Plaintiff Josh Porter brought suit against Defendants Lowe's Companies, Incorporated's Business Travel Accident Insurance Plan, and Gerber Life Insurance Company to challenge the Plan Administrator's denial of benefits under an ERISA Plan. The district court granted relief from that denial and awarded benefits, concluding that the Plan Administrator had abused its discretion. Because we find the Plan Administrator did not abuse its discretion, we reverse and render judgment in favor of the defendants.
This is a suit to recover benefits under a plan governed by the Employment Retirement Income Security Act of 1974 ("ERISA").
Elizabeth was an Administrative Manager at Lowe's. On February 24, 2008, she closed the store and was returning home when she received a call that the security alarm at Lowe's had been triggered. Elizabeth turned around to return to the store. She was one of three employees on call to respond to the alarm. En route to the store, her car was hit head-on by an automobile in the wrong lane of traffic. Both Elizabeth and her unborn child died.
The Plan provides benefits for a death that occurred on a bona fide business trip in furtherance of Lowe's business. The Plan provides in pertinent part:
(emphasis added).
As emphasized above, the Plan explicitly excludes from coverage injuries sustained "during travel to and from work." Thus the question of coverage turns on whether Elizabeth's accident occurred while she was on a "bonafide trip" — in which case Mr. Porter could recover benefits — or if her accident simply occurred "during travel to and from work" — in which case Mr. Porter could not recover benefits.
On May 14, 2008, Mr. Porter made a claim for benefits under the Plan. Newman investigated the claim and wrote to Lowe's to inquire into Elizabeth's employment schedule, her normal job duties, and whether she received a workers' compensation award. Lowe's responded that her workers' compensation claim was "accepted as compensable based on [the] fact she was on a special errand while returning to the store to shut off the alarm." (emphasis added). Newman also wrote to Lowe's: "As Mrs. Porter's name was on file with the alarm company as an employee responsible to reply to an alarm, please confirm that this was part of her regular job duties." Lowe's "confirm[ed] that responding to alarms was part of Elizabeth Porter's regular job duties." While the job description of Elizabeth's duties does not specifically list responding to security alarm triggers, it does state that her job "requires morning, afternoon and evening availability any day of the week."
On October 22, 2008, Newman issued an opinion denying benefits which stated that "[a]t the time of the motor vehicle crash, Mrs. Porter was traveling to work to perform her regular job duties, thus, she was not on Business for the Policyholder during any bonafide trip at the time of her motor vehicle crash." Mr. Porter appealed the denial and Newman again denied benefits.
Mr. Porter appealed to the district court. The parties agreed that there was no need for discovery and filed cross-motions for summary judgment. The district court found that Newman's conclusion that Elizabeth was not on a bona fide business trip was legally incorrect and an abuse of discretion.
The district court entered judgment for Mr. Porter in the sum of $181,830.37, plus pre-judgment interest, but later denied Mr. Porter's request for attorneys' fees because there was no "bad faith" in denying the claim.
"We review a district court's grant of summary judgment in ERISA cases de novo, applying the same standard as the district court."
When, as here, the ERISA plan grants the administrator the discretion to interpret the meaning of the plan, this court will reverse an administrator's decision only for an abuse of discretion.
Notably, this court can "bypass, without deciding, [the issue of] whether the Plan Administrator's denial was legally correct, reviewing only whether the Plan Administrator abused its discretion in denying the claim" if that can be "more readily determine[d]."
The district court found that because the Plan reserved to the Administrator the discretion in both plan interpretation and eligibility determination, the proper standard of review is the arbitrary and capricious standard. And the district court found that there was no conflict of interest, as the Administrator was not also insuring the Plan. Neither party challenges these conclusions on appeal.
The district court held that the determination by Newman, the Plan Administrator, to deny benefits was not legally correct because the "only fair construction to put on the phrase `travel to and from work' is travel in the ordinary daily commute" and found that this is the "commonly ascribed to this type of exclusion." After concluding that Newman's decision was not legally correct, the district court went on to conclude that the decision to deny benefits "was not supported by the evidence" and was an abuse of discretion.
Defendants argue that the district court essentially rewrote the terms of the Plan to cover Elizabeth's normal commute as a "bonafide business trip." They contend that Newman interpreted the phrase "travel to and from work" in its common sense meaning as dictated by this court's
Mr. Porter cites, and the district court relied upon, several cases with similar policy provisions as standing for the principle that accidents which take place during the ordinary commute are excluded from coverage, but business-related deviations beyond the normal commute — whether spatially or temporally — are covered.
Most notably, the district court cited Duffer v. American Home Assurance Co.
As discussed above, in our review of the Plan Administrator's decision this court can bypass, without deciding, whether the determination was legally correct, and move directly to whether the determination was an abuse of discretion.
Accordingly, we REVERSE the district court and RENDER judgment in favor of defendants.
RENDERED.
High, 459 F.3d at 578-79 (citations omitted); see also Winters v. Costco Wholesale Corp., 49 F.3d 550, 554 (9th Cir.1995) ("We hold that the rule of contra proferentem is not applicable to self-funded ERISA plans that bestow explicit discretionary authority upon an administrator to determine eligibility for benefits or to construe the terms of the plan.").