The summary plan description for a long-term disability plan provided that the forms to receive benefits must be completed and returned to the claims administrator within one year of a participant’s last day of work. The plan document did not make reference to any time limitation for filing claims; however, the plan document cited certain “operative documents,” including plan summaries, as being part of the plan.
The participant’s last day of work had been no later than August 30, 2003, but she failed to file her application for benefits under the plan until December 25, 2007. In denying the participant’s claim for benefits, the issue that the participant’s claim was untimely was raised for the first time at the administrative appeals stage. The court initially held for the plan based upon the one-year limitation set forth in the summary plan description.
The participant then filed a motion for reconsideration, where the participant argued that 1) Cigna Corp. v. Amara prevented the terms of a summary plan description from becoming part of a plan, and 2) the plan had waived the time limitation when the limitation was not raised in the initial claim denial.
The court held that Amara did not stand for the blanket proposition that the terms of a summary plan description could never become part of a plan. Instead, Amara stands for the general proposition that a summary plan description does not alter the terms of a plan. However, since the plan document here incorporated the terms set forth in plan summaries, the summary plan description terms were also terms for the plan document. Thus, the time limitation for filing claims was part of the plan document.
Having disposed of the issue of whether the time limitation was a part of the plan document, the court remanded the issue of whether the plan had waived the limitation by failing to assert the limitation in its initial denial of benefits. Following the court’s decision, the question potentially arises as to what should happen when a plan document incorporates the terms of a summary plan description but the summary plan description’s terms conflict with the plan document. The court strongly hinted that the terms of the plan document would preempt the summary plan description in such a situation, stating: “[t]his court does not read Amara as holding that the terms of a summary plan description cannot be part of a benefit plan, at least where, as here, the terms of the plan summary at issue do not conflict with the language of the formal plan document, and the plan document authorizes the creation of the terms in the summary plan description.” (Grant v. Eaton Disability Long-Term Disability Plan, S.D. Miss. Dec. 13, 2011).