2009 D e c i sion s O p inion s of the U nit e d S t at e s C our t of Appe al s for the Thir d C ir c uit 11-9-2009 

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Thi s de c i sion i s br ou ght t o you for f r e e and ope n a c c e s s b y the O p inion s of the U nit e d S t at e s C our t of Appe al s for the Thir d C ir c uit at V i ll anova U nive r sity S choo l of L a

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___________ S T E P HANI E L . F OR D,

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D elaw are ( D . C . C i vi l A ct i on N o. 05- cv- 0118) D istri ct Ju d g e: H o n o rab le Jo sep h J. F arn an , Jr.

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O ct ober16, 2009 B efor e: M C K E E , FU E N T E S and N Y G A A R D , C i r cui tJ udges

( O pi ni on fi l ed: N ovember9, 2009)

___________ OP I NI ON

___________ P E R C UR I AM A ppel l antSt ephani e For d appea l s fr om the or derof the U ni t ed St at es D i s tr i ct C o u rt f o r t h e D is tr ic t o f

D e la w a re g ra n tin g s u m m a ry ju d g m e n t in f a v o r o f th e d e f e n d a n t. W e w ill a f

f ir m .2 I . St ephani e For d i s a form erempl oy ee of C hr i s t i ana H eal th C ar e Sy s t em, I nc. (“C hri st i ana”), w here she w orked a s a r adiol og ycl erk for seventeen y ears . F ord w as a part i ci panti n C hr i s t i ana’ s L ong- T erm D i s abi l i tyPl an, eff ect i ve J anuary1999. T he Pl an i ndi cat ed thati tw as “funde d as an i ns ur ed pl an . . . i s s ued byU num L i fe I ns ur ance C om panyof A m er i ca. ” O n O c to b e r 2 8 , 2 0 0 3 , F o rd w a s in v o lv e d in a h it- a n d -r u n a u to m o b ile a c c id e n t. W hi l e r ecove r i ng fr om the ac ci dent , s he r eques t ed l eave underthe Fami l yand M edi cal L eave A ct( “FM L A ”) . T he FM L A form i ns truct ed For d thatherj ob w as guar ant eed f or u p to tw e lv e w e e k s o f

lea v e , b u t F o rd ’s p h y sic ian d id n o t cle a r h e r to re su m e w o rk u n til A pr i l 13, 2004. Pr i ort o gai ni ng m edi cal cl ear ance fr om herdoct or , For d fi l ed a l ongt erm di s abi l i tycl ai m w i th U num L i fe I ns ur ance C om panyof A m er i ca ( “U num ”) , w hi ch U n u m d en ied o n M arc h 2 9 , 2 0 0 4 . U n u m ’s ow n p h y sici an s h ad ev alua ted F o rd’s c o n d itio n a n d d e te rm in e d th a t h e r c la im w a s n o t m e d ic a lly su p p o rt e d . In 2 0 0 5 , F o rd f

iled tw o law su its a g a in st U n u m – o n e in sta te c o u rt a n d o n e in fede r al court . I n t he s t at e courtact i on, For d s oughtdamages forl os tw ages , pai n and s uffe r i ng, m or t gage pa ym ent s , a l os tl i fe i ns ur ance pol i cy , and “l os tel i gi bi l i tyt o [s i c] be r ehi r ed forempl oym entaft er17 y ear s of s ervi ce, ” as a r es ul tof U num ’ s deni al of r eques t ed bene fi t s . She fi l ed a s epar at e compl ai nti n the U ni t ed St at es D i s tr i ctC our tfor the D istri ct of

D elaw are all eg ing d iscri m ination an d see k ing rec o v eryo f h er lon g -t erm3

di s abi l i tybenef

i t s . T he s t at e courtact i on w as r emoved t o the D i s tr i ctof D el aw ar e and the ca s es w er e cons ol i dat ed. I n M a r c h 2 0 0 6 , th e Di s tr i c tCo u r tg r a n t e d Un u m’ s M o t i o n t o Di s mi s s th e c l a i ms thatFor d r ai s ed i n heror i gi nal s t at e courtact i on, fi ndi ng thathers t at e l aw cl ai m s for b rea ch o f c o n tr ac t, n eg li g en ce , an d inten ti o n al i n fli cti o n o f e m o ti o n al distr ess w ere pr eempt ed underthe Em pl oy ee Ret i r ementI ncome Secur i tyA ct( “ER I SA ”) , and thatt he damages s he r eques t ed w er e notavai l abl e underE R I SA . I n D ece m ber2006, the D i s tr i ct C o u rtalso g ran ted U n u m ’s pa rt ial m o ti o n fo r sum m aryjud g m en t. In d o ing so , the c o u rt d en ied b o th F o rd’s d iscri m ination claim an d h er b rea ch o f c o n tr ac t cl aim , w h ich th e c o u rt p re v io u slyru led w e re c o v e re d b yE R IS A . T h e c o u rt c o n c lu d e d th a t U n u m ’s d e c isio n to denyFor d benef

i t s w as nei therarbi tr arynorcapr i ci ous and w as s uppor t ed bys ubs t ant i al evi dence . A s a r es ul t , For d’ s onl yr emai ni ng cl ai m w as thatU num w r ongful l yt erm i nat ed h e r $ 7 5 ,0 0 0 lif

e in s u ra n c e p o lic yo n w h ic h s h e h a d p a id p re m iu m s . I n a Sept ember19, 2008 opi ni on, the D i s tr i ctC our tgr ant ed U num ’ s m ot i on for s u m m a ry ju d g m e n t, d is m is s in g F o rd ’s re m a in in g c la im . F o rd f ile d a tim e ly ap p e a l. I I . W e h av e jurisdicti o n o v er the ap p ea l un d er 2 8 U . S . C . § 1 2 9 1 an d ex erc ise p lena ry r evi ew overthe D i s tr i ctC our t ' s deci s i on t o gr ants um m aryj udgm ent . M cG r eevyv. St r oup, 413 F. 3d 359, 363 ( 3d C i r . 2005) . Sum m aryj udgm enti s appr opr i at e w hen the “pl eadi ngs , the di s coveryand di s cl os ur e mat er i al s on fi l e, and anyaff i davi t s s how that4

th e re is n o g e n u in e iss u e a s to a n ym a ter ial f a c t an d th a t th e m o v a n t is e n tit led to jud g m en t as a m att er o f law . ” F ed . R . C iv. P. 56 (c). A co u rtrev iew ing a su m m ary j udgm entm ot i on m us teval uat e the evi dence i n the l i ghtm os tfavor abl e t o the nonm ovi ng partyand dr aw al l r eas onabl e i nfer ence s i n thatparty ' s favor . B r ew erv. Q uakerSt at e O i l R ef. C orp. , 72 F. 3d 326, 330 ( 3d C i r . 1995) . H ow ever , a partyoppos i ng s um m aryj udgm ent“mustpr es entm or e than j us t‘ bar e as s ert i ons , concl us oryal l egat i ons o r s u s p ic io n s ’ t o s h o w th e e x is te n c e o f a g e n u in e is s u e .” P o d o b n ik v . U .S . P o s ta l S e rv ., 4 0 9 F . 3 d 5 8 4 , 5 9 4 (3d C ir . 2 0 0 5 ). III . S t a t e La w Cl a i ms F ir st, the D istri ct C o u rtco rrectl yd eterm ined that F o rd’s state law claim s are pr eempt ed byE R I SA . E R I SA i s des i gned t o pr ovi de a uni form r egul at oryr egi m e over e m p lo y e e b e n e f

it p lan s. A e tn a H e a lth In c . v . D a v ila, 5 4 2 U .S . 2 0 0 , 2 0 8 (2 0 0 4 ). “T o th is e n d , E R IS A in c lu d e s e x p a n s iv e p re -e m p tio n p ro v is io n s , s e e E R IS A § 5 1 4 , 2 9 U .S .C . § 1144, w hi ch ar e i nt ended t o ens ur e thatempl oy ee be nefi tpl an r egul at i on w oul d be excl us i vel ya fe der al conce r n. ” I d. St at e l aw cl ai m s s uch as thos e r ai s ed byFor d i n her com plai nt – breach of

con tract , neg l i gen ce, and i ntent i on al i nfli ct i on of em oti on al dis tres s – w oul d or di nar i l yfal l w i thi n t he s cope of E R I SA pr eempt i on, i f the cl ai m s r el at e t o anA n empl oy ee w el far e bene fi tpl an i s defi ned underE R I SA as "a nypl an, fund, or 1 pr ogr am w hi ch w as . . . es t abl i s hed orm ai nt ai ned byan empl oy erorbyan empl oy ee or gani zat i on, orbyboth, t o t he ext entthats uch pl an, fund, orpr ogr am w as es t abl i s hed or i s m ai ntai ned for the p urpose o f prov i ding fo r i t s part i ci pan t s or theirben efi ci ari es, throug h the purchase o f i nsurance o r otherw i se . . . ben efi t s i n the even tof . . . death. " 2 9 U . S . C . § 1 0 0 2 (1). 5 E R I SA - governed bene fi t s pl an. See Pry zbow s ki v. U . S. H eal thcar e, I nc. , 245 F. 3d 266, 1 27 8 (3d C i r. 20 01 ) ( ho l ding t hat s uit s agai nsti nsurance co m pan i es for denial of b enef i t s, "e ven w hen the cl ai m i s couche d i n t erm s of comm on l aw negl i gence orbr eac h of contr act , " a r e pr eempt ed) . T her efor e, beca us e For d’ s s t at e l aw cl ai m s r el at e t o a qual i fi ed E R I SA - governed pl an, the D i s tr i ctC our tcorr ect l ydet erm i ned thattheyar e pr eempt ed by th e p r o v i s i o n s o f

E RI S A. Di s c r i mi n a t i o n Cl a i m T he D i s tr i ctC our tal s o corr ect l ydet erm i ned thatFor d’ s di s cr i m i nat i on cl ai m i s not co g n izab le. F o rd a ll eg ed that U n u m d iscri m inated ag ains t her in v iolati o n o f T it le V II w h e n it d e n ie d h e r c la im f o r l o n g -t e rm b e n e f

its . T itle V II , 4 2 U .S .C . § 2 0 0 0 e e t s e q ., p roh ibit s em p loy ers f

rom d iscri m inating ag ains t th eir em p loy ee s b ase d o n rac e, co lor, r el i gi on, s ex, ornat i onal or i gi n. For d neveri dent i fi ed the bas i s of herdi s cr i m i nat i on cl ai m . I n anyevent , beca us e U num w as neverherempl oy er , s he ca nnotes t abl i s h a di s cr i m i nat i on cl ai m agai ns tthe companyunderT i t l e V I I . See W al t er s v. M etr o E duc. E n ters. , Inc . , 5 1 9 U . S . 2 0 2 , 2 0 5 (19 9 7 ) (st ati n g that a d ef en d an t i s su b

ject t o T it le V II o n lyif it m e e ts th e sta tu to ryd e f in iti o n o f “ e m p lo y e r” ). T h u s, th e D istric t C o u rt c o rre c tly6

e n t e r e d s u mma r yj u d g me n ti n f a v o ro f Un u m o n th i s c l a i m. D e n ial o f

B e n e f its C laim F ord al so assert ed thatU nu m i m properl yden i ed h er cl ai m for di sabi l i tyben efi t s. A f ter c a re f u llyre v iew in g th e re c o rd , the D istric t C o u rt g ra n ted su m m a ryju d g m e n t in f a v o ro f Un u m. T h e S u p rem e C o u rth as d eterm ined that a d en ial o f b en ef it s ch all en g e u n d er E R I SA i s t o be r evi ew ed undera de novo s t andar d “unl es s the bene fi tpl an gi ves the a d m in istra to r o r f

id u c iar yd isc re tio n a rya u th o rityto d e ter m in e e lig ib ili tyf o r b e n e f its o r to cons true the t erm s of the pl an. ” Fi r es t one Ti r e & R ubberC o. v. B ruch, 489 U . S. 101, 115 (1 9 8 9 ). W e p re v io u slyh e ld th a t w h e n th e a d m in istra to r h a s d isc re tio n a rya u th o rityto det erm i ne el i gi bi l i tyforbenef i t s , as U num di d i n thi s cas e, the dec i s i on m us tbe r evi ew ed u n d e r a n a rb itr a ry a n d c a p ri c io u s s ta n d a rd . S e e A b n a th y a v . H o f f m a n -L a R o c h e , In c ., 2 F. 3d 40, 45 ( 3d C i r . 1993) . W e furtheri ns truct ed di s tr i ctcourt s t o appl ya “he i ght ened s t andar d of r evi ew ” or“hei ght ened s crut i ny ” w hen a pl an admi ni s tr at orboth eval uat es cl ai m s forbenef

i t s and pay s thos e cl ai m s . Pi nt o v. R el i ance St andar d L i fe I ns . C o. , 214 F .3 d 3 7 7 , 3 8 7 (3 d C ir . 2 0 0 0 ). T he Supr eme C our tr ece nt l ycl ar i fi ed, how ever , i n M etr opol i t an Li fe I ns ur ance C o. v. G l enn, 128 S. C t . 2343, 2346 ( 2008) , thatw her e the pl an gi ves the admi ni s tr at or s u c h d is c re tio n a ry a u th o ri ty, th e a p p ro p ri a te s ta n d a rd o f re v ie w is f

o r a b u s e o f

d is c re tio n . T he C our tfur therhel d t hatw hen ther e i s a conf l i ctof i nt er es t , i . e. , w hen a pl anA s m e n tio n e d , u n d e r G len n , a p lan a d m in istra to r' s c o n f lict o f in ter e st n o w re p re se n ts 2 o n ly o n e o f

s e v e ra l f

a c to rs u s e d to d e te rm in e w h e th e r t h e re w a s a n a b u s e o f d is c re tio n . 128 S. C t . at2352- 53. A l though w e now appl ythe abus e of di s cr et i on s t andar d s etfor th i n G l enn, w e have 3 re c o g n ize d th a t, at lea st in th e E R IS A c o n tex t, th e se sta n d a rd s o f re v iew a re p ra c tica lly iden ti ca l. E stat e o f S ch w ing v . L il lyH ea lth P lan, 56 2 F . 3 d 5 2 2 , 5 2 6 n . 2 (3d C ir . 2 0 0 9 ). 7 ad m inistrator b o th ev alua tes claim s fo r be n ef it s an d p ay s tho se c lai m s, the d istri ct co u rt s houl d w ei gh the conf

l i ctof i nt er es tas onl yone fa ct ori n det erm i ni ng w hetherther e w as a n a b u s e o f

d is c re tio n . Id . a t 2 3 5 2 -5 3 . I n th i s c a s e , b e c a u s e th e Di s tr i c tCo u r tru l e d o n F o r d ’ s c l a i m b e f o r e th e S u p r e me C our ti s s ued i t s rul i ng i n G l enn, the D i s tr i ctC our tr evi ew ed the admi ni s tr at or ’ s deci s i on underthe arbi tr aryand capr i ci ous s t andar d. B efor e r evi ew i ng the cl ai m underthat s t andar d, how ever , the D i s tr i ctC our tal s o r el i ed on ourrul i ng i n Pi nt o w hi ch r equi r ed the u se o f a slid in g sc a le to d e ter m in e th e lev e l o f a rb itrar ya n d c a p ric io u s re v iew to a p p ly w h e n a p a rtyis u n d e r a c o n f lict o f in ter e st. In c o n c lu d in g th a t itw a s a p p ro p ria te to a p p ly

2 “a s l i ght l y - hei ght ened a rbi tr aryand capr i ci ous s t andar d, ” the D i s tr i ctC our tpoi nt ed t o, i nteral i a, U nu m ’s adv antage as a soph i st i cat ed p artyfam i l i ar w i th E R ISA cl ai m s. E ven appl y i ng thi s m or e r i gor ous r evi ew , the D i s tr i ctC our tconcl uded that U n u m ’s d e n ial o f

F o rd ’s d isa b ili tyc laim w a s n o t ar b itrar ya n d c a p ric io u s a s th e re is ampl e evi dence i n t he r ecor d t o s uppor ta deni al of bene fi t s . W e agr ee w i th the D i s tr i ct C o u rt’s c o n c lu sio n . U n u m e m p lo y e d tw o re g iste re d n u rse s a n d tw o p h y sic ian s to 3 exami ne For d’ s m edi cal r ecor ds . C ons i s t entw i th i t s exami ner s ’ concl us i ons , U num8

det erm i ned thatFor d s us t ai ned s oftt i s s ue i nj ur i es fr om the aut om obi l e ac ci denti n the form of a s pr ai n/ s tr ai n, and thatthe us ual r ecove ryt i m e fors uch i nj ur i es s houl d nothave exce eded s i x w eeks . A ft ers um m ar i zi ng the fi ndi ngs of For d’ s phy s i ci an, U num c o n c lu d e d th a t h is tre a tm e n t o f F o rd w a s n o t co n sis ten t w ith in c a p a c itatin g p a in , an d th a t, in th e p re se n c e o f

in c a p a c itatin g p a in , o n e w o u ld h a v e e x p e c ted a d d iti o n a l d iag n o stic tes tin g , a c h ro n ic p a in m a n a g e m e n t re f e rra l, an d th e p re sc rip tio n o f stro n g e r p a in m e d ic a tio n . A l though For d’ s tr eat i ng phy s i ci an mayhave c oncl uded otherw i s e, the mer e fa ct thatan admi ni s tr at orr el i es on m edi cal evi dence thatconfl i ct s w i th the tr eat i ng p h y sici an ’s op inion d o es n o t r en d er the d en ial o f b en ef it s arb itrary . S ee S tr att o n v . E . I. D uPontde N emours & C o. , 363 F. 3d 250, 258 ( 3d C i r . 2004) . A l though For d’ s tr eat i ng phy s i ci an opi ned thats he w as di s abl ed unt i l m i d- A pr i l 2004, U num anal y zed a nd r ej ect ed h is o p in io n b a s e d o n in c o n s is te n c ie s b e tw e e n h is s ta te d o p in io n a n d h is tr e a tm e n t p la n . Be c a u s e Un u m’ s e x p l a n a t i o n s we r e r e a s o n a b l e a n d s u p p o r t e d b ys u b s t a n t i a l e v i d e n c e , we cannotconcl ude thati t s deci s i on t o denyFor d l ong- t erm benef i t s w as an abus e of di s cr et i on. W r ongful T erm i nat i on of For d’ s I ns ur ance Pol i cy L as t l y , the D i s tr i ctC our tpr oper l yrul ed thatFor d’ s s t at e l aw cl ai m of w r ongful term ination o f h er insu ran ce p o li cylack s m erit . A s an init ial m att er, th e D istri ct C o u rt c o rre c tlyo b se rv e d th a t th e c laim is p re e m p ted b yE R IS A . S e e P ry z b o w sk i, 24 5 F .3 d a t9

2 7 8 . T o th e e x ten t itw a s c o v e re d b yE R IS A , w e a g re e th a t th e c laim lac k s a rg u a b le m e rit. U n d e r h e r p o licy , co v e ra g e e n d e d o n F o rd ’s la st d a yo f a c tiv e e m p lo ym e n t w ith C hr i s t i ana. A l though underthe t erm s of the pl an s he coul d have e xt ended he rpol i cyby appl y i ng forconver s i on orpor t abl e cove r age w i thi n 45 day s of the end of her empl oym ent , i ti s undi s put ed thatFor d di d notappl yforext ended c over age. A c c o rd in g ly , w e w ill a f f irm th e ju d g m e n t o f

th e D istric t C o u rt.