Fairness Finding Was Not Clearly Erroneous

WILLIAMS v. ROHN AND HAAS PENSION PLAN (September 2, 2011)

In 2002, Gary Williams filed a class action against the Rohm and Haas Pension Plan, alleging that his lump-sum distribution should include cost-of-living adjustments. The district court granted summary judgment to the class. The Seventh Circuit affirmed and remanded for a damages calculation. On remand, the Plan took the position that class members who took early retirement were entitled to no damages. The parties reached a settlement before the issue was adjudicated. One group of class members objected to the settlement on the ground that it discriminated against early retirees, who (they maintained) should have been given separate counsel. The group also objected to the amount of fees awarded. Another objector claimed that the settlement released his unrelated claims and that he should have been allowed to opt out. Judge Barker (S.D. Ind.) approved the settlement. The objectors appeal.

In their opinion, Seventh Circuit Judges Bauer, Kanne, and Evans (who, as a result of his death, took no part in the decision) affirmed. First, the Court affirmed the district court's fairness finding with respect to the early retirees. The Court noted that the early retirees received $60 million as part of the settlement on a claim that rested on unsettled law. The district court had already heard arguments on the issue and was well positioned to assess the settlement's fairness. Her decision was not clearly erroneous. Likewise, her decision not to create a separately represented subclass was not an abuse of discretion. With respect to the individual objector, the Court concluded that the settlement only released pension plan related claims. The district court did not abuse its discretion in denying his opt out. Finally, with respect to the fee award, the Court stated that, given the district court's application of the correct methodology and intimate familiarity with the litigation, it did not abuse its discretion in the fee award.

Negligence Does Not Amount To Knowing Misrepresentation

PEARSON v. VOITH PAPER ROLLS, INC. (August 25, 2011)

Voith Paper Rolls terminated Kenneth Pearson's employment after 14 years on the job. Because Pearson had a potential age discrimination claim against the company, Voith offered to negotiate a severance package with a release. Joseph Booth, Voith's Human Resources Manager and the administrator of the its Pension Plan, conducted the negotiations. At the negotiations, Booth provided Pearson with his benefit calculations and gave him a benefit election form with five options. One option was a lump-sum payment -- the other four options were different variations of payments over time. Unfortunately, the calculations were not entirely accurate. The lump-sum option was stated correctly but the other four options overstated Pearson's pension benefits. Pearson negotiated his severance package with the understanding, based on the inaccurate calculations, that he would receive a monthly pension benefit in excess of $1150. Pearson signed a severance agreement and made his pension benefit election. When the company re-checked the calculations, it caught the error and sent Pearson a new election form with the corrected numbers. The numbers on his option of choice declined from $1150 to approximately $700. Pearson brought suit against the Plan for promissory estoppel. Judge Griesbach (E.D. Wis.) granted summary judgment to the plan, concluding that the Seventh Circuit had never recognized a promissory estoppel claim against a single employer pension plan and that, even if it did, Pearson could not show a knowing misrepresentation, detrimental reliance, or economic harm. The court also concluded that any misrepresentation was made by the company, not the Plan. Pearson appeals.

In their opinion, Seventh Circuit Judges Rovner, Evans (who, due to his death, did not participate in the decision), and Williams affirmed. The Court decided not to resolve whether a promissory estoppel claim can lie against a defined benefit, funded pension plan. Instead, it resolved the appeal assuming that such a claim is viable. Estoppel will only lie in extreme circumstances, which are shown by a knowing misrepresentation in writing that the plaintiff reasonably relied on to his detriment. Here, Pearson fails to make that case. First, the record shows no evidence of the Plan’s intentional misrepresentation. Although Voith may have had an incentive to overstate the pension in order to negotiate a better severance package, the Plan had no such incentive. The Court refused to attribute the employer’s motivation to the Plan. Furthermore, if there was an incentive to overstate the numbers, there was an incentive to overstate all the numbers. The Court found it unbelievable that Booth would overstate four of the five options but communicate the fifth one accurately when he had no idea which option Pearson would elect. The best the evidence supports is negligence, which is not enough for a knowing misrepresentation. The Court also found no evidence of detrimental reliance. Detrimental reliance requires an economic harm. Pearson's contention that he would have achieved a better package had he known the real number is entirely speculative. Furthermore, he testified that he does not want to rescind his severance package and renegotiate it, further supporting the speculative nature of any economic harm.

ERISA's Anti-Cutback Provision Protects Only Benefits Tied To Retirement

CARTER v. PENSION PLAN OF A. FINKL & SONS COMPANY FOR ELIGIBLE OFFICE EMPLOYEES (August 15, 2011)

A. Finkl & Sons is a large, Chicago-based steel company. Until 2006, it offered its employees a defined benefit pension plan. It was then that it decided to terminate the Plan. Because the plan was an ERISA-qualified plan, the termination process was rather complicated and involved many steps. Finkl began the involved process, after receiving permission to do so from the Pension Benefit Guarantee Corporation. The Plan notified the employees of the termination and adopted Amendment 1, which provided that all Plan participants, even current employees, could elect to receive their pension benefits as an immediate annuity upon Plan termination. The Plan even distributed election forms for employees to indicate whether they wanted an immediate annuity or wait for retirement. Ultimately, Finkl decided not to terminate the Plan. It advised its employees and the PBGC of that decision. The PBGC approved the company's actions and the Plan adopted Amendment 2, which deleted Amendment 1. A group of employees demanded that the Plan go ahead with the termination and distribution and also demanded that the Plan revise the way benefits were calculated as it related to bonuses. The plaintiffs claimed that they were unaware of the distinction between regular bonuses (which were credited to an employee’s retirement calculation) and special bonuses (which were not credited to an employee’s retirement calculation). The Plan denied both claims and plaintiffs filed suit under ERISA. Judge Pallmeyer (N.D. Ill.) granted summary judgment to the Plan. She concluded that Amendment 2 violated neither ERISA’s anti-cutback provision or the Plan’s anti-cutback clause. She also concluded that plaintiffs could not prevail on their benefit recalculation argument. Plaintiffs appeal.

In their opinion, Seventh Circuit Judges Manion, Wood, and Williams affirmed. The Court agreed with plaintiffs that ERISA prohibits a plan from decreasing beneficiaries' protected benefits. Likewise, a Plan can include a clause that protects beneficiaries' benefits. It is these "anti-cutback" provisions the plaintiffs claim were violated in this case. The Court first addressed the statutory claim. The ERISA anti-cutback clause applies only to benefits tied to a participant’s actual retirement. The Amendment 1 benefit is not tied to retirement and is therefore not protected. The Court turned to the Plan language. That language protects "pension benefits already accrued." When the Plan denied plaintiffs' claim, it concluded that Amendment 1 conferred a protected benefit only upon the Plan's termination and thus was not subject to the anti-cutback clause. The Court concluded that the Plan’s interpretation was reasonable. It also rejected plaintiffs' argument that the benefit was protected because the plan had, in fact, terminated. The Court reiterated the number of required steps in the approval process before statutory termination. The record does not support plaintiffs' conclusion. With respect to the second claim, regarding the inclusion of bonuses in the benefit calculation, the Court concluded that there was no evidence in the record creating a material issue of fact. Even if plaintiffs were unaware of the distinction used by the company, summary judgment was still appropriate.

Court Did Not Abuse Its Discretion In Denying Unsubstantiated Fee Request

PAKOVICH v. VERIZON LTD PLAN (July 22, 2011)

Lisa Pakovich became disabled during her employment with Verizon. Verizon denied her request for long-term disability benefits under its ERISA plan. Although the district court affirmed the denial, the Seventh Circuit reversed and remanded to the plan administrator for a new determination. Pakovich heard nothing from the administrator for almost 5 months so she filed another suit. Shortly thereafter, the Plan agreed to pay all the benefits she requested and moved to dismiss her suit as moot. Judge Reagan (S.D. Ill.) denied the motion, entered judgment for Pakovich in the amount the Plan agreed to pay, but denied Pakovich's fee motion.

In their opinion, Seventh Circuit Judges Flaum, Evans, and Tinder vacated in part and affirmed in part. The Court first agreed with the Plan that Pakovich's case was moot. The Plan agreed to pay everything she asked for in her claim for benefits. Her fee request did not prevent her case from being moot. The Court next considered whether the district court even had jurisdiction of her fee claim. Relying on its FOIA jurisprudence, the Court concluded that a district court retains equitable jurisdiction to address a fee claim. Addressing the merits of the fee claim, the Court noted that a fee award under ERISA has two elements. First, the claimant must show "some degree of success on the merits." Second, the defendant's position must be not substantially justified. The Court ultimately determined that it did not need to decide either of those elements. Here, the district court denied her fee request because of inadequate documentation and support for either the hourly rate or the time spent. It was her burden to adequately support her request. The district court did not abuse its discretion when it denied fees.

Summary Plan Description Was Not Clear Enough To Trigger Limitations Period For Benefits Claim

THOMPSON v. RETIREMENT PLAN FOR EMPLOYEES OF S.C. JOHNSON & SON, INC. (June 22, 2011)

S. C. Johnson & Son changed its ERISA plan from a defined benefit plan to a cash balance plan in 1988. In the amended plan, each participant's account received interest credit at the greater of 4% or 75% of the Plan's rate of return. The Plan also allowed participants to take a lump-sum early withdrawal. But the plan penalized early withdrawers by including a provision that equated the future interest rate credits with the discount rate reduction. Thus, those that opted for the lump-sum received only their then-current account balance. A number of former participants in the Plan who received lump-sum distributions filed suit against the Plan in November of 2007. Although the Plan conceded the provision violated ERISA, it moved for summary judgment on the grounds that the claims were time-barred. Judge Stadtmueller (E.D. Wis.) concluded that Wisconsin's six-year contract statute of limitations applied and that each plaintiff's claim accrued when he received his distribution. Any plaintiff who took his distribution prior to November of 2001, therefore, was time-barred. With respect to the calculation of future interest credit, the court concluded that the Plan was entitled to some deference in choosing an appropriate calculation and adopted a modified version of the Plan’s proposed calculation. Plaintiffs appealed. The Plan cross-appealed.

In their opinion, Judges Cudahy, Kanne, and Tinder affirmed in part, reversed in part, and remanded. With respect to the statute of limitations, the Court noted the general rule that an ERISA claim for benefits accrues "upon a clear and equivocal repudiation of rights" known to the beneficiary. Although it considered it a very close question, the Court rejected the Plan's argument that the claims accrued when the Summary Plan Description and other materials were circulated in 1988 and 1989. Although those documents did disclose the illegal provision at issue, the Court concluded that they did not amount to an unequivocal repudiation. The ERISA right itself is fairly obscure, the information appeared in numerous publications received by Plan participants over the course of months, most of the information about the provision itself was not clear, and the clearest statements were found in the informal documents rather than the more formal Summary Plan Description. The Court did agree with the district court that the receipt of the distributions themselves did equal an unequivocal repudiation. The district court was correct. The Court turned to the method of calculation. It disagreed with the district court’s deference to the Plan. Plan administrators are normally given deference, particularly if the Plan itself gives them discretion. But that deference is given in situations where the Plan administrator is interpreting the Plan. Here, the Plan administrator is not interpreting the plan -- the Plan is illegal. Instead, the Court instructed the district court to exercise its usual role in calculating plaintiffs' recovery. The Court remanded for that purpose.

Plan's Refusal To Consider Late Appeal Not Arbitrary And Capricious

EDWARDS v. BRIGGS & STRATTON RETIREMENT PLAN (April 29, 2011)

Briggs & Stratton employed Augusta Edwards until November of 2005. She stopped working because of several nerve conditions, including carpal tunnel and cubital tunnel syndromes. Edwards' doctor believed that she was totally and permanently disabled. She filed a claim with the Briggs & Stratton Retirement Plan in August 2007. The Plan’s physician rendered an opinion that she was not permanently disabled. The Plan denied her claim on September 29 and advised her that she had 180 days to appeal the denial. The Plan received Edwards’ appeal on April 11, 2008, 195 days after she received the denial. She offered no explanation for her tardiness. The Plan refused to consider her appeal. Edwards filed suit under ERISA against the plan. Magistrate Judge Goodstein (E.D. Wis.) granted summary judgment to the Plan. Edwards appeals.

In their opinion, Circuit Judges Tinder and Hamilton and District Judge Murphy affirmed. The Court noted that its review was under the arbitrary and capricious standard because the Plan gave its administrator discretionary authority to determine eligibility. The Court further noted that it has interpreted ERISA to require exhaustion of administrative remedies. That requirement, however, rests with the discretion of the district court and can be excused where, for example, an appeal would have been futile. Here, Edwards does not dispute that her appeal was late. But she does not claim that an appeal would have been futile. The Court rejected her attempt to excuse the tardiness because of the "substantial compliance" doctrine. It noted that the doctrine had never been used in such a way. The Court also rejected her arguments based on the Wisconsin "notice-prejudice" statute, interpreting her earlier letters as notices of appeal, and the Plan's conflict of interest. Here, the Plan adopted a reasonable appeal deadline, included the deadline in the Plan documents, and gave Edwards specific notice at the time it denied her claim. Although the Plan could have exercised its discretion to entertain the appeal, it was not arbitrary and capricious for it not to do so.

Plan Trustee's Failure To Divest Company Stock Was Imprudent Under The Circumstances

PEABODY v. DAVIS (April 12, 2011)

Jonathan Peabody joined the Rock Island Corporation, a closely held operation, in 1998. He first invested in the company’s pension plan in 1999 when he rolled over a $167,000 IRA into the Plan. Almost all of the rolled over funds were used to purchase Rock Island stock. There was no market for, and therefore no easy way to value, the stock. The Plan's trustee issued valuation statements periodically. At different times between 2000 and 2004, it was assigned values of $757, $500, $625 and $550 per share. Peabody left Rock Island in 2004. At the time he had 835 Rock Island shares. Peabody and Rock Island entered into a loan agreement pursuant to which Rock Island agreed to purchase the stock and to pay $350 per share in one year. However, when the loan became due, Rock Island was unable to pay. It went out of business in 2005. Peabody brought suit against the company, the Plan trustees, and two insurance companies that had issued policies protecting Rock Island against employee dishonesty. Judge Coar (N.D. Ill.) held a bench trial and ruled that: a) Peabody had waived any fiduciary duty claim with respect to the initial rollover or the defendants' failure to diversify his account, b) the Plan and the trustee's violated their fiduciary duties by maintaining the Rock Island investment and by failing to distribute the benefit, c) one trustee breached his fiduciary duty by offering the loan, d) ERISA prohibited the loan transaction, e) Rock Island itself was not liable, and f) Peabody did not have standing to assert a claim against the insurance company defendants. The court awarded damages based on a $500 per-share valuation in reliance on the fact that the Plan purchased shares for Peabody's account at that price in 2001. Peabody and the defendants appealed.

In their opinion, Judges Cudahy, Flaum, and Kanne affirmed in part and reversed and remanded in part. The Court first noted it was dealing with three separate claims: a) a § 502(a)(2) claim against the fiduciaries on behalf of the Plan, b) a § 502(a)(1)(b) claim for benefits, and c) a § 502(a)(3) equitable claim against the insurance companies. The Court first concluded that the trustees breached their fiduciary duties under § 502(a)(2). A new SEC rule had substantial negative implications for the company's profit margins and its stock steeply declined over a five-year period. The trustee's knew of the changed rule, knew it was prominent, and knew of its significant impact on Rock Island’s business model. The company did not require employees to invest in Rock Island stock. In fact, Peabody apparently had a greater percentage of company stock than any other employee. A prudent investor would have divested earlier. The Court also concluded that Peabody's initial consent to the stock purchase did not affect the trustee's continuing fiduciary duty over the course of the investment. The Court rejected Peabody's alternative theory of liability arising from the loan for stock transfer. Although the Court agreed that the transaction violated ERISA, it concluded that Peabody suffered no damages from the transaction. As the Court pointed out, it was simply the trade "of worthless stock for a worthless loan." The district court erred, however, in computing damages when it applied the $500 per-share figure to all of the stock. The Court remanded for a damages recalculation, advising the district court to start with Peabody's original investment , consider using average values over the length of the investment, and assume that 25% to 33% of the stock could have been left in the account without violating a duty of prudence. The Court also affirmed the district court's rejection of Peabody's § 502(a)(1)(B) benefits claim on the grounds that it would result in no additional relief. Finally, the Court agreed with the district court’s rejection of the § 502(a)(3) claim against the insurance companies. That section allows for "other appropriate equitable relief." The Supreme Court has limited the section to "typical" equitable relief. Peabody's request for money damages from the insurance policies is not typical equitable relief.

Breadth Of Class Definition Makes Certification Inappropriate

SPANO v. THE BOEING COMPANY (January 21, 2011)

Like most American companies, the Boeing Company and the International Paper Company offered their employees participation in defined-contribution benefit plans. Members in each of the plans brought suit against each company and the plans. The allegations in each of the suits were quite similar. They claimed that the plans breached their fiduciary duties by a) paying excessive fees and expenses, b) choosing to include imprudent investment options in the plans, and c) concealing information from plan participants. Chief Judge Herndon (S.D. Ill.) certified a class in each case under Rule 23(b)(1). Each class definition included all persons who are, were, or ever will be participants or beneficiaries of the plan. Boeing and IP sought review.

In their opinion, Judges Bauer, Wood, and Tinder granted the request for review, vacated each certification order, and remanded. The Court noted that the case was brought under § 502(a)(2) of ERISA, which allows a participant to bring a civil action for relief under § 409, which in turn makes a fiduciary personally liable for a breach of fiduciary duty. In 1985, the Supreme Court held, in Russell, that a fiduciary in a defined-benefit plan context was not personally liable to a participant for damages. In a defined-benefit plan, assets are held in trust and the plan is administered by a fiduciary. Obligating a fiduciary to restore funds to the plan is sufficient to make the plan whole. In 2008, the Supreme Court had an occasion to apply that principle to a defined-contribution plan in LaRue. LaRue alleged a breach by a fiduciary that affected his account only and sought restoration of that amount to his account. Relying principally on the differences between defined-benefit and defined-contribution plans, the Supreme Court held that § 502(a) does authorize recovery for breaches of fiduciary duty that impair only the assets in a particular participant's account. But LaRue was an individual claim. The consolidated appeals involve class claims. The Court had to distinguish between an individual injury and an injury that should be considered a plan injury -- only a complaint about the latter is appropriately treated as a class. The Court turned to Rule 23. In order to proceed as a class, a claim must meet all of the elements of Rule 23(a) and fit into one of the 23(b) categories. For class certification purposes, a district court should not take the facts as alleged but, rather, make any required factual determinations. If the court finds that the claims meet the Rule 23 requirements, it issues an order in which it certifies and defines the class. The class definition is a very important aspect of the order, affecting both the litigation's scope and its res judicata effect. With those principles in mind, the Court turned first to the Boeing case. Although the Court found that the class met the numerosity and commonality requirements of Rule 23(a), it concluded that it did not meet the typicality and adequacy of representation requirements. Given the breadth of the class definition and the specific objections to two of the several investment options included in the plan, it is possible that many plan participants never owned shares in the targeted funds. Because the plaintiffs could potentially correct the Rule 23(a) problems by redefining the class, the Court also addressed Rule 23(b). The Court mentioned the Supreme Court’s cautionary remarks in Ortiz regarding the use of mandatory (b)(1) classes. Again, using the class definition certified, the Court concluded that the class could not meet the (b)(1)(A) or (b)(1)(B) requirements. The class was simply too diverse to for the Court to conclude that the class members had an identity of interest or that there was a risk of incompatible standards of conduct. Turning to the IP class, the Court found some of the same problems. It addressed the theories of relief (misrepresentation, imprudent investment, and excessive fees) individually. Under the misrepresentation theory, the Court concluded that it was not clear that the class representative's claims were typical of those of the group. With respect to the imprudent investment theory, the Court concluded (like in the Boeing class) that the allegation that some funds were imprudent while others were not, in conjunction with the diversity of the class, made the claim inappropriate for class treatment. Finally, with respect to the excessive fee theory, it appears that some fees were plan specific while others were fund specific. Given the class members’ different decisions regarding specific fund investments, this theory is also not appropriate for class treatment. The Court again emphasized that its decision was based on the definition provided by the district court and that it was not holding that an appropriate class could not be defined.

ALJ May Discount Subjective Reports Of Pain When Inconsistent With Objective Medical Evidence

JONES v. ASTRUE (October 22, 2010)

Jacklin Jones was injured in a car accident in 2001. Over the course of the next several years, she sought medical treatment as her condition worsened. She complained of lower back pain and numbness in her hands. The objective medical evidence, including the results of multiple MRIs, identified the principal problem as a mild, lower- back disc bulge. Her orthopedic surgeon advised her to discontinue the strong pain medication and instead to lose weight and begin physical therapy. She quit her job in November of 2003 because of her pain. She continued to see the orthopedic surgeon, who continued to tell her to lose weight and get into better condition. Jones sought disability benefits. At her hearing, she testified that she was in substantial pain, that she could not sit or stand for long periods, that her pain medication made her drowsy and nauseous, and that she had trouble holding onto objects. A vocational expert, responding to the ALJ's hypotheticals, testified that there were over 3000 jobs available for a person with Jones' conditions. The ALJ concluded that Jones was not disabled, finding that she could perform simple, routine, sedentary work. In reaching that conclusion, the ALJ found Jones' testimony about the intensity of her pain not credible. Judge Randa (E.D. Wis.) concluded that substantial evidence supported the decision and affirmed. Jones appeals.

In their opinion, Chief Judge Easterbrook and Circuit Judge Flaum and District Judge Hibbler affirmed. Jones' principal argument was that the ALJ's credibility determination was flawed. The Court noted that that determination is entitled to significant deference and would be overturned only if "patently wrong." Here, the ALJ credited a significant amount of Jones' testimony, there was substantial objective medical evidence in the record inconsistent with Jones' testimony regarding the extent of her pain, and Jones' treating physicians did not consider her disabled. An ALJ may not ignore subjective statements of pain simply because they are not supported by medical evidence. An ALJ may, however, consider subjective statements of pain as exaggerations when they are inconsistent with objective medical evidence. Here, the Court found that her testimony was inconsistent with objective medical evidence and concluded that substantial evidence supported the ALJ's findings.

Plant Closing Agreement Unambiguously Granted Retirees Lifetime Medical Benefits

TEMME v. BEMIS CO. (September 13, 2010)

Hayssen Manufacturing Company operated a facility in Sheboygan, Wisconsin until 1985. A strike during the summer of that year led to the company's decision to close the plant. The company and the union representing its workers entered into a Plant Closing Agreement (the “Agreement”). The agreement terminated the strike, all employment relationships, and the union bargaining relationship. It also addressed employee benefits. With respect to health benefits, it provided that terminated employees who were not eligible for or who did not apply for retirement benefits could continue their medical coverage for 12 months, or until they were covered by another plan, by paying the full monthly premiums. It further provided that individuals who qualified and elected to retire were eligible for retired employee medical benefits. Although the agreement did not define the scope of "retired employee medical benefits," the final Collective Bargaining Agreement (CBA) did. Among other terms, it provided for: a) two $50 deductibles per year, b) 100% prescription drug coverage, and c) dependent spouse coverage after the death of a retiree. The company provided those benefits, even after being acquired by Bemis Company, until 2004. In 2005, the deductible was increased to $250. In 2007, prescription drug coverage was eliminated. A class action was filed on behalf of the retirees. Judge Stadtmueller (E.D. Wis.) certified the class and granted summary judgment to Bemis. The class appeals.

In their opinion, Circuit Judges Kanne and Williams and District Judge Springmann reversed and remanded. The Court laid out several principles of contract interpretation: a) if a contract is not ambiguous, there is no need for external evidence, b) contract terms are given their ordinary meaning, c) a contract is read as a whole and in conjunction with related documents, and d) welfare benefits contracts are presumed not to create a lifetime vested benefit unless specifically provided. Applying those principles, the Court looked to both the Agreement and the CBA. It rejected Bemis’ argument that the CBA was extrinsic evidence, citing language in the Agreement expressly permitting reference to the CBA "to effectuate the provisions" of the Agreement. Reading the agreements together, the Court concluded that they unambiguously provided retired employees with health benefits. Bemis further argued, however, that any benefits were not vested for life. The Court disagreed, noting that the presumption against vesting is not as strong in a plant closing agreement as it is in, for example, a short-term collective bargaining agreement. It found several indicia of an intent to vest. It identified the "stark contrast" between the terminated employee and retired employee benefits. The retired employee benefits do not have an end date, as do those for the terminated employees. In addition, the provision granting coverage to spouses after the death of a retiree strongly implied an intent to vest lifetime coverage. Although the Court concluded that the Agreement provided for lifetime medical benefits (and it reversed summary judgment in Bemis' favor), it did not conclude that Bemis breached the agreement. The Court found questions of fact regarding whether any changes could be made to the lifetime coverage and the impact, if any, of a reservation of rights clause in the underlying insurance contract. The Court remanded for further determinations. 

Withdrawal Liability Payments Are Not Deferred Pending Arbitration When Accelerated Due To Insolvency

CENTRAL STATES SOUTHEAST AND SOUTHWEST AREAS PENSION FUND v. O'NEILL BROS. TRANSFER & STORAGE (August 31, 2010)

Until 2007, O’Neill Bros. Transfer & Storage took part in a multi-employer pension fund administered by the Central States Southeast and Southwest Areas Pension Fund (the “Fund”). A multi-employer fund is a pension plan in which numerous employers make contributions to a single fund on behalf of their employees. ERISA requires adequate funding levels and withdrawal liability payments upon the withdrawal of an employer from the plan. When O'Neill advised the Fund that it was preparing to liquidate, the Fund considered it a withdrawal, deemed O'Neill in default, and demanded immediate payment. The Fund filed a complaint several months later seeking the entire amount of the payment. The Court ordered the Fund to propose a payment schedule, which it did. O'Neill never accepted the schedule. Judge Der-Yeghiayan (N.D. Ill.) granted summary judgment to the Fund for a lump sum payment of the entire amount of liability. O'Neill appeals.

In their opinion, Judges Bauer, Ripple, and Kanne affirmed. The Court reviewed relevant statutory and plan provisions:

  •  the plan must calculate withdrawal liability and provide an installment payment plan
  •  the employer may challenge but must make the payments during the arbitration process
  •  the plan may demand immediate payment in the event of default (defined as the failure to make payment if not cured or any event which the plan defines as indicating a substantial likelihood that the employer will be unable to pay)
  • under the "substantial likelihood" default, a plan may demand full payment of withdrawal liability
  • the Fund adopted a rule that included an employer's insolvency as a default event under the "substantial likelihood" clause.

The issue before the Court was whether the employer must immediately pay, notwithstanding arbitration, its entire withdrawal liability when demanded under the substantial likelihood default clause. The Pension Benefit Guarantee Corporation (PBGC) has promulgated a regulation that a default under the failure to pay paragraph does not take effect until 61 days after the arbitrator makes its decision. The substantial likelihood clause does not contain the same language as the failure to pay clause relied upon by the PBGC in reaching that conclusion. The PBGC is the agency charged with the administration of the provision -- the Court found that interpretation a reasonable one and found it worthy of deference. It therefore concluded that an accelerated default payment under the substantial likelihood clause is not deferred pending arbitration.

Several Factors Support "Arbitrary And Capricious" Finding

 HOLMSTROM v. METROPOLITAN LIFE INSURANCE CO. (August 4, 2010)

Lanette Holmstrom developed a painful nerve condition in her right arm in 2000 and stopped working. Metropolitan Life Insurance Company administered her employer's benefit plan. MetLife paid disability benefits first under the "own-occupation" standard and then under the "any-occupation" standard for several years. Meanwhile, Holmstrom underwent three surgeries. None of the surgeries relieved her pain. Her physician diagnosed complex regional pain syndrome and concluded that further surgical intervention was unwarranted. Instead, Holmstrom was placed on a heavy pain medication regimen. With MetLife's help, Holmstrom applied for and began receiving Social Security benefits. Despite any lack of improvement in her condition, MetLife terminated Holmstrom's benefits in 2005 after a periodic review. Its rationale for the denial was that the medical data "no longer support(ed)" the severity of her impairment. Holmstrom appealed and provided substantial additional information, including a 2005 Functional Capacity Evaluation ("FCE") and a detailed statement from her physician with his diagnosis and his conclusion that she could perform no hand functions. MetLife denied the appeal, noting a lack of "objective findings." MetLife specifically noted that it could have reached a different decision had it been provided a more thorough FCE. Holmstrom submitted the requested FCE and additional test results. MetLife's physicians concluded that Holmstrom's physical limitations were not severe and that her diagnosis was not established by medical data. After a further exchange, one of MetLife's physicians recommended an independent medical examination. MetLife upheld its denial of benefits without seeking such an examination. Holmstrom brought suit under ERISA. Judge Dow (N.D. Ill.) granted summary judgment to MetLife. Holmstrom appeals.

In their opinion, Judges Kanne, Wood, and Hamilton reversed and remanded. Even applying the arbitrary and capricious standard of review, the Court found error. The Court first rejected three of Holmstrom arguments: a) that MetLife could not periodically review and reverse prior benefit decisions, b) that MetLife had to prove that her condition actually improved to reverse its course, and c) that the court could take into consideration MetLife's "batting average" in other federal cases challenging its benefit decisions. On the other hand, the Court found that several factors supported an arbitrary and capricious conclusion: a) erroneously concluding that certain normal test results contraindicated the diagnosis, b) unreasonably demanding objective pain data were no objective test exists, c) not adequately explaining its rejection of the FCEs, d) failing to even consider the Social Security determination, e) discounting Holmstrom's own extensive medical history, f) rejecting the evidence of Holmstrom's cognitive impairment resulting from the medication regimen, g) relying on the opinion of the records-review doctors in the face of overwhelming contrary evidence, h) ignoring the recommendations of its own physician to conduct an independent medical examination, and i) its repeated practice of asking for new data and then rejecting the data for reasons never communicated to Holmstrom. Holmstrom submitted evidence sufficient to establish her disability -- MetLife failed to counter it with sound reasoning supported by the record. The Court added that it saw several factors that suggested a conflict of interest existed. Finally, with respect to the remedy, the court conceded that the normal remedy in such a case is a remand for a fresh administrative decision. Here, however, there was an earlier award of benefits, there has been no apparent positive change in Holmstrom's condition, and the Court had a "firm grasp" of the merits. It decided that the appropriate remedy was a reinstatement of benefits. It remanded for the district court to consider the request for fees, costs, and interest.

Benefit Plan's Annual Increase Is Not An ERISA "Benefit Accrual" If It Does Not Affect Final Retirement Benefit

WALKER v. MONSANTO COMPANY PENSION PLAN (July 30, 2010)

Prior to 1997, Monsanto's employees had a variety of the retirement plan benefits. All employees had an age-65 benefit, but some employees had a discounted early retirement option while others had a subsidized early retirement option. Monsanto standardized and restructured its retirement plan in 1997 from a traditional plan into a cash balance plan. It created two accounts for each employee -- one that reflected benefits already earned at the time of the restructuring (the Prior Plan Account or PPA) and one to reflect newly earned benefits. The opening PPA balance was arrived at by converting the prior plan annuity amount to a lump sum equivalent and then discounting the amount by 8.5% per year for each year under 55 the employee was at the time of restructuring. Once the PPA was created, its balance increased through pay credits (4% per year law while employed) and interest credits (8.5% per year until age 55). It granted to all employees the subsidized early retirement option that only some of them had previously had. For the first time, it also gave employees an opportunity to receive retirement benefits before the age of 55. A number of Monsanto employees filed lawsuits, which were then consolidated. The employees allege that the restructured plan violates ERISA's prohibition on reducing an employee’s benefit accrual when the employee reaches a certain age. Judge Gilbert (S.D. Ill.) granted summary judgment to defendants. Plaintiffs appeal.

In their opinion, Judges Bauer, Flaum, and Evans affirmed. The plaintiffs claim that the 8.5% interest credit is a "benefit accrual" under ERISA and that termination of that benefit once an employee reaches the age of 55 violates the statute. The Court noted that ERISA prohibits a plan from reducing "an employee’s rate of benefit accrual" but does not define "benefit accrual." Benefit accrual depends, in part, on the type of plan at issue. Many cash balance plans operate like defined contribution plans. In those situations, the court must look to the annual additions to the employee’s hypothetical account. The Monsanto plan, however, operates like a defined benefit plan. Here, the court should look instead to the total accrued benefit at retirement. The Court looked at the total benefit at retirement under various scenarios and concluded that the Monsanto interest credits do not increase the employee’s total benefits. They are therefore not "benefit accruals" under ERISA and their termination at age 55 does not violate ERISA.

Treatment For Heart Condition Met Pre-Existing Condition Exclusion

ESTATE OF BLANCO v. PRUDENTIAL INSURANCE CO. (May 21, 2010)

Norman Blanco was hired by Porsche Engineering Services in April of 2005. After one month of employment, he was covered by Porsche's benefit plan. The plan included both short and long term disability benefits. Blanco suffered a heart attack in July and, by the end of August, was no longer able to work. The long-term disability plan had a pre-existing condition exclusion. It precluded coverage for conditions for which the beneficiary, in the three months prior to his coverage effective date, had either a) received care or took medication or b) had symptoms for which a prudent person would have sought care. Pursuant to the pre-existing condition exclusion, Prudential denied Blanco's claim for long-term benefits. Blanco filed an ERISA suit. Judge McKinney (S.D. Ind.) granted summary judgment to Prudential.

In their opinion, Judges Cudahy, Flaum, and Evans affirmed. Before addressing the core issue, the Court noted that a) Blanco had a long history of heart problems, including congestive heart failure (CHF), for which he was being treated and b) pre-existing condition exclusions were regularly upheld. On the merits, the Court found that he failed to qualify under either prong of the exclusion. He was taking heart medication. The fact that he was taking it for hypertension as well as CHF does not matter. Even if it did, the hypertension and CHF are related and taking medication for the hypertension would disqualify him. The Court also found that Blanco was excluded under the second prong of the policy. He had an episode of high blood pressure for which a prudent person would have sought treatment.

Plan Administrator's Interpretation That Contravenes Plain Language Of Plan Is Arbitrary And Capricious

GREEN v. THE UPS HEALTH AND WELFARE PACKAGE (February 10, 2010)

UPS negotiates collective bargaining agreements (CBAs) covering its employees who are members of the International Brotherhood of Teamsters (“IBT”). It actually negotiates with the international union and also directly and separately negotiates with some large locals, including Local 705. Under the 2002-2008 CBA with Local 705, UPS agreed to provide health care to Local 705 retirees. The benefit was outlined in the Summary Plan Description (SPD), which applied to all IBT retirees. The SPD set a monthly contribution for each retiree and provided that, if the cost of coverage exceeded a certain threshold, each retiree would share in the excess cost “by making an additional contribution.” It also stated that additional contributions would not be implemented until after the “current” CBA expired. The cost threshold was exceeded in 2006. In October 2007, UPS issued a Summary of Material Modification (SMM) advising all IBT retirees of that fact and imposing an additional contribution for each retiree effective January 1, 2008. Before implementing the additional contribution, however, UPS agreed with both the international and local unions to delay implementation until their respective CBAs expired. UPS sent a revised SMM to Local 705 retirees in December 2007 advising that increased contributions “well be effective” after the expiration of the “current” CBA. After the Local 705 CBA expired in mid-2008, UPS notified Local 705 retirees that it would implement an additional contribution effective February 2009. Local 705 retirees brought a class action, alleging that the collection of additional contributions violated the Plan and ERISA because a) the retirees were not sharing equally since the international retirees were not yet contributing, and b) the SPD stated that contributions would not be implemented until the expiration of the “current” plan and the Local 705 current plan now expired in 2013. The district court agreed with Local 705 on the first argument but agreed with the Plan on the second – and enjoined further collection of contributions until further order of the court. The retirees and the Plan appeal.

In their opinion, Judges Cudahy, Wood, and Evans affirmed. The Court agreed with the district court that the collection of contributions from Local 705 retirees only controverted the plain language of the Plan and was, therefore, arbitrary and capricious. The Court rejected UPS’ contrary interpretation of the “share equally” language and rejected its plea to consider extrinsic evidence under the doctrine of extrinsic ambiguity. Although the Court was more receptive to the use of the extrinsic ambiguity doctrine with respect to the meaning of “current” in the SPD, it concluded that it need not. Instead, it held that the December 2007 revised SMM modified the SPD and made it clear that the “current” CBA referred to was the 2002 CBA.

Benefits Determination That Does Not Address Claimant's Key Medical Evidence Is Unreasonable

MAJESKI v. METROPOLITAN LIFE INSURANCE CO. (December 29, 2009)

Kirsten Majeski was a nurse consultant for Metropolitan Life Insurance Co. ("MetLife"). Her typical workday involved sitting at a desk, using a phone and computer. In 2006, she was diagnosed with cervical radiculitis, a compression in the upper spinal. MetLife originally approved short-term disability benefits. It later determined that Majeski was not entitled to benefits, concluding that her impairment did not prevent her from performing her job. Majeski appealed and submitted medical evidence from her doctor and physical therapist. The conclusion of the medical evidence was that she had difficulty sitting and using her hands -- and was thus unable to perform her job. MetLife had a physician review the records. He concluded that there were "minimal objective findings" to support the suggested limitations. MetLife rejected the appeal. Majeski brought suit under ERISA. The district court granted summary judgment to MetLife. Majeski appeals.

In their opinion, Judges Wood, Evans and Tinder vacated and remanded. The Court first rejected Majeski's argument that the Supreme Court's decision in Glenn required a heightened standard of review. The Court admitted that it was still undecided on how to weigh a Plan administrator's conflict of interest. In Marrs, the Court concluded that the circumstances of the case should determine the impact of the conflict. The Court also rejected Majeski's argument that the district court should have considered evidence outside of the administrative record. On the merits, however, the Court agreed with Majeski. The physician's report on which MetLife solely relies did not address key findings presented by Majeski's medical evidence. Although the report concludes that there were "minimal objective findings," the Court cited several objective findings contained in Majeski's material that MetLife physician failed to mention or rebut. The failure to address this significant medical evidence amounts to an absence of reasoning and lack of fair review. The Court declined to rule directly in Majeski's favor, concluding that the typical and proper course is to remand to the plan administrator.

Benefit Plan Fiduciary Does Not Owe A Fiduciary Duty To Benefit Plan Administrator Under ERISA

SHARP ELECTRONICS CORP. v. METROPOLITAN LIFE INSURANCE CO. (August 18, 2009)


Sandra Rudzinski was an active employee of Sharp Electronics when she began experiencing fatigue and headaches. As a Sharp employee, she participated in its disability plan. Under the plan, Sharp paid short-term benefits during an initial 180-day period and Metropolitan Life Insurance Company ("MetLife") paid long-term benefits. Sharp paid premiums to MetLife on behalf of its employees. Rudzinski received short-term benefits from Sharp and applied for long-term benefits from MetLife. MetLife denied her application, first on the ground that she had a pre-existing disability and later on the ground that she had not completed the 180 days of short-term benefits. Rudzinski sued MetLife under ERISA. During the litigation, MetLife told Rudzinski that MetLife also denied her benefits because Sharp stopped remitting premium payments after her employment ended. She added Sharp as a defendant. She accused Sharp of interfering with her benefits, violating fiduciary duties, and for telling her that she could maintain her benefits by obtaining a conversion policy. Sharp cross-claimed against MetLife, alleging breach of fiduciary duty, equitable estoppel and indemnity. Rudzinski voluntarily dismissed her claim against Sharp and the court entered judgment in her favor in her claim against MetLife, leaving only Sharp's cross-claim. Sharp filed an amended complaint, alleging breach of fiduciary duty under ERISA, indemnification, negligence, negligent inducement, negligent misrepresentation, abuse of process and common-law breach of fiduciary duty. The court granted MetLife's motion to dismiss, concluding that MetLife had not breached a fiduciary duty and that the state law claims were preempted by ERISA. Sharp appeals.

In their opinion, Judges Kanne, Rovner and Wood affirmed with respect to ERISA and vacated and dismissed with respect to the state law claims. In order to recover under its ERISA claim, Sharp had to prove that MetLife owed it a fiduciary duty, that it was involved in fiduciary functions when it told Rudzinski about Sharp's failure to pay premiums, and that it was seeking damages for losses suffered by the plan (as opposed to the company). Although the Court agreed that Sharp and MetLife both occupied fiduciary roles, it concluded that MetLife did not owe a fiduciary duty to Sharp. It also concluded that Sharp's only losses were its fees and expenses in defending the suit brought by Rudzinski, losses not recoverable under ERISA. With respect to the state law claims, the Court disagreed with the district court that they were preempted by ERISA. ERISA does not preempt state law claims that are not related to a benefit plan. Here, Sharp's claims relate to its contractual relationship with MetLife. Even though the subject of that relationship is a benefit plan, claims relating to the contract are not preempted. The Court nevertheless dismissed the state law claims based on the lower court's alternative ruling that it would not exercise its discretion to hear the state law claims, considering that the only federal claim was dismissed. 

The Absence Of A Serious Conflict Of Interest Affecting A Plan Administrator's Judgment Results In Affirmance Of Benefits Termination

MARRS v. MOTOROLA, INC. (August 14, 2009)

Years ago, Michael Marrs developed a psychiatric condition that forced him to leave his job at Motorola and go on disability leave. Six years after he started his leave, Motorola amended its disability plan. It imposed a two-year limit on disability benefits resulting from mental, rather than physical, conditions. Marr's benefits were terminated by Motorola two years after the amendment. Marrs brought a class action under ERISA. The district court granted summary judgment to Motorola. Marrs appeals.

In their opinion, Chief Judge Easterbrook and Judges Bauer and Posner affirmed. ERISA limits a plan's ability to amend its terms. It provides that no amendment can adversely affect benefits with respect to periods of disability prior to the date of the amendment. The Court rejected Marrs' interpretation under which a plan could not affect any benefits for a period of disability that began before the amendment, but continues to run. The Court also addressed and rejected Marrs' argument that the Supreme Court's Glenn decision required a different outcome. Normally, the Court stated, if the plan administrator is given discretion to interpret the terms of the plan, a court will only reject its interpretation if it is unreasonable. That discretion exists in Motorola's plan. In Glenn, the Supreme Court addressed the situation when a plan administrator is laboring under a conflict of interest. Here, however, the Court concluded that the record did not establish that the administrator had a serious conflict of interest.
 

An Employer Need Not Reinstate An Employee On FMLA Leave Before Firing Him

DAUGHERTY v. WABASH CENTER, INC. (August 14, 2009)

Michael Daugherty worked for Wabash Center, Inc. for seven years. He had an excellent employment record. He was promoted on several occasions and always received positive reviews. Things changed in 2006. He started having trouble with his coworkers and his staff. He was given a written reprimand for abusive e-mails and unacceptable management style. Permission for a month-long vacation was revoked. Daugherty immediately visited his doctor and requested two weeks FMLA leave from the Center. His request was granted. In his absence, the Center discovered that he had used the Center's credit card to make at least five unauthorized purchases. It also discovered that he had failed to follow through on some key responsibilities. When Daugherty was due back from his leave, the Center presented him with a corrective action plan -- which he refused to sign. He instead requested additional medical leave. The Center granted his request but asked that he not access the network while on leave and asked him for his keys and passwords. He refused. After further analysis revealed that he had deleted thousands of files while on leave, the Center fired him. Daugherty filed suit, alleging a violation of the FMLA. The court granted summary judgment to the Center. Doherty appeals.

In their opinion, Judges Posner, Kanne and Sykes affirmed. Under the FMLA, the Court stated, an employee is not entitled to any right he or she would otherwise not be entitled to absent the leave. The FMLA does not prohibit an employer from terminating an employee's employment during FMLA leave if it discovers misconduct that justifies the termination. Here, Daugherty admitted most, if not all, of the misconduct. The Center did not violate the FMLA by failing to reinstate Daugherty. The Court also rejected the Daugherty's alternative claim that the Center retaliated against him for taking leave. The undisputed evidence in the record is that the Center fired Daugherty for multiple instances of misconduct. Finding no factual dispute, the Court affirmed the summary judgment for the Center. 

Benefit Plan's Denial Of Long-Term Disability Benefits Is Upheld When It Has Support In The Record

FISCHER v. LIBERTY LIFE ASSURANCE CO. (August 4, 2009)

After five years as a programmer with Stein Roe, Bruce Fischer complained of memory loss and problems with his attention. He applied for and received short-term disability benefits. A few months later, he submitted a claim for long-term benefits. The three medical reports he submitted with his application contained diagnoses of severe or profound depression. The plan administrator approved his application but informed him of the plan's 24-month maximum benefit period for mental illnesses, including depression. After the 24 months, the plan discontinued Fischer's benefits. Fischer continued to see additional medical personnel during the period of the plan's evaluation and his appeal. In all, at least thirteen physicians reviewed Fischer’s case. There was disagreement among the physicians as to whether Fischer's condition was organic or psychological. Fischer brought an action under ERISA for reinstatement of benefits. The district court granted summary judgment to the plan administrator. Fischer appeals.

In their opinion, Judges Posner, Flaum and Wood affirmed. The Court noted its limited scope of review. Only if the plan's decision is arbitrary and capricious will the court disturb it. The Court noted the "ample evidence" in the record supporting Fischer's contention that his condition is organic, at least in part. It also noted, however, the evidence in the record that concluded that his condition was solely psychological. On that record, applying an arbitrary and capricious standard of review, Fischer cannot prevail.

Failure Of Plan Administrator To Explain Rationale For Benefits Denial Renders Denial Arbitrary

LOVE v. NATIONAL CITY CORPORATION WELFARE BENEFITS PLAN (July 23, 2009)

Nancy Love had worked at National City for over twenty years when she was diagnosed with multiple sclerosis. After almost 3 years of receiving long-term disability benefits, the Plan told her she no longer fit their definition of "disabled." The controlling definition, after two years of long-term disability, is that a claimant must not be able to perform any job for which she is or could be qualified. The Plan's assessment concluded that, although she probably suffered from multiple sclerosis, she had never suffered an attack nor exhibited clinical signs. Love appealed the determination. She supported her appeal with several medical reports concluding that she had limited functional ability. The Plan denied her appeal, citing its doctor's conclusion that Love was able to do certain simple jobs. Love sued the Plan under ERISA. The district court granted summary judgment to the Plan. Love appeals.

In their opinion, Judges Ripple, Evans and Sykes reversed and remanded. The court stated that ERISA requires a plan to set forth its specific reasons for any denial of benefits. Love's medical file and her appeal contained multiple medical reports questioning for functional capacity. In fact, each of Love's treating physicians concluded that she was unable to work for more than a few hours a day. The Court noted that neither the initial termination letter nor the letter denying her appeal explained the Plan's reasons for discrediting the reports. The Court concluded that the Plan acted arbitrarily by denying benefits without an adequate explanation. The Court declined, however, to order reinstatement of benefits. Instead, it remanded to the district court with instructions to remand to the Plan Administrator for further proceedings.

Prior To The Amendments Of 2006, ERISA Allowed A Defined-Benefit Pension Plan To Select Its Own Operative "Normal Retirement Age"

FRY v. EXELON CORPORATION CASH BALANCE PENSION PLAN (July 2, 2009)
 

Exelon Corporation created a defined-benefit pension plan in 2002. In order to be able to distribute the balance of employee's account as if the Plan were a defined-contribution plan, Exelon defined "normal retirement age" to be five years after commencement of employment. Exelon was thus able to avoid what it considered to be a problem with ERISA's treatment of defined-benefit plans (Congress fixed the problem in ERISA in 2006). Thomas Fry retired from Exelon in 2003 at age 55. Fry sued the Plan when it turned over only his account balance rather than his balance plus investment credits through age 65. The lower court held that the Plan satisfied ERISA. Fry appeals.

In their opinion, Chief Judge Easterbrook and Judges Evans and Sykes affirmed. The Court examined the statute. ERISA defines "normal retirement age" as either a) when an employee attains normal retirement age under the plan, or b) the later of i) age 65 or ii) the employee’s fifth anniversary in the Plan. The Court agreed with Exelon that its approach was allowable under the first prong of the definition. It concluded that ERISA did not require a retirement age to be actuarially accurate. Under the statute, an age is a "normal retirement age" if the plan says it is.

Notice of Appeal in Class Representative's Name Only Does Not Serve to Perfect Appeal on Behalf of Class

MARRS v. MOTOROLA, INC. (November 7, 2008)

Michael Marrs sued Motorola, Inc. and several of its benefit plans (“Motorola”), alleging violations of ERISA. The parties stipulated to class action certification. Marrs served as the class representative. The district court granted summary judgment to Motorola. Marrs appealed. Marrs moves for leave to correct his notice of appeal.

In their opinion, Judges Cudahy, Posner, and Flaum denied Marrs’ motion. Marrs’ original notice was in his name only. It did not mention other claimants or the class. In fact, it did not indicate that he is appealing in any capacity other than individually. Marrs moved to amend his notice to indicate that he is appealing on behalf of the class. The Court began with Rule 3(c) of the Federal Rules of Appellate Procedure. That rule provides that a notice of appeal in a class action is sufficient if it names one person who is qualified to bring the appeal. It also provides that an appeal should not be dismissed for failure to name a party “whose intent to appeal is otherwise clear from the notice.” The Court cited its decision in Murphy v. Keystone Steel & Wire Co. for the further proposition that the notice of appeal by a class representative must indicate the he is appealing in his representative capacity. One of the reasons the Court limited the appeal in Murphy to the named plaintiffs was the inclusion on the notice of another party who was not a class member. The Court also looked to its decision in Clay v. Fort Wayne Community Schools. In Clay, there were two separate classes. The Court held that the appeal in the name of one class did not support review of the claims of the other. Neither case involved a single class as the only plaintiff. Nevertheless, the Court found the differences “too slight” to warrant a different result.

Benefit Plan's Denial of Long-Term Disability Benefits Without Assessment of Qualifications and Available Jobs Violates ERISA

TATE V. LONG-TERM DISABILITY PLAN FOR SALARIED EMPLOYEES OF CHAMPION INT’L CORP. #506 (September 19, 2008)

in 1988, Jo Ann Tate left her job with Nationwide Papers as a sales representative because of problems with anxiety and depression. Her employer’s benefits plan (the “Plan”), governed by ERISA, gave her the right to short-term and long-term disability benefits. The long-term disability program was divided into two stages. A person could receive up to two years of long-term disability on a showing that she was unable to perform the duties of her job. After two years, a person had to show that she was unable to perform the duties of any job for which she was or could be qualified. Tate received short-term disability benefits for six months and applied for and was granted long-term disability benefits in 1999. In 2003, the Plan notified Tate that she was no longer eligible for benefits because she did not meet the second stage (i.e., any job) test. The Plan based its decision terminating her benefits on the report of a physician who had not examined Tate but had access to her file. Tate appealed the denial. A second physician reviewed her file and came to the same conclusion. She based her conclusion on the facts that Tate kept her home, complied with her treatment schedule, and experienced some benefit from medication. Tate challenged the determination in district court. On cross motions for summary judgment, the court found that the Plan’s decision to terminate her benefits was arbitrary and capricious in that it consisted only of conclusory statements unsupported by fact. The court specifically noted the absence of any employability review or identification of jobs available to Tate. The Plan appeals. In addition, the court remanded in order for the Plan to make a proper determination of benefits and denied Tate’s request for attorneys’ fees. Tate appeals.

In their opinion, Judges Posner, Kanne, and Williams affirmed all aspects of the district court’s decision. On the Plan’s appeal, the Court noted its de novo review of the district court’s decision and the highly deferential, “arbitrary and capricious,” standard of review of the denial of benefits. Nevertheless, the panel found that it was arbitrary and capricious because neither physician’s report was based on any explanation or reasoning. The first physician apparently did not even review her employment file. The second physician reviewed her employment file but did not tie the conclusion that Tate was unable to work to anything that was relevant to that issue. ERISA requires the Plan to assess her qualifications to work and relate those to jobs she might be able to perform.

Tate’s appeal argued that reinstatement, not remand, was appropriate because the Plan terminated previously awarded benefits, and did not simply deny benefits. Tate relied on the fact that the Plan provided benefits for two years after the “any job” standard took effect. The Court was puzzled by the Plan’s continued payments of benefits after two years without any determination but still found no such determination and held that a remand was proper. The panel also agreed with the district court’s conclusion that obtaining a remand in an ERISA case is not equivalent to “prevailing” for purposes of attorneys’ fees awards. 

Seven Month Contractual Limitiations Period in a Benefits Plan is Reasonable and Enforceable Under ERISA

ABENA v. METROPOLITAN LIFE INS. CO. (September 16, 2008)

Albert Abena worked as a dentist for American Dental Partners, Inc. (“ADP”). ADP provided long-term disability benefits to eligible employees through a plan administered by Metropolitan Life Insurance Co. (“MetLife”). An employee seeking benefits had to file a “Proof of Disability” within three months of the end of an “Elimination Period” (a ninety day period from the date of disability during which benefits were not paid). The Plan provided that no legal action could be filed before the sixtieth day after the filing of the Proof of Disability or after three years from the date Proof of Disability had to be filed. Abena submitted a Proof of Disability on October 23, 2000. He asserted that his disability commenced on May 16, 2000. MetLife approved the claim in early 2001 and began paying benefits. After learning that Abena was again working as a dentist, MetLife reviewed his claim and notified him on August 8, 2002 that his benefits would be terminated. Abena took advantage of an internal appeals process. MetLife affirmed its decision on April 16, 2003. Abena filed suit on April 17, 2006 under ERISA against ADP and MetLife. The district court granted summary judgment to the defendants on the ground that the suit was not timely filed. Abena appeals.

In their opinion, Judges Manion, Rovner, and Evans affirmed. The Court agreed with the court below that the issue was controlled by the Court’s 1997 decision in Doe v. Blue Cross Blue Shield United of Wisconsin. In Doe, the Court noted that ERISA did not contain a Statute of Limitations and that the normal practice would be to borrow a limitations period from a closely analogous statute. It also held that a shorter contractual limitations period would be enforced if it was reasonable. Doe dealt with an employer-sponsored health plan. Like the ADP plan, the Doe plan provided that a claimant had to file for reimbursement within ninety days of the date of service and that the claimant could not initiate a suit after three years from the last day a claim could be filed. The plan also required a claimant to pursue an internal appeals process. The appeals process in Doe was concluded with seventeen months left in the three year limitations period. Particularly given that the claimant was represented by counsel, the Court held that the seventeen months was reasonable and enforceable. In applying Doe to Abena’s situation, the three year period expired in November of 2003. MetLife notified him of its affirmance of termination of benefits in April of 2003. Abena, therefore, had seven months to file suit. Abena argues that Doe was an initial claim case and his is a denial of previously granted benefits and therefore distinguishable. The Court agreed that the limitations provision may be better suited to an initial claim but did not see that as a reason to depart from Doe’s holding. The Court also agreed with Abena that a situation could arise in which benefits were paid for thirty nine months before termination, leaving no time to bring suit. Unfortunately for Abena, the Court’s view was that the possibility of that result did not invalidate the limitations period or make a seven month period unreasonable – it merely would have made the application of the provision in that case unreasonable. Abena, too, was represented by counsel. In those circumstances, the Court held that a seven month period was reasonable and enforceable.