Mogck

Mogck v. Unum Life Insurance Co. of America

Good Law
292 F.3d 1025
United States Court of Appeals for the Ninth CircuitJune 10, 2002No. 00-56797California1,547 words

Opinion

Lead Opinion

Leavy, J.

The question presented in this case is whether the contractual time limitation has expired on an insured’s action against his insurer for disability benefits. The long-term disability policy at issue is governed by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq. We conclude that the insurer, in its correspondence to the insured, did not utilize language from its own policy which would inform the insured that the contractual time limitation for legal proceedings would begin to run. Therefore, we reverse the judgment of the district court and. remand for further proceedings.

BACKGROUND

A. The Claimant

Kenneth Mogck (“Mogck”) was injured in a car accident on March 25, 1993. In October 1993, Mogck submitted a claim for long-term disability benefits under his employer’s policy underwritten by Unum Life Insurance Company of America (“Unum”). Under the policy terms, a qualified claimant is provided approximately 66 percent of his basic monthly earnings, following a 91 day elimination period. Unum began *1027 paying disability benefits to Mogck effective June 25,1993.

B. The Insurance Policy

The policy defines “disability” during the…

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