# U ni te d S ta te s Co ur t of A pp ea ls

For the Eig hth Circu it

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No. 1 3- 22 33

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Sal va do r Si lv a

ll ll ll ll ll ll ll ll ll ll l Pla in ti

ff - App el la nt

v.

Met ro po li ta n Li fe In su ran ce Co m pa ny; Sav vi s C om m

un ic at io ns Co rp or at io n

ll ll ll ll ll ll ll ll ll ll l Defe nd

an ts - App el le es

----- ----- ----- ----- ----- -----

Tho m as E. Perez, Se cret ary of U.S. Depar tm en t o f Lab or

ll ll ll ll ll ll ll ll ll ll l

Amicu s o n Beh al

f o f Ap pe ll an t(s )

__ __ __ __ __ __

App eal fro m

Uni te d S ta te s Di st ric t Co ur t
fo r th e Eas te rn Dis tri ct of M is so ur i - St . Lou is

__ __ __ __ __ __

Su bm it te d: Jan ua ry

14 , 20 14

Fil ed : Au gu st 7, 2 01 4

__ __ __ __ __ __

Befo re GRUENDER, BRIGHT, an d M ELLOY, Cir cu it Ju dg es

.

__ __ __ __ __ __

MELLOY, Circu it Ju dg e.Abe l Si lv a ("Ab el ") di ed on Ju ne 27

, 20 10

. His fa t h e r , Sal va do r Si lv a

("S il va "), so ug ht to reco ve r th e be ne fit s of Abe l's li fe in su ran ce po li cy

. The in su rer

de ni ed Si lv a's cl ai m , as se rti ng th at Abe l di d no t act ua ll y ha ve a po li cy be cau se he ha d

no t pr ov id ed req ui red pa pe rwo rk

. Si lv a br ou gh t su it ag ai ns t Abe l's em pl oyer, Sav vi s

Co m m un ic at io ns Co rp or at i on ("S av vi s" ), an d th e in su rer, Met ro po li ta n Life

In su ran ce Co m

pa ny ("M et Life "), un de r t h e Em pl oyee Ret ire m en t In co m e Secu rit y

Act of 19 74 ( " ER I S A"), 29 U.S.C. §§ 10 01 et se q

. The di st ric t co ur t de ni ed rel ie f,

an d S il va ap pe al s. Fo r th e rea so ns be lo w, we rev ers e an d re m an d.

I. Bac kg ro un d

S i l v a ' s so n, Abe l, be ga n wor ki ng at Sav vi s in Sep te m be r 20 04

. Abe l w a s

el ig ib le to pu rch as e Su pp le m en ta l Life In su ran ce be ne fit s whe n he st art ed hi s job bu t

de cl in ed to do so . He si gn ed th e fo ll owi ng st at em en t at th at ti m e:

I ha ve be en gi ve n th e op po rtu ni ty to en ro ll in SAVVIS Co m m un ic at io ns Co rp or at io n's Grou p S up pl em en ta l Li fe In su ran ce p la ns . I u nd ers ta nd

th at if I de cl in e no w, bu t la te r de ci de to en ro ll

, I wil l be req ui red to

pr ov id e ev id en ce of go od he al th th at is sa ti sf act or y to Hart fo rd Life an d

un de rs ta nd m

y req ue st for co ve rag e m ay be de ni ed

. 1

Sev eral y ears la te r, Abe l de ci de d he w an te d Su ppl em en ta l Life In su ran ce an d en ro ll ed

fo r a po li cy th ro ug h S a v v i s ' s on li ne en ro ll m en t syste m

. He req ue st ed a co ve rag e

le ve l of fiv e ti m es hi s sa la ry , whi ch am ou nt ed to $ 4 2 9,0 00

. Abe l's be ne fit s were

a pp aren tl y sc he du le d to ta ke effe ct on Ja nu ary 1 , 2 01 0, an d th e po li cy ap pe are d o n

Abe l's "Be ne fit s Elec ti on Pack ag e" pa ge on th e Sav vi s in tra ne t. Sav vi s wit hh el d 2

Hart fo rd Life was th e pr io r in su rer for th e Sav vi s Plan

. Met Life be cam e th e 1

in su rer i n 2 00 8.

Defen d a n ts

, Saav is an d Met Life

, st res s th at th is web pa ge m erel y sh owe d 2

in su ran ce po li ci es Abe l h a d se le ct ed

, rat he r th an in su ran ce po li ci es th at ha d be en

-2

-ap pr ox im at el y $1 0 fro m Abe l's bi -week ly pa y ch eck s fo r th e po li cy un ti l Abe l di ed on

Ju ne 27

, 20 10

. He ha d pa id ro ug hl y $1 28 in pr em iu m s fo r th e li fe in su ran ce po li cy

.

Abe l ha d na m ed Si lv a as hi s po li cy 's be ne fic ia r y. Fo ll owi ng Abe l's de at h,

Si lv a req ue st ed pa y m en t of th e li fe in su ran ce pr oc eed s fro m MetL ife

. Met Life de ni ed

Si lv a's cl ai m be cau se th e co m pa ny be li ev ed th at Abe l ha d no t su cces sf ul ly co m pl et ed

th e en ro ll m en t co nd it io ns req ui red to ob ta in a su pp le m en ta l li fe in su ran ce po li cy

. In

pa rti cu la r, Met Life req ui re d t h a t Abe l pr ov id e "ev id en ce of in su rab il it y " be fo re

Met Life wou ld ap pr ov e h i s req ue st fo r in su ran ce. In Met Life 's le tt ers of de ni al to

Si lv a, an d in se ve ral in te rn al Met Life co m m un ic at i o n s, va rio us Met Life

rep res en ta ti ve s in di cat ed th at th e co m pa ny req ui res "ev id en ce of in su rab il it y " (1 ) in

al l in st an ces of la te req ue st s ; an d (2 ) fo r req ue st s of co ve rag e in ex ces s of th ree ti m es 3

an em pl oyee's ba se sa la ry am ou nt

, whe th er su ch req ue st s are ti m el y or no t. At le as t

on e in te rn al Met Life co m m un ic at io n in vo lv ed Met Life rep res en ta ti ve s di sc us si ng a

gr an t of pa rti al co ve rag e to Abe l. In th at co m m un ic at io n, on e of th e rep res en ta ti ve s

rai se d th e is su e of gr an ti ng Abe l th ree ti m es hi s ba se sa la ry am ou nt as a li fe in su ran ce

be ne fit

, pr es um ab ly be cau se Met Life co ns id ered th ree ti m es th e ba se sa la ry ge ne ral ly

no t to req ui re ev id en ce of in su rab il it y

. Ult im at el y , ho wev er, Met Life as se rte d in it s

le tt ers to Si lv a th at Abe l was req ui red to pr ov id e ev i d e n ce of in su rab il it y to ob ta in

an y co ve rag e d ue to th e fac t t ha t h is req ue st was a lat e req ue st

.

Evi de nc e of in su rab il it y is ex pl ai ne d in th e Sav vi s Pl an ("t he Pl an "), whi ch is

96 pa ge s lo ng

. Two of th os e pa g e s d e s c r i be Met Life 's "Ev id en ce of In su rab il it y "

req ui rem en t. Und er th e "El ig ib il it y Pro vi si on s: In su ran ce fo r You " pa ge , it read s, in

pa rt:

ap pr ov ed

. W e no te th at th e sc reen sh ot of Abe l's "Be ne fit s Elec ti on " web pa ge do es

no t s ay whet he r hi s i ns ur an ce s el ect io ns were ap pr ov ed

.

Met Life de fin es a la te req ue st fo r co ve rag e as a req ue st m ad e 31 da y s or m or e 3

aft er b eco m in g e li gi bl e.

-3

-ENROLLMENT PROCESS

If You are el ig ib le fo r in su ran ce, You m ay en ro ll fo r su ch in su ran ce by

co m pl et in g th e req ui red fo rm

. In ad di ti on , You m u s t g i v e ev id en ce of

You r In su rab il it y sa ti sf

act or y to Us at You r ex pe ns e if You are req ui red

to do so un de r th e se ct io n e nt it le d EVIDENCE OF INSURABI LITY.

The EVIDENCE OF INSURABILITY sec ti on read s, i n p art :

W e req ui re ev id en ce o f in su rab il it y sat is fact or y

to Us as fol lo ws:

. . .

5. [I]f You m ak e a req ue st du rin g an an nu al en ro ll men t pe rio d to
in crea se th e am ou nt of You r Su pp le m en ta l Life In su ran ce t o an

op ti on whi ch is m or e th an on e le ve l abo ve You r cu rren t am ou nt
of Su pp le m en ta l Li fe In su ran ce

If You do no t gi ve Us ev id en ce of in su rab il it y or th e ev id en ce of

in su rab il it y is no t acce pt ed by Us as sa ti sf act or y , t h e am ou nt of

You r Su pp le m en ta l Li fe In su ran ce wi ll no t b e in crea se d. . . .

9. [I]f You m ak e a la te req ue st fo r Su pp le m en ta l Life In su ran ce. A

la te req ue st is on e m ad e m or e th an 31 da y s aft er Yo u b e c om e el ig ib le

.

If You do no t gi ve Us ev id en ce of in su rab il it y or th e ev id en ce of

in su rab il it y is no t acce pt ed by Us as sa ti sf act or y , You wil l no t be

co ve red for Su pp le m en ta l Li fe In su ran ce.

Bec au se Abe l el ect ro ni cal ly se le ct ed a po li cy co ve rag e le ve l th at req ui red

ev id en ce of in su rab il it y , Sav v i s as se rts th at a pr om pt win do w ap pe ared on hi s

co m pu te r sc reen

. The pr om

pt al le ge dl y no ti fie d Abe l to co nt act th e Sav vi s Ben efi ts
Dep art m en t (lo cat ed in th e sa m e of fic e bu il di ng as Abe l) to co m pl et e a St at em en t of

Heal th fo rm , whi ch was a ne ces sa ry st ep to fu lfi ll Met Life 's ev id en ce of in su rab il it y

req ui rem en t. Sav vi s wo u l d th en se nd th e fo rm to Met Life fo r rev ie w a nd ap pr ov al

or de ni al of a li fe i ns ur an ce p ol ic y

.

-4

-W e pa us e he re to em ph as iz e fo ur p o i nt s: Fi rs t, th ere is no m en ti on of a

St at em en t of Heal th fo r m a n ywh ere in th e Sav vi s Pl an , on ly th at pl an pa rti ci pa nt s

m us t p ro vi de ev id en ce of ins ur ab il it y

. In fact

, th ere are no d ire ct io ns at a ll for ho w

to fu lfi ll th e ev id en ce of in su rab il it y r e q ui rem en t. Seco nd

, Defen da nt s ha ve no t

pr od uc ed a co py of a St at em en t of Heal th fo rm or an y ot he r ev id en ce reg ard in g wha t

in fo rm at io n M et Life req ui red pl an pa rti ci pa nt s to pro vi de . Thir d, Def en da nt s h av e

no t pr ov id ed ev id en ce of th e on li ne pr omp t

, w h i c h t he y as se rt no ti fie d Abe l of th e

St at em en t of Heal th fo rm req ui rem en t. The on ly ev id en ce th at th is pr om pt ex is te d

is a si ng le in te rn al m em o fro m a Met Life rep res en ta ti v e st at in g th at su ch a pr om pt

ex is ts

, bu t wit ho ut pr ov id in g an y ad di ti on al in fo rm at io n su ch as th e te xt in cl ud ed in

th e pr om pt or a sc reen cap tu re. Tha t m em o, whi ch is in th e f o r m of a cal l lo g 4

co m m en t se ct io n, read s: "ee 's co m pl et e th ei r en ro ll m en t on li ne an d if th ey el ect m or e

th an 3x th ei r ba e [b as ic an nu al earn in gs ] t h e y r pr om pt ed to co m

pl et e a pa pe r so h

[s ta te m en t of heal th ] an d su bm it th at to th ei r HR de pt

. HR do es no t fol lo w up on if

th e SOH was co m

pl et ed or no t as it is th e ee's res po ns ib il it y to co m pl et e[.]" Fi na ll y ,

as di sc us se d be lo w, it was la te r re v e a l e d t h a t aro un d 20 0 ot he r Sav vi s em pl oyees

si m il arl y ha d no t su bm it te d th ei r St at em en t of Heal th fo rm s, or if th ey ha d, th ey ha d

no t b een pro vi de d t o M et Life

.

Met Life ad dr es se d an d de fen de d so m e of th es e c o mp l i c a ti on s in it s be ne fit s

de ni al let te r to Sil va 's a tt or ne y , whi ch st at ed , in pa rt:

Ev e n th ou gh ev id en ce of in su rab il it y is no t de fin ed in th e Pl an , th e

on li ne en ro ll m en t syste m ad vi se d [Ab el ] of th e St at em en t of Heal th

req ui rem en t. Reg ard le ss , . . . th e Pl an req ui res th at ev i d e n c e of

in su rab il it y be 'acc ep te d by Us as sa ti sf act or y .' Met Li fe req ui res a St at em en t of Heal th

, whi ch is t h e n r e vi ewed in co nn ect io n wit h

At or al arg um en t, Defen da nt s' co un se l co ul d no t ex pl ai n why ev id en ce of th is 4

on li ne pr om

pt was no t in th e reco rd an d hypo th es iz ed th at Sav vi s m us t ha ve ch an ge d

th e co m pu te r syste m

an d t ha t t he pro m

pt was n o l on ge r in us e.

-5

-u n d e rwri ti ng

. [Ab el 's] at te nd an ce at wor k wit h no he al th is su es is no t

su ffi ci en t pr oo f of ev id en ce of in su rab il it y

. Fi na ll y , pr em iu m pa y m en ts

a re no t a gu aran te e of co ve rag e an d th e acce pt an ce of p r e mi u m

pa y m en ts in erro r do es no t crea te co ve rag e un de r an ERISA-g ov ern ed

Pl an

.

Fu r t h er, Defen da nt s are un su re whe th er Abe l rece iv ed a co py of th e Pl an (wh ic h co nta ine d inf

or m at ion re ga

rd ing the ev ide nc e of in su rab il it y req ui rem en t), an d

if he di d, whe n an d ho w h e rece iv ed it

. Defen da nt s cl ai m th at Abe l sh ou ld ha ve

rece iv ed a co py of th e Pl an at so m e po in t, ei th er whe n he was fir st hi red at Sav vi s an d

de cl in ed co ve rag e or whe n he la te r si gn ed up fo r su pp le m en ta l li fe in su ran ce in

Ja nu ary 20 10

. In an y cas e, th e Pl an was av ai la bl e fo r vi ewin g on th e Sav vi s in tra ne t.

ERISA m an da te s th at pl an ad m in is tra to rs pr ov id e a co nd en se d an d

un de rs ta nd ab le Pl an ex pl an at io n, in th e fo rm of a su m m ary pl an de sc rip ti on , to pl an

pa rti ci pa nt s. 29 U.S.C. §§ 10 22

, 10 24 (b ). A su m m ary pl an de sc rip ti on is req ui red 5

to ad vi se pa rti ci pa nt s, in pl ai n an d si m pl e te rm s, ho w to ob ta in co ve rag e an d in wha t

in st an ces pa rti ci pa nt s can lo se co ve rag e, su c h a s by no t pr ov id in g ev id en ce of

in su rab il it y

. See § 102 2. Met Life co nt en ds th at th e Pl an it se lf, whi ch is ne arl y 10 0

pa ge s, al so fu nc ti on ed a s t h e P l an 's su m m ary pl an de sc rip ti on

. It ap pe ars th at no

se pa rat e su m

m ary pl an de sc rip ti on ex is te d fo r th e Pl an

.

Afte r th is la wsu it be ga n, Met Life co nd uc te d an in te rn al in ve st ig at io n to se e if

ot he r Sav vi s Pl an po li cy ho ld ers al so di d no t ha ve an ap pr ov ed St at em en t of Heal th

fo rm on fil e. The co m

pa ny di sc ov ered aro un d 20 0 Sav vi s em pl oyees la ck ed th is

do cu m en ta ti on

. Sav v i s n o ti fie d th es e em pl oyees an d al lo wed th em to co rrec t or 6

The Pla n i s an ERISA-g ov ern ed pl an

. 29 U.S.C. § 1 00 3. Sa vv is is th e p la n 5

ad m in is tra to r, an d M et Life is als o a pl an fid uc ia ry

.

The in te rn al in ve st ig at io n lo g in cl ud es , in pa rt, th e fo ll owi ng no te fro m wha t 6

ap pe ars to be a Met Life em pl oyee: "Th ere are a who le tru ck lo ad of pe op le who fil le d

ou t a SOH bu t th ey were ne ve r su bm it te d du e to a gl it ch in th e em pl oyer's en ro ll m en t

-6

-su bm it th e req ui red do cu m en ts bu t di d no t al lo w Si lv a to do so

. Si lv a po in ts ou t th at 7

Defen da nt s ha ve no t sh own an y di sq ua li fy in g he al th co nd it io n or act iv it y th at wou ld

ha ve pr om

pt ed Met Life to de ny Abe l li fe in su ran ce co ve rag e ha d th ey rece iv ed a

co m pl et ed Sta te m en t o f Heal th for m fro m hi m

.

II. Pro ced ur al His to ry

As no te d ab ov e, Met Life

, th e pl an fid uc ia ry res po ns ib le fo r rev ie win g cl ai m s, 8

de ni ed Si lv a's cl ai m fo r A b e l ' s su pp le m en ta l li fe in su ran ce be ne fit s. Met Life

de te rm in ed th a t A b e l ' s req ue st fo r su pp le m en ta l li fe in su ran ce was ne ve r ap pr ov ed

by Met Life be cau se Abe l di d no t su bm it a St at em en t of He a l th fo rm

. Si lv a su ed

Met Life an d Sav vi s in Mi ss ou ri st at e co ur t, an d Defen da nt s rem ov ed th e cas e to th e

pr oc es s."

A t o r al arg um en t, Defen da nt s' co un se l st at ed th at m an y of th es e Sav vi s 7

em pl oyees ha d fil le d ou t St at em en t of Heal th fo rm s, bu t th at Sav vi s ha d ne gl ect ed to

s e n d th e co m

pl et ed fo rm s to Met Life

. Defen da nt s' co un se l arg ue d th at th i s f a c t
di st in gu is he s th e gr an df

at he red po li ci es fro m Abe l, si n c e acco rd in g to Defen da nt s, Abe l had no t fi ll ed ou t a f or m at a ll . W e fi nd th is di st in ct io n u np ers ua si ve be cau se th e en d res ul t— Met Life fai li ng to rece iv e th e fo rm s to m ak e a co verag e de te rm in at io n

on a req ue st for su pp le m en ta l l ife in su ran ce— is th e sa m e.

Met Life an d Sav vi s bo th ha ve fid uc ia ry ob li ga ti on s to pl an pa rti ci pa nt s un de r 8

ER ISA be cau se th ey are bo th ad m in is tra to rs of th e Pl an

. See 29 U

. S

. C

. §§ 10 02 (1 6) (A) (d efi ni ti on of "ad m in is tra to r")

, 11 02 (a)( 1) ("Ev ery em pl oyee be ne fit pl an

. . . sh al l pr ov id e fo r on e or m or e na m ed fid uc ia rie s who joi nt ly or se ve ral ly sh al l

ha ve au th or it y to co nt ro l an d m an ag e th e op erat io n an d ad m in is tra ti on of th e pl an ."),

10 02 (2 1) (a) (d efi ni ti on of a "fi du ci ary" un de r ERISA), 11 04 (a)( 1) (B) ("[ A] fid uc ia ry sh al l di sc ha rg e hi s du ti es wit h res pe ct to a pl an so le ly in th e in te res t of th e

pa rti ci pa nt s an d be ne fic ia rie s

. . . wit h th e care , sk il l, pr ud en ce, an d di li ge nc e un de r th e ci rcu m st an ces pr ev ai li ng th at a pr ud en t m an act in g in a li ke cap aci ty an d fam il ia r wit h su ch m at te rs wou ld us e in th e co nd uc t of an en te rp ri s e o f a li ke ch arac te r an d

wit h l ik e ai m s." )

-7

-East ern Dis tri ct of Mi ss ou ri. 28 U.S.C. § 14 41

. In hi s co m pl ai nt

, Si lv a cl ai m ed

ERISA al lo wed hi m "t o r e c o v e r be ne fit s du e to hi m un de r th e te rm s of hi s pl an , to

en fo rce hi s rig ht s un de r th e te rm s of th e pl an , or to cl ari fy hi s rig ht s to fu tu re be ne fit s

un de r th e te rm s o f th e p la n[ .] " 2 9 U.S.C. § 11 32 (a)( 1) (B)

Afte r th e de ad li ne se t by th e di st ric t co ur t pa ss ed

, Si lv a m ov ed to am en d hi s

co m pl ai nt to ad d a c a u s e of act io n un de r 29 U.S.C. § 11 32 (a)( 3)

, whi ch al lo ws "a

pa rti ci pa nt

, be ne fic ia ry , or fid uc ia ry (A) to en joi n an y act or pr act ic e whi ch vi ol at es

an y p r o v i s i o n o f th is su bc ha pt er or th e te rm s of th e pl an , or (B) to ob ta in ot he r

ap pr op ri at e eq ui ta bl e re li ef (i) to red res s su ch vi ol at io ns or (ii ) to en fo rce an y

pr ov is io ns of th is su bc ha pt er or th e te rm s of th e pl an [.]" (em ph as is a d d e d )

. W he n

an al y zi ng th e un ti m el y am en dm en t, th e di st ric t co ur t no te d th at Si lv a ha d sh own go od

cau se du e to la te r-d is co ve red fact s (n ot ab l y, t he in fo rm at io n th at 20 0 ot he r Sav vi s

em pl oyees al so sh ou ld ha ve su bm it te d a St at em en t of Heal th fo rm bu t di d no t). The

di st ric t co ur t, ho wev er, fo un d th at th e ph ras e "o th er ap pr op ria te eq ui ta bl e rel ie f un de r § 11 32 (a)( 3) (B)" di d n o t al lo w Si lv a to cl ai m li fe in su ran ce be ne fit s be cau se th at

wou ld be a co m

pe ns at or y rem ed y , no t an eq ui ta bl e on e. Bec au se Si lv a's cl ai m co ul d

no t pro vi de hi m wit h th e rel ie f he so ug ht

, th e di st ric t co ur t de ni ed Si lv a's req ue st to

am en d a s fu ti le

.

Afte r de nyin g Si lv a's m ot io n to am en d th e co m pl ai nt

, th e di st ric t co ur t gr an te d

su m m ary jud gm en t in fav or of Defen da nt s on Si lv a's § 11 32 (a)( 1) (B ) c l a i m

. The

di st ric t co ur t fo un d th at th e ne arl y 10 0- pa ge Pl an c o u l d d o u b le as a su m m ary pl an

de sc rip ti on an d was "d is tri bu te d to em pl oyees an d av ai la bl e o n Sav vi s' in tra ne t."

Si lv a v. Met ro po li ta n Life In s. Co

., 91 2 F. Su pp

. 2d 78 1, 78 7 (E.D. Mo

. 20 12 ). The

d i st ric t co ur t al so fo un d th at "t he en ro ll m en t Abe l co m pl et ed on li ne pr om

pt ed h i m

to co mp l e t e a s t a te m en t of he al th fo rm ." Id

. at 78 8. Thu s, th e co ur t fo un d th at

Met Life ha d no t a b u s e d i t s di sc ret io n whe n it de ni ed Si lv a's cl ai m to Abe l's li fe

in su ran ce be ne fit s. The di st ric t co ur t al so fo un d t h a t

, ev en if Met Life erro ne ou sl y

de du ct ed in su ran ce pr em iu m s f r o m Abe l's pa y ch eck s, su ch erro r di d no t co ns ti tu te

-8

-a waiv er of th e ev id en ce-o f-i ns ur ab il it y req ui r e ment

. Thu s, th e di st ric t co ur t

co nc lu de d t ha t Ab el ha d n ot co m pl et ed th e req ui rem en ts fo r ob ta in in g app ro va l for

a la te -en ro ll m en t su pp le m en ta l li fe in su ran ce po li cy , an d th eref or e, Met Life di d no t

owe Sil va pa y m en t u nd er t he ter m s o f an y su ch po li cy

.

Si lv a ap pe al s th e di s t r i c t co ur t's gr an t of su m m ary jud gm en t on hi s § 11 32 (a)( 1) (B) c l ai m an d th e di st ric t co ur t's de ni al of hi s m ot io n to am en d hi s

co m pl ai nt to ad d a cla im

un de r § 1 13 2( a)(3 ).

III. Ana lysis

The Sav vi s Pl an pr ov id es th at Met li fe, as a pl an fid uc ia ry , "s ha ll ha ve

di sc ret io na ry au th or it y to in te rp ret th e te rm s of th e Pl an an d to de te rm in e el ig ib il it y

fo r an d en ti tl em en t to Pl an be ne fit s in acco rd an ce wit h th e te rm s of th e Pl an ." W he n

a pl an g r an ts an ad m in is tra to r th is type of di sc ret io n, th e di st ric t co ur t rev ie ws th e

"ad m in is tra to r's co ns t r u c t i o n of th e pl an te rm s fo r an ab us e of di sc ret io n; an d we

rev ie w de no vo th e di st ric t co ur t's ap pl ic at io n of th at de fere nt ia l ab us e-o f-d is cret io n

st an da rd ." Tus se y v. ABB, In c., 74 6 F.3 d 32 7, 33 3 (8 th Ci r. 20 14 ) (in te rn al qu ot at io n

m ark s om it te d)

. "[A]n ad m in is tra to r's d e c i s i o n is up he ld if it is reas on ab le , t ha t is

,

su pp or te d by s ub st an ti al ev id en ce

. . . [ whi ch ] m ean s ' mo r e t h a n a sc in ti ll a bu t le ss

th an a pr ep on de ran ce.'" Darv el l v. Life Ins . Co. o f N. Am ., 5 97 F.3 d 92 9, 93 4 (8 th

Ci r. 20 10 ) (ci ta ti on s o m it te d)

.

In th is cas e, Met Life ha d th e res po ns ib il it y of bo th de te rm in in g el ig ib il it y fo r

be ne fit s and al so pa y in g th os e be ne fit s. Thi s du al ro le crea te s a co nf li ct of in te res t.

Man ni ng v. Am

. Rep

. In s. Co., 60 4 F.3d 10 30

, 10 38 (8 th Ci r. 20 10 ). In su ch cas es ,

ou r ci rcu it reco gn iz es th at th is co nf li ct can "t rig ge r a le ss d e f e r e n ti al st an da rd of

rev ie w" be fo re rev ie win g co ur ts

. Til le ry v. Hof fm an Enc lo su res , In c., 28 0 F.3 d 11 92

, 11 97 (8 th Ci r. 20 02 ). W hi le ou r ci rcu it ha s no t de fin it iv el y art ic ul at ed wha t th at le ss

de fere nt ia l st an da rd of rev ie w sh ou ld be

, we ha ve sa id th at "a rev ie win g co ur t sh ou ld

-9

-co ns id er th at co nf li ct as a fact or " whe n de te rm in in g if an ad m in is tra to r ha s ab us ed it s

di sc ret io n. Ma nn in g, 6 04 F.3d at 1 03 8. We do so he re.

A. § 1 13 2( a)(1 )(B) Cla im

The di st ric t cou rt g ran te d s um m ary jud gm en t to Defen da nt s bec au se it fo un d

th at Si lv a was no t en ti tl ed to be ne fit s un de r th e Pl an

. S u mm ary jud gm en t is

ap pr op ria te whe n "t he m ov an t sh ows th at th e r e i s no ge nu in e di sp ut e as to an y

m at eri al fact an d th e m ov an t is en ti tl ed to jud gm en t as a m at te r of la w." Fed

. R. Ci v.

P. 56 (a). W e rev ie w th e gr an t of su mm ary jud gm en t de no vo , "co ns id eri ng al l

ev id en ce in th e li gh t m os t fav or ab le to

, an d m ak in g al l reas on ab le in fere nc es fo r, th e

no nm ov in g pa rty." Carm od y v. Kan

. Ci ty Bd

. of Po li ce Co m m 'rs

, 71 3 F.3 d 40 1, 40 4
(8 th Cir . 20 13 ).

Sect io n 11 32 (a)( 1) (B) al lo ws Si lv a to br in g a ci vi l act io n "t o reco ve r be ne fit s

du e to hi m un de r th e te rm s of hi s pl an ." Defen da nt s ar gu e th at Sil va is no t en ti tl ed

to "re co ve r be ne f

i t s u n de r th e te rm s of hi s pl an " be cau se th e te rm s of th e Pl an

req ui red Abe l to su bm it ev id en ce of in su rab il it y as a la te en ro ll ee. Si lv a arg ue s th at
§ 11 32 (a)( 1) (B) en ti tl es hi m to be ne fit s owe d un de r th e Pl an

. To su ccee d, Si lv a m us t

sh ow th at Met Life 's de te rm in at io n th at he ha d no t pr ov id ed "ev id en ce of in su rab il it y "

was an ab us e of di s c ret io n. See Man ni ng , 60 4 F.3 d at 10 39

. W e lo ok at th e

fo l l o w i ng fiv e fact or s whe n m ak in g th is de te rm in at io n: "(1 ) whe th er th e

ad m in is tra to r's la ng ua ge is co nt rary to th e cl ear la ng ua ge of th e pl an ; (2 ) whe th er th e

int er pr et at io n co nf

li ct s wit h th e su bs ta nt iv e or pr oc ed ur al req ui rem en ts of ERISA; (3 )

whe th er th e in te rp ret at io n ren de rs an y la ng ua ge in th e pl an m ean in gl es s or in te rn al ly

i nc on si st en t; (4 ) whe th er th e in te rp ret at io n is co ns is te nt wit h th e go al s of th e p l a n ;

an d (5 ) whe th er th e ad m in is tra to r ha s co ns is te nt ly fo ll owe d th e in te rp ret at i o n."

Man ni ng , 60 4 F.3 d 10 30

, 10 41 –4 2. In ad di ti on to th es e fiv e fact or s, we ke ep in m in d

Met Life 's c on fli ct an d wei gh th at acco rd in gl y . See i d. at 10 38

.

-1 0-Si lv a's § 11 32 (a)( 1) (B) arg um en t tu rn s on th e fo ll owi ng qu es ti on : W ha t do es

th e ph ras e "ev id en ce of i n s u r a b i l it y " m ean in th e Pl an ? The Pl an it se lf do es no t

de fin e th e ph ras e. Met Life on ly req ui res ev id en ce of in su rab il it y in a few in st an ces

— (1 ) whe n a pe rs on el ect s co ve rag e ex ceed in g th ree ti m es hi s or he r ba se sa la ry , or (2 )

whe n a pe rs on en ro ll s in a po li cy m or e th an a m on th aft er fir st be in g el ig ib le

. Am on g

ot he r reas on s, Met Life ha s an in te res t in no t al lo win g th os e who m ay be ve ry il l fro m

ta ki ng ou t a la rg e li fe in su ran ce po li cy sh or tl y be fo re de at h. Evi de nc e of in su rab il it y

al lo ws MetLi fe to scru ti ni ze certa in po li cy se le ct io ns be fo re ap pr ov in g an un ti m el y

po li cy req ue st

. Howev er, it is un cl ear wha t ev id en ce of a pe rs on 's he al th th e Sav vi s

P l a n req ui red

. Met Life as se rts th at pl an pa rti ci pa nt s sa ti sf y th is pr ereq ui s i t e f

o r

co ve rag e by su bm i t t i n g a co m pl et ed St at em en t of Heal th fo rm th at Met Life th en

a pp ro ve s, bu t th at la ng ua ge do es no t ap pe ar in th e Pl an

. In ad di ti on , th er e i s n o

ev id en ce t h a t a su m

m ary pl an de sc rip ti on ex is ts fo r th e Pl an , whi ch co ul d ha ve

ex pl ai n e d t h e S ta te m en t of Heal th fo rm req ui rem en t to Pl an pa rti ci pa nt s. Fu rth er,

be cau se t h e r e i s n o St at em en t of Heal th fo rm in ev id en ce, we do no t kn ow wha t

in fo rm at io n t ha t fo rm

req ui red

.

To res ol ve wha t "ev id en ce of in su rab il it y " m ean s, it m ay be ne ces sa ry to kn ow:

wha t Sav vi s co m

m un ic at ed to Abe l reg ard in g th e St at em en t of Heal th fo rm

req ui rem en t th ro u g h th e on li ne pr om pt or ot he rwis e; wha t in fo rm at io n wou ld be

di sc lo se d in th e St at em en t of Heal th fo rm ; an d whe th er Abe l's al le ge dl y he al th y , da il y

pr es en ce at wor k co ul d be su ffi ci en t to es ta bl is h in su rab il it y

. The se fact s are m at eri al

in th e se ns e th at th ei r res ol ut io n m ay sh ow th at Met Life 's i nt erp ret at io n o f th e Pl an

is "co nt rary to th e cl ear la ng ua ge of th e p l a n " or th at Met Life 's in te rp ret at io n

"co nf li ct s wit h th e su bs ta nt iv e or pr oc ed u r a l r e q u ire m en ts of ERISA" du e to th e

se em in g la ck of no ti ce to Abe l of th e req ui rem en ts of hi s Pl an

. See Man ni ng , 60 4

F.3 d at 10 41

. W e are tro ub le d by Met Life 's un su pp or te d ch arac te riz at io n of th e fact s.

W e ha ve a du ty to rev ie w whe th er Met Life ab us ed it s di sc ret io n whe n it de ni ed

Si lv a's req ue st fo r th e be ne fit s of Abe l's su pp le m en ta l li fe in s u r a n c e po li cy

. The se

ou ts ta nd in g qu es ti on s of m at eri al fact pr ev en t ou r co ur t fro m as se ss in g whe th er

-1 1-Met Life ab us ed it s di sc ret io n. Acco rd in gl y , we rev e r s e an d rem an d Si lv a's

§ 1 13 2( a)(1 )(B) cla im

to th e d is tri ct co ur t fo r fu rth er p ro ceed in gs

.

B. Mo ti on to Am en d— Add it io n of § 11 32 (a)( 3) Cl ai m fo r Equ it ab le Rel ie f

Si lv a al so ap pe al s th e di st ric t co ur t's de ni al o f hi s m ot io n to am en d hi s

co m pl ai nt to ad d an ad di ti on al ERISA cl ai m un de r 29 U.S.C. § 11 32 (a)( 3)

. Th at

su bs ect io n re ad s:

(a) Pe rs on s empowe red to bri ng a ci vi l ac ti on

A civ il act io n m ay

be bro ug ht

--

(3 ) by a pa rti ci pa nt

, be ne fic ia ry , or fid uc ia ry (A) to en joi n an y act

or pr act ic e whi ch vi ol at es an y pr ov is io n of th is su bc ha pt er or th e

te rm s of th e pl an , or (B) to ob ta in ot he r ap pr op ri a t e eq ui ta bl e

re li ef (i) to red res s su ch vi ol at io ns , or (ii ) to en fo rce an y

pr ov is io ns of t hi s s ub ch ap te r or th e te rm s o f th e p la n[ .]

(em ph as is ad de d)

. Si lv a at te m pt ed to am en d hi s co m

pl ai nt aft er th e fin al sc he du li ng

o r d e r ' s d ead li ne , whi ch req ui res hi m to sh ow go od cau se

. Fed

. R. Ci v. P. 16 (b ) ( 4 )

("A sc he du le m ay

be m od ifi ed on ly fo r go od cau se an d wit h th e jud ge 's co ns en t." ).

The di st ric t co ur t fo un d th at Si lv a ha d sh own go od cau se be cau se he ha d rece iv ed

ad di ti on al in fo rm at io n reg ard in g th e Sav vi s on li ne en ro ll m en t pr oc es s. Sp eci fic al ly,

Si lv a le arn ed th a t ro ug hl y 20 0 ot he r Sav vi s em pl oyees al so la ck ed a req ui red

St at em en t o f Heal th for m , su gg es ti ng th at th ere was so m e is su e o f no ti ce re ga rd in g

if an d ho w Defen da nt s req ue st ed th is in fo rm at io n. Howev er, th e di st ric t co ur t de ni ed

th e m ot io n, fin di ng th at th e § 11 32 (a)( 3) cl ai m was fu ti le be cau se Si lv a so ug ht m on ey

da m ag es ($ 42 9,0 00 in po li cy be ne fit s)

, rat he r th an eq ui ta bl e rel ie f, whi ch th e di st ric t

co ur t co nc lu de d was un av ai la bl e u nd er t ha t s ect io n o f th e st at ut e.

-1 2-Dis tri ct co ur ts ha ve di sc ret io n to all ow a p art y to am en d hi s or her com

pl ai nt

aft er th e sc he du le d de ad li ne

. See Fed

. R. Ci v. P. 15 (a)( 2) ("Th e co ur t sh ou ld free ly

gi ve le av e w h e n jus ti ce so req ui res ."). Dis tri ct co ur ts can de ny m ot io ns to am en d

whe n th ere "'ar e co m

pe ll in g reas on s su ch as

. . . fu ti li ty of th e am en dm en t.'" Reu te r

v. J a x Lt d., 71 1 F.3 d 91 8, 92 2 (8 th Ci r. 20 13 ). So m e ex am pl es of fu ti le cl ai m s are

on es th at are du pl ic at iv e or fri vo lo us , id

., or cl ai m s th at "co ul d no t wit hs ta nd a m ot io n

to di sm is s un de r Ru le 12 (b )(6 )[,]" Zut z v. Nels on , 60 1 F.3 d 84 2, 85 0 (8 th Ci r. 20 10 ).

See Fed

. R. Ci v. P. 12 (b )(6 ) (fai lu re to st at e a cl ai m up o n w hi ch rel ie f can be

gr an te d)

. "To su rv iv e a m ot io n to di sm is s, a co m pl ai nt m us t co nt ai n su ffi ci en t fact ua l

m at te r, acce pt ed as tru e, to st at e a cl ai m to rel ie f th at is pl au si bl e on it s f a ce."

Ash cro ft v. Iq ba l, 55 6 U.S. 6 62 , 67 8 (2 00 9) ((i nt ern al qu ot at io n m ark s an d ci ta ti on

om it te d) ); Bel l Atl an ti c Co rp

. v. Twom bl y , 55 0 U.S. 54 4, 55 5 (2 00 7) ("Whi le a

co m pl ai n t at ta ck ed by a Ru le 12 (b )(6 ) m ot io n to di sm is s do es no t ne ed de ta il ed

fact ua l al le ga ti on s, a pl ai nt iff 's ob li ga ti on s to pr ov id e th e gr ou nd s of hi s en ti tl em en t

to rel ie f req ui res m or e th an la be ls an d co nc lu si on s." (in te rn al ci ta ti on s an d qu ot at io n

m ark s om it te d) ). Fu rth er, we "re vi ew fo r ab us e of di sc ret io n th e di st ric t co ur t's de ni al

of le av e to am en d a co m pl ai n t

, b u t w h en th e di st ric t co ur t ba se s it s de ni al on th e

fu ti li ty of th e pr op os ed am en dm en ts

, we rev ie w th e un de rlyin g le ga l co nc lu si on s de

no vo ." W al ke r v. Barr et t, 65 0 F.3 d 11 98

, 1 2 1 0 (8 th Ci r. 20 11 ) (in te rn al qu ot at io n

m ark s o m it te d)

.

W e ag ree with th e di st ric t cou rt' s fin di ng th at Si lv a ha d go od cau se to am en d

hi s co m pl ai nt aft er th e de ad li ne pa ss ed

. The refo re, we fo cu s ou r rev ie w on th e

di st ric t co ur t's fin di ng of fu ti li ty. The di st ric t c o u rt he ld th at br in gi ng a cl ai m fo r

eq ui ta bl e rel ie f ba se d on th e br each o f f i d u c i a ry du ti es was fu ti le whe re th e rel ie f

so ug ht was "co m

pe ns at io n fo r th e be ne fit s th at wou ld ha v e b een pa id bu t fo r th e

de fen da nt s' erro rs ." The di st ric t co ur t ba se d it s de ni al of S il va 's m ot io n m ai nl y on

Pi ch of f v. QHG of Sp rin g d al e, In c., 55 6 F.3 d 72 8 (8 th Ci r. 20 09 ). In Pi ch of f, th e Eig ht h Ci rcu it de ci de d w h e t h e r th e ph ras e "o th er ap pr op ria te eq ui ta bl e rel ie f" in

§ 11 32 (a)( 3) al lo wed th e pl a in ti ff to reco ve r li fe in su ran ce he wou ld ha ve be en

-1 3-en ti tl ed to ha d t he pl an 's a dm in is tra to r no t fa il ed to ex te nd hi s co ve rag e, an all eg ed

br each of fid uc ia ry du t y. I d

. at 73 1. The co ur t ex pl ai ne d th at th e te rm "'o th er

ap pr op ria te eq ui ta bl e rel ie f' is li m it ed to rel ie f th at was 'typic al ly av ai la bl e in eq ui ty
(s uc h as in

jun ct io n, m an da m

us , an d res ti tu ti on , bu t no t co m pe ns at or y da m ag es ).'" Id

. (q uo ti ng Mer te ns v. Hewit t Ass oc s., 50 8 U.S. 2 4 8

, 2 5 6– 57 (1 99 3) ). App lying

Pi ch of f, t h e d i s t r ic t co ur t in th is cas e de te rm in ed th at Si lv a co ul d no t se ek

co m pe ns at or y rel ie f un de r § 11 32 (a)( 3)

, so hi s cl ai m was fu ti le be ca u se th e co ur t

co ul d n ot gra nt th at rel ie f.

The di st ric t co ur t al so ad dr es se d th e Su pr em e Co ur t's m or e rece nt de ci si on in

CIGNA Co rp

. v. Am ara, 13 1 S. Ct

. 18 66 (2 01 1)

, bu t ul ti m a t e l y d e t e r m in ed th at

Am ara di d no t ov erru le Pi ch of f. I n A mar a, th e Su pr em e Co ur t id en ti fie d th ree

po ss ib le "eq ui ta bl e" th eo rie s of reco ve ry u n d er § 11 32 (a)( 3) fo r an ad m in is tra to r's

br each of fid uc ia ry du ty: su rch arg e, refo rm at io n, an d es to pp el

. Id

. at 18 79 –8 0. Si lv a

an d th e Dep art m en t of La b o r a r g ue th at Am ara ab ro ga te d Pi ch of f in th e se ns e th at

Am ara's ch arac te riz at io n of "o th er ap pr op ria te eq ui ta bl e r e l i ef" un de r § 11 32 (a)( 3)

is br oa d en ou gh to en co m pa ss Si lv a's req ue st ed co m pe ns at or y rel ie f in th is cas e—t he

fu ll am ou nt of th e su pp le m en ta l li fe in su ran ce po li cy

. W e di sc us s be lo w th es e th ree

types of eq ui ta bl e cl ai m s, an d we ex pl ai n ho w Am ara ha s ch an ge d th e av ai la bi li ty of

rel ie f an d t he sco pe of t ha t re li ef.

1. Fi du ci ary Dut y

Cla im Agai ns t Sa vv is —Su rch arg e

Si lv a cl ai m s th at Sav vi s, as a pl an ad m in is tra to r, br each ed an ERISA-i m po se d

fid uc ia ry du ty by fai li ng to pr ov id e Abe l wit h a su m m a r y p l a n d es cri pt io n, whi ch

co ul d ha ve ex pl ai ne d th e St at em en t of Hea l t h fo rm req ui rem en t as be in g a

pr ereq ui si te

. See 29 U.S.C. § § 11 09 (li ab il it y fo r br each of fid uc ia ry du ty), 11 04
(li st in g th e du ti es in cu m

be nt up on th e fid uc ia r y ), 10 22 (li st in g th e de sc rip ti on an d

req ui rem en ts fo r a su m

m ary pl an de sc rip ti on ), 10 24 (b ) (s ta ti ng th e an ad m in is tra to r

"s ha ll fu rn is h" a su m

m ary pl an de sc ri p t i o n t o each pa rti ci pa nt ). Si lv a arg ue s th e

-1 4-ab se nc e of a su m m ary pl an de sc rip ti on cau se d ha rm be cau se it wou ld ha ve li st ed th e

req ui rem en ts fo r en ro ll in g in a li fe in su ran ce po li cy in an eas y -to -u nd ers ta nd fo rm at ;

an d, if Abe l had be en pr ov id ed wit h th at in fo rm at io n, he woul d hav e co m pl et ed th e

req ui rem en ts to en ro ll in th e Pl an

. 9

Und er ERISA, th e pl an ad m in is tra to r m us t di st rib ut e a s u mm ary pl an

de sc rip ti on to al l pa rti ci pa nt s. 29 U.S.C. § 10 22

. The su m m ary pl a n d e s c r i p ti on

"s ha ll be writ te n in a m an ne r cal cu la te d to b e u n d e rs to od by th e av erag e pl an

pa rti ci pa nt ," § 10 22 (a), an d it m us t co nt ai n, am on g o t h e r req ui rem en ts

, "ci rcu m st an ces whi ch m ay res ul t in di sq ua li fic at io n, in el ig ib il it y , or de ni al or lo ss of

be ne fit s," § 10 22 (b ). The Su pr em e Co ur t ha s sa id th at th e su m m ary pl an de sc rip ti on 's

ob jecti ve is to pr ov id e "cl ear, s i mple co m m un ic at io n" th at st at es th e te rm s an d

co nd it io ns of th e Pl an

. Am ara, 13 1 S.Ct

. a t 18 77

. In ad di ti on , th e su m m ary pl an

de sc rip ti on m

us t be "fu rn is he d" by th e pl an ad mi n i s tra to r to th e pl an pa rti ci pa nt s.

See 29 U.S.C. § 10 24 (b )(1 ); se e al so Ley da v. All ie dS ig na l, In c., 32 2 F.3 d 19 9, 20 8
( 2 d C i r

. 20 03 ) ("[ T] he su m m ary pl an de sc rip ti on 'm us t be se nt by a m et ho d o r

m et ho ds of de li ve ry li kel

y to re su lt in f

u ll di st ri bu ti on ,' t ha t th e 'ad m in is tra to r sh al l

us e m eas ur es re as on ab ly ca lc ul at ed to en su re ac tu al re cei pt of th e m at eri al by pl an

pa rti ci pa nt s,' an d th at 'in no cas e is it acce pt ab le m erel y to pl ace co pi es of th e m at eri al

in a lo cat io n freq ue nt ed by pa rti ci pa nt s.'" ) (q uo ti ng 29 C.F.R. § 25 20 .10 4b -1 (b )(1 )).

Defen da nt s arg ue that if no se pa rat e su m m ary pl an de sc rip ti on ex is te d, th en th e

Pl an can fu nc ti on as bo th

. Reg ard le ss of th e po te nt ia l vi ab il it y of su ch an arg um en t

in ot he r cas es , we di sa gr ee o n t he pre se nt fact s. The Pl an in th is cas e is ne arl y 10 0

pa ge s lo ng an d co nt ai ns te ch ni cal la ng ua ge un li ke ly to be read or un de rs to od by "t he

Defen da nt s do no t as se rt th at Abe l ha d a di sq ua li fy in g m ed ic al co nd it io n or 9

t ha t th e St at em en t of Heal th fo rm wou ld ha ve al ert ed Met Life th at Ab e l w a s in el ig ib le fo r su pp le m en ta l li fe in su ran ce. Defen da nt s' de ni al of b e n e f i ts is ba se d

so le ly on Defen da nt s' po si ti on th at Abe l di d no t co m pl et e a St at em en t of Heal th fo rm

.

-1 5-a v e r a g e pl an pa rti ci pa nt ." 29 U.S.C. § 10 22 (a). It is no t a "cl ear" an d "s im pl e "

co m m u n i cat io n. Am ara, 13 1 S.Ct

. at 18 77

. Si lv a al so al le ge s in hi s pl ead in g th at

ev en if th ere ex is ts a di ffer en t su m m ary pl an de sc rip ti on , it was no t pr ov id ed to

Abe l. W e co nc lu d e t h e s e al le ge d fact s, if pr ov en , sh ow th at Sav vi s br each ed it s 1 0

fid uc ia ry du ty to act in th e in te res t of pl an pa rti ci pa nt s whe n it fai le d to pr ov id e Abe l

wit h ne ces sa ry in fo rm at io n reg ard in g en ro ll in g in th e Pl an

. See Gall ag he r v. Ci ty of

Cl ay to n, 69 9 F.3 d 10 13

, 10 16 (8 th Ci r. 20 12 ) (s ta ti ng th at on a m ot io n to di sm is s, th e

co ur t m us t "ac cep t as tru e al l fact s pl ead ed by th e no n- m ov in g pa rty an d gr an t al l

reas on ab le in fere nc es fro m th e p le ad in gs in fav or of t he no n- m ov in g p art y ").

The ne xt qu es ti on we as k is whe th er thi s wron g has a rem ed y

. W e reco gn iz e

th at so m e ERISA vi ol at io ns do n o t a l w a ys ha ve rem ed ie s. See, e.g ., Mayberr y v.

Uni te d Stat es , 15 1 F.3 d 85 5, 85 9 n.4 (8 th Ci r. 19 98 ) ("M os t of the ci rcu it s had he ld

at th e ti m e of th e se tt le m en t.

. . th at su ch da mag e s [ f o r a b r each of fid uc ia ry du ty]

were no t av ai la bl e un de r ERISA.") ; Bro wn v. Am pc o- Pi tt sb ur gh Co rp ., 87 6 F.2 d 54 6,

55 0 (6 th Ci r. 19 89 ) ("Th e fai lu re t o c om pl y wit h ERISA's pr oc ed ur al req ui rem en ts

is no t or di na ril y a ba si s fo r su bs ta nt iv e rel ie f."). In Pi ch of f, ou r co ur t de sc rib ed th is

ph en om en on as a "re m ed y -le ss 'reg ul at or y va cu um ' crea te d b y ER ISA's br oa d

pr eem pt io n of st at e la w cl ai m s an d th e Su pr e me C o u r t's na rro w in te rp ret at io n of

'ot he r ap pr op ria te eq ui ta bl e rel ie f.'" Pi ch of f, 55 6 F.3 d at 73 2. Fo r ex am pl e, ou r co ur t

ha s he ld th at a pl an ad m in is tra to r's fai lu re to di st rib ut e a su m m ary p la n de sc rip ti on

di d no t en ti tl e ha rm ed pl an pa rti ci pa nt s t o b en efi ts . Ant ol ik v. Sa ks , Inc ., 46 3 F .3d

79 6, 8 02 (8t h C ir. 2 00 6)

.

Si lv a al so cl ai m s it is po ss ib le Abe l ne ve r rece iv ed a co py of th e Pl an it se lf. 1 0

Defen da nt s s ug ge st th at Abel sh ou ld ha ve rece iv ed on e whe n he sta rte d work in g a t
Sav vi s, se ve ral y ears be fo re he el ect ed to si gn up fo r li fe in su ran ce c o v e rag e. Defen da nt s al so su gg es t th at it is po ss ib le Abe l rece iv ed a co py of th e Pl an whe n he

el ect ed to en ro ll in a be ne fit s p la n, b ut Sav vi s h as no ev id en ce o f th is

.

-1 6-Howev er, th e Su pr em e Co ur t's de ci si on in Am ara ch an ge d th e le ga l la nd sc ap e

b y c l e a r l y sp el li ng ou t th e po ss ib il it y of an eq ui ta bl e rem ed y un de r ERISA fo r

br each es of fid uc ia ry ob li ga ti on s by pl an ad m in is tra to rs

. Am ara, 13 1 S. Ct

. at 18 81

. Th e A mar a Co ur t di rect ly ad dr es se d th e ne ed fo r th is rem ed y , st at in g: "[I ]t is n o t

di ffi cu lt to im ag in e ho w th e fai lu re to pr ov i d e pr op er su m m ary in fo rm at io n, in

vi ol at io n of the st at ut e, in jure d em pl oyees. .

. . W e do ub t th at Co ng res s wou ld ha ve

wan te d t o b ar t ho se em

pl oyees fr om

rel ie f." Am ara, 1 31 S. Ct. at 18 81

.

Si lv a arg ue s th e rem ed y fo r hi s cl ai m ag ai ns t Sav vi s is th e eq ui ta bl e th eo ry of

su rch a r g e

. The Am ara Co ur t de sc rib ed eq ui ta bl e su rch arg e un de r § 11 32 (a)( 3) as

fo ll ows :

Equ it y co ur ts po ss es se d th e po we r t o p r o v id e rel ie f in th e fo rm of

m on et ary "co m

pe ns at io n" fo r a lo ss res ul ti ng fro m a tru st ee's br each of

d ut y , o r to pr ev en t th e tru st ee's un jus t en ric hm en t. In de ed , p rio r t o t h e

m erg er of la w an d eq ui ty th is ki nd of m on et ary rem ed y ag ai ns t a tru st ee,

so m et im es cal le d a "s ur ch arg e," was "ex cl us iv el y eq ui ta bl e."

Th e su rch arg e rem ed y ex te nd ed to a br each of tru st co m m it te d by a fid uc ia ry en c o mp a s si ng an y vi ol at io n of a du ty im po se d up on th at
fid uc ia ry

.

Am ara, 1 31 S.Ct . at 1 88 0 (i nt ern al cit at io ns an d ci ta ti on s to au th or it y om it te d) . To

ob ta in rel ie f un de r th e su rch arg e th eo ry , a pl an pa rti ci pa nt is req ui red to sh ow ha rm

res ul ti ng fro m th e pl an ad m in is tra to r's br each of a fid uc ia ry du ty. See Am ara, 13 1 S.

Ct

. at 18 81 –8 2 ("We be li ev e th at

, to ob ta in rel ie f by su rch arg e fo r vi o l a t i o n s of §§

[1 02 2 an d 10 24 (b )], a pl an pa rti ci pa nt o r b e ne fic ia ry m us t sh ow th at th e vi ol at io n

in jure d hi m o r h er. Bu t to do so , he or sh e ne ed on ly sh ow ha rm an d cau sa ti on

. Alt ho ug h it is no t al way s ne ces sa ry to m eet th e m or e rig or ou s st an da rd im pl ic it in th e

wor ds 'de tri m en ta l re li an ce,' ac tu al ha rm m us t b e sh own .").

-1 7-Bec au se Si lv a pl ead s fact s th at

, if pr ov en to be tru e , c o u l d s ho w an ERISA

vi ol at io n an d res ul ti ng ha rm , an d be c a u s e th at br each ha s a rem ed y un de r th e

eq ui ta bl e th eo ry of su rch arg e, we rev ers e th e di st ric t co ur t's de te rm in at io n t h a t a

cl ai m un de r § 1 13 2( a)(3 ) ag ai ns t Sa vv is wou ld be fut il e.

2. Fi du ci ary Dut y

Cla im Agai ns t M et Life —Re fo rm at io n

In ad di ti on to hi s cl ai m ag ai ns t Sav vi s, Si lv a cl ai m s th at Met Life br each ed it s

fid uc ia ry du ti es to Abe l by co ll ect in g in su ran ce po l i c y p rem iu m s fro m hi m fo r si x

m on th s an d th en , aft er Abe l's de at h, de nyin g th at he ha d a va li d po li cy

. See 29 U.S.C.

§ 11 04 (a)( 1) (B) (es ta bl is hi ng th e fid uc ia ry du ti es of "ca re, sk il l, pr u d e n c e , an d

di li ge nc e")

. Si lv a arg ue s th at Met Life 's pr em iu m de du ct io ns , co up le d wit h th e fact s

de sc rib ed ab ov e, reas on ab ly in du ced Abe l to be li ev e t h a t h i s ap pl ic at io n fo r a

su pp le m en ta l li fe in su ran ce po li cy was ap pr ov ed by Met Life an d th at n o f ur th er

act io n was ne ed ed

, ei th er to en su re co ve rag e wit h M e t Li f e or to acq ui re ot he r

in su ran ce pr iv at el y

. Si lv a al so a r g u e s th at Met Life 's act io ns sh ou ld be de em ed a

waiv er of th e ev id en ce-o f-i ns ur ab il it y req ui rem en t. The di st ric t co ur t reject ed th is

arg um en t, st at in g th at whi le Met Life 's co ll ect io n of pr em iu m s was in erro r, "an erro r

is no t al way s a waiv er." Si lv a, 91 2 F. Su pp

. 2d at 79 1. The di st ric t co ur t co nc lu de d 1 1

th at "[a ]ny co nf

us io n crea te d by th e de du ct io n of pr em iu m s fo r ex ces s in su ran ce di d

no t o ve rco m e th e cl ear l im it at io n i n t he pl an do cu m en ts ."

Si lv a arg ue s th at Met Life "wai ve d" th e "ev id en ce of in su rab il it y " pr ov is io n in

th e Pl an be cau se th e co m

pa ny ap pe ared to ap pr ov e Abe l's req ue st fo r co ve rag e whe n

it be ga n to de du ct pr em iu m pa y m en ts

. Si lv a arg ue s a rem ed y fo r hi s cl ai m ex is ts in

th e eq ui ta bl e th eo ry of refo rm at io n. W e fin d su pp or t for th is in Am ara's di sc us si on

of refo rm at io n un de r § 11 32 (a)( 3)

. See Am ara, 13 1 S. Ct

. at 18 79

. The re, th e Co ur t

The di st ric t co ur t di d or de r Met Life to refu nd Si lv a th e am ou nt th e co m pa ny 1 1

ha d d ed uc te d fr om

Abel 's p ay ch eck s fo r si x m on th s, wh ic h t ot al ed $1 28 .76

.

-1 8-st at ed th at "[t ]he po wer to refo rm co nt ract s (as co nt ras te d wit h th e po wer to en fo rce

co nt ract s as writ te n) is a tra di ti on al po wer of an eq ui ty co ur t, no t a co ur t of la w, an d

was us ed to pr ev en t frau d." Id

. ( c i t a ti on s om it te d)

. On rem an d, th e Dis tri ct of

C o n n ect ic ut de sc rib ed th e refo rm at io n rem ed y av ai la bl e un de r § 11 32 (a)( 3) a s

al lo win g co ur ts "t o refo rm co nt ract s th at fai le d to ex pr es s th e ag reem en t o f th e

pa rti es , owi ng eit he r to m ut ua l m is ta ke or to th e frau d of on e pa rty an d th e m is ta ke

of th e o th er." Am ara v . CIGNA, 92 5 F . Sup p. 2 d 2 42 , 25 2 (D. Co nn . 20 12 ).

On re m an d, Si lv a m ay be ab le to sh ow m ut ua l m is ta ke or " frau d o f on e p art y

an d th e m is ta ke of th e ot he r." See Id

. It was arg ua bl y frau d u l e n t f o r Met Life to

co ll ect pr em iu m s f

r o m a Sav vi s em

pl oyee who

, Met Life no w arg ue s, ne ve r ha d an

ap pr ov ed po li cy

. Fu rth er, Met Li f e d i d no t jus t erro ne ou sl y co ll ect pr em iu m s fro m

Abe l— an in te rn al Met Life in ve st ig at io n sh owe d th at ro ug hl y 20 0 Sav vi s em pl oyees

ha d be en pa y in g pr em iu ms f o r p o l ic ie s th at were ne ve r ap pr ov ed by Met Life

. W e

co nc lu de th at Si lv a is al lo wed to m ak e hi s waiv er arg um e n t o n r e man d, an d if

su cces sf ul , recei ve m on et ary da m ag es , as wi ll be di sc us se d b el ow.

3. Fi du ci ary Dut y

Cla im Agai ns t M et Life —Es to pp el

Bec au se Met Life ad m it te d erro r in co ll ect in g th e pr em iu m s an d Abe l rel ie d on

th at co ll ect io n as pr oo f th at he ha d a po li cy , Si lv a arg ue s th at Met Life sh ou ld al so be

eq ui ta bl y es to pp ed fro m cl ai m in g th at no po li cy ex is te d. Aga in

, wit ho ut res ol vi ng

Si lv a's cl ai m on t h e merit s, we fin d th at th is al le ge d wro ng can su rv iv e a Ru le

12 (b )(6 ) mo t i on be cau se rel ie f co ul d be gr an te d un de r § 11 32 (a)( 3) 's cat ch al l

pr ov is io n us in g th e tra di ti on al eq ui ta bl e es to pp el th eo ry di sc us se d in Am ara, 13 1 S.

Ct

. at 18 80

. The co nc ep t of eq ui ta bl e es to pp el is si m pl e; it "o pe rat es to pl ace th e

pe rs o n e n ti tl ed to it s be ne fit in th e sa m e po si ti on he wou ld ha ve be en in ha d th e

rep res en ta ti on s b een tru e." Id . (ci ta ti on om it te d)

.

-1 9-In Tod d v. Dow Ch e mi c a l C o., 76 0 F.2 d 19 2 (8 th Ci r. 19 85 ), th e co ur t

di sc us se d es to pp el in a li fe in su ran ce po l i c y di sp ut e whe re th e in su red -d eced en t

rece iv ed a le tt er st at in g he was in su red an d ha d pr em iu m s de du ct ed fro m hi s po li cy

. The co ur t s ta te d t he req ui rem en ts for sh owi ng est op pe l:

[P]rejud ic e or de t rimenta l rel ia nc e is an es se nt ia l el em en t of es to pp el

. Co ur ts ha ve he ld t h a t w r on gf ul ret en ti on of pr em iu m s can sa ti sf y th e

pr ej udi ce req ui rem en t. Evi de nc e sh owi ng th at th e in su red di d no t ob ta in

ad ditio na l li fe in su ran ce in rel ia nc e up on th e in su rer's rep res en ta tio n tha t
th e i n s u r ed was co ve red by a po li cy of in su ran ce is al so su ffi ci en t to

sa ti sf y th is ele m en t.

Id . a t 19 5– 96 ( i n t e r n a l c it at io ns om it te d)

. The co ur t wen t on to fin d th at th ere was

no su ch ev i d en ce of pr ejud ic e or de tri m en ta l rel ia nc e, an d be cau se of th at

, th e

de ced en t's fam il y co ul d no t reco ve r mo n e t a ry da m ag es un de r th e li fe in su ran ce

po li cy

.

The di st ric t co ur t in th e pr es en t cas e qu ot ed fro m a m or e rece nt Eig ht h Ci rcu it

cas e, Lin co ln Gen eral Hos pi ta l v. Bl ue Cro ss /B lu e Sh ie ld of Neb ras ka

, 96 3 F.2 d 11 36
(8 th Ci r. 1 99 2)

, fo r th e pr op os it io n th at "[i ]n ge ne ral

, th e do ct rin e of eq ui ta bl e

es to pp el req ui res pr oo f of wor ds or de ed s (o r so m et im es om is si on s t o s pe ak or a ct )

th at crea te a m is le ad in g im pr es si on up on whi ch a reas on ab le pe rs on wou ld rel y ." Id

.

at 11 41

. The di st ric t co ur t rel ie d on Lin co ln Gen eral Hos pi ta l to fin d th at Defen da nt s

ha d no affi rm at iv e du ty to te ll Abe l th at he ne ed ed to su bm it ev id en ce of in su rab il it y ,
st at in g th at "[a ]ny

ne gl ect by th e em

pl oyer an d th e in su rer di d no t alt er the te rm s of

th e p la n p la ci ng th e b ur de n fo r pr ov id in g th e req ui red [ev id en ce of in su rab il it y ] on

th e em pl oyee." Si lv a, 91 2 F. Su pp

. 2d at 79 3. Bec au se th e di st ric t co ur t de te rm in ed

th at Defen da nt s di d no t m ak e an y m is le ad in g rep res en ta ti on s to Abe l ex cep t fo r

de du ct in g pr em iu m s fro m hi s pa y ch eck

, th e di st ric t co ur t refu se d to ap pl y eq ui ta bl e

es to pp el

.

-2 0-W e rev ers e th e di st ric t co ur t an d ho ld th at Si lv a's § 11 32 (a)( 3) cl ai m ba se d on

eq ui ta bl e es to pp el can s u r v iv e a Ru le 12 (b )(6 ) m ot io n. The ev id en ce th at Met Life

co ll ect ed pr em iu m pa y m en ts fro m 20 0 ot he r Sav vi s em pl oyees who la ck ed ap pr ov ed

p o l i c i es co nv in ces us th at Abe l al so rel ie d on Met Life 's wro ng fu l co ll ect io n of h i s

pr em iu m s. In ad di ti on , Abe l di d no t ob ta in an y ot h er su pp le m en ta l li fe in su ran ce

po li cy

. It is un cl ear wha t a rea s o n a b l e pe rs on in Abe l's po si ti on wou ld ha ve do ne

di ffer en tl y to pr ev en t th is si tu at io n. Eve n if Abe l read th e en ti re Pl an , he reas on ab ly

co ul d ha ve be li ev ed th at Met Life ha d su ffi ci en t ev id en ce of in su rab il it y fro m hi m or

th at th e pr ov is io n di d no t ap pl y to hi m si nc e Met Life be ga n de du ct in g pr em iu m s fro m

hi s pa y ch eck an d th e su pp le m en ta l li fe in su ran ce po li cy sh owe d up on hi s Sav vi s

on li ne be ne fit s en ro ll men t p a g e

. Tod d cap tu res th is si tu at io n su cci nc tl y : "[T]he

ob jecti vely re as ona

ble ex pe ct at ion s of ap pli ca nts an d int en de d be ne ficia rie s reg ard in g

th e te rm s of in su ran ce co nt ract s wil l be ho no red ev en th ou gh pa in st ak in g st ud y of th e

po li cy pr ov is io ns wou ld h a ve ne ga te d th os e ex pe ct at io ns ." 76 0 F.2 d at 19 6 n.2
(q uo ti ng Ro be rt Keet on , In s. Law Ri gh t s at Vari an ce wit h Po li cy Pro vi si on s, 83

Harv ard L. Rev. 9 61 , 96 7 (1 97 0) ).

4. Ava il ab le Rel ie f

Bec au se w e d e t e r mi ne d th at Am ara ch an ge d th e la w as ou r co ur t ha d

pr ev io us ly in te rp ret ed it

, we co nc lu de a rem ed y m ay be av ai la bl e. Th e qu es ti on

rem ai ns , ho wev er, wha t m ig ht th at rem ed y lo ok li ke

. At or al arg u men t

, Si lv a's

co un se l an d th e Dep art m en t of Lab or , ap pe ari ng as an am ic us , ag reed th at th e

ap pr op ria te rem ed y un de r § 11 32 (a)( 3) is th e pa y m en t of be ne fit s th at were se em in gl y

owe d un de r th e Pl a n— $4 29 ,00 0. The ir req ue st fo r m ak e-wh ol e, m on et ary rel ie f

un de r § 11 32 (a)( 3) is su p p o r t e d b y th e cas e la w of ot he r ci rcu it co ur ts of ap pe al s.
See, e.g ., Osb erg v. Fo ot Loc ke r, In c., 55 5 F. App 'x 77

, 80 –8 1 ( 2 d C i r

. 20 14 );

Ken se th v. Dean Heal th Pl an , In c., 72 2 F.3 d 86 9, 89 1– 92 (7 th Ci r. 20 13 ) ("[ Am ara]

su bs ta ntial ly ch an ge s our unders ta nd in g of th e eq ui ta bl e rel ie f av ai la bl e un de r se ct io n

11 32 (a)( 3)

. [The pl ai nt iff ] ha s arg ue d fo r m ak e-wh ol e rel ie f in th e fo rm of m on et ary

-2 1-c o mp e ns at io n fo r a br each of fid uc ia ry du ty

. . . W e no w kn ow th at

, in ap pr op ria t e

ci rcu m st an ces , th at rel ie f is av ai la bl e un de r se ct io n 11 32 (a)( 3) ."); Gearl ds v. Ent erg y

Serv s., In c., 70 9 F.3 d 44 8, 45 2 (5 th Ci r. 20 13 ); McC rav y v. Met ro

. Life In s. Co

., 69 0

F.3 d 17 6, 18 2– 83 (4 th Ci r. 20 11 ); Teis m an v. Uni te d of Om ah a Life In s. Co

., 90 8 F.

Su pp

. 2d 87 5, 88 0 (W. D. Mi ch

. 20 12 ) ("[ T] he Co ur t fin ds th at § 11 32 (a)( 3)

au th or iz e s t h e 'm ak e-wh ol e' eq ui ta bl e rel ie f so ug ht by Pl ai nt iff be cau se [th e

co m pa ny] is a fid uc ia ry ."). Bu t se e Mo y le v. Lib ert y Mu t. Ret ire m en t Ben

. Pl an , No.

98 5 F. Su pp

. 2d 12 47

, 12 66 (S.D. Cal

. 20 13 ) ("'Ap pr op ria te eq ui ta bl e rel ie f' do es no t

au th or iz e su it s fo r m on ey da m ag es fo r br each of fid uc ia ry du ty."). The Fo ur th Ci rcu it

st res se d why a l l o w i n g pl an pa rti ci pa nt s to se ek th e fu ll am ou nt of be ne fit s fo r a

br each of f

id uc ia ry ob li ga ti on s u nd er § 11 32 (a)( 3) is so im po rta nt :

[W] it h Am ara, th e Su pr em e Co ur t clar ifi ed th at rem ed ie s be y on d m ere

pr em iu m refu nd s

. . . are in de ed av ai la bl e to ERISA pl ai nt i f f s s u in g fid uc ia rie s un de r Sect io n 11 32 (a)( 3)

. Thi s m ak es se ns e—o th erwi se , th e

st ifl ed st at e of th e la w in te rp ret in g Sect io n 11 32 (a)( 3) wou ld en co ur ag e ab us e by fid uc ia rie s. In de ed

, fid uc ia rie s wou ld ha ve ev ery in cen ti ve to

wro ng fu ll y acce pt pr em iu m s, ev en if th ey ha d no id ea as t o w h e t h er

co ve rag e ex is te d— or ev en if th ey affi rm at iv el y kn ew th at it di d n o t

. The bi gg es t ris k fid uc ia rie s wou ld face wou ld be th e ret ur n of the ir il lg o t te n ga in s, an d ev en th is ris k wou ld on ly m at eri al iz e in th e (li ke l y

sm al l) su bs et of ci rcu m st an ces whe re pl an pa rti ci pa nt s act ua ll y ne ed ed

th e be n e f i t s f or whi ch th ey ha d pa id

. Mea nwh il e, fid uc ia rie s wou ld

e n jo y es se nt ia ll y ris k- free win df al l pr of it s fro m em

pl oyees who pa id

pr em iu m s on no n- ex is te nt be ne fit s bu t who ne ve r fil ed a cl ai m fo r th os e be ne fit s. W it h Am ara, th e S up rem e Co ur t ha s pu t th es e pe rv ers e in cen ti ve s to res t an d pa ve d th e way fo r [th e pl ai nt iff ] to se ek a rem ed y be y on d m ere p rem iu m

refu nd

.

McC rav y , 69 0 F .3d at 1 82 –8 3.

W e ag ree an d di rect th e di st ric t co ur t to al lo w Si lv a to am en d hi s co m pl ai nt to

ad d hi s cl ai m s ag ai ns t Sav vi s an d Met Life un de r § 11 32 (a)( 3) ba se d on th e eq ui ta bl e

-2 2-th eo rie s of su rch arg e, refo rm at io n, an d eq ui ta bl e es to pp el as d e s c r i be d by th e

Su pr em e Co ur t i n Am ara.

C. Si m

ul ta ne ou s C la im s Un de r § 1 13 2( a)(1 )(B) an d § 11 32 (a)( 3)

Bec au se we co nc lu de th at an eq ui ta bl e rem ed y m ay be av ai la bl e, th e m ot io n

to am en d can no t be reject ed on a th eo ry o f f u t i l i t y. W e ne xt ad dr es s th e se pa rat e

qu es ti on of whe th er it co ul d be de ni ed on th e ba si s of red un da nc y

. Defen da nt s arg ue

th at Si lv a sh ou ld n o t b e a ll owe d to am en d hi s co m pl ai nt to ad d a cl ai m un de r § 1 13 2( a)(3 ) ba se d o n t he Su pr em e Co ur t case Vari ty Corp . v. Ho we, 51 6 U.S. 4 89
(1 99 6)

, whi ch ou r co ur t rece nt ly in te rp ret ed in Pi lg er v. Sween ey , 72 5 F.3 d 92 2 (8 th

Ci r. 20 13 ). In Vari ty, th e Co ur t di sc us se d th e in te ract io n be twee n th e su bs ect io ns in

29 U.S.C. § 11 32

, in cl ud in g th e two at is su e in th is cas e, §§ 11 32 (a)( 1) (B) an d (a)( 3)

. 51 6 U.S. at 5 1 2. The Co ur t st at ed th at § 11 32 (a)( 1) (B) fo cu se d up on pr ov id in g a

rem ed y fo r th e "wro ng fu l de ni al of be ne fit s an d in fo rm at io n," whi le § 11 32 (a)( 3) was

a "ca tc ha ll " th at pr ov id ed "'ap pr op ria te eq ui ta bl e rel ie f' fo r 'an y ' st at ut or y vi ol at io n."

Id

. The Co ur t no te d th at th is "s tru ct ur e su g g e s t s th at th es e 'cat ch al l' pr ov is io ns act

as a sa fet y ne t, of

feri ng ap pr op ria te eq ui ta bl e rel ie f fo r in juri es cau se d by vi ol at io ns

th at § [1 13 2] do es no t el se whe re ad eq ua te ly rem ed y ." Id

. The Co ur t th en co nc lu de d

th at "wh ere C on gr es s el se whe re p ro vi de d ad eq ua te rel ie f fo r a be ne fic ia ry 's i nju ry , th ere will be no ne ed for fur th er eq ui ta bl e rel ie f, in whi ch cas e su ch rel ie f no rm al ly

wou ld no t b e 'ap pr op ria te .'" Id . at 5 15 (em ph as is ad de d)

.

In Pi lg er, ou r co u r t in te rp ret ed Vari ty to st an d fo r th e pr op os it io n th at if a pl ai nt iff br in gs a cau se of act io n un de r § 11 32 (a)( 1) (B), th en th e pl ai nt iff is ba r red

fro m pu rs in g a cl ai m un de r § 11 32 (a)( 3)

. Pi lg er, 72 5 F.3 d at 92 7. At or al arg um en t,

Defen da nt s argu ed th at Si lv a m us t ch oo se be twee n § 11 32 (a)( 1) (B) or § 11 32 (a)( 3)

at th e pl ead in g st ag e be cau se Pi lg er fo recl os ed th e ab il it y to arg ue fo r rel ie f un de r

bo th

. Und er Defen da nt s' read in g of Pi lg er, in jure d pl ai nt iff

s wou ld ne ed to as se ss

-2 3-th ei r po ss ib le cl ai m s un de r 29 U.S.C. § 11 32 an d th en se le ct on ly th e su bs ect io n th ey

be li ev ed m os t l ik el y

to bri ng th em

th e rel ie f th ey

see k.

We d o n ot read Vari ty an d Pi lg er to st an d fo r th e pr op os it io n th at Si lv a m a y

on ly pl ead on e cau se of act io n to se ek reco v e r y o f h i s so n's su pp le m en ta l li fe

in su ran ce be ne fit s. Rat he r, we c on cl ud e th os e cas es pr oh ib it du pl ic at e re co ver ie s

whe n a m or e sp ec i f

i c s e c t i on of th e st at ut e, su ch as § 11 32 (a)( 1) (B), pr ov id es a

rem ed y si m il ar to wha t th e pl ai nt iff se ek s un de r th e eq ui ta bl e cat ch al l pr ov is io n, § 11 32 (a)( 3)

. See A.A., ex rel

. J.A. v. Bl ue Cro ss & Bl ue Sh ie ld of Ill

., No. 2: 13 -cv

00 35 7, 20 14 W L 91 01 44

, at *1 1 (W. D. W as h. Mar

. 7, 20 14 ) ("Di sm is sa l of a Sect io n [1 13 2](a)( 3) cl ai m is ap pr op ria te at th e su m m ary jud gm en t st ag e whe re a pl ai nt iff ha s

as se rte d, an d ob ta in ed re li ef fo r , a cl ai m un de r Sect io n [1 13 2](a)( 1) (B)." (em ph as is

ad de d) ); Jo ne s v. All en , No. 2: 11 -cv -3 80

, 20 14 W L 11 55 34 7, at *9 (S.D. Ohi o Mar

. 21

, 20 14 ) ("I t [is ] well es ta bl is he d in [th e Si xt h] C irc ui t th at pl ai nt iff s [can ] br in g

cl ai m s fo r br each es of fid uc ia ry du ty in ERISA cas es , an d [can ] ev en do so al on gs id e

a cl ai m for be ne fit s i n c ert ai n c irc um st an ces .").

Co nt rary to Defen da nt s' arg um en t, Vari ty do es no t li m it th e nu m be r of way s

a pa rty can in it ia ll y se ek rel ie f at th e m ot io n to di sm is s st ag e. The cas e Bl ack v. Lon g

Term Dis ab il it y

Ins ur an ce s um m ari zes ou r vi ews well :

Vari ty Co rp

. do es no t ho ld th at whe n an ERISA pl ai nt iff al le ge s fact s

su pp or ti ng bo th a § 11 32 (a)( 1) (B) an d a § 11 32 (a)( 3) cl ai m , a co ur t m us t

or sh ou ld gr an t a de fen da nt 's Ru le 12 (b )(6 ) m ot io n to di sm is s th e la tt er cl ai m

. Vari ty Co rp

. di d no t de al wit h pl ead in g bu t rat he r wit h rel ie f.

. . .

Fu rth er, no th in g in Vari ty Co rp

. ov erru le s fed eral pl ead in g ru le s. And

,

un de r s u c h ru le s, a pl ai nt iff m ay pl ead cl ai m s hypo th et ic al ly or al te rn at iv el y

. To d i s mi s s an ERISA pl ai nt iff 's § 11 32 (a)( 3) cl ai m as du pl ic at iv e at th e pl ead in g st ag e of a cas e wou ld , i n effe ct , r eq ui re th e pl ai nt iff to el ect a le ga l th eo ry an d wou ld

, th eref or e, vi ol at e [th e Fed eral

Ru le s o f Ci vi l Pr oc ed ur e].

37 3 F . Sup p. 2 d 8 97 , 90 2– 03 (E.D. W is . 20 05 ) (i nt ern al cit at io ns om it te d)

. -2 4-Silv a pr es en ts two al te rn at iv e—a s op po se d to du pl ic at iv e—t he orie s of lia bil ity

an d is al lo wed to pl ead bo th

. See F e d

. R

. C i v

. P

. 8( a)(3 ) ("A pl ead in g th at st at es a

cl ai m for rel ie f m

us t co nt ai n

. . . a de m an d fo r th e rel ie f so ug ht , whi ch m ay in cl ud e

rel ie f in th e al te rn at iv e or di ffer en t types of rel ie f."); Fed

. R. Ci v. P. 8( d) (2 ) ("A pa rty

m ay se t ou t 2 or m or e st at em en ts of a cl ai m or de fen se al te rn at iv el y or hypo th et ic al ly,

ei th er i n a si ng le co un t o r de fen se or in se pa rat e on es ."); se e al so Fed

. R. Ci v. P. 1 8
("A pa rty as se rti ng a cl ai m

. . . m ay joi n, as in de pe nd en t or al te rn a t i v e cl ai m s, as

m an y cl ai m s as it ha s ag ai n st an op po si ng pa rty."). The pl ai nt iff is si m pl y no t

al lo wed to reco ve r twi ce.

W e fi nd fur th er s up po rt for ou r in te rp ret at io n of Varit y in Am ara. In Am ara,

th e pl ai nt iff

s so ug ht rel ie f un de r § 11 32 (a)( 1) (B). Afte r di sc us si ng § 11 32 (a)( 1) (B)

an d de te rm in in g th at pl ai nt iff s co ul d no t ob ta in rel ie f un de r th at se ct io n of ERISA,

th e Co ur t tu rn ed to § 11 32 (a)( 3) an d st at ed th at p l a i n ti ffs m ay be ab le to ob ta in

eq ui ta bl e rel ie f un de r th at se ct io n. 13 1 S. Ct

. at 18 78 –7 9. The Co ur t ad dr es se d th e

is su e in te rm s of av ai la bl e rel ie f an d di d no t sa y th at pl ai nt iff s wou ld be ba rred fro m

in it ia ll y br in gi ng a cl ai m un de r th e § 11 32 (a)( 3) cat ch al l pr o v i s i o n si m pl y be cau se

th ey ha d al read y br ou gh t a cl ai m un de r th e m or e sp eci fic p o r t i o n o f th e st at ut e, § 1 13 2( a)(1 )(B)

.

W e re c o g ni ze th at th is in te rp ret at io n of Vari ty m ay se em to be at od ds wit h

earl ie r Eig ht h Circ ui t case s. See, e.g., Pi lg er, 725 F.3 d at 92 7 ("Pl ai nt iff s' abi li ty to

se ek th is rel ie f in th ei r § 11 32 (a)( 1) (B) cl ai m fo recl os es th em fro m al so pu rs in g it in

th is § 11 32 (a)( 3) (B) cl ai m ."); Ant ol ik

, 46 3 F

. 3d at 80 3 (s am e); W al d v. Sw. Bel l

Co rp

. Cu st om care Med

. Pl an , 83 F.3 d 10 02

, 10 06 (8 th Ci r. 19 96 ) (s am e). The se

cas es , ho w e v e r , a r e di st in gu is ha bl e ba se d on th e st ag e of li ti ga ti on th e co ur t was

rev ie win g. All th ree cas es were on ap pe al fro m a m ot io n fo r su m m ary jud gm en t— no t

a m ot io n to di sm is s. Thi s is im po rta nt be cau se cl ai m s are m or e de ve lo pe d by th e ti m e

a m ot io n fo r su mm a ry jud gm en t is fil ed

. At su m m ary jud gm en t, a co ur t is be tt er

eq ui pp ed to as se ss th e li ke li ho od fo r du pl ic at e reco ve ry , an al y ze th e ov erl ap be twee n

-2 5-c l a i ms , an d de te rm in e whe th er on e cl ai m al on e wil l pr ov id e th e pl ai nt iff wit h

"ad eq ua te rel ie f."

At th e m ot io n to di sm is s st ag e, ho wev er, it is di ffi cu lt fo r a co ur t to di sc ern th e

in tri caci es of th e pl ai nt iff 's cl ai m s to de te rm in e if th e cl ai m s are ind eed du pl ic at iv e,

rat he r th an al te rn at iv e, an d de te rm in e if on e or bo th co ul d pr ov i d e a d e q ua te rel ie f.

See Bl ack

, 37 3 F. Su pp

. 2d at 90 1– 02 ("[ A] di st ric t co ur t sh ou ld ge ne ral ly no t di sm is s

a § 11 32 (a)( 3) cl ai m as du pl ic at iv e of a cl ai m fo r be ne fit s at th e m ot i on to di sm is s

st ag e of a cas e."); All ba ug h v. Cal

. Fi el d Iro nwo rk ers P e n s io n Trus t, No. 2: 12 -cv

00 56 1, 2 01 4 WL 21 12 93 4, at *6 (D. Nev

. May 20

, 20 14 ) ("[ A] t t he pl ead in g s ta ge ,

a pl ai nt iff m ay ad va nc e m ul ti pl e, al te rn at iv e, ev en co nt rad ic to ry th eo rie s of li ab il it y [u nd er ERISA]."). At th e pl ead in g st ag e, it is di ffi cu lt to de te rm in e if rel ie f is in de ed

owe d un de r § 11 32 (a)( 1) (B), an d req ui rin g th e p l ai nt iff to pu rs ue th at pa th m ay

fo recl o s e t h e p l a i nt iff fro m br in gi ng a be tt er cas e pu rs ua nt to § 11 32 (a)( 3)

. Fo r

ex am pl e, th e East ern Dis tri ct of Mi ss ou ri— th e sa m e d is tri ct whe re the pr es en t case

or ig in at es —re cen tl y de cl i n ed to di sm is s a pl ai nt iff 's cl ai m s fo r rel ie f un de r §§ 11 32 (a)( 1) (B) an d (a)( 3) on a m ot io n to di sm is s be cau se th e fact ua l reco rd ha d no t

be en de ve lo pe d su ffi ci en tl y fo r th e c o u r t t o be ab le to di sc ern if th e cl ai m s were

in de ed du pl ic at iv e. Mar ti n v. Aetn a Li f e I n s

. Co

., No. 4: 13 cv 11 08

, 20 14 W L

20 09 07 9, at *4 (E.D. Mo

. May 16

, 20 14 ) (n ot in g th at th e pr o h i b i t i on ag ai ns t

du pl ic at iv e ERISA cl ai m s ap pl ie s " o nl y whe n § 11 32 (a)( 1) pr ov id es an ad eq ua te

rem ed y ").

At or al arg um en t, Defen da nt s' co un se l arg ue d th at be cau se Si lv a ha s a c la im

un de r § 11 32 (a)( 1) ( B ), al be it

, acco rd in g to Defen da nt s, no t a su cces sf ul on e, he is

ba rred fro m as se rti ng a cl ai m un de r § 1 13 2( a)(3 ). Defen da nt s' arg um en t il lu st rat es

th e un fai rn es s of th ei r po si ti on

. As st at ed a t l e n g th ab ov e, we be li ev e Vari ty on ly

ba rs du pl ic at e reco ve ry an d do es no t ad dr es s pl ead in g al te rn at e th eo rie s of li ab il it y

. Und er § 11 32 (a)( 1) (B), Si lv a is arg ui ng th at th e in su ran ce po li cy was va li d an d th at

Abe l's fai lu re to pr ov id e ev id en ce of in su rab il it y do es no t al te r t h e va li di ty of th e

po l i c y. I n t h e al te rn at iv e, un de r § 11 32 (a)( 3) , S il va is arg ui ng th at if Abe l's po li cy

-2 6-w a s n e v er va li dl y ap pr ov ed an d th eref or e di d no t go in to effe ct du e to th e m is si n g

St at em en t of Heal th fo rm , Met Life an d Sav vi s are st il l li ab le to hi m du e to fid uc ia ry

m is co nd uc t. The se arg um en ts ass ert di ffer en t t he or ie s o f li ab il it y

. Beca us e th es e 1 2

cl ai m s are ba se d on al te rn at iv e le ga l ba se s fo r rel ie f, Si l va m ay pl ead bo th

. If on

rem an d, th e di st ric t co ur t fin ds Defen da nt s li ab le un de r Si lv a's § 11 32 (a)( 1) (B) cl ai m , th en th e co ur t ne ed no t reac h hi s cl ai m un de r th e eq ui ta bl e cat ch al l pr ov is io n, § 11 32 (a)( 3)

, as t h e f

o rm er su bs ect io n ha s al read y pr ov id ed Si lv a wit h "ad eq ua te

rel ie f." See Vari ty, 51 6 U.S. at 51 5. Bu t at th e m ot io n to di sm is s st ag e of li ti ga ti on ,

Und er § 11 32 (a)( 1) (B), th e rem ed y Si lv a se ek s is pa y m e n t o f th e $4 29 ,00 0 1 2

li fe in su ran ce po li cy

. The rem ed y un de r § 11 32 (a)( 3) is le ss cl ear, bu t a t or al

a r g u men t, Si lv a's co un se l an d co un se l fo r th e Dep art m en t of Lab or arg ue d th at th e

rem ed y sh ou ld be th e sa m e: m ak e-wh ol e rel ie f, ta ki ng th e fo rm of th e fu ll pa y m en t
of be ne fit s un d e r th e po li cy

. See Am ara, 13 1 S. Ct

. At 18 80 ("[ T] he fact th at th is

rel ie f ta ke s th e fo rm of a m on ey pa y m en t do es no t rem ov e it f r o m t h e cat eg or y of

tra di ti on al ly eq ui ta bl e rel ie f."). The fact th at th e rem ed y so ug ht is th e sa m e am ou nt
of m on ey in th is cas e do es no t affe ct ou r an al y si s be cau se th e arg um en ts Si lv a m ak es

to reac h th at rem ed y rem ai n al te rn at e, eq ui ta bl e th eo rie s of li ab il it y

. See Ech ag ue v. Met

. Life In s. Co

., No. 12 -CV-0 06 40

, 20 14 W L 20 89 33 1, at *1 1 (N.D. Cal

. May 19

, 20 14 ) ("Th e m ere fact th at th e a mo u n t th at pl ai nt iff se ek s un de r he r (a)( 3) cl ai m is

si m il ar to th e am ou nt pl ai nt iff se ek s un de r he r (a)( 1) (B) cl ai m do es no t au to m at ic al ly

pr ecl ud e he r (a)( 3) cl ai m ."). In de ed

, in th e co nt ex t of a li fe in su ran ce po li cy , th e

rem ed y so ug ht un de r § 11 32 (a)( 3) ge ne ral ly al way s be th e fu ll be ne fit s av ai la bl e

un de r th e po li cy

. The refo re, si m il ari ty in th e fo rm of th e rem ed y so ug ht do es no t al te r

ou r vi ew th at Si lv a sh ou ld ha ve th e op po rtu ni ty to pl ead an d arg ue bo th cl ai m s. See

Jo ne s v. Am

. Gen

. Life & Acc i d e n t In s. Co

., 37 0 F.3 d 10 65

, 10 73 –7 4 (1 1t h Ci r. 20 04 ) (co nc lu di ng th at si m il ari ty of th e rel ie f so ug ht do es no t de te rm in e whe th er bo th § 11 32 ( a ) ( 1 ) (B) an d (a)( 3) cl ai m s can pr oc eed ). In ad di ti on , pr io r to th is su it

, Met Life in te rn al co rres po nd en ce sh ows th at th e co m pa ny th ou gh t S i lv a m ay be

en ti tl ed to th ree ti m es hi s sa la ry , $2 57 ,10 0, rat he r th an th e en ti re va lu e of th e l ife

in su ran ce po li cy

. Alt ho ug h Si lv a is as ki ng fo r fu ll rel ie f, it is no t cl ear th at th e rel ie f

un de r §§ 11 32 (a)( 1) (B) a nd (a)(3 ) is ne ces sa ril y th e sa m e. -2 7-we si m

pl y ho ld th at on rem an d th at Si lv a is al lo wed to as se rt li ab il it y un de r th e two

su bs ect io ns of 2 9 U.S.C. § 11 32 at i ss ue in th is cas e. 1 3

IV. Co nc lu si on

W e rev ers e th e di st r i c t c o u rt' s gr an t of su m m ary jud gm en t to Defen da nt s on

Si lv a's § 11 32 (a)( 1) (B) cl ai m an d th e di st ric t co ur t's de ni al of Si lv a's m ot io n to am en d

to ad d a cl ai m un de r § 11 32 (a)( 3)

. W e rem an d to th e di st ric t co ur t so Si lv a ha s a fu ll

op po rtu ni ty to l it ig at e b ot h o f hi s ERI SA cl ai m s i n l ig ht of o ur de ci si on

.

GRUENDER, Circ ui t J ud ge , con cu rri ng in pa rt a nd di ss en ti ng in pa rt.

I joi n th e op in io n of th e co ur t wit h res pe ct to it s di sp os it io n of Si lv a’s m ot io n

to am en d hi s co m

pl ai nt to ad d a cl ai m un de r 29 U.S.C. § 11 32 (a)( 3)

. H o w e v e r,

be cau se I be li ev e th at th e di st ric t co ur t pr op erl y gr an te d su m m ary jud gm en t in fav or

of Met Life an d Sav vi s on Si lv a’s cl ai m un de r 29 U.S.C. § 11 32 (a)( 1) (B), I

res pe ct fu ll y

di ss en t fr om

Part III.A o f th e o pi ni on of t he co ur t.

In co ns id eri ng a § 11 32 (a)( 1) (B) cl ai m , we rev ie w a pl an ad m in is tra t o r ’s

be ne fit s de te rm in at io n fo r ab us e of di sc ret io n wh e n , a s h e re, th e “ pl an gr an ts th e

ad m in is tra to r di sc ret io n to de te rm in e el ig ib il it y fo r be ne fit s an d to in te rp ret th e pl an ’s

te rm s.” Gre en v. Uni on Se c. In s. Co

. , 6 46 F.3 d 10 42 , 1 05 0 (8 th Ci r. 20 11 ). Und er

th is st an da rd

, a pl an “ ad m in is tra to r’s de ci si on sh ou ld be affi rm ed if it is reas on ab le .”

Id

. (in te rn al ci ta ti on s an d qu ot at io ns om it te d)

. As th e co ur t ob se rv es , th e ERISA pl an

in th is cas e pr ov id es th at Abe l’s su pp le m en ta l-l ife -in s u r a n c e co ve rag e wou ld no t

co m m en ce if he di d no t gi ve Met Life “ ev id en ce of in su rab il it y or t h e e v i d en ce of

in su rab il it y is no t acce pt ed by [Me tLi fe] as s a t i s f a c t o r y .” Se e an te at 4. Met Life

in te rp ret ed th is pr ov is io n to req ui re Abe l to su bm it a St at em en t of Heal th

, whi ch he

W e le av e fo r an ot he r da y th e is su e of whe th er fu tu re cas es m ay req ui re th e 1 3 pl ai nt iff to el ect whi ch th eo ry it is go in g to pu rs ue at tri al on ce fu ll di sc ov ery ha s be en co nd uc te d.

-2 8-di d no t do

. The di sp os it iv e qu es ti on in th is cas e, th en , is w h e t he r Met Life ’s

in te rp ret at io n was reas on ab le

. Se e a nt e at 1 1.

In rev ie win g [a pl an ad m in is tra to r’s] in te rp ret at io n of it s pl an la ng ua ge , we ge ne ral ly ex am in e th e fo ll owi ng fact or s [o fte n kn own as th e Fin le y fact or s]: (1 ) whe t h e r th e in te rp ret at io n is co ns is te nt wit h th e go al s of th e pl an ; (2 )

whe th er it ren de rs an y la ng ua ge in th e pl an m ean in gl es s or in te rn al ly in co ns is te nt ; (3 ) whe th e r i t co nf li ct s wit h th e

su bs ta nt iv e or pr oc ed u r al req ui rem en ts of ERISA; (4 )

wh e t h e r [th e pl an ad m in is tra to r] ha s in te rp ret ed th e

pr ov is io ns at is su e he re co ns is te nt ly; a n d (5 ) whe th er th e in te rp ret at io n is co nt rary to th e cl ear la ng ua ge of th e pl an

.

McCl el la nd v. Li

fe In s. Co

. of N. Am.

, 67 9 F.3 d 75 5, 75 9 (8 th C i r

. 20 12 ) ( ci ti ng

Fin le y v. Sp eci al Age nt

s Mut

. Ben ef

it Ass ’n

, 95 7 F.2 d 61 7, 62 1 ( 8 th Ci r. 19 92 )). 1 4

“ [W] e do no t se arch fo r th e be st or pr efer ab le in te rp ret at io n of a pl an te rm .” Hut ch in s

v. Ch amp io n In te rn

. Co rp

. , 11 0 F.3 d 13 41

, 13 44 (8 th Ci r. 19 97 ). “ [W] e m ay no t fin d

th e in te rp ret at io n in va li d m erel y be cau se we di sa gr ee wit h it

, bu t on ly if it is

un reas on ab le .” Id

.

Co ns id erat io n of th e Fin le y fact or s sh ows th at Met Life reas on ab ly in te rp ret ed

th e pl an to req ui re su bm is si on of a St at em en t of Heal th

. Fi rs t, Met Life ’s

i nt erp ret at io n is co ns is te nt wit h th e cl ear la ng ua ge of th e pl an

. The pl an req ui res

pa rti ci pa nt s to su bm it ev id en ce of in su rab il it y th at is “ sa ti sf act or y ” to Met Life

. Thi s

Alt ho ug h we al so m

us t co ns id er Met Lif

e ’s i nh eren t co nf

li ct of in te res t as 1 4

bo th in su rer an d pl an ad m in is tra to r, th at co nf li ct wil l be m os t rel ev an t “ ‘as a ti eb reak er’ w h e n th e is su e is cl os e” or “ ‘w he re ci rcu m st an ces su gg es t a hi gh er l i k e l i h oo d th at it affe ct ed th e be ne fit s de ci si on .’ ” Jo ne s v. Reli aS ta r Li fe In s. C o

. , 61 5 F.3 d 94 1, 94 6 (8 th Ci r. 20 10 ) (q uo ti ng Met ro po li ta n Li fe In s. Co

. v. Glen n , 55 4

U.S. 10 5, 11 7 (2 00 8) ). I do no t fin d th is cas e so cl os e as to req ui re a ti eb reak er, an d

Si lv a ha s no t po in te d to an y ev id en ce th at Met Life ’s co nf li ct of in te res t was

pa rti cu la rly lik el y

to affe ct th is sp eci fic be ne fit s d eci si on

.

-2 9-ph ras in g ne ces sa ril y co nt em pl at es th at Met Life wou ld req ui re so m e ev id en ce— su ch

as a St at em en t of Heal th —t ha t is no t sp eci fie d by th e pl an ’s te rm s an d th at Met Life

wou ld be th e jud ge of th e ad eq ua cy of th at ev id en ce. S i l v a ha s no t pr ov id ed an y

reas on to do ub t th at req ui rin g th e su bm is si on of a St at em en t of H e a l t h i s a fai r

m et ho d of as se ss in g th e he al th of a li fe-i ns ur an ce a p p l i c a n t

. Seco nd

, th e reco rd

de m on st rat es th at Met Life ha s ap pl ie d it s in te rp ret at io n co ns is te n t l y. A s th e co ur t

o b s erv es , ap pr ox im at el y 20 0 ot he r Sav vi s em pl oyees were fo un d no t to ha ve

co m pl et ed a St at em en t of Heal th

. Se e an te at 6- 7. Met Life ap pl ie d th e sa m e p l an

in te rp ret at io n to th es e em pl oyees as i t d i d to Si lv a an d req ui red th em to su bm it

St at em en ts of Heal th

. Se e App el la nt ’s App en di x at 56 5 (co nt ai ni ng Met Life in te rn al

cl ai m s- de te rm in at io n fil e) (“ [W] e ha ve de te rm in ed th at we wil l no t be gr an df at he rin g

th es e in di vi du al s in to th e pl an at th e am ou nt s th ey ’ve req ue st ed

. W e wil l req ui re ALL pas t part ic ip an ts to su bm it a fo rm .”). Thi s co ns is te nt ap pl ic at io n s up po rts th e

reas on ab le ne ss of Met Life ’s in te rp ret at io n. Thi rd

, req ui rin g su bm is s i o n of a

St at em en t of Heal th al so c o m po rts wit h at le as t on e pl an go al

, th at is

, en su rin g

affo rd ab il it y fo r pa rti ci pa nt s. As th e co ur t no te s, th e ev id en ce-o f

- i n s u r ab il it y

pr ov is io n can pr ev en t “ th os e who m ay be ve r y i l l fro m ta ki ng ou t a la rg e li fe

in su ran ce po li cy sh or tl y be fo re de at h.” Ant e at 11

. By l i mi t i n g Met Life ’s ris k

ex po su re , s u ch a req ui rem en t co ul d in tu rn red uc e pr em iu m co st s fo r ot he r

pa rti ci pa nt s. Refu si ng to en fo rce th is pr ov is io n in th e reas on ab le m an ne r se le ct ed by

Met Life co ul d im

po se fu tu re pr em iu m in crea se s on ot he r pl an pa rti ci pa nt s. Fi na ll y ,

no ne of th e ot he r Fin le

y fact or s un de rm in es Met Life ’s in te rp ret at io n. In li gh t of th es e

fact or s, whi ch t h e c o u r t do es no t sp eci fic al ly an al y ze, I co nc lu de th at Met Life

reas on ab ly in te rp ret ed th e pl an to req ui re su bm is si on of a S t at em en t of Heal th

, a

req ui rem en t wi th whi ch Abel di d n ot co m pl y

.

The co ur t ob

jects th at th e ad m in is tra ti ve reco rd om it s cer t a i n f a c ts th at th e

co ur t de em s ne ces sa ry to de te rm in in g whe th er Met Life ab us ed it s di sc ret io n. Bu t I

am no t co nv in ced th at th es e ev id en ti ary l a cu na e are so gl ari ng

. In pa rti cu la r, th e

ad m in is tra ti ve reco rd sh ows th at Met Life in ve st ig at ed Sav vi s’s m et ho d of no ti fy in g

em pl oyees th at su bm it ti ng a St at em en t of Heal th is req ui red

. And Sav vi s res po nd ed

-3 0-th at whe n em pl oyees at te m

pt to e n r o l l fo r be ne fit s th ro ug h it s on li ne en ro ll m en t

syste m , th e syste m pr om

pt ed th em to co m

pl et e a St at em en t of Heal th an d di rect ed

th em to th e co m

pa ny’ s be ne fit s de pa rtment, fro m whi ch th e fo rm co ul d be ob ta in ed

. Se e App el la nt ’s Ap pe nd ix 57 3- 76 . Sil va di d n ot pre se nt ev id en ce t o co nt rad ic t th e

res ul ts of Met Life ’s in ve st ig at io n. Thu s, th e un co nt rad ic te d ev id en c e i n th e

ad m in is tra ti ve reco rd su pp or ts th e co nc lu si on th at Abel rece iv ed no ti ce tha t he was

req ui red to co m

pl et e a St at em en t of Heal th

. Se e Gre en , 64 6 F.3 d at 10 50 (ex pl ai ni ng

th at a pl an ad m in is tra to r’s be ne fit s de te rm in at io n is reas on ab le if “ it is su pp or te d by

su bs ta nt ia l ev id en ce”)

. As su ch

, I be li ev e t h a t t h e di st ric t co ur t co rrec tl y gr an te d

su m m ary jud gm en t in fav or of Met Life an d Sav vi s on Si lv a’s § 11 32 (a)( 1) (B) cl ai m

.

As no te d ab ov e, I ag ree wit h th e co ur t th at Si lv a was pe rm it te d to pl ead

si m ul ta ne ou sl y cl ai m s un de r bo th § 11 32 (a)( 1) (B) an d § 1 1 3 2 (a)( 3)

. The co ur t

co rrec tl y ex pl ai ns th at at th is earl y st ag e of li ti ga ti on , an ERISA pl ai nt iff m ay pl ead

cl ai m s un de r bo th pr ov is io ns in th e al te rn at iv e. Se e an te at 23 -2 8. Cri ti cal ly, th ou gh

,

a § 1 1 3 2 ( a)(3 ) cl ai m

—ev en if pl ed in th e al te rn at iv e—c an no t su rv iv e a m ot io n to

di sm is s if th e pl ai nt iff se ek s to en fo rce rig ht s th at ari se un de r th e te rm s of an ERISA
pl an ; § 11 32 (a)( 1) (B) pr ov id es th e e x c l us iv e rem ed y fo r vi nd ic at in g rig ht s ari si ng

un de r th e te rm s of th e pl an

. Se e Pil ge r v. Sw een ey , 72 5 F.3 d 92 2, 9 2 7 (8 th Ci r.

20 13 ). Here, ho wev er, Si lv a pr em is es hi s § 11 32 (a)( 3) cl ai m on al le ge d br each es of

th e de fen da nt s’ fid uc ia ry du ti es th at pr ev en te d hi m fro m be co m in g el ig ib le fo r

be ne fit s u nd er t he pl an

. Se e Gea rl ds v. Ent er gy Se rv s., In c. , 70 9 F.3d 44 8 (5 th Cir

. 20 13 ); McCr av

y v. Met ro

. Li

fe In s. Co

. , 69 0 F.3 d 17 6 (4 th Ci r. 20 12 ). Acco rd in gl y , I joi n th e co ur t’s di sp os it io n of Si lv a’s m ot io n to am en d hi s co m pl ai nt to ad d a cl ai m

un de r § 1 13 2( a)(3 ).

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __

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