RONALD E. BUSH, Magistrate Judge.
Now pending before the Court is Defendant Reliance Standard Life Insurance Company's ("Reliance") Motion for Summary Judgment (Docket No. 19). Having carefully reviewed the record, participated in oral argument, and otherwise being fully advised, the undersigned enters the following Report and Recommendation:
1. Reliance issued to Clearwater Paper Corp. ("Clearwater"),
2. Relevant here, benefits are calculated under the Plan pursuant to the following "benefit provisions" within the Policy:
Id. at SOF Nos. 5, 6 & 12 (quoting Ex. A to Pope Aff. at pp. 1.0 & 9.0 (Docket No. 19, Att. 3)). Moreover, the Policy states that:
Id. at SOF No. 7 (quoting Ex. A to Pope Aff. at p. 9.0 (Docket No. 19, Att. 3)).
3. Ms. Nye was an employee of Clearwater and, in 2009, submitted a claim for disability under the Plan which was approved; since that time, her disability status has not changed. See id. at SOF No. 2.
4. Since Ms. Nye's claim for disability was approved, her benefits have been recalculated on several occasions. See id. at SOF No. 3
5. The first Monthly Benefit adjustment occurred in June 2011, based on Ms. Nye's May 28, 2011 award of Social Security Disability benefits. See id. at SOF No. 8. Reliance's June 6, 2011 letter to Ms. Nye stated in relevant part:
Id. at SOF Nos. 8 & 9 (quoting Ex. B to Pope Aff. (Docket No. 19, Att. 4));
6. The second Monthly Benefit adjustment occurred on August 15, 2011 when Reliance learned of Ms. Nye's June/July 2011 award of Dependent Social Security Disability benefits in the amount of $1,098.00 per month beginning in June 2009. See SOF No. 10 (Docket No. 20) (citing Ex. C to Pope Aff. (Docket No. 19, Att. 5).
7. On September 2, 2011, the entity representing Ms Nye in her Social Security claim made a partial payment to Reliance in the amount of $41,584.08. See id. at SOF No. 11; see also Ex. C to Pope Aff. (Docket No. 19, Att. 5) (referencing "payment made on 9/2/2011" in amount of $41,584.08). This partial payment reduced the balance of the overall overpayment to $24,849.30. See id.
8. On February 27, 2012, Reliance identified another error, in that Ms. Nye's Gross Monthly Benefit had not been properly adjusted. See SOF No. 13 (Docket No. 20) (citing Ex. D to Pope Aff. (Docket No. 19, Att. 6) (February 27, 2012 letter from Matrix Absence Management, Inc. ("Matrix"), the Policy's claims administrator,
9. On July 10, 2012, Mr. Cannon — on behalf of Ms. Nye — requested "all documents, records, and or other information relevant to Ms. Nye's claim" from Matrix. See Ex. A to Cannon Aff. (Docket No. 32, Att. 1).
10. On July 19, 2012, Matrix provided Mr. Cannon with the "Claim Report" for Ms. Nye. See Ex. B to Cannon Aff. (Docket No. 32, Att. 2).
11. On August 23, 2012, Mr. Cannon responded to Matrix's February 27, 2012 letter, appealing the latter's "decision regarding overpayment and seek[ing] a review and redetermination." Ex. C to Cannon Aff. (Docket No. 32, Att. 3). Mr. Cannon claimed that "[t]his appeal is based upon the company errors which have left Ms. Nye in a very difficult financial position," before going on to say:
Id.
12. On November 2, 2012, Reliance discovered that the earlier change in Covered Monthly Earnings should have occurred on March 6, 2011, not March 6, 2010 as previously calculated in February 2012 — resulting this time in an underpayment of $8,994.92. See SOF No. 14 (Docket No. 20). Applying the underpayment ($8,994.92) to the then-pending overpayment balance ($37,581.72) reduced the actual overpayment amount to $28,586.80. See id. Even so, Reliance contends that, "as a courtesy to [Ms. Nye]," it decided not to recover the overpayment based on the calculation of Covered Monthly Earnings, thus reducing the balance Ms. Nye owed to Reliance from $28,586.80 to $24,849.30. See id; see also Ex. C to Pope Aff. (Docket No. 19, Att. 15) (November 19, 2012 letter from Reliance to Mr. Cannon, stating in part: "Unfortunately, the use of March 6, 2010 was incorrect as it did not encompass the entire 18-month period. The Covered Monthly Earnings percentage change should have occurred on March 6, 2011. Based on these events, RSL, at this time, has decided to not pursue the overpayment amount in regards to Ms. Nye's Covered Monthly Earnings percentage change.").
13. On November 19, 2012, Reliance communicated the findings of its independent review to Mr. Cannon, acknowledging that (1) its original decision regarding an overpayment of Ms. Nye's Monthly Benefits as to her Covered Monthly Earnings "was calculated incorrectly," but (2) the calculation regarding Ms. Nye's Social Security Disability benefits "was correct," and (3) "an outstanding balance of $24,849.30 remains." See Ex. C to Pope Aff. (Docket No. 19, Att. 15).
Id.
14. On March 14, 2013, Mr. Cannon noted his "disagree[ment] with the results of Reliance['s] findings" in a letter to Reliance, while again "request[ing] all materials the company used in rendering its denial." Ex. D to Cannon Aff. (Docket No. 32, Att. 4). Mr. Cannon also cited legal authority which he said "will guide the Idaho Federal District Court awarding Ms. Nye an amount equal to all withheld funds, her attorney fees and costs, along with the prospects of exemplary damages." Id.
15. On April 19, 2013, Reliance responded to Mr. Cannon's March 14, 2013 letter, advising him that (1) its internal guidelines permit only one administrative appeal, (2) the appeal was concluded, and (3) its decision to uphold the initial denial was communicated to him on June 29, 2012. See Ex. E to Cannon Aff. (Docket No. 32, Att. 5).
16. Reliance has continued to reduce the overpayment by withholding the monthly benefit of $440.00 per month in accordance with the Policy's terms. See SOF No. 15 (Docket No. 20). During that time, the overpayment balance has decreased to approximately $8,000.00 (as of the filing of Reliance's Motion for Summary Judgment). See id. Reliance intends to continue withholding the monthly benefit until the overpayment is erased. See id.
17. On December 12, 2013, Ms. Nye sued in Idaho state court. See Compl. (Docket No. 1, Att. 1). Ms. Nye's Complaint references Reliance's June 6, 2011 letter and Matrix's February 27, 2012 letter and the alleged overpayments stated therein. See id. at ¶¶ VI-VII. As to each, Ms. Nye contends that Reliance's withholding of monthly benefits ($13,655.50 as of December 12, 2013) is "wrongful and prejudicial . . . and is a violation and breach of her contract for Long Term Disability" as well as "a violation of Contract Rules and her rights under ERISA." Id.; see also id. at ¶ IX ("WHEREFORE, Plaintiff prays for judgment against Defendants, jointly and severally . . . [f]or benefits wrongfully withheld from Plaintiff in the amount of $13,655.50, accruing monthly.").
18. On January 21, 2014, Reliance removed the case to this Court pursuant to 28 U.S.C. § 1441(c), as an action arising under federal law. See Not. of Removal (Docket No. 1).
19. On December 3, 2014, Reliance filed the pending Motion for Summary Judgment, arguing that the Policy permits the repayment of overpaid benefits through a reduction in monthly benefits. See Mem. in Supp. of MSJ, pp. 1-2 (Docket No. 19, Att. 1) ("Under the plain language in the Policy, if a benefit is overpaid `the overpayment must be repaid to [Reliance].' Moreover, the Policy provides that Reliance `may reduce the Monthly Benefit' to recover any overpayment.'"). In short, Reliance contends that it is legally entitled to a reduction in Ms. Nye's monthly benefit payments until the outstanding overpayment amount is satisfied.
The several twists and turns of this dispute described above present a somewhat convoluted backdrop. Even so, the issues presented here are precise enough: (1) can Reliance offset/reduce Ms. Nye's monthly long term disability benefit payments in an amount equal to her Primary and/or Dependent Social Security awards? and, relatedly, (2) can Reliance recover the overpayment of monthly long term disability benefits (owing to such after-the-fact awards) via a reduction/withholding of the monthly benefit payment itself? Reliance says yes, having withheld and continuing to withhold Ms. Nye's monthly benefit until the overpayment amount is accounted for in full. See Mem. in Supp. of MSJ, pp. 5-9 (Docket No. 19, Att. 1). Ms. Nye does not dispute that the Plan/Policy seems to permit Reliance's specific actions; instead, she argues that such actions are not permitted by equitable principles found in applicable case law. See Resp. to MSJ, p. 2 (Docket No. 26) ("Plaintiff does not contend that the Policy's provisions do not provide for a reduction of her monthly benefit to recoup past overpayments; however, Plaintiff disagrees that the law provides that the Plan's terms control in all circumstances where an overpayment has been made where the mistake was no fault of the plan participant, especially when the participant has become accustomed to the monthly benefit payments and to withhold the same creates substantial hardship for the plan participant.").
Although Ms. Nye's Complaint does not assert a specific cause of action per se, she obviously seeks to recover benefits she believes are due to her and remain unpaid under the terms of the Plan/Policy. See Compl., ¶¶ VI-VII (Docket No. 1, Att. 1) ("[S]uch withholding has been, and is wrongful and prejudicial to the Plaintiff and is a violation and breach of her contract for Long Term Disability. . . . Such breaches are a violation of Contract Rules and her rights under ERISA and have directly caused Plaintiff to suffer damages. . . ."). In this respect, then, the claim or claims contained within Ms. Nye's Complaint are governed by federal law — i.e., ERISA. See 29 U.S.C. § 1132(a)(1)(B). "In actions challenging denials of benefits pursuant to 29 U.S.C. § 1132(a)(1)(B), the district court reviews de novo `unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.'" Cady v. Hartford Life & Accidental Ins. Co., 930 F.Supp.2d 1216, 1223 (D. Idaho 2013) (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)). "If the plan unambiguously confers discretionary authority, then the standard of review shifts to abuse of discretion." Cady, 930 F. Supp. 2d at 1223 (citing Firestone, 489 U.S. at 115; Kearney v. Standard Ins. Co., 175 F.3d 1084, 1089 (9th Cir. 1999)).
Here, Reliance concedes that "[t]he Plan in this case does not contain an explicit grant of discretionary authority to Reliance" and, "[t]herefore, the de novo standard of judicial review applies." Mem. in Supp. of MSJ, p. 6 (Docket No. 19, Att. 1) (citing Kearney v. Std. Ins. Co., 175 F.3d 1084, 1089 (9th Cir. 1999)). Under the de novo standard of review, the Court gives no deference to Reliance's decisions regarding Ms. Nye's benefits; rather, the Court evaluates whether Reliance correctly or incorrectly denied benefits, cross referenced against the summary judgment standard. See Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006).
Summary judgment is appropriate where a party can show that, as to any claim or defense, "there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a). One of the principal purposes of the summary judgment "is to isolate and dispose of factually unsupported claims. . . ." Celotex Corp. v. Catrett, 477 U.S. 317, 323-24 (1986). It is "not a disfavored procedural shortcut," but is instead the "principal tool[] by which factually insufficient claims or defenses [can] be isolated and prevented from going to trial with the attendant unwarranted consumption of public and private resources." Id. at 327. "[T]he mere existence of some alleged factual dispute between the parties will not defeat an otherwise properly supported motion for summary judgment." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48 (1986). There must be a genuine dispute as to a material fact — a fact "that may affect the outcome of the case." Id. at 248.
The evidence must be viewed in the light most favorable to the non-moving party, and the Court must not make credibility findings. See id. at 255. Direct testimony of the non-movant must be believed, however implausible. See Leslie v. Grupo ICA, 198 F.3d 1152, 1159 (9
The moving party bears the initial burden of demonstrating the absence of a genuine dispute as to material facts. See Devereaux v. Abbey, 263 F.3d 1070, 1076 (9th Cir. 2001). To carry this burden, affirmative evidence is not required. Instead, the moving party may simply point out the absence of evidence to support the nonmoving party's case. See Fairbank v. Wunderman Cato Johnson, 212 F.3d 528, 532 (9th Cir. 2000). This then shifts the burden to the non-moving party to produce evidence sufficient to support a jury verdict in her favor. See Devereaux, 263 F.3d at 1076. The non-moving party must go beyond the pleadings and show "by her [] affidavits, or by the depositions, answers to interrogatories, or admissions on file" that a genuine dispute of material fact exists. Celotex, 477 U.S. at 324.
ERISA requires that "[e]very employee benefit plan shall be established and maintained pursuant to a written instrument," and an administrator must act "in accordance with the documents and instruments governing the plan" insofar as they accord with the statute. 29 U.S.C. §§ 1102(a)(1), 1104(a)(1)(D). "Each such plan must (1) provide a policy and a method for funding the plan, (2) describe a procedure for plan operation and administration, (3) provide a procedure for amending the plan, and (4) specify a basis for payments to and from the plan." Cinelli v. Sec. Pac. Corp., 61 F.3d 1437, 1441-42 (9th Cir. 1995) (internal quotation marks and citation omitted); see also 29 U.S.C. § 1102(b). ERISA's statutory scheme "is built around reliance on the face of written plan documents" and reflects ERISA's principal function: to "protect contractually defined benefits." US Airways, Inc. v. McCutchen, 133 S.Ct. 1537, 1548 (2013) (internal quotation marks and citations omitted).
Here, under its plain language, the Plan provides that "Other Income Benefits" received by a claimant are to be subtracted from the claimant's monthly "Benefit Amount." See supra. Importantly, the Plan defines "Other Income Benefits" to include primary and dependent "disability or Retirement Benefits under the United States Social Security Act." Id. Courts within the Ninth Circuit have consistently enforced nearly-identical offset provisions relating to a claimant's receipt of primary and dependent Social Security benefits. See Franks v. Aetna Life Ins. Co., 2012 WL 5372578, *4 (N.D. Cal. 2012) (granting defendant administrator's motion for summary judgment, finding that plan documents "conclusively demonstrate that the policy contains offset provisions for other income such as social security benefits."); Ayers v. Life Ins. Co. of North America, 869 F.Supp.2d 1248, 1267 n.9 (D. Or. 2012) ("[T]he terms of the Policy allow LINA to offset monthly benefits by the assumed receipt of other income, including SDDI benefits. Therefore, LINA had the right to withhold LTD benefits regardless of whether Ayers applied for or received SSDI . . . ."); Mayhew v. Hartford Life and Acc. Ins. Co., 822 F.Supp.2d 1028, 1035 (N.D. Cal. 2011) (acknowledging lack of Ninth Circuit authority on point (but see Bilyeu v. Morgan Stanley Long Term Disability Plan, discussed infra), but still holding that "the express terms of the Plan support offsetting the DSSD benefits" and "to hold that Mayhew's DSSD benefits do not constitute a benefit for loss of income would render this language entirely superfluous.").
With all this in mind, the Court recommends a holding that the express terms of the Plan allow for Ms. Nye's monthly long term disability benefit payments to be offset by her Social Security awards (primary and dependent). However, such a holding does not mean ipso facto that Reliance is justified in withholding Ms. Nye's monthly long term disability benefit payments to recover in full an overpayment of benefits due to those same later-in-time awards. The Court addresses this more nuanced issue below.
Reliance points out that it is not asking Ms. Nye to pay any money to Reliance from her existing personal assets, highlighting the fact that the undisputed overpayment resulting from her Social Security awards is being satisfied by reducing/withholding benefits that have not yet been paid and, therefore, were never in Ms. Nye's possession. See Mem. in Supp. of MSJ, p. 8 (Docket No. 19, Att. 1). As before, Reliance notes that this is expressly permitted by the Plan and Policy language. See id. Ms. Nye argues that the proposition is not so black and white, contending that, for equitable reasons, her monthly long term disability benefit payments should not be reduced or withheld when the overpayment was the result of a mistake for which she had no fault. See Resp. to MSJ, pp. 2-4 (Docket no. 26).
Ms. Nye's arguments and the cases she relies upon are, however, insufficient to carry the day on this issue. First, it goes too far to say that the overpayment in question here was the result of Reliance's (or anybody's) mistake.
Second, any argument that Bilyeu v. Morgan Stanley Long Term Disability Plan, 683 F.3d 1083 (9th Cir. 2012), supports Ms. Nye's position here, is misplaced.
Importantly, Unum had already terminated Bilyeu's benefits under the plan provision which carried a limit of 24 months of disability benefits due to mental illness (leading to Bilyeu's underlying claim to reinstate benefits). See id. at 1086-87. Hence, at the time of its counterclaim Unum had no means of offsetting the overpayment against future long term disability payments. Instead, through its counterclaim, Unum sought to recover the overpayment directly from Bilyeu, asserting a claim for equitable relief under ERISA (in the form of an equitable lien), as well as a claim for breach of contract. See id. at 1087-88. In vacating the district court's entry of summary judgment in Unum's favor, the Ninth Circuit examined the United States Supreme Court's analysis of equitable liens in Sereboff v. Mid Atl. Med. Servs., Inc., 547 U.S. 356 (2006). See id. at 1091.
In Sereboff, the Supreme Court held that a provision of an ERISA plan calling for recovery of funds where the beneficiary had also recovered from a third party was an "equitable lien by agreement," and an action to enforce it was "equitable" in nature, even though it shared many of the characteristics of a legal action for breach of contract. See id. at 362-63. The Court distinguished this holding from several of its previous decisions by noting that, in the case before it, the funds sought by the trustee (settlement proceeds) were "specifically identifiable" and "within the possession and control" of the beneficiaries. Id.
In turn, the Ninth Circuit in Bilyeu interpreted Sereboff to establish three criteria for securing a claim for equitable lien by agreement in an ERISA action: first, a promise by the beneficiary to reimburse the fiduciary for benefits paid under the plan in the event of a recovery from a third party; second, a reimbursement agreement that specifically identifies a particular fund, distinct from the beneficiary's general assets; and third, the funds being specifically identified by the fiduciary must be within the possession and control of the beneficiary. Bilyeu, 683 F.3d at 1092-93.
The narrow precedent of Bilyeu is of limited use when resolving Reliance's Motion for Summary Judgment and its attendant facts. Preliminarily, unlike the facts in Bilyeu and Sereboff, Reliance has not asserted an equitable lien or any other claim for that matter against Ms. Nye. This is made apparent not only by the fact that there is no actual pleading from Reliance in which it asserts any claim against Ms. Nye to account for the overpayment of long disability benefits, but also because Reliance is not attempting to recover any money from Ms. Nye's assets vis à vis the overpayment. Had Ms. Nye's long term disability payments ceased for whatever reason or had already been paid out, and Reliance then tried to proactively recover any intervening overpayment amount through litigation, Bilyeu's reach might well be tested, perhaps to Ms. Nye's ultimate benefit. But that is not the case here. This record involves Reliance reducing Ms. Nye's existing and ongoing Monthly Benefits per the Plan documents and Reimbursement Agreement. Simply put, there is no claim of an equitable lien that this Court must scrutinize. As a result, Bilyeu does not apply.
With all this in mind, the Court circles back to the Plan, recognizing that its clear terms control over Ms. Nye's understandable pleas for equitable relief here. As the Supreme Court recently counseled in McCutchen:
McCutchen, 133 S.Ct. at 1548 (internal quotation marks and citations omitted). The Court acknowledges that there is an equitable pull that leans the way of Ms. Nye because of the economic strain into which she has been placed. But the equities in this case have competing claims, given the fact of the prior over payments, and the Plan at issue in this action permits Reliance to do what it has done and what it continues to do — recover an overpayment of benefits resulting from social security awards by reducing/withholding monthly long term disability benefit payments. Reliance's Motion for Summary Judgment should therefore be granted.
Based on the foregoing, IT IS HEREBY RECOMMENDED that Defendant Reliance Standard Life Insurance Company's ("Reliance") Motion for Summary Judgment (Docket No. 19) be GRANTED.
Pursuant to District of Idaho Local Civil Rule 72.1(b)(2), a party objecting to a Magistrate Judge's recommended disposition "must serve and file specific, written objections, not to exceed twenty pages . . . within fourteen (14) days. . ., unless the magistrate or district judge sets a different time period." Additionally, the other party "may serve and file a response, not to exceed ten pages, to another party's objections within fourteen (14) days after being served with a copy thereof."
Id.
Ex. B to Cannon Aff. (Docket No. 32, Att. 2).
See supra (citing Def.'s SOF No. 7 (quoting Ex. A to Pope Aff. at p. 9.0 (Docket No. 19, Att. 3))).