It’s that time of year again… when you may see ERISA plans amending policies or plans— during the time employees are receiving benefits.

Employers have the right to amend long term disability plans at any time, and to apply the amended version even to employees receiving benefits under the original plan.

But which policy applies during a lawsuit? The policy in effect when the ERISA cause of action accrued.

And “accrual” can occur when the claims administrator fails to render an appeal decision by the deadline prescribed in the ERISA regulations.

Here’s the case of Vaccaro v. Liberty Life Assurance Company of Boston, 2017 WL 5564910 (N.D. Cal. November 20, 2017)(“The ERISA cause of action accrued upon the expiration of Liberty’s June 8, 2016 deadline to issue an appeal decision.”)

FACTS: Vaccaro sought ERISA governed long term disability benefits. Vacarro became disabled, with her last day of work as April 29, 2015. She submitted a claim July 2, 2015, which Liberty initially denied. After Liberty failed to render an appeal decision by June 8, 2016, Vaccarro sued Liberty on June 10, 2016. Liberty granted her appeal (on some but not all issues) on June 14, 2016. In December 2016, Liberty and the employer amended the 2015 policy, effective January 1, 2017.

ISSUE: Which Policy (the 2015 or the 2017 policy) governs?

DISTRICT COURT HELD:

  1. “[A]n employer has the right to amend its long term disability plan at any time and to apply the amended version even to employees receiving benefits under the original plan.” Op. at 10.
  2. “The governing policy is the policy in effect when the ERISA cause of action accrued.” Op. at 10.
  3. In a situation in which one version of the disability policy is in effect when the claimant becomes disabled and begins receiving benefits, but an amended version of the policy is in effect when those benefits are terminated, the court would ordinarily look at the revised plan. Op. at 10.
  4. “The ERISA cause of action accrued upon the expiration of Liberty’s June 8, 2016 deadline to issue an appeal decision.” Op. at 11.
  5. “[T]he Supreme Court has stated expressly that when a plan fails to resolve an internal appeal within the time provided under ERISA regulations, ‘the participant shall be deemed to have exhausted the administrative remedies’ and ‘is entitled to proceed immediately to judicial review.’” Op. at 11.
  6. “Policy amendments made after accrual of ERISA cause of action do not apply.” Op. at 14.