JERRY E. SMITH, Circuit Judge:
Donna Rhea was the beneficiary of an employee benefit plan organized under the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), 29 U.S.C. § 1001 et seq. Rhea suffered injuries from medical malpractice. The plan covered some of her medical expenses. After she settled the malpractice claim, the plan sought reimbursement.
The plan used a single document as both its summary plan description and its written instrument. That document had a reimbursement provision. Rhea refused to reimburse the plan, claiming that it did not have an enforceable written instrument. She sought a declaratory judgment and appeals an adverse summary judgment and attorneys' fees. Finding no error, we affirm.
Alan Ritchey, Inc. ("Alan Ritchey"), is the sponsor and administrator of an employee benefit program called the "Alan Ritchey, Inc. Welfare Benefit Plan" ("the Plan"), which purports to comply with ERISA. Rhea, the wife of an Alan Ritchey employee, was a beneficiary of the Plan. In November 2011, Rhea underwent surgery and alleged injury from malpractice. The Plan covered $71,644.77 of her medical expenses. After she settled the malpractice claim for more than that amount, the Plan sought reimbursement.
As a beneficiary, Rhea received a document entitled "Summary Plan Description UnitedHealthcare Choice Plus Silver Plan for Alan Ritchey, Inc." The summary plan description ("SPD") contains reimbursement and subrogation language. It states that "if a third party causes a Sickness or Injury for which you receive a settlement,
The SPD alludes to the existence of a separate "official Plan Document" and provides that "[i]n the event of any discrepancy between this Summary Plan Description and the official Plan Document, the Plan Document shall govern." But when the Plan paid Rhea's medical expenses, the SPD was the only document describing a beneficiary's rights and obligations under the Plan.
Rhea has refused to reimburse the Plan for the $71,644.77 it spent on her medical treatment. She claims that Alan Ritchey did not have an ERISA-compliant written instrument in place when the Plan paid her medical expenses. As a result, she says, the Plan does not have a right to be reimbursed. Rhea also accuses Alan Ritchey of making "knowing misrepresentations" about the Plan's compliance with ERISA. Defendants claim that the Plan was ERISA-compliant at all relevant times and that it established a right to be reimbursed for Rhea's medical expenses.
In September 2013, Rhea sued Alan Ritchey and the Plan for a declaratory judgment that she is not required to reimburse the Plan. Defendants filed a counterclaim requesting equitable relief and damages under ERISA. Both sides moved for summary judgment. The magistrate judge ("MJ") recommended granting summary judgment and $31,415.50 in attorneys' fees and costs to defendants. The district court adopted those recommendations and entered final judgment against Rhea, who appeals.
ERISA requires plan administrators to provide SPDs to beneficiaries. 29 U.S.C. § 1024(b)(1). An SPD must "reasonably apprise [plan] participants and beneficiaries of their rights and obligations under the plan" and must be "written in a manner calculated to be understood by the average plan participant." Id. § 1022(a). ERISA also mandates that plans "be established and maintained pursuant to a written instrument." Id. § 1102(a)(1). A plan's written instrument sets forth its terms and must do the following:
Id. § 1102(b). Courts often refer to written instruments as "plan documents."
When the Plan paid Rhea's medical expenses, its SPD was functioning as both an SPD and a written instrument. That is nothing peculiar: Plan sponsors commonly use a single document to satisfy both requirements,
Rhea claims that CIGNA Corp. v. Amara, 563 U.S. 421, 437-38, 131 S.Ct. 1866, 179 L.Ed.2d 843 (2011), requires a plan's SPD and written instrument to be separate documents. But courts have consistently rejected that reading of Amara.
Amara arose from a dispute between CIGNA and its pension plan's beneficiaries. Until 1997, CIGNA had a traditional defined-benefit pension plan. It issued an SPD announcing changes while assuring beneficiaries that the new plan would provide "the same benefit security" with "steadier benefit growth." Id. at 426-28, 131 S.Ct. 1866. Eleven months later, CIGNA rolled out its new written instrument, which reduced benefits considerably. Id. at 426-31, 131 S.Ct. 1866. The beneficiaries challenged CIGNA's adoption of the new plan. Id. at 424, 131 S.Ct. 1866.
The United States submitted a brief as amicus curiae urging that the (more favorable) terms of the SPD should govern rather than the (less favorable) terms of the written instrument. The Court rejected the premise that SPDs are inherently enforceable: "[W]e cannot agree that the terms of statutorily required plan summaries... necessarily may be enforced ... as the terms of the plan itself." Id. at 436, 131 S.Ct. 1866 (emphasis added). The Court added that a plan's written instrument contains its terms. Id. at 436-38, 131 S.Ct. 1866.
The present case is factually distinguishable from Amara. We are not grappling with a conflict between an SPD and a written instrument but, instead, are deciding whether an SPD can function as a written instrument in the absence of a separate written instrument. As the district court correctly concluded, Amara does not bear on these facts.
Rhea claims that the SPD does not comply with § 1102(b) because it does not go into enough depth about how the Plan is funded or how it can be amended. Here, too, we disagree.
The SPD devotes a few paragraphs to discussing the Plan's amendment procedures. It explains that the Plan's sponsor reserves the right to amend the Plan without notice, but any amendment must be in writing. The SPD also provides that "[a]ny provision of the Plan which, on its effective date, is in conflict with the requirements of federal statutes or regulations, or applicable state law provisions not otherwise preempted by ERISA ... is hereby amended to conform to the minimum requirements of such statutes and regulations." Rhea describes the SPD's amendment
The SPD includes a brief discussion of the Plan's funding. An addendum to the SPD provides that "[a]ll Benefits under the Plan are paid from the general assets of the Plan Sponsor. Any required employee contributions are used to partially reimburse the Plan Sponsor for Benefits under the Plan." The same section includes a short description of how employee contributions are calculated. Elsewhere, the SPD instructs Plan participants to contact their benefits representatives for more information about contributions. The SPD does not mention its source of funding: the Alan Ritchey, Inc. Employee Benefit Plan Trust (though it does name "Alan Ritchey, Inc." as the plan sponsor).
Rhea is right that the SPD does not lay out complex amendment or funding procedures. But ERISA does not require written instruments to set forth complex procedures. In fact, the Supreme Court has approved of an amendment procedure less detailed than the one in this case. See Curtiss-Wright Corp. v. Schoonejongen, 514 U.S. 73, 79-80, 115 S.Ct. 1223, 131 L.Ed.2d 94 (1995). Given that precedent, it is unlikely that the Court would find the amendment procedure here to be lacking. Likewise, the SPD's discussion of the Plan's funding is sufficient to satisfy ERISA's requirements.
Rhea claims that the SPD was never adopted as the Plan's written instrument. But when an SPD is a plan's only plausible written instrument, courts assume that the SPD is the written instrument. In Feifer v. Prudential Ins. Co. of America, 306 F.3d 1202, 1208-10 (2d Cir. 2002), the court concluded that an SPD's terms were controlling even though the plan administrator had argued otherwise.
The Plan's SPD references an "official Plan Document" that does not exist. Defendants did not inform Rhea that they considered the SPD to be the official plan document until her lawyers asked to see the plan document. Rhea claims that defendants "lied" to her and therefore should not be able to enforce the SPD as the plan document. For support, Rhea cites cases holding that plan administrators breached their duty of loyalty to beneficiaries when they lied or misrepresented material facts.
We agree with the MJ's conclusion that the equities favor the defendants. Rhea had a pre-existing obligation to reimburse the Plan for payments it made for her medical expenses in the event she received a third-party recovery. The SPD's errant disclaimer does not tip the balance of the equities in her favor. When Rhea settled her malpractice claim, an equitable lien by agreement was created.
The district court adopted the MJ's recommendation to award $29,412 in attorneys' fees and $2,003.50 in court costs to defendants. The MJ found that the fee award was appropriate under 29 U.S.C. § 1132(g)(1), which gives discretion to award reasonable attorneys' fees and court costs in ERISA cases. This court reviews an ERISA fee award for abuse of discretion.
To determine whether to award fees under § 1132(g)(1), we weigh the factors in Iron Workers Local No. 272 v. Bowen, 624 F.2d 1255 (5th Cir. 1980).
(1) the degree of the opposing parties' culpability or bad faith; (2) the ability of the opposing parties to satisfy an award of attorneys' fees; (3) whether an award of attorneys' fees against the opposing parties would deter other persons acting under similar circumstances; (4) whether the parties requesting attorneys' fees sought to benefit all participants and beneficiaries of an ERISA plan or to resolve a significant legal question regarding ERISA itself; and (5) the relative merits of the parties' positions.
Id. at 1266 (footnote omitted).
In his report on attorneys' fees and court costs, the MJ considered each of these factors, including, most significantly, that Rhea was at least arguably acting in
AFFIRMED.
Wilson v. Walgreen Income Prot. Plan, 942 F.Supp.2d 1213, 1248 n.26 (M.D. Fla. 2013). But the following year, the Eleventh Circuit construed Amara much more narrowly. See Montanile, 593 Fed.Appx. at 910.