to include time limits for review procedures in final denial letters.

Michael C.D. argued in court that United was required to notify him in the denial letters of the limitations period and the date the period began to run while United stated that he had filed his claims after the expiration of the one-year contractual limitations period provided in the plan.

The courts ruled in favor of United, stating that the clause on contractual limitations was “sufficiently clear for the average plan participant to determine both the limitation period and the date that the period begins to run.”