Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca8-09-01880/USCOURTS-ca8-09-01880-0/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 

---

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 09-1880

___________

Diane Chorosevic; Lawrence * 

Chorosevic, on behalf of themselves * 

and all others similarly situated, * 

* 

Appellants, * 

* Appeal from the United States

v. * District Court for the 

* Eastern District of Missouri.

MetLife Choices; Metropolitan Life * 

Insurance Company; United Healthcare * 

Insurance Company; United Healthcare * 

of Alabama, Inc.; United Healthcare of *

Arizona, Inc.; United Healthcare of *

Arkansas, Inc.; United Healthcare of *

Colorado, Inc.; United Healthcare of *

Florida, Inc.; United Healthcare of *

Georgia, Inc.; United Healthcare of *

Illinois, Inc.; United Healthcare of *

Kentucky, Inc.; United Healthcare of *

Louisiana, Inc.; United Healthcare of *

Mid-Atlantic, Inc.; United Healthcare *

of the Midlands, Inc.; United *

Healthcare of the Midwest, Inc.; United *

Healthcare of Mississippi, Inc.; United *

Healthcare of New England, Inc.; *

United Healthcare of New Jersey, Inc.; *

United Healthcare of New York, Inc.; *

United Healthcare of North Carolina, *

Inc; United Healthcare of Ohio, Inc.; *

United Healthcare of Tennessee, Inc.; *

United Healthcare of Texas, Inc.; *

United Healthcare of Utah, Inc.; United *

Appellate Case: 09-1880 Page: 1 Date Filed: 04/02/2010 Entry ID: 3651026
Healthcare of Wisconsin, Inc.; *

Uniprise, Inc.; United Healthcare *

Service Corporation; United *

Healthgroup, Inc., *

*

 Appellees. *

___________

Submitted: December 15, 2009

Filed: April 2, 2010

___________

Before RILEY, Chief Judge,1

 WOLLMAN, and MELLOY, Circuit Judges.

___________

MELLOY, Circuit Judge.

Appellant Lawrence Chorosevic pursues this ERISA2

 action on behalf of

himself and others similarly situated, alleging that Appellees improperly calculated

secondary health benefits owed to him for services rendered in 2004. The district

court3

 denied class certification and granted Appellees’ motion for summary judgment

due to Chorosevic’s failure to exhaust available administrative remedies. Chorosevic

argues that the district court erred by denying class certification, denying further class

discovery, granting Appellees’ motion for leave to file answers out-of-time, and

granting summary judgment. For the following reasons, we affirm. 

1

The Honorable William Jay Riley became Chief Judge of the United States

Court of Appeals for the Eighth Circuit on April 1, 2010.

2

Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq.

3

The Honorable Charles A. Shaw, United States District Judge for the Eastern

District of Missouri. 

-2-

Appellate Case: 09-1880 Page: 2 Date Filed: 04/02/2010 Entry ID: 3651026
I. Background

In 2004, Chorosevic received health insurance benefits through two

ERISA-covered employee welfare benefit plans: a plan issued by Blue Cross and Blue

Shield of Missouri (“BCBS”) and a plan issued by Appellee Metropolitan Life

Insurance Company (“MetLife”) known as the MetLife Choices Plan (“the Choices

Plan”). Chorosevic was eligible for coverage under the Choices Plan through his wife,

Diane (“Mrs. Chorosevic”), who was formerly employed by a wholly owned

subsidiary of MetLife. The plan administrator of the Choices Plan was MetLife, and

the claims administrator was Appellee United HealthCare Insurance Company

(“United”).4

 Accordingly, MetLife had full discretion in determining benefit

eligibility, whereas United reviewed benefit decisions and had final decision-making

authority on whether or not to pay a claim. 

Coordination of benefits, which occurs when a person has more than one source

of reimbursement for health care expenses, is of central importance in this lawsuit. 

BCBS was Chorosevic’s primary insurer, meaning that BCBS was obligated to pay

first when Chorosevic made a claim for medical benefits. The 2003 Summary Plan

Description (“SPD”) for the Choices Plan included a provision for coordinating

benefits, which the parties refer to as the “come out whole” method with a benefits

reserve.5

 According to Chorosevic, this method required the Choices Plan to credit

4

United, its state and regional affiliates, and its parent companies are

collectively referred to in this opinion as “United.”

5

The SPD provides:

If the MetLife Plan is secondary, it adjusts benefits so that your total

reimbursement from all plans is no more than the total allowable

expenses. The amount by which the MetLife’s Plans benefits have been

reduced shall be used by the MetLife Plan to pay allowable expenses not

otherwise paid, which were incurred during the calendar year by the

person for whom the claim is made. 

-3-

Appellate Case: 09-1880 Page: 3 Date Filed: 04/02/2010 Entry ID: 3651026
the money that it saved by being the secondary insurer to a reserve, which could be

used to reimburse a claimant for out-of-pocket expenses during the applicable

calendar year. 

The SPD also set forth procedures for submission of claims and appeals, stating

in part: “Participants wanting to dispute an adverse benefit determination, payment

amount or plan interpretation that relates to the receipt of plan benefits or exercise of

a current right available under the plan must file a claim within 180 days of receipt of

the adverse determination.” United would review the benefits determination and issue

a final decision within thirty days, unless a fifteen-day extension was needed. If

United upheld a denial of benefits, a dissatisfied plan participant had sixty days from

the notification letter’s date to submit a second appeal. After that sixty-day period,

no further administrative appeals were permitted under the SPD. United was to

review second appeals and determine benefits payable within thirty days. 

Chorosevic’s claims relate to medical services he received on June 17 and

August 20, 2004. For each of those services, the BCBS plan paid an amount and

United determined that the Choices Plan owed nothing. Consequently, Chorosevic

incurred out-of-pocket expenses in the following amounts: $13.00 for services

rendered on June 17, 2004; $69.20 for services rendered on August 20, 2004; and

$190.10 for services rendered on August 20, 2004. For each benefits determination,

United issued an Explanation of Benefits (“EOB”) to Chorosevic describing the

appeals procedure, including the 180-day deadline for requesting review of the

benefits determination. 

On November 17, 2004, Mrs. Chorosevic wrote to United, disputing the

determination of secondary benefits under the Choices Plan related to her husband’s

$69.20 claim. Mrs. Chorosevic complained that United was using the wrong preferred

provider rates, which caused it to understate the amount that the Choices Plan saved

-4-

Appellate Case: 09-1880 Page: 4 Date Filed: 04/02/2010 Entry ID: 3651026
by being a secondary benefits provider. Mrs. Chorosevic attached copies of the EOBs

from BCBS and United and the hospital bill showing $69.20 due. She also addressed

what she called a “multiple coverage limitation” credit, explaining that “[United]

saves money as the secondary carrier and that money should be used to pay any

remaining charges in full, if the secondary carrier does not pay them.” 

United denied Chorosevic’s appeal on December 7, 2004, concluding that

Chorosevic’s claim for benefits was processed correctly. The denial letter explained

the coordination-of-benefits procedure under the Choices Plan in a way that appears

inconsistent with the so-called come-out-whole method with a benefits reserve. The

denial letter also notified Chorosevic of his right to submit a second appeal of the

adverse benefits determination, which he did not do. 

On January 26, 2005, Sharon Bibby, a senior benefits specialist at MetLife, sent

a letter to Mrs. Chorosevic stating that United incorrectly processed the $69.20 claim

and that MetLife directed United to pay Mrs. Chorosevic $69.20 related to the claim

(“the Bibby letter”). This payment, the parties agree, resolved the $69.20 claim. The

letter continued: “[United] is reviewing your other claims as well. We are also

working with [United] to review and if necessary take corrective action regarding all

of the MetLife secondary coordination-of-benefits claims processed by [United].”

On April 28, 2005, Mrs. Chorosevic wrote to Bibby, detailing her belief that

United improperly processed her husband’s claims in 2002, 2003, and 2004. She

attached several EOBs and requested reprocessing of “any claims where [United] did

not make payment” since 2002. Additionally, Mrs. Chorosevic specifically addressed

the issue of “banked money” and explained, “During those years [United] saved a

considerable amount of money as the secondary carrier for which I should not have

incurred any out-of-pocket expenses.” MetLife did not respond to the April 28 letter. 

Then, on May 23, 2005, Mrs. Chorosevic sent a letter to United requesting that United

reprocess her husband’s claims and pay them out of the “banked money” account. 

She explained, “Since I was not aware that I could request reimbursement out of the

-5-

Appellate Case: 09-1880 Page: 5 Date Filed: 04/02/2010 Entry ID: 3651026
‘banked money’ account, I am doing so now.” Fourteen days later, on June 7, 2005,

Mr. and Mrs. Chorosevic commenced this litigation. 

Effective January 1, 2006, MetLife amended the Choices Plan to change its

method of coordinating secondary benefits to a “non-duplication” method without a

benefits reserve. The non-duplication method is less favorable for plan members

because the Choices Plan generally pays less secondary benefits and the money the

Plan saves by being a secondary insurer is not placed in a reserve for the member’s

allowed out-of-pocket expenses. Chorosevic does not allege that Appellees

improperly processed benefits under the non-duplication method, and therefore, this

lawsuit concerns only the coordination of benefits prior to 2006.

In August 2007, United entered into a regulatory settlement agreement, which

over thirty states have joined. The State of Missouri joined the agreement by entering

a memorandum of understanding with United in November 2008. The settlement

agreement identifies coordination of benefits as an area of review and requires United

to reprocess claims, make restitution to past and present insureds, and make restitution

with interest on underpaid claims. However, neither the settlement agreement nor the

memorandum of understanding covers members of self-funded plans, such as

Chorosevic.

II. Procedural History

The Chorosevics filed their initial complaint in the Southern District of Illinois

challenging United and MetLife’s failure to pay secondary benefits due under the

Choices Plan. They voluntarily dismissed that action in November 2005. One month

later, they filed their first complaint in this putative class action in the Eastern District

of Missouri. With leave from the court, Appellees filed their answers in April 2006,

asserting several affirmative defenses, including failure to exhaust administrative

remedies. 

-6-

Appellate Case: 09-1880 Page: 6 Date Filed: 04/02/2010 Entry ID: 3651026
In December 2006, Appellants filed a motion to certify a class consisting of all

members of ERISA-covered health plans controlled, underwritten, or administered by

United where the applicable plan was a secondary insurer and included a

coordination-of-benefits provision using the come-out-whole method with a benefits

reserve. The district court denied the motion for class certification in July 2007, but

permitted the Chorosevics to engage in limited class discovery. In September 2007,

the district court again denied broader class discovery.

In October 2007, the Chorosevics filed their first amended complaint, asserting

a claim to recover benefits under 29 U.S.C. § 1132(a)(1)(B) and claims for breach of

fiduciary duty under 29 U.S.C. § 1132(a)(2) and (3). On April 28, 2008, upon review

of Appellees’ partial motion to dismiss, the district court dismissed the § 1132(a)(2)

claim for failure to state a claim and all claims by Mrs. Chorosevic for lack of Article

III standing.6

 Appellees did not file an answer to the surviving portion of the first

amended complaint within ten days after the court’s order. 

Meanwhile, Chorosevic submitted an amended motion to certify a class action. 

The newly proposed class consisted of “All persons who used the [Choices] Plan as

a secondary insurer from June 30, 1995 to January 1, 2006.” In June 2008, the district

court denied class certification because the proposed class failed to satisfy the

requirements of Federal Rule of Civil Procedure 23(a)(2) and (3). 

Appellees’ failure to file an answer to the surviving portion of the first amended

complaint re-emerged during a hearing on a motion to compel in November 2008. 

Chorosevic’s counsel brought this omission to the district court’s attention, and

Appellees filed a motion for leave to file answers out of time, explaining that the

omission was the result of “an inadvertent oversight.” Despite Chorosevic’s

opposition, the district court granted Appellees leave to file answers out of time. The

6

At oral argument, Appellant’s counsel clarified that Mrs. Chorosevic does not

join in this appeal.

-7-

Appellate Case: 09-1880 Page: 7 Date Filed: 04/02/2010 Entry ID: 3651026
court noted that it could not find that Chorosevic suffered any prejudice from the

delay and that “defendant’s failure to answer was not a result of bad faith, but rather

the result of excusable neglect.” 

Chorosevic and Appellees filed motions for summary judgment on the

remaining claims in December 2008. While the summary judgment motion was

pending, Chorosevic requested leave to file, in essence, a third motion for class

certification based on newly discovered evidence that United incorrectly calculated

secondary benefits for other ERISA-covered plans with similar coordination-ofbenefits provisions. The district court denied the motion to reopen the class

certification question, explaining that the new evidence did not cure the problems

identified by the court in the two prior orders denying class certification. 

The district court granted summary judgment for Appellees on Chorosevic’s

remaining claims and denied Chorosevic’s summary judgment motion. The district

court concluded that Chorosevic’s failure to exhaust administrative remedies under

the Choices Plan barred his § 1132(a)(1)(B) claim to recover benefits owed to him. 

With regard to Chorosevic’s § 1132(a)(3) claim for breach of fiduciary duty, the court

noted an exhaustion-of-remedies problem but held that Chorosevic’s claim failed as

a matter of law because he was essentially requesting an injunction to enforce a

contractual obligation to pay money past due, which the Supreme Court disallowed 

under § 1132(a)(3) in Great-West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204,

210–12 (2002). 

Chorosevic appeals the district court’s orders granting summary judgment,

granting Appellees leave to file answers out of time, denying class discovery, denying

class certification, and denying alteration of the orders denying class certification. 

-8-

Appellate Case: 09-1880 Page: 8 Date Filed: 04/02/2010 Entry ID: 3651026
III. Summary Judgment

The district court granted summary judgment because of Chorosevic’s failure

to exhaust available administrative remedies under the Choices Plan. Chorosevic

contends that (1) he exhausted his administrative remedies through the November

letter to United, (2) his remedies should be deemed exhausted due to United’s failures

to follow its own appeals procedures, and (3) the exhaustion requirement is

inapplicable because further appeals would have been futile. “Exhaustion is a

threshold legal issue we review de novo.” Kinkead v. S.W. Bell Corp. Sickness &

Accident Disability Benefit Plan, 111 F.3d 67, 68 (8th Cir. 1997).

A. Exhaustion of Administrative Remedies

“Where a claimant fails to pursue and exhaust administrative remedies that are

clearly required under a particular ERISA plan, his claim for relief is barred.” Layes

v. Mead Corp., 132 F.3d 1246, 1252 (8th Cir. 1998). Exhaustion of available

administrative remedies enables employers and ERISA-covered plans “to obtain full

information about a claim for benefits, to compile an adequate record, and to make a

reasoned decision,” Back v. Danka Corp., 335 F.3d 790, 792 (8th Cir. 2003). “The

process is of substantial benefit to reviewing courts, because it gives them a factual

predicate upon which to proceed.” Id.

Chorosevic alleges that Appellees violated the Choices Plan’s coordination-ofbenefits provision by failing to reimburse him for out-of-pocket expenses from the

benefits reserve, i.e., the money that the Choices Plan saved by being Chorosevic’s

secondary insurer instead of his primary insurer. The parties refer to this as the

“banked money issue.” Specifically, Chorosevic contends that Appellees owe him

$13.00 for services rendered in June 2004 and $190.10 for services rendered in

-9-

Appellate Case: 09-1880 Page: 9 Date Filed: 04/02/2010 Entry ID: 3651026
August 2004.7

 Chorosevic does not dispute that the 180-day deadline for appealing

the denial of benefits expired on approximately February 16, 2005 for the $13.00

claim and April 3, 2005 for the $190.10 claim. As such, we turn to the

correspondence prior to those dates. 

Chorosevic argues that the November letter from Mrs. Chorosevic to United

satisfied the exhaustion requirement. In that letter, Mrs. Chorosevic detailed the

charges her husband incurred for surgery on August 20, 2004 and specifically

requested that United pay $69.20 immediately. Appellees, on the other hand, contend

that this letter did not raise the banked money issue. Appellees interpret the

November letter as challenging United’s procedure of calculating the amount saved

by using BCBS’s provider discounts instead of United’s provider discounts. 

Chorosevic responds, and we agree, that Mrs. Chorosevic raised the banked money

issue when she stated that United “saves money as the secondary carrier and that

money should be used to pay any remaining charges in full, if the secondary carrier

does not pay them.” The substance of the November letter is what matters, not

whether Mrs. Chorosevic used the words, “banked money.”

Nonetheless, the November letter does not overcome the exhaustion defense,

because Mrs. Chorosevic did not appeal or even reference the claims that her husband

now asserts in this lawsuit. “It is well-established that when exhaustion is clearly

required under the terms of an ERISA benefits plan, the plan beneficiary’s failure to

exhaust her administrative remedies bars her from asserting any unexhausted claims

in federal court.” Burds v. Union Pac. Corp., 223 F.3d 814, 817 (8th Cir. 2000)

(emphasis added); see also Wolf v. Nat’l Shopmen Pension Fund, 728 F.2d 182,

186–87 (3d Cir. 1984) (“Section 502(a) of ERISA does not require either issue or

theory exhaustion; it requires only claim exhaustion.”). The November letter explains

7

Chorosevic does not address his breach-of-fiduciary-duty claim or the district

court’s analysis of that claim. Therefore, we interpret his appeal as limited to his

§ 1132(a)(1)(B) claim. 

-10-

Appellate Case: 09-1880 Page: 10 Date Filed: 04/02/2010 Entry ID: 3651026
in detail the $69.20 in out-of-pocket expenses and explicitly requests payment of

$69.20.8

 In contrast, the letter does not reference, let alone describe, the $191.10 or

$13.00 claims. Indeed, the letter does not mention any other out-of-pocket expenses

or benefits that were improperly processed. Furthermore, Mrs. Chorosevic attached

the EOB for $69.20 claim but not the EOBs for the $190.10 and $13.00 claims. In

light of these facts, we conclude that the November letter did not put Appellees on

notice of the specific claims pursued in this appeal—the $191.10 and $13.00 claims. 

As such, the November letter did not satisfy the exhaustion requirement with regard

to the $190.10 and $13.00 claims. 

The only other correspondence prior to the 180-day deadline was the Bibby

letter, in which Bibby acknowledged that United should have paid the $69.20 claim

and stated that United “is reviewing your other claims as well.” Without citing any

authority or a legal theory for the Court to apply, Chorosevic argues that the Bibby

letter demonstrates that he exhausted his administrative appeals. He argues that the

Bibby letter “flies in the face” of Appellee’s position that Chorosevic “needed to take

additional steps to exhaust with respect to those other claims.” 

Giving Chorosevic the benefit of the doubt, we interpret his argument as a claim

of estoppel. “The principle of estoppel declares that a party who makes a

representation that misleads another person, who then reasonably relies on that

representation to his detriment, may not deny that representation.” Farley v. Benefit

Trust Life Ins. Co., 979 F.2d 653, 659 (8th Cir. 1992). Chorosevic’s estoppel-like

argument fails as a matter of law because Chorosevic has not offered any evidence

that he relied on the Bibby letter to his detriment. There is no indication that, but for

Bibby’s representations, he would have exhausted available administrative appeals,

i.e., filed a second appeal within the sixty-day limitations period. See Gallegos v. Mt.

Sinai Med. Ctr., 210 F.3d 803, 811 (7th Cir. 2000) (rejecting plaintiff’s estoppel claim

“because she has not shown that but for [her insurer’s] representations she would have

8

As previously explained, United paid the $69.20 claim and Chorosevic does

not pursue it any further.

-11-

Appellate Case: 09-1880 Page: 11 Date Filed: 04/02/2010 Entry ID: 3651026
filed an administrative appeal within the [plan’s] limitations period.”); Brant v.

Principal Life & Disability Ins. Co., 50 F. App’x 330, 332 (8th Cir. 2002)

(unpublished per curiam) (stating that an equitable estoppel claim based on an ERISAplan fiduciary’s misrepresentation requires “evidence showing reasonable and

detrimental reliance or extraordinary circumstances”). As such, this is not a case

where an insurance company or claims administrator misled a claimant into

procedurally defaulting his or her opportunity for administrative review and then

asserted failure to exhaust administrative remedies as an affirmative defense. See

Gallegos, 210 F.3d at 810 (stating that estoppel may preclude an affirmative defense

of failure to exhaust administrative remedies “where that failure results from the

claimant’s reliance on written misrepresentations by the insurer or plan

administrator.”). 

Furthermore, as the district court explained, this result is consistent with our

decisions that have encouraged administrators of ERISA-covered plans to informally

review and reconsider claims for benefits. E.g., Abdel v. U.S. Bancorp, 457 F.3d 877,

881 (8th Cir. 2006); Mason v. Aetna Life Ins. Co., 901 F.2d 662, 664 (8th Cir. 1990)

(per curiam). If we were to conclude that the Bibby letter exhausted Chorosevic’s

administrative appeals or restarted the time limit for such appeals, then claims

administrators may become less willing to reconsider claims on their own accord, as

MetLife did in this case. That said, our decision does not affect the limits on what an

insurance company can say to an insured when a company informally reconsiders a

denial of benefits. See, e.g., Cavegn v. Twin City Pipe Trades Pension Plan, 223 F.3d

827, 830–31 (8th Cir. 2000) (holding that the statute of limitations did not bar

plaintiff’s claim because his ERISA plan represented that it was treating his

submission of information as a new application for benefits); Black v. TIC Invest.

Corp., 900 F.2d 112, 116 (7th Cir. 1990) (applying estoppel where a pension plan

represented that benefits would be paid as soon as they were approved by a

bankruptcy court; stating, “No fair reading of the language would give a casual reader

notice that [the plan] intended to contest any claim.”). 

-12-

Appellate Case: 09-1880 Page: 12 Date Filed: 04/02/2010 Entry ID: 3651026
B. “Deemed” Exhausted

Relying on the Secretary of Labor’s ERISA regulations, Chorosevic argues that

he is deemed to have exhausted his administrative remedies because Appellees failed

to “follow reasonable claims procedures.” 29 C.F.R. § 2560.503-1(l). Specifically,

Chorosevic contends that Appellees’ EOBs were inadequate and that Appellees failed

to respond to the April and May letters sent to United. We first address the EOBs.

ERISA’s notice provision requires that every employee benefit plan “provide

adequate notice in writing to any participant or beneficiary whose claim for benefits

under the plan has been denied, setting forth the specific reasons for such denial,

written in a manner calculated to be understood by the participant.” 29 U.S.C.

§ 1133(1). “The purpose of this requirement is to provide claimants with enough

information to prepare adequately for further administrative review or an appeal to the

federal courts.” DuMond v. Centex Corp., 172 F.3d 618, 622 (8th Cir. 1999). The

Secretary of Labor has promulgated regulations governing the manner and content of

notification-of-benefit determinations under employee benefit plans, requiring the

plans to set forth several categories of information in a manner calculated to be

understood by the claimant. See 29 C.F.R. § 2560.503-1(g).9

 We have explained that

9

Section 2560.503-1(g) lists the information required in an EOB: 

(i) The specific reason or reasons for the adverse determination; 

(ii) Reference to the specific plan provisions on which the determination is based; 

(iii) A description of any additional material or information necessary

for the claimant to perfect the claim and an explanation of why

such material or information is necessary; [and]

(iv) A description of the plan’s review procedures and the time limits

applicable to such procedures, including a statement of the

claimant’s right to bring a civil action under section 502(a) of the

Act following an adverse benefit determination on review[.]

-13-

Appellate Case: 09-1880 Page: 13 Date Filed: 04/02/2010 Entry ID: 3651026
“administrative efficiency is a virtue” at the initial claim denial stage, “so long as

disappointed claimants are advised of their right to pursue the plan’s review

procedures.” Kinkead, 111 F.3d at 69. “Therefore, the initial claim denial need not

be extensive, provided that it explains the basis for the adverse initial decision

sufficiently to permit the claimant to prepare an informed request for further review.” 

Id. 

Chorosevic claims that United’s EOBs were inadequate for three reasons. First,

Chorosevic alleges that the EOBs did not clearly state that his benefits were denied. 

Having reviewed the EOBs for the $13.00 and $190.10 claims, we disagree. The

EOBs both say “PLAN PAYS 0.00” and explain that no benefits are payable because

Chorosevic had not yet exceeded his deductible amount. Chorosevic cites no

misleading or ambiguous language from an EOB. Furthermore, Mrs. Chorosevic’s

subsequent letters to United show that she was aware of United’s decisions to deny

benefits. 

Second, Chorosevic contends that the EOBs were deficient because they did not

identify “additional materials or information” upon which the denials were based. 

Nothing in the Choices Plan, ERISA, or the regulations requires an EOB to identify

such materials or information. 

Third, Chorosevic complains that the EOBs did not describe the additional

materials or information needed for further review. However, United had to identify

and request additional information only if it “believe[d] that more information [was]

needed to make a reasoned decision.” Booton v. Lockheed Med. Benefits Plan, 110

F.3d 1461, 1463 (9th Cir. 1997). We may excuse a claimant from exhausting

administrative appeals when the ERISA plan’s actions or omissions deprive the

claimant of information or materials necessary to prepare for administrative review

or for an appeal to federal courts. See Brown v. J.B. Hunt Transp. Servs., Inc., 586

F.3d 1079, 1086 (8th Cir. 2009) (detailing the specific types of information that

-14-

Appellate Case: 09-1880 Page: 14 Date Filed: 04/02/2010 Entry ID: 3651026
plaintiff was deprived of due to plan’s failure to respond to plaintiff’s repeated

requests for the administrative record). Chorosevic has made no such showing here. 

As an alternative basis to deem his remedies exhausted, Chorosevic points to

the undisputed fact that United failed to respond within thirty days to the letters Mrs.

Chorosevic sent in April and May 2005. However, it is also undisputed that her letters

were untimely under the SPD’s appeals procedure.10 The district court concluded that

United was not obligated to respond to Chorosevic’s untimely appeals, because “[t]he

exhaustion requirement would be rendered meaningless if a claimant could belatedly

appeal a denial of benefits, and thereby trigger the obligation of a provider to

respond.” Chorosevic does not dispute this reasoning. He merely quotes Abdel v.

U.S. Bancorp, 457 F.3d 877 (8th Cir. 2006), in which we said, in dictum, that the

claimant’s “request and subsequent internal appeal may have been sufficient to meet

the exhaustion requirement even though [the claimant] did not initially pursue her

internal remedies in a timely manner.” Id. at 881. Because the quoted language was

not essential to the judgment in Abdel,

11 we are not obligated to follow it, although we

will respectfully consider the suggested conclusion. Wilson v. Zoellner, 114 F.3d

713, 721 n.4 (8th Cir. 1997). 

10The SPD required Chorosevic to appeal a benefits denial within 180 days and

to file a second appeal within sixty days of receiving a denial of a first appeal. The

April and May letters were sent after both of these deadlines passed. 

11The issue actually decided in Abdel was when the relevant claim accrued and

therefore whether the statute of limitations expired. Chorosevic apparently admits that

the suggestive language from Abdel was dictum, because he does not argue that the

district court erroneously reached that conclusion.

-15-

Appellate Case: 09-1880 Page: 15 Date Filed: 04/02/2010 Entry ID: 3651026
Ultimately, we agree with the district court’s reasoning.12 Appellees did not

violate their appeals procedure, because the SPD did not require United or the Choices

Plan to respond to Chorosevic’s untimely appeals. Requiring such a response (or

deeming Chorosevic’s appeals exhausted) would enable claimants to easily

circumvent a plan’s appeals procedure, thereby rendering toothless a plan’s time limits

for claims and appeals. See Conley v. Pitney Bowes, 34 F.3d 714, 717 (8th Cir. 1994)

(stating that terms of an ERISA plan “must be construed to render none of them

nugatory.”). We decline to interpret the SPD appeals procedures in a way that would

undermine claimants’ incentives to follow such procedures. See Amato v. Bernard,

618 F.2d 559, 567 (9th Cir. 1980). As such, Chorosevic’s administrative remedies are

not deemed exhausted.

C. Futility

Chorosevic’s last argument in regard to the exhaustion-of-remedies defense is

that additional efforts to exhaust would have been “wholly futile.” See Burds, 223

F.3d at 817 n.4. This “narrow” exception to the exhaustion-of-remedies requirement

requires a plan participant to “show that it is certain that her claim will be denied on

appeal, not merely that she doubts that an appeal will result in a different decision.”

Brown, 586 F.3d at 1085 (quotation and alterations omitted). “Unsupported and

speculative claims of futility do not excuse a claimant’s failure to exhaust his or her

administrative remedies.” Midgett v. Wash. Group Int’l Long Term Disability Plan,

561 F.3d 887, 898 (8th Cir. 2009) (quotation and alterations omitted). 

We conclude that Chorosevic has not demonstrated futility; he has not shown

that Appellees would not have paid the $190.10 and $13.00 claims if he had appealed

those claims. He has not shown that the Choices Plan’s position was “so fixed that

12We diverge from the district court’s order on one point: the premise that the

April letter was not an appeal because it was sent to Bibby directly instead of United. 

Under the facts of this case, we believe it was reasonable for Mrs. Chorosevic to

respond to the person who sent her a notice of reconsideration. 

-16-

Appellate Case: 09-1880 Page: 16 Date Filed: 04/02/2010 Entry ID: 3651026
an appeal would serve no purpose.” Tomczyscn v. Teamsters, Local 115 Health &

Welfare Fund, 590 F. Supp. 211, 216 (E.D. Pa. 1984). All we have from Appellees

on the banked money issue are the EOBs, and those notices are not enough to show

futility. See Kimble v. Int’l Bhd. of Teamsters, 826 F. Supp. 945, 947 (E.D. Pa.

1993). Moreover, as the district court noted, Appellees’ pattern of conduct belies the

conclusion that the appeals procedure here was futile. Importantly, Appellees actually

paid the only claim that Chorosevic appealed in the November letter (the $69.20

claim). MetLife’s reconsideration and payment of the $69.20 claim on its own

initiative indicate that exhaustion was not futile.

Chorosevic argues that Appellees’ position in this litigation demonstrates that

further administrative appeals would have been futile. In support, he cites Appellees’

answers to the first amended complaint, in which Appellees stated that denial of

secondary benefits to Chorosevic was correct and within their discretion. The district

court rejected this theory of futility, noting that it was “not inclined to adopt any

argument that would put a party at a disadvantage for exercising their rights to defend

themselves in litigation.” Again, we agree with the district court’s reasoning, which

Chorosevic does not challenge. If a litigation position is enough to show futility, as

Chorosevic suggests, then the futility exception would swallow the exhaustion

doctrine. Cf. Springer v. Wal-Mart Assocs.’ Group Health Plan, 908 F.2d 897, 901

(11th Cir. 1990) (rejecting an application of the futility doctrine because “the

exhaustion of internal administrative remedies would be excused in virtually every

case.”). Because exhaustion of administrative remedies serves worthwhile purposes,

we decline to apply the futility exception so broadly. 

We hold that Chorosevic failed to exhaust administrative remedies available

under the Choices Plan and that none of the reasons for excusing such failure apply. 

Accordingly, the district court properly granted Appellees’ motion for summary

judgment.

-17-

Appellate Case: 09-1880 Page: 17 Date Filed: 04/02/2010 Entry ID: 3651026
IV. Leave to File Answers Out of Time

Chorosevic also appeals the district court’s order granting Appellees leave to

file answers nearly seven months after the court partially granted Appellees’ motion

to dismiss. We review a district court’s decision to allow a party to submit a late

filing for an abuse of discretion. Sugarbaker v. SSM Health Care, 187 F.3d 853,

855–56 (8th Cir. 1999). “An abuse of discretion occurs where the district court fails

to consider an important factor, gives significant weight to an irrelevant or improper

factor, or commits a clear error of judgment in weighing those factors.” Gen. Motors

Corp. v. Harry Brown’s, LLC, 563 F.3d 312, 316 (8th Cir. 2009). 

Federal Rule of Civil Procedure 6(b)(1)(B) permits a district court to extend the

time for a party to submit a filing “if the party failed to act because of excusable

neglect.” Excusable neglect is an “elastic concept” that empowers courts to accept,

“where appropriate, . . . late filings caused by inadvertence, mistake, or carelessness,

as well as by intervening circumstances beyond the party’s control.” Pioneer Inv.

Servs. Co. v. Brunswick Assocs. Ltd. P’ship, 507 U.S. 380, 392, 388 (1993). The

determination of whether neglect is excusable “is at bottom an equitable one, taking

account of all relevant circumstances surrounding the party’s omission.” Id. at 395. 

“[T]he following factors are particularly important: (1) the possibility of prejudice to

[Chorosevic]; (2) the length of [Appellees’] delay and the possible impact of that

delay on judicial proceedings; (3) [Appellees’] reasons for delay, including whether

the delay was within [their] reasonable control; and (4) whether [Appellees] acted in

good faith.” Sugarbaker, 187 F.3d at 856.

The district court relied primarily on two considerations. First, Appellees’

failure to file an answer to the surviving portion of the amended complaint was not a

result of bad faith, but instead an inadvertent oversight. Second, Chorosevic did not

suffer any prejudice from the delay, because he had notice of Appellees’ affirmative

defenses, including his failure to exhaust administrative remedies, since Appellees

pled those defenses in their answers to the first complaint in April 2006. In addition,

-18-

Appellate Case: 09-1880 Page: 18 Date Filed: 04/02/2010 Entry ID: 3651026
although the court did not explicitly rely on this consideration, it noted that

Chorosevic failed to bring the Appellees’ omission to the court’s attention or to

Appellees’ attention until November 2008, which was over six months after the

deadline passed. 

Chorosevic contends that Appellees were required to show a factual basis for

their “excusable neglect.” He urges the Court to examine the reasons Appellees gave

for missing the deadline instead of accepting their “naked assertion of inadvertent

oversight.” According to Chorosevic, Appellees must justify or satisfactorily explain

their failure to file an answer to the surviving portion of the complaint. Further,

Chorosevic asserts that the court may consider the equitable factors (e.g. prejudice,

bad faith, and impact on the proceedings) only if there is an adequate showing of

excusable neglect. We disagree.

Chorosevic relies on Lowry v. McDonnell Douglas Corp., 211 F.3d 457 (8th

Cir. 2000), in which the plaintiff filed her notice of appeal to the district court out of

time after her claims were dismissed on summary judgment. In that case, we held that

the district court abused its discretion in holding that a plaintiff demonstrated

excusable neglect under Federal Rule of Appellate Procedure 4(a)(5). Id. at 464. Our

opinion focused on “the reasons [the plaintiff] gave for missing the deadline.” Id. at

463. We noted, however, “that a finding of sufficient innocence on the part of the

movant is not a condition precedent to our obligation to consider the other equitable

factors.” Id. (emphasis added); see also Pioneer, 507 U.S. at 395 n.14 (rejecting the

position that judges may “take account of the full range of equitable considerations

only if they have first made a threshold determination that the movant is sufficiently

blameless in the delay.”) (quotation omitted). Thus, Lowry does not support the

conclusion that the district court erred by considering the equitable factors, such as the

lack of prejudice to Chorosevic and Appellees’ good faith. Indeed, Lowry suggests

the opposite—that the district court was obligated to consider those factors.

-19-

Appellate Case: 09-1880 Page: 19 Date Filed: 04/02/2010 Entry ID: 3651026
We conclude that the district court did not commit a clear error of judgment in

how it evaluated the considerations relevant to excusable neglect. The court’s

reasoning with regard to lack of prejudice and Appellees’ good faith is sound and

unchallenged on appeal. Moreover, the district court’s order is supported by the fact

that Appellees have a meritorious defense, see supra Section III, which is a relevant

consideration. Union Pac. R.R. Co. v. Progress Rail Servs. Corp., 256 F.3d 781, 783

(8th Cir. 2001); Johnson v. Dayton Elec. Mfg. Co., 140 F.3d 781, 784 (8th Cir. 1998). 

If the district court would have denied leave to file answers out of time, it would have

imposed on Appellees a severe penalty unmatched by any prejudice to Chorosevic. 

Such a result would have contravened “[t]he judicial preference for adjudication on

the merits[, which] goes to the fundamental fairness of the adjudicatory process.” 

Oberstar v. F.D.I.C., 987 F.2d 494, 504 (8th Cir. 1993). In cases where “the judicial

disfavor for default dispositions is not implicated,” courts may focus primarily on the

reason for the movant’s delay. Gibbons v. United States, 317 F.3d 852, 855 n.4 (8th

Cir. 2003). However, that concern is implicated here. Thus, we hold that the district

court did not abuse its discretion in granting Appellees leave to file answers out of

time. 

V. Class Certification and Discovery

Because Chorosevic’s individual claim was properly dismissed for failure to

exhaust administrative remedies, he “cannot represent the putative but uncertified

class.” Telco Group, Inc. v. Ameritrade, Inc., 552 F.3d 893, 894 (8th Cir. 2009) (per

curiam). Chorosevic was the only remaining named plaintiff, and “[w]ithout a class

representative, the putative class cannot be certified.” Great Rivers Coop. of Se. Iowa

v. Farmland Indus., Inc., 120 F.3d 893, 899 (8th Cir. 1997); see also In re Milk Prods.

Antitrust Litig., 195 F.3d 430, 436 (8th Cir. 1999). Therefore, we do not reach

Chorosevic’s arguments that the district court abused its discretion by denying class

discovery, class certification, and leave to amend the order denying class certification. 

Telco, 552 F.3d at 894; Hutchins v. A.G. Edwards & Sons, Inc., 116 F.3d 1256, 1257

(8th Cir. 1997). 

-20-

Appellate Case: 09-1880 Page: 20 Date Filed: 04/02/2010 Entry ID: 3651026
VI. Conclusion

For the foregoing reasons, the judgment of the district court is affirmed. 

______________________________

-21-

Appellate Case: 09-1880 Page: 21 Date Filed: 04/02/2010 Entry ID: 3651026