Filed: Mar. 21, 2007
Latest Update: Feb. 21, 2020
Summary: United States Court of Appeals Fifth Circuit F I L E D UNITED STATES COURT OF APPEALS March 21, 2007 FIFTH CIRCUIT Charles R. Fulbruge III Clerk No. 06-30956 Summary Calendar RAYMOND HOLMES, Plaintiff - Appellant, versus PROCTOR AND GAMBLE DISABILITY BENEFIT PLAN, Defendant - Appellee. Appeal from the United States District Court for the Eastern District of Louisiana (2:05-CV-1227) Before DAVIS, BARKSDALE, and BENAVIDES, Circuit Judges. PER CURIAM:* Raymond Holmes appeals the summary judgment aw
Summary: United States Court of Appeals Fifth Circuit F I L E D UNITED STATES COURT OF APPEALS March 21, 2007 FIFTH CIRCUIT Charles R. Fulbruge III Clerk No. 06-30956 Summary Calendar RAYMOND HOLMES, Plaintiff - Appellant, versus PROCTOR AND GAMBLE DISABILITY BENEFIT PLAN, Defendant - Appellee. Appeal from the United States District Court for the Eastern District of Louisiana (2:05-CV-1227) Before DAVIS, BARKSDALE, and BENAVIDES, Circuit Judges. PER CURIAM:* Raymond Holmes appeals the summary judgment awa..
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United States Court of Appeals
Fifth Circuit
F I L E D
UNITED STATES COURT OF APPEALS March 21, 2007
FIFTH CIRCUIT Charles R. Fulbruge III
Clerk
No. 06-30956
Summary Calendar
RAYMOND HOLMES,
Plaintiff - Appellant,
versus
PROCTOR AND GAMBLE DISABILITY BENEFIT PLAN,
Defendant - Appellee.
Appeal from the United States District Court
for the Eastern District of Louisiana
(2:05-CV-1227)
Before DAVIS, BARKSDALE, and BENAVIDES, Circuit Judges.
PER CURIAM:*
Raymond Holmes appeals the summary judgment awarded against
his challenge to the termination of his disability benefits by the
Proctor and Gamble Disability Benefit Plan.
In March 2002, Holmes sustained serious back injuries, due to
an accident unrelated to his employment at the Folgers Coffee
Company, a subsidiary of Protector and Gamble. It maintains a
*
Pursuant to 5TH CIR. R. 47.5, the court has determined that
this opinion should not be published and is not precedent except
under the limited circumstances set forth in 5TH CIR. R. 47.5.4.
disability benefit plan for its employees; and, after a physician
found him to be completely disabled, Holmes applied for benefits
under the Plan. It began paying Holmes disability benefits.
In January 2004, however, the Plan stopped paying such
benefits because Holmes had failed to provide the Plan
administrators with an updated disability status report, certifying
his continued disability, as required under the Plan. (Holmes
claims he did so only because a health-services employee at Folgers
told him he could discontinue such reports until after he underwent
a physical examination by a Plan-selected physician.)
The Plan notified Holmes of its decision in a March 2004
letter. It also stated: Holmes had a right to appeal the denial
of benefits; the appeal had to take place within 180 days of the
March 2004 letter; and Holmes could submit supporting documents.
In April 2004, Holmes’ attorney notified Folgers of Holmes’
“inten[t] to pursue an appeal of the decision of the [review
board]” and, to that end, asked for a copy of Holmes’ personnel
file so “[Holmes] may properly prepare his appeal”. In response,
in May 2004, an attorney for the Plan sent a letter to Holmes’
attorney, stating: the Plan was a separate legal entity from
Folgers and all communications regarding the Plan should be
addressed to the trustees of the Plan; and Holmes would have to
follow the Plan’s appeal procedures if he wished to challenge the
denial of benefits.
2
In March 2005, over a year after Holmes was denied disability
benefits, a new attorney for Holmes contacted both an attorney for
the Plan and a Plan manager, asking for an extension of the 180-day
appeal period. Both individuals stated they did not have the power
to authorize such a request and asked Holmes’ attorney to contact
the Plan’s trustees. Holmes did not contact the Plan again.
Instead, in April 2005, Holmes filed this action in district
court, claiming, inter alia, the Plan acted arbitrarily and
capriciously in terminating his benefits. See 29 U.S.C. §
1132(a)(1)(B) (authorizing ERISA plan participants to maintain
civil actions to recover benefits from an ERISA plan). The Plan
moved: to dismiss; and, in the alternative, for summary judgement.
In August 2006, the district court awarded summary judgment
against Holmes. It held: Holmes’ April 2004 letter could not be
considered an appeal of the Plan’s decision; and, therefore, Holmes
failed to exhaust administrative remedies under the Plan.
A summary judgment is reviewed de novo. Tango Transp. v.
Healthcare Fin. Servs. LLC, 322 F.3d 888, 890 (5th Cir. 2003).
Such judgment is proper if there is no genuine issue of material
fact and the movant is entitled to a judgment as a matter of law.
FED. R. CIV. P. 56(c). “We resolve doubts in favor of the nonmoving
party and make all reasonable inferences in favor of that party.”
Dean v. City of Shreveport,
438 F.3d 448, 454 (5th Cir. 2006). No
genuine issue of material fact exists if the evidence is such that
3
no reasonable juror could find for the nonmovant. Wheeler v. BL
Dev. Corp., 415 F.3d 399, 402 (5th Cir.), cert. denied,
126 S. Ct.
798 (2005).
In challenging the summary judgment, Holmes contends: he
substantially complied with the Plan’s appeal procedures; and the
Plan arbitrarily and capriciously terminated his benefits. He
seeks to have the Plan consider his appeal.
“[C]laimants seeking benefits from an ERISA plan must first
exhaust available administrative remedies under the plan before
brining suit to recover benefits”. Bourgeois v. Pension Plan for
Employees of Santa Fe Int’l Corps., 215 F.3d 475, 479 (5th Cir.
2000) (citing Denton v. First Nat’l Bank of Waco,
765 F.2d 1295,
1300 (5th Cir. 1985)). The exception to this requirement is
limited, arising only when resorting to administrative remedies is
futile or the remedy inadequate. See, e.g., Cooperative Ben.
Adm’rs, Inc. v. Ogden,
367 F.3d 323, 363, n. 61 (5th Cir. 2004).
Under the Plan, Holmes was required to submit a request for an
appeal in writing within 180 days of the March 2004 denial-of-
benefits letter. Holmes claims he did appeal the Plan’s decision
through his April 2004 letter; as noted, he maintains it
substantially complied with the Plan’s appeal procedures. See,
e.g., Lacy v. Fulbright & Jaworski, 405 F.3d 254, 256-57 (5th Cir.
2005) (holding strict compliance with claims regulations and
procedures is not always essential).
4
As the district court correctly noted, however, Holmes’ April
2004 letter did not substantially comply with the Plan’s appeal
procedures. In the letter, Holmes stated only his intent to appeal
the Plan’s decision at some time in the future. Indeed, in the
letter, Holmes’ attorney requested Holmes’ personnel file in order
to prepare an appeal.
Subsequent to Holmes’ April 2004 letter, the Plan contacted
Holmes’ attorney; gave clear indication that his April 2004 letter
was not an appeal; and stated that, if he desired to challenge the
Plan’s decision, he had to follow Plan procedures. Furthermore, in
March 2005, Holmes’ attorney contacted Plan administrators to ask
for an extension to the 180-day appeal deadline, belying Holmes’
claims that he intended the April 2004 letter to be an appeal of
the Plan’s decision.
Holmes’ inaction, in not properly appealing the Plan’s
decision within the 180-day window, was not a harmless, technical
error under which substantial-compliance relief may sometimes be
granted. See, e.g., Davis v. Combes, 294 F.3d 931, 942 (7th Cir.
2002) (holding plan participant substantially complied with plan
procedures, despite participant’s failure to sign and date form
because participant’s intent was clear and form was later accepted
by plan administrator). Holmes’ now claimed intent that the April
2004 letter be considered an appeal was not evident, particularly
in the light of the Plan’s follow up letter, dated May 2004,
5
telling Holmes that if he still wished to appeal, he had to follow
Plan procedure.
Holmes did not comply with the Plan’s procedures in appealing
its decision and therefore did not exhaust his administrative
remedies. His failure to do so was fatal; the Plan’s 180-day
deadline has passed and his appeal of its decision is now time
barred. Therefore, summary judgment was properly awarded against
Holmes for failure to exhaust administrative remedies. See Gayle
v. United Parcel Service, 401 F.3d 222, 230-31 (4th Cir. 2005)
(holding where Plan review of benefits is time barred, dismissal
with prejudice is appropriate).
AFFIRMED
6
