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Luis Arturo Santaliz-R_os v. Metropolitan Life Insurance Company

August 30, 2012

LUIS ARTURO SANTALIZ-R_OS, PLAINTIFF, APPELLANT,
v.
METROPOLITAN LIFE INSURANCE COMPANY, DEFENDANT, APPELLEE, MONARCH PHARMACEUTICALS, INC.; KING PHARMACEUTICAL, INC.; KING PHARMACEUTICALS WELFARE BENEFIT PLAN, DEFENDANTS.



APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF PUERTO RICO [Hon. Jos_ Antonio Fust_, U.S. District Judge]

The opinion of the court was delivered by: Lipez, Circuit Judge.

Before Torruella, Selya, and Lipez, Circuit Judges.

The only issue before us in this appeal is whether appellant's Employee Retirement and Income Security Act ("ERISA") claim for reinstatement of disability benefits is time-barred. The district court found that appellant's claim was time-barred, and that his various arguments regarding tolling of the limitations period had no merit. Accordingly, it granted appellee's motion to dismiss.

On appeal, appellant renews his tolling arguments and also raises new arguments concerning the applicable limitations period and the sufficiency of the information that he received from the appellee concerning the terms of its insurance coverage. Finding no error in the district court's decision, and declining to consider arguments raised for the first time on appeal, we affirm the judgment of the district court.

I.

Appellant Luis Arturo Santaliz-R_os was an employee of Monarch Pharmaceuticals, Inc., a subsidiary of King Pharmaceuticals, Inc. Monarch offers its employees the opportunity to participate in the King Pharmaceuticals Welfare Benefit Plan (the "Plan"). Metropolitan Life Insurance Company ("MetLife") provides insurance coverage for the Plan and serves as claims administrator, adjudicating claims of disability and paying benefits. While employed by Monarch, Santaliz-R_os participated in the Plan.

On September 17, 2001, appellant left his job with Monarch because of a mental disability. The Plan's insurance policy with MetLife covers "[m]ental or [n]ervous [d]isorder[s] or [d]isease[s]," and provides that disability benefits for those conditions are limited to twenty-four months, unless the disability results from, inter alia, bipolar disorder. Under the policy, no long-term disability benefits are paid during a ninety-day "Elimination Period" after the disability first arises. Thus, appellant became eligible for long-term disability benefits on December 16, 2001. From that date, MetLife provided him monthly disability benefits until December 16, 2003, when the twenty-four-month eligibility period expired.

At that time, appellant requested reconsideration of the decision to cease paying benefits, arguing that he suffered from bipolar disorder and thus the twenty-four-month cap on benefits should not apply to him.*fn1 MetLife denied his request for reconsideration on February 27, 2004. In the following months, appellant repeatedly requested information from MetLife, including documents, records, and other information relevant to his claim, but, according to appellant, MetLife never responded to these requests.

On December 15, 2004, appellant filed a complaint in Puerto Rico state court seeking reinstatement of disability benefits. However, he voluntarily withdrew this complaint on June 15, 2005, because of difficulties obtaining medical records necessary to support the allegations in the complaint.*fn2 Five years later, on May 28, 2010, he filed the complaint triggering this action in the United States District Court for the District of Puerto Rico. Pursuant to 29 U.S.C. _ 1132(a)(1)(B), the appellant's ERISA claim sought to recover the accumulated balance of unpaid disability benefits and to reinstate the monthly payments for the duration of his condition.

The group policy between the Plan and MetLife contains a three-year limitations period on legal claims against MetLife. Before the district court, appellant acknowledged that this period is generally applicable to claims such as his. However, he argued that the limitations period should not apply in this case for two reasons: 1) it should be deemed tolled by the 2004 complaint he filed in Puerto Rico state court, and 2) it would be unfair to subject his claim to a three-year limitations period because of the difficulty of diagnosing bipolar disorder. The district court rejected both of these arguments and granted the appellee's motion to dismiss. This appeal ensued.

II.

We review a district court's decision to grant a motion to dismiss de novo. Ocasio-Hern_ndez v. Fortu_o-Burset, 640 F.3d 1, 7 (1st Cir. 2011).

A. The Applicable Limitations Period

Congress has not established a limitations period for ERISA claims brought pursuant to 29 U.S.C. _ 1132(a)(1)(B). Island View Residential Treatment Ctr. v. Blue Cross Blue Shield of Mass., Inc., 548 F.3d 24, 27 (1st Cir. 2008). Therefore, in adjudicating ERISA claims, federal courts borrow the most closely analogous statute of limitations in the forum state. Id. (citing Edes v. Verizon Commc'n, Inc., 417 F.3d 133, 138 (1st Cir. 2005)). In Puerto Rico, the default limitations period applicable to contract claims is fifteen years. P.R. Laws Ann. tit. 31, _ 5294; Caribbean Mushroom Co. v. Gov't Dev. Bank for P.R., 102 F.3d 1307, 1312 (1st Cir. 1996) ("[C]ontract claims that are covered by the Commerce Code but are not designated for special prescriptive treatment automatically fall under the Civil Code's fifteen-year catch-all provision."). This ...


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