Statute of limitations for benefit claim - Discovery rule

[Guest calcu]

For purposes of determining when a cause of action accrues under ERISA 502(a)(1)(B), the participant must have made a formal claim for benefits. However, my understanding is that under the discovery rule if the plan has made a clear repudiation of the benefits claimed such that the participant should have known of the denial, then a "formal" claim is not necessary. We are certain that we definitively told the participant's attorney that the person is not entitled to benefits. Can the attorney's knowledge be imputed to the participant such that the SOL begins? Any help/guidance/cites will be greatly appreciated

[SoCalActuary 11]

Your point is well worth reminding all of us. If you tell a participant or their representative about their benefits, you should follow up in writing immediately.

This puts them on notice of your decision and locks in the date of the opinion.

[Guest calcu]

The problem is we have a letter from the attorney acknowledging that we denied the benefit, but is the attorney's knowledge sufficient to start the clock?

[mbozek 27]

Doesnt the plan administrator have a copy of the correspondence sent to the attorney? As a general rule the s/l begin when the benefit claim is denied in accordance with ERISA 503 and the dol regs. The denial must include notice of the right to appeal the denial and give an explanation in clear language of the reason for the denial with citations to the plan provisons. A plan participant who does not appeal the denial of the claim with 60 days can be deemed to waive the right to sue in ct. Merely stating that the participant is not eligible for benefits may not be a sufficient basis for a denial of benefits under the regs. The employer needs to retain counsel to review the issues to see if there was a repudiation by the fidicuary. Worst case may be that the emplyee can submit a benefit claim to the PA which can be denied under the regs in ERISA 503.