KRISTI K. DuBOSE, District Judge.
This action came before the Court for a non-jury trial on April 3, 2012. Upon consideration of the documentary and testimonial evidence presented at trial and all other pertinent portions of the record, the Court makes the following findings of fact and conclusions of law:
Howington filed this action against Smurfit-Stone Container Corporation (Smurfit-Stone) and Smurfit-Stone Container Corporation Pension Plan for Hourly
Defendants filed a motion for judgment as a matter of law on basis that Howington's claim had been discharged in the Smurfit-Stone Container Corporation, Inc. bankruptcy proceedings or released pursuant to the settlement agreement and release in Howington v. Smurfit-Stone Container Corporation, Inc., Civil Action No. 08-00252-CG-B (S.D.Ala.2008). The motion was denied. (Doc. 26). Defendants filed a motion for summary judgment on the merits and the motion was denied. (Doc. 41). The non-jury trial was held on April 3, 2012.
Howington was an hourly employee at Smurfit-Stone's paper mill in Brewton, Alabama and he participated in the Pension Plan for hourly employees. (Doc. 1). The Smurfit-Stone paper mill was sold to Georgia Pacific Corporation and effective midnight on September 28, 2007, it became the property of Georgia Pacific Corporation. Howington was scheduled to work from 10:00 p.m. until midnight on September 28, 2007. However, he left work on September 27, 2007 and did not return. Howington left work because of pain in his feet and told his supervisor that was why he was leaving. His personnel records do not contain any documentation of that statement. Instead, his personnel records indicate that he was terminated on September 27, 2007. At the time of sale of the paper mill, Smurfit-Stone employees fell into three groups: those who chose to take early retirement, those who applied with Georgia Pacific and were hired, and those who applied but were not offered a job. Howington fell into the latter group.
After he left work, Howington accessed the funds in his 401(k) and also contacted the Social Security Administration in regard to applying for disability benefits but was told he had to wait three months. In January 2008, he applied for disability benefits and on June 2, 2009, benefits were awarded based upon his record and without a hearing. (Howington Exhibit 1). In the application, Howington wrote that his date last employed was October 27, 2007 and his onset of disability was October 28, 2007. Howington testified that he was on pain medication at the time of the application and made an error when gave the SSA the incorrect date of last employment with Smurfit-Stone. The Administrative Law Judge (ALJ) then found Howington had not "engaged in substantial gainful activity since October 28, 2007, the alleged onset date" and that he "has been under a disability as defined in the Social Security Act since October 28, 2007, the alleged onset date of disability." (Exhibit 1).
After the award, Howington applied for long-term disability benefits with the Pension Plan through the Pension Plan Service Center. He spoke with at least two female employees at the Service Center but could not recall their names. Howington
On September 1, 2009, Howington's claim was denied on basis that the Social Security decision indicated an onset of disability of October 28, 2007, after he was terminated from Smurfit-Stone on September 27, 2007. (Howington's Exhibit 2). The unsigned letter explained that Howington had the "right to request a review of the denial of your benefits by the Administrative Committee", the "right to review relevant documents and to submit issues and comments in writing", and that if he "decided[d] to appeal" to "please provide any documentation that you believe supports your claim." (Id.). Howington was aware of these requirements.
After receiving the denial, Howington discovered that he had incorrectly written the date he last worked on his SSA application. He called the Service Center and asked what he should do to appeal. He was told to type an appeal letter and send documents to support his claim. He did not ask whether he should send medical records nor was he asked to send medical records.
On or near October 27, 2009, Howington sent an appeal letter to the Smurfit-Stone Administrative Committee explaining that he "made a mistake on last date worked" for Smurfit-Stone when he applied for Social Security disability benefits. (Howington's Exhibit 3). Howington explained that "I had said that my last work date was in October, 2007. The correct date should have been on September 2007. So I was an employee of Smurfit-Stone when I became Disabled." (Id.) He explained that the "social security Judge agreed that I was disabled back to the date that I entered on the questionnaire sheet, the wrong date Oct. and should have been Sept." (Id.) Howington enclosed with this letter "the sheet [he] had filled out for Social Security with the mistake" and his statement to Social Security that his medications made him feel drunk. (Id.) He wrote that he included an "investigative letter from Smurfit-Stone" which stated he was terminated on September 27, 2007 and "a statement from T. Rowe Price that states that Smurfit-Stone gave a separation date of October 1, 2007" to support his claim that "it is a common mistake for humans to put the wrong date on some forms". (Id.)
Howington called the Service Center and was told to provide the complete SSA decision. He wrote the Service Center on April 5, 2010, confirming the call and providing a copy of the notice of decision from the SSA. (Howington's Exhibit 4). He reiterated that he made a mistake when answering the SSA questionnaire, perhaps due to medication or "just an honest mistake", and points out again that "Smurfit-Stone made the same mistake" when it
At some time after July 13, 2010, Howington was notified by letter from Cheryl Curik, Manager of Compliance and 401(k) for Smurfit-Stone, that the decision was affirmed on appeal by the Smurfit-Stone Administrative Committee. (Howington's Exhibit 5, Letter from Smurfit-Stone Pension Service Center, dated July 13, 2010). In the letter, Curik explained that the Administrative Committee reviewed Howington's claim, his Social Security disability award, his personnel file, and the applicable Pension Plan document. (Id.) Also, at some time after the denial on appeal, an employee at the Service Center told Howington to try to get his SSA decision changed but it was too late since more than sixty days had passed.
John Higdon was employed by Smurfit-Stone Pension Center as the Pension Manager at the time Howington applied for benefits. His duties were to review claims for hourly employees such as Howington and to apply and follow the Pension Plan provisions. He reviewed and processed Howington's initial claim but not his appeal. Higdon testified that pursuant to the Pension Plan's interpretation of § 5.16 of the Pension Plan, the claims reviewers rely upon the SSA's decision as to both disability and date of onset of disability. Therefore, they uniformly deny any claim based upon a SSA decision finding a date of onset of disability after active employment with Smurfit-Stone. He denied Howington's claim based on this interpretation of § 5.16. For Howington's application, the Pension Plan does not require consideration of objective medical evidence and providing medical evidence such as medical records would not matter because there is no one to perform a medical evaluation. Higdon acknowledged that Howington's personnel records showed his date last employed as September 27, 2007, but that Howington's remedy would be to correct the mistake with the SSA and obtain an amended decision.
Cheryl Curik reviewed Howington's claim on appeal. She testified that the Pension Plan interprets § 5.16 to mean that the claims reviewers should rely upon the SSA decision to establish disability and the onset of disability date and that even though the Pension Plan language in § 5.16 does not specifically require reliance on the SSA decision to establish the date of onset, that has been the historical application of the provision. Curik explained that this interpretation applies on appeal, such that Howington cannot correct his mistake through the Pension Plan's appeal process, but that other mistakes may be addressed and corrected on appeal such as a deficiency in the number of years in service. Curik confirmed that
Curik further testified that Howington did not apply for short-term disability through Smurfit-Stone's disability insurance carrier as was usually the case with employees who become disabled while employed. Had he done so, he would have been kept on the payroll.
Curik stated that the claims reviewers looked to the reason for termination in the personnel record and looked for no gap in time between employment with Smurfit-Stone and the date of onset of disability. Howington's personnel records showed a date last employed of September 27, 2007 but they do not show that he was on short-term disability or that he had left work because of a disabling condition. Curik contends she could not consider Howington's explanation for the mistaken onset date or his contention that he became disabled while employed because to do so would deviate from Pension Plan procedure. Curik admitted she had no reason to disbelieve Howington and agreed that there was no method under the Pension Plan for correcting his mistake.
Under the terms of the Pension Plan, benefits are paid from a Trust Fund defined as "the fund established under the Trust Agreement by contributions made by the Employers, and from which retirement benefits may be paid." (Defendants' Exhibit 3, Smurfit-Stone Container Corporation Pension Plan for Hourly Employees, p. 7). The Trust Agreement is defined as "the trust agreement made and entered into by the Company with the Trustee." (Id.).
The Pension Plan defines disability in § 5.16 which sets forth as follows:
(Defendants' Exhibit 3, p. 23).
The Pension Plan also provides for an Administrative Committee of at least three members appointed by the Board of Directors of Smurfit-Stone Container Enterprises, Inc., to serve as the Plan Administrator "and in that capacity, it will have the duties provided for the Plan Administrator in ERISA". (Defendants' Exhibit 3,
(Id., p. 36).
As to the Claims Procedure, the Pension Plan sets forth in relevant part, as follows:
(Id., p. 38). The Pension Plan also provides for review if the claim is denied (Id., pp. 38-39) Upon review of a denial,
(Id., p. 39 at § 11.5(d)).
As an ERISA benefit plan participant, Howington may bring a civil action to recover, enforce or clarify his rights to benefits under the terms of the Pension Plan. 29 U.S.C. § 1132(a)(1)(B). In that regard, "ERISA does not set out standards under which district courts must review an administrator's decision to deny benefits." Doyle v. Liberty Life Assur. Co. of Boston, 542 F.3d 1352, 1355 (11th Cir.2008) citing Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109, 109 S.Ct. 948, 953, 103 L.Ed.2d 80 (1989). The Court of Appeals for the Eleventh Circuit developed a six-step review process which has been modified in response to the decision in Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008). After Glenn, this circuit no longer requires the district courts to apply a heightened standard of review to a conflicted plan administrator's decision (the sixth step). Doyle, 542 F.3d at 1360.
Blankenship v. Metropolitan Life Ins. Co., 644 F.3d 1350, 1355 (11th Cir.2011) cert. denied, ___ U.S. ___, 132 S.Ct. 849, 181 L.Ed.2d 549 (2011) (amending the sixth step).
If there is a reasonable basis for the Plan Administrator's benefits decision, based upon the facts known at the time, it must be upheld as not an abuse of discretion or arbitrary or capricious, even where the evidence may support a different decision. Blankenship, 644 F.3d at 1354 citing Jett v. Blue Cross & Blue Shield of Ala., 890 F.2d 1137, 1139-1140 (11th Cir.1989) "[W]here the administrator exercises discretion, deferential (i.e., arbitrary and capricious) review is appropriate according to trust principles, which guide review of decisions affecting ERISA-governed plans." Doyle, 542 F.3d at 1356 (citation omitted). To determine whether the Plan Administrator's decision was arbitrary and capricious, the Court begins with the language of the Pension Plan. Oliver v. Coca Cola, Co., 497 F.3d 1181, 1195 (11th Cir. 2007).
Pursuant to ERISA, the Plan Administrator's fiduciary duties are defined as the "prudent man standard of care". 29 U.S.C. § 1104(a)(1)(A). The statute explains, in relevant part, that the "fiduciary shall discharge his duties with respect to a plan solely in the interest of the participants and beneficiaries and — (A) for the exclusive purpose of: (i) providing benefits to participants and their beneficiaries; and (ii) defraying reasonable expenses of administering the plan[.]" 29 U.S.C. § 1104(a)(1)(A). ERISA also states that the fiduciary shall act "with the care, skill, prudence, and diligence under the circumstances then prevailing that a prudent man acting in a like capacity and familiar with such matters would use in the conduct of an enterprise of a like character and with
In this action, the Plan Administrator has discretion to construe and interpret the terms of the Pension Plan and to determine all questions as to benefits. Also, because benefits are paid from the Trust Fund, the Plan Administrator does not have a conflict of interest. Therefore, this Court's review concludes at the fourth steps of the analysis. See Eady v. American Cast Iron Pipe Co., 203 Fed.Appx. 326, 326-329 (11th Cir.2006) (per curiam) (beginning the analysis at the third step and reviewing "the plan administrator's decision denying disability benefits to determine if it was arbitrary or capricious.").
In the order on summary judgment, the Court found that there was an "issue of fact as to whether the decision was based on mistaken information as to the date of last employment and therefore, was incorrect." (Doc. 41). Giving credibility to Howington's testimony that he wrote the wrong date of last employment and to Curik's testimony as to the date that Howington was last employed, the Plan Administrator's decision to deny Howington's benefits was based on mistaken information and therefore was incorrect. Howington contends that the Pension Plan acted arbitrarily and capriciously by not allowing an opportunity or a method to correct his mistake through the claims procedure process instead of requiring him to obtain an amendment of his SSA decision which was a legal impossibility.
There is no question that Howington made a mistake when he wrote down his alleged onset date and but for the mistake, he would have been awarded disability benefits under the Pension Plan. The question is whether the Plan Administrator's refusal to look beyond the SSA award to determine an onset date is arbitrary and capricious.
While that may be a reasonable interpretation of the plain language of the Pension Plan, the Plan Administrator still owes a fiduciary duty to Howington. Thus, "[a]lthough [Howington] is precluded from bringing a breach of fiduciary duty claim in conjunction with a wrongful denial of benefits claim," the Plan Administrator's "responsibilities as a fiduciary illustrates the proper standard of investigation."
Upon consideration of the foregoing, the decision is reversed and remanded to the Plan Administrator for further consideration and investigation as to Howington's onset of disability.
Pursuant to Rule 58 of the Federal Rules of Civil Procedure, judgment shall be entered by separate document.