THOMAS C. MUMMERT, III, United States Magistrate Judge.
In the remaining count of his two-count First Amended Complaint,
This dispute has its origins in the untimely death of Plaintiff's son, Abel Silva (Abel), on June 27, 2010. (Pl. Am. Compl. ¶ 1,
Under the Group Life and Supplemental Life Plan for Savvis employees ("the Plan"), Abel later could, during an annual enrollment period as determined by Savvis, "enroll for insurance for which [he][was] eligible or choose a different option than the one for which [he][was] currently enrolled." (Id. at 88.
(Id.)
A separate section of the Plan, titled "
(Id. at 104-05.)
"
The Plan further provides that:
(Id. at 135.)
Several years later, on an online enrollment form, Abel requested supplemental life insurance with a coverage level of five times his salary. (Defs. Stat. ¶ 13.) Plaintiff was the sole beneficiary of this coverage, $429,000. (Id.; Defs. Mot. Ex. at 08-09.) The cost was $10.73 bi-monthly. (Id. at 08.) Abel also added his domestic partner, Jill Bitter, on his health insurance plan. (Id. at 12.)
After Abel's death, Plaintiff made a claim against Savvis and MetLife for supplemental life insurance benefits under the Plan. (Id. at 02-03.) Subsequently, Savvis' representative, Terry Flynn, faxed MetLife a "Life Insurance Claim Form: Employer's Statement" listing Basic Life benefits of $172,000 and supplemental life insurance benefits of $429,000. (Id. at 07.) The former had an effective date of January 1, 2005; the latter had an effective date of January 1, 2010. (Id.) Plaintiff's claim for supplemental life insurance benefits was denied by MetLife. (Defs. Stat. ¶ 17.) The November 2010 letter explaining the denial quoted paragraphs five and nine of the EOI provisions, see pages 3 to 5, supra, and read, in relevant part:
(Id.)
The following month, Plaintiff appealed this adverse decision to MetLife. (Defs. Stat. ¶ 18-19; Defs. Mot. Ex. at 36.) As grounds for his appeal, Plaintiff explained: "Your basis for denying the claim was that Able [sic] Silva failed to provide you proof of his insurability. That is not true. You issued his policy, accepted his premium and therefore owe him coverage." (Defs. Mot. Ex. at 176.)
Subsequently, Plaintiff pursued his appeal and also initiated this action. As part of his appeal, Plaintiff submitted to MetLife an affidavit from Ms. Bitter attesting to Abel's general good health, lack of any suicidal ideation, and lack of any participation in inherently dangerous activities, e.g., skydiving. (Id. at 205.) Ms. Bitter also averred that, to her knowledge, Abel had not received any request for EOI or a statement of health. (Id.) Plaintiff argued that the lack of any evidence that Abel had a health problem meant that there was no indication that Abel would not have been issued supplemental life insurance had EOI or a statement of health been submitted. (Id. at 214.)
When investigating Plaintiff's claim for Abel's supplemental life insurance benefits, it was discovered that there were "around 200 other individuals who should have sent in a [statement of health] form for one reason or another, but forms were never submitted." (Id. at 242.) MetLife attributed the error to a problem at Savvis' end. (Id.) It was determined that the individuals who had not sent in a statement of health form would not be "grandfathered" into the Plan at the amounts requested. (Id.) Instead, all past participants were required to submit a form. (Id.) It was further determined that:
(Id.)
Also in the course of its investigation, MetLife learned that a Savvis employee completing an online enrollment form is prompted to complete a paper statement of health form if the employee elects more than three times his or her base annual earnings. (Id. at 251.) If prompted to complete the form, the employee is also told to contact the benefits department. (Id. at 250.) That department was located in the same building that Abel worked in; hence, he could have walked to the department and requested a form, or as had other employees, called or emailed his request. (Id.) Abel did not submit a statement of health form. (Id. at 243.)
Deductions for the cost of the increased supplemental life insurance began to be deducted, however, from Abel's paycheck on January 1, 2010. (Pl. Stat. ¶ 34.) A check was issued by MetLife to Savvis in November 2011 for $128.76. (Defs. Resp. Att. 1 ¶ 3, ECF No. 82-1.) This amount represents the refund of Abel's premiums for the increased supplemental life insurance.
In this action, Plaintiff alleges that Defendants (1) violated the Employer Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1001-1461,
Before this Court, Defendants argue that they are entitled to summary judgment because (1) Abel was required to submit EOI having requested (a) the supplemental life insurance after his initial enrollment and (b) life insurance benefits that exceeded one level above his current amount; (2) Abel did not submit the required EOI; and (3) Abel was, therefore, not covered for and entitled to supplemental life insurance benefits. Plaintiff counters that he is entitled to summary judgment because the EOI requirement (a) was not properly noticed to the insureds, (b) is impermissibly vague, (c) was satisfied by Defendants and by evidence submitted after the fact, and (d) was waived by Defendants.
"Summary judgment is proper `if the pleadings, the discovery and disclosure materials on file, and any affidavits show that there is no genuine issue as to any material fact and that the movant is entitled to judgment as a matter of law.'" Torgerson v. City of Rochester, 643 F.3d 1031, 1042 (8th Cir.2011) (en banc) (quoting Fed.R.Civ.P. 56(c)(2)). "The movant `bears the initial responsibility of informing the ... [C]ourt of the basis for its motion,' and must identify `those portions of [the record] ... which it believes demonstrate the absence of a genuine issue of material fact.'" Id. (quoting Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986)) (last two alterations in original). "If the movant does so, the nonmovant must respond by submitting evidentiary materials that set out `specific facts showing a genuine issue for trial.'" Id. (quoting Celotex Corp., 477 U.S. at 324, 106 S.Ct. 2548). "`Where the record taken as a whole could not lead a rational trier of fact to find for the nonmoving party, there is no genuine issue for trial.'" Id. (quoting Ricci v. DeStefano, 557 U.S. 557, 586, 129 S.Ct. 2658, 174 L.Ed.2d 490 (2009)).
Plaintiff's claims in his First Amended Complaint implicate two types of civil actions authorized by ERISA to be brought by beneficiaries.
Refusal to Supply Requested Information. Title 29 U.S.C. § 1024(b)(1)(A) requires that the plan administrator "furnish to each participant, and each beneficiary receiving benefits under the plan, a copy of the [SPD]...." The relevant regulation provides that, to comply with this requirement, "the plan administrator shall use measures reasonably calculated to ensure actual receipt of the material by plan participants, beneficiaries and other specified individuals. Material which is required to be furnished to all participants under the plan and beneficiaries receiving benefits under the plan ... must be sent by a method or methods of delivery likely to result in full distribution." 29 C.F.R. § 2520.104b-1(b)(1).
Defendants represent that the Plan and SPD is given to the Plan participants by Savvis. (See Defs. Mot. Ex. at 248, 251.) Plaintiff counters that this representation is unavailing absent a signed receipt by the participants and any evidence of how the distribution was made. (Pl. Mem. at 9-10.) In reliance on his position, Plaintiff cites a June 2011 letter from Defendants' attorney denying his claim. This letter refers to Savvis not requiring its employees to sign a receipt for the SPD. (Defs. Mot. Ex. at 197.) The letter further states that the SPD is "always available to [its] employees." (Id.) It is accessible on Savvis' intranet or a copy can be requested. (Id.) See Meltzer-Marcus v. Hitachi Consulting, No. 03 C 7687, 2005 WL 2420367, *2 (N.D.Ill. Sept. 30, 2005) (noting that copies of SPD discussing evidence of insurability requirement were available on employer's intranet site).
In support of his argument that there was no proper notice of the SPD, Plaintiff notes the lack of any evidence of "how many, which ones, or in what manner that distribution takes place, citing Leyda v. AlliedSignal, Inc., 322 F.3d 199 (2nd Cir.2003). Plaintiff's reliance on that case is unavailing. There, after purchasing the company the employee had worked for, the new employer held optional departmental meetings to inform the old company's employees of its benefit plan. Id. at 201-02. The SPDs, enrollment forms, and beneficiary designation forms were distributed at the meetings. Id. at 202. Attendance was not taken at the meetings; however, additional copies of the documents were left at the various facilities and were mailed to employees who were on sick leave, traveling, or on extended leave the day of the meeting. Id. Plaintiff's husband did not attend a meeting and never received an SPD. Id. Thinking that his life insurance coverage with the old company remained in effect in the new company, he declined other opportunities to obtain additional life insurance. Id. After he died, his widow and beneficiary filed a claim for the benefits her husband thought he had, arguing that such benefits were due her because AlliedSignal, as plan administrator, had failed to provide her husband with the SPD. (Id.) The district court found "AlliedSignal's assumption that only those employees who were traveling or on leave would fail to attend the meetings was unreasonable," especially given the lack of attendance records. Id. at 209. The appellate court held that these findings were not clearly erroneous. Id. In the instant case, the SPD and Plan were distributed to employees and available on Savvis' intranet. Neither Savvis nor MetLife assumed, as did AlliedSignal, that employees would either attend informational meetings or pick up either document at the facility's
Additionally, the enrollment form Abel completed online prompted him to complete a statement of health form. "[I]t would be unfair to hold the employer liable when a claimant fails to adhere to a known plan requirement through `procrastination,' `indecision,' or the like." Weinreb v. Hosp. for Joint Diseases Orthopaedic Inst., 404 F.3d 167, 172 (2nd Cir.2005) (requiring a showing of "likely prejudice" for an ERISA claim based on the complete absence of an SPD and finding that such prejudice is lacking when evidence shows claimant had actual knowledge of requirement at issue). See also Schad v. Stamford Health Sys., Inc., 358 Fed.Appx. 242, 244 (2nd Cir.2009) (employee's written notice of requirement of evidence of insurability form "was sufficient to render harmless any shortcomings of the SPD," although there was no evidence that the defendants had provided employee with necessary form).
Defendants properly provided Abel with a SPD.
Recovery of Benefits. Title 29 U.S.C. § 1132(a)(1)(B) authorizes a civil action for the recovery of benefits due under an ERISA plan. When, as in the instant case, an entity "both determines whether an employee is eligible for benefits and pays benefits out of its own pocket" the resulting "dual role creates a conflict of interest." Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 108, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008). This conflict then "`must be weighed as a factor in determining whether there is an abuse of discretion.'" Id. at 111, 128 S.Ct. 2343 (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989)). This is true even when, as here, the entity is an insurance company and not the employer itself. Id. at 114-15, 128 S.Ct. 2343. The conflict does not, however, change the standard of review from deferential to de novo. Id. at 115, 128 S.Ct. 2343. Rather, the conflict is "but one factor among many that a reviewing judge must take into account." Id. at 116, 128 S.Ct. 2343. "Benefits decisions arise in too many contexts, concern too many circumstances, and can relate in too many different ways to conflicts — which themselves vary in kind and in degree of seriousness — for [courts] to come up with a one-size-fits-all procedural system that is likely to promote fair and accurate review." Id.
In Glenn, "[t]he [Supreme] Court acknowledged the existence of a conflict should be weighed more heavily `where circumstances suggest a higher likelihood that it affected the benefits decision, including, but not limited to, cases where an insurance company administrator has a history of biased claims administration.'" Khoury v. Group Health Plan, Inc., 615 F.3d 946, 953-54 (8th Cir.2010) (quoting Glenn, 554 U.S. at 117, 128 S.Ct. 2343). "The conflict should be given less weight `(perhaps to the vanishing point) where the administrator has taken active steps to reduce potential bias and to promote accuracy, for example, by walling off claims administrators from those interested in firm finances....'" Id. at 954 (quoting Glenn, 554 U.S. at 117, 128 S.Ct. 2343).
Plaintiff contends that MetLife's conflict should be given more weight because it "refused to wall claims team from financial aspects of the company" and because the claims team that denied his seminal claim also denied his appeal. (Pl. Mem. at 1, 2, ECF No. 81.) As noted above, however, the conflict created by MetLife's dual role is a factor to consider when determining whether there has been an abuse of discretion. Although there has been no showing that "active steps" have been taken to wall off the team deciding the claims from the
Additionally, a decision to deny benefits reviewed for an abuse of discretion is to "be affirmed if it is reasonable, meaning it is supported by substantial evidence," i.e., evidence that "is more than a scintilla but less than a preponderance." Green, 646 F.3d at 1050. "`The requirement that the plan administrator's decision be reasonable should be read to mean that a decision is reasonable if a reasonable person could have reached a similar decision, given the evidence before him, not that a reasonable person would have reached that decision.'" Id. (quoting Midgett v. Wash. Group Int'l Long Term Disability Plan, 561 F.3d 887, 897 (8th Cir. 2009)).
Defendants' reason for denying Plaintiff's claim for benefits is that Abel did not complete the necessary statement of health form and, consequently, he was never approved for enrollment in the supplemental life insurance plan. Under the terms of the Plan, Abel had to submit EOI if he wished to (a) increase the amount of his supplemental life insurance to an amount which was greater than one level above his current amount or (b) request supplemental life insurance more than thirty-one days after he became eligible. Several years after he became eligible, he wished to increase his life insurance benefits to an amount five times greater than his current level. He did not, however, submit EOI, including a completed statement of health form.
When considering whether Defendants' interpretation of the Plan leading to their denial of Plaintiff's claim is reasonable, the Court is guided by five factors: "(1) whether the administrator's language is contrary to the clear language of the plan; (2) whether the interpretation conflicts with the substantive or procedural requirements of ERISA; (3) whether the interpretation renders any language in the plan meaningless or internally inconsistent; (4) whether the interpretation is consistent with the goals of the plan; and (5) whether the administrator has consistently followed the interpretation." Manning, 604 F.3d at 1041-42. There is nothing in the record before the Court to suggest that consideration of any of these five factors, including the fifth, detracts from Defendants' interpretation of the Plan. Although there is evidence that, during the review of Plaintiff's claim, it was discovered that approximately 200 individuals should have sent in a statement of health form but did not and that those individuals would now be required to, there is no evidence that this corrigendum in processing employees' enrollment requests reflects any inconsistency in interpreting the Plan. Plaintiff argues that there is inconsistency in that the 200 individuals are being allowed to submit statement of health forms, but he is not being allowed to submit one for Abel. As noted by Defendants, however, the distinction is different in that Abel is no longer an employee; the other individuals are. Moreover, under the unambiguous terms of the Plan, the supplemental life insurance coverage Abel requested was not effective until his application, including EOI, was approved by MetLife. See Kehoe v. Ryder Truck Rental, Inc., No. 05-2139, 2006 WL 2414197, *4 (E.D.La. Aug. 17, 2006) (finding no abuse of discretion in denial of claim given plan's provision that application for increased coverage did not take effect until insurer approved evidence of insurability). It was not.
Nor was it unreasonable to require Abel to obtain the statement of health form from the benefits department. There is no showing that the department was difficult to reach or contact, or that a phone or email request for the form would not have been successful. Plaintiff takes issue with Defendants' failure to send him the statement of health form after Abel's death. He is not a participant in the Plan. And, there is no support for his contention that the Plan must entertain evidence of Abel's insurability submitted after Abel's death.
Arguments similar to Plaintiff's were rejected in Meltzer-Marcus, supra, when the court denied a widow's claim for supplemental life insurance benefits her husband had elected to purchase through his employer's group insurance policy. Although he knew that he had to submit proof of insurability to qualify for the increased
Plaintiff contends that even if Defendants' interpretation of the Plan is reasonable, they waived the EOI requirement by deducting premiums for the supplemental life insurance benefits Abel requested.
"A waiver is `a voluntary and intentional relinquishment of a known right.'" Farley v. Benefit Trust Life Ins. Co., 979 F.2d 653, 659 (8th Cir.1992) (quoting J. Calamari and J. Perillo, The Law of Contracts, § 11-29(c) at 491 (3rd ed.1987)) (assuming, without deciding that "a waiver of policy provisions could be asserted in an ERISA case"). It is the plaintiff's burden to show there is a waiver. Hargis, 2005 WL 6456898 at *7 n. 1.
Defendants erred by deducting premiums for six months for supplemental life insurance benefits for which Abel had not been approved. But, an error is not always a waiver. "Certainly, someone made an error; either the employer made a mistake in deducting the premium payments without receiving approval, or the defendant [insurer] received the premiums and simply forgot to insist on evidence of insurability. But there is no evidence that the defendant was aware of the amount of the [employee's] annual earnings and
Similarly, in Hargis, applying the same definition of waiver as did the Eighth Circuit in Farley, supra, the court rejected the plaintiffs' argument that defendants — the deceased son's former employer and group policy insurer — had waived their EOI requirement by taking premiums for increased benefits from the son's paycheck for thirteen months. 2005 WL 6456898 at *2, *7. To be found to have intentionally waived its right to require evidence of insurability, the court determined that the insurer had to have known (a) of the son's failure to submit the evidence of insurability form and (b) that it was accepting premiums for the additional insurance. Id. at *7. Although the insurer's knowledge of the first element could be assumed, knowledge of the second could not. Id. See also Crosby v. Rohm & Haas Co., 480 F.3d 423, 431 (6th Cir.2007) (rejecting claim brought by beneficiary of employee's life insurance policy for amount of benefits shown on employee's enrollment worksheet based on incorrect formula used by insurer, and for which deductions had been made from employee's paycheck); Lawler v. Unum Provident Corp., No. 05-CV-71408, 2006 WL 2385043, *3 (E.D.Mich. Aug. 17, 2006) (acceptance of premiums for eight years was not waiver of unambiguous plan provisions).
Plaintiff further argues that Defendants should be equitably estopped from denying him Abel's supplemental life insurance benefits because they withheld premiums without informing Abel that he needed to submit EOI, which Abel could have done had he been so advised.
"In general, the doctrine of equitable estoppel requires proof of words or deeds (or sometimes omissions to speak or act) that create a misleading impression upon which a reasonable person would rely." Lincoln Gen. Hosp. v. Blue Cross/Blue Shield of Neb., 963 F.2d 1136, 1141 (8th Cir.1992) (internal quotations omitted).
The doctrine of equitable estoppel was found to be unavailing in a similar case, Colardo, 2011 WL 1899253 at *4, in which the employee attempting to enroll in optional life insurance benefits program had not provided EOI when electing such insurance and the lack of such evidence was not discovered by either the employer or the insurer until after the employee's death. The employer had not recognized the necessity of such insurance and had not requested such evidence, but had confirmed
Additionally, as was the case in Fink, the relief sought by Plaintiff — a monetary award of the amount of life insurance benefits Abel requested — is not available. "Monetary relief in the form of restitution may be considered equitable only if `seek[s] not to impose personal liability on the defendant, but to restore to the plaintiff particular funds or property in the defendant's possession.'" Calhoon v. Trans World Airlines, Inc., 400 F.3d 593, 596 (8th Cir.2005) (quoting Great-West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204, 214, 122 S.Ct. 708, 151 L.Ed.2d 635 (2002)) (alteration in original). "Monetary damages that are compensatory in nature are traditionally considered to be legal relief because they `focus on the plaintiff's losses and seek to recover in money the value of the harm done' to the plaintiff instead of punishing `the wrongdoer by taking his ill-gotten gains.'" Id. (quoting Kerr v. Charles F. Vatterott & Co., 184 F.3d 938, 944 (8th Cir.1999)). The litmus test in determining whether the sought-after monetary relief is equitable or legal in nature is whether the harm done "is measured by loss to the plaintiff or the gain to the defendant and whether the money sought is specifically identifiable `as belonging in good conscience to the plaintiff' and can `clearly be traced to particular funds or property in the defendant's possession.'" Id. at 596-97 (first quotation omitted) (second quotation from Great-West, 534 U.S. at 213, 122 S.Ct. 708). An example of loss to the plaintiff is overpayment of premiums and the resulting claim for the specific amount of overpayment. Id. at 597. Additionally, when determining whether the relief sought is legal or equitable in nature, the status of the defendant, whether it be a fiduciary or not, is not relevant to the germane inquiry of
The instant case is unlike the one before the court in Papenfus v. Flagstar Bankcorp, Inc., 517 F.Supp.2d 969 (E.D.Mich. 2007), cited by Plaintiff. In that case, the court found that the plan documents were ambiguous; "a reasonable person" could have believed from the plan documents that the plan administrator was responsible for asking for evidence of good health, which could have included information contained in "`questionnaires, physical exams, or written documentation as required by Us.'" Id. at 971. A "reasonable person" could also have believed, after reading the plan, that the plan administrator would inform an enrollee if an application was incomplete. Id. at 973. Although the employee was never asked for proof of good health of his family member to be enrolled and had not submitted such, premiums were regularly deducted from his paycheck. Id. at 974. Additionally, he was sent at least two annual benefit statements showing he had the supplemental insurance and was never informed his employee application was incomplete. Id. The court found that defendants had misrepresented material facts by sending the employee benefits statements and not informing him that his application was incomplete when the plan could reasonably be read to require such. Id. at 974. These considerations were in addition to withholding premiums and were relevant because the plan provisions at issue were ambiguous. Id. at 973.
For the foregoing reasons, Plaintiff's arguments why he should receive the supplemental life insurance benefits for which Abel enrolled regardless of Abel having failed to satisfy a properly-noticed condition precedent are unavailing. As noted by the Eighth Circuit, claims such as Plaintiff's are defeated by the "remedy-less `regulatory vacuum' created by ERISA's broad preemption of state law claims and the Supreme Court's narrow interpretation of `other appropriate equitable relief.' Nevertheless, [the Court is] bound by the precedent of th[e] [Eighth] [C]ircuit and the Supreme Court." Pichoff, 556 F.3d at 732.
What is undefeated, however, is Plaintiff's claim for the withheld premiums.
Accordingly,