IN THE UNITED STATES COURT OF APPEALS 1

FOR THE FIFTH CIRCUIT 2

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No. 92-1147 4

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CRYSTAL CAMMACK MEDINA, 6

Plaintiff-Appellant, 7

VERSUS 8

ANTHEM LIFE INSURANCE COMPANY, 9

f/k/a American General Group Insurance Co., 10

Defendant-Appellee. 11

_________________________ 12

Appeal from the United States District Court 13

for the Northern District of Texas 14

_________________________ 15

(January 28, 1993) 16

Before GOLDBERG, SMITH, and EMILIO M. GARZA, Circuit Judges. 17

JERRY E. SMITH, Circuit Judge: 18

Cryst al Cammack Medina sought to amend her complaint to add 19

claims for recovery of extracontractual and punitive damages from 20

her insurance carrier, Anthem Life Insurance Company ("Anth em"), 21

under section 502(a)(1) (B) of the Employee Retirement Income 22

Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132(a)(1)(B). She 23

also sought recovery from Anthem of certain payments she had made 24

to one of her doctors. The district court refused to find that 25

section 502(a)(1)(B) allows extracontractual and punitive relief 26

and also refused to grant Medina recovery of other payments because 272

she failed to exhaust administrative remedies. We affirm. 28

I. 29

Medina works for Credit Finance Corporation, which is insured 30

by Anthem, which presently insures Medina. In January 1988, Medina 31

began a course of dental treatments during which her doctor 32

submitted a request to Anthem for predetermination of a dental 33

procedure. Anthem's claim committee reviewed the request, 34

concluded that sufficient evid ence did not exist to prove the 35

medical necessity of the procedure, and refused to pay any benefit. 36

Medina's doctor submitted the request again in 1990; Anthem's claim 37

committee further reviewed the request and once again reached the 38

same conclusion. 39

In April 1990, Medi na sought a second opinion from another 40

doctor, who recommended a different procedure. Anthem's claim 41

committee still determined that it would not cover the procedure. 42

In June, Medina's attorney wrote to Anthem seeking to convince 43

Anthem to approve the new procedure. Anthem sent Medina's records 44

to the Medical Review Institute of America for an inde pendent 45

evaluation. When the institute recommended going forward with the 46

procedure, Anthem approved the procedure on August 16, 1990. 47

The next day, Medina brought suit against Anthem in state 48

court, seeking $10,035 as the cost of treatment, $50,000 for pain 49

and suffering and mental anguish, and $500,000 in punitive damages. 50

Anthem removed the case to federal court. 51

Medina then filed an amended complaint that acknowledged that 523

ERISA preempts her state law remedies. She requested that the 53

court clarify her rights to future benefits, enjoin Anthem's "acts 54

and practices," and award her costs and attorneys' fees. 55

On October 16, 1991, Medina sought leave to file a second 56

amended complaint to add a claim for extracontractual and punitive 57

damages based upon Anthem's handling of her claims. The magistrate 58

judge refused to allow Medina to amend her complaint, finding that 59

ERISA precludes the award of extracontractual and punitive relief. 60

On November 18, 1 991, Anthem moved to dismiss the complaint 61

for failure to exhaust administrative remedies. Anthem argued that 62

it had paid all claims that Medina had submitted in accordance with 63

its policy. All that remained was a disputed $1,363.20 that Medina 64

averred to have paid her doctor for the l atest procedure she had 65

undergone. Anthem asserted that Medina never submitted proper 66

documentation to Anthem's claims department, so Anthem had no 67

obligation to reimbur se Medina. The magistrate judge agreed and 68

dismissed Medina's complaint for failure to exhaust administrative 69

remedies. 70

II. 71

We turn first to Medina's contention that the magistrate judge 72

erred in refusing to allow Medina to amend her complaint to add a 73

claim for extracontractual and punitive damages. Medina urges us 74

to develop a body of federal common law to supplement the express 75

provisions of ERISA, which includ e no mechanism for awarding 76

extracontractual or punitive dama ges. Joining the Seventh and 774

Eleventh Circuits, we decline this invitation. 78

ERISA section 502(a) is the civil enforcement provision of the 79

statute. It provides that 80

[a] civil action may be brought )) 81

(1) by a participant or beneficiary )) 82

. . . 83

(B) to recover benefits due to him under the terms 84

of his plan, to e nforce his rights under the 85

terms of the plan, or to clarify his rights to 86

future benefits to under the terms of the plan 87

. . . . 88

The plain language of this statute does not mention recovery of 89

extracontractual or punitive damages. Nothing in the statute 90

instructs us to fashion a federal common law remedy to grant 91

plaintiffs the right to recover p unitive or extracontractual 92

damages. Nevertheless, Medina asks us to do just that. 93

Medina points to legislative history that indicates a 94

willingness on the part of Congress to allow federal courts to mold 95

a federal common law of ERISA. The Conference Report describing 96

ERISA section 502(a) states that a plan beneficiary may bring a 97

civil action 98

to recover benefits under the plan which do not involve 99

application of the title I provisions . . . [and suits] 100

may be brought not only in U.S. district courts but also 101

in State courts of compet ent jurisdiction. All such 102

actions in Federal or State courts are to be regarded as 103

arising under the laws of the United States in similar 104

fashion to those brought under section 301 of the Labor105

Management Relations Act of 1947. 106

H.R. Conf. Rep. No. 1280, 93d Cong., 2d Sess. 327, r eprinted in 107

1974 U.S.C. C.A.N. 4639, 5107. As late as 1989, the House Budget 108

Committee "reaffirmed the authority of the federal courts to shape 1095

legal remedies to fit the facts and circumstances of the cases 110

before them, even though those remedies may not be specifically 111

mentioned in E RISA itself." Report of the Comm. on the Budget, 112

House of Rep., 101st Cong., 1st Sess. 55-56 (1989). 113

Unfortunately for Medina, Congress has had almost two decades 114

to enact its putative intent into law and has not done so. Had 115

Congress intended to develop ERISA remedies additional to the ones 116

it specifically crafted, it has had ample opportunity to enact such 117

legislation. Since Congress has not translated its intent into 118

law, we are loathe to take this initiative on our own. 119

In Pilot Life Ins. Co. v. Dedeaux

, 481 U.S. 41, 52 (1987), the 120

Court considered whether Congress meant for the civil enforcement 121

provisions of section 502(a) to be the exclusive remedy for 122

beneficiaries. While the Court directed its opinion to the 123

question of whether ERISA preempts a state law claim for improper 124

processing of disability benefits, and decided that ERISA did 125

preempt, it also noted that the text of the statute argues 126

"strongly for the conclusion tha t ERISA's civil enforcement 127

remedies were intended to be exclusive." I d. at 54. The Court 128

concluded that the "`carefully integrated civil enforcement 129

provisions found in § 502(a) of the statu te as finally 130

enacted

. . . provide strong evidence that Congress did not intend 131

to authorize othe r remedies that it simply forgot to incorporate 132

expressly.'" I d. (quoting Massachusetts Mut. Life Ins. Co. v. 133

Russell , 473 U.S. 134, 146 (1983)). 134

In Russell

, 473 U.S. at 144, the Court also addressed section 1356

502(a)(1)(B). Although the issue at bar in that case was whether 136

a fiduciary to a plan may be held liable for extracontractual or 137

p unitive damages under ERISA section 409(a), the Court turned to 138

section 502(a)(1)(B) for insight by a nalogy. I d. It noted that 139

since t hat section "says nothing about the recovery of 140

extracontractual damages

. . . there really i s nothing at all in 141

the statutory text to support the conclusion" that the statute 142

intended to give "rise to a private right of action for 143

compensatory or punitive relief." I d. The Court held that 144

Congress did not intend for section 409(a) to include any relief 145

outside of that expressly authorized by the statute. Id. 146

Medina points out that the Court more recently has addressed 147

this issue in Ingersoll-Rand Co. v. McClendon

, 498 U.S. 133, 111 148

S. Ct. 478, 486 (1990). In a case once more holding that ERISA 149

preempts state law claims for damages for wrongful discharge, the 150

Court mentioned in dicta that "there is no basis in § 502(a)'s 151

language for limiting ERISA actions to those which seek ` pension 152

benefits.' It is clear that the relief requested here 153

[compensatory and punitive damages] is well within the power of 154

federal courts to provide." Id. 155

Both the Seventh and Eleventh Circuits ha ve considered 156

Ingersoll-Rand and nevertheless have refused to fashion an 157

extracontractual or punitive remedy under section 502(a). In M cRae 158

v. Seafarers' Welfare Plan

, 920 F.2d 819, 821 n.7 (11th Cir. 1991), 159

Judge Wisdom, sitting by designation, explained the Ingersoll-Rand 160

dicta as follows: 1611 See also Reinking v. Philadelphia Life Ins. Co. , 910 F.2d 1210, 1219

(4th Cir. 1990) (denying claim for extracontractual damages for emotional

distress).

7 We do not interpret these statements to mean that the 162

remedies which the plaintiff in Ingersoll-Rand was 163

seeking )) future lost wages, mental anguish and punitive 164

damages )) are necess arily available under ERISA 165

§ 502(a). The Supreme Court was stating that federal law 166

provides relief for ERISA actions other than those that 167

seek to recover pension benefits, such as the plaintiff's 168

cause of action for wrongful termination. The Supreme 169

Court is not holding that the specific remedies this 170

plaintiff had sought under state law are necessarily the 171

remedies that will be afforded him should he be granted 172

relief under ERISA § 502. 173

The court then went on to rely upon the reasoning in Russell to 174

hold that section 502(a)(3) precludes extracontractual remedies. 175

Id. at 822. It refused to "create a federal common law of remedies 176

for the benefit of the plaintiff on the sole authority of the House 177

Committee Report." Id. at 823. 178

Similarly, in Harsch v. Eisenberg

, 956 F.2d 651, 660 (7th 179

Cir.), cert. denied

, 113 S. Ct. 61 (1992), the court dealt with the 180

Ingersoll-Rand dicta by declaring, 181

We are not rash enough to believe that the Court intended 182

to overrule settled law in most of the circuits, as well 183

as narrowly limit )) if not overrule )) its own decision 184

in Russ ell in such an off-hand manner

. . . . We will 185

continue to doubt the availability of extracontractual 186

damages under ERISA until a more plausible signal reaches 187

us from above. 188

The court held that neither extracontractual nor punitive damages 189

were available under section 502(a)(1)(B). Id. at 660-61. 1 190

We join the other circuits that have held that section 191

502(a)(1)(B) does not allow the recovery of extracontractual or 192

punitive damages. Like the court in H arsch

, we are r eluctant to 1938

believe that the Supreme Court intended us to create a body of 194

federal common law based upon an off-hand statement in Ingersoll195

Rand

. The more direct language in P ilot Life

, 481 U.S. at 54, and 196

Russell

, 473 U.S. at 144, shows t hat the Court felt that the 197

statutory enforcement scheme Congress crafted for ERISA in section 198

502(a) did not include a private remedy for e xtracontractual and 199

punitive damages. Without explicit instructions from Congress, we 200

are bound to the plain language of the statute that limits suits to 201

the terms of the plan at issue, rather than arbitrarily extending 202

its scope to include suits for ex tracontractual and punitive 203

damages. The magistrate judge correctly refused to allow Medina to 204

amend her complaint to include a claim for extracontractual and 205

punitive damages under section 502(a)(1)(B). 206

III. 207

We turn next to the issue of whether the magistrate judge 208

properly dismissed Medina's claim for failure to exhaust 209

administrative remedies. We first note that Medina's brief admits 210

that Anthem has paid all benefits due her in full. The only 211

possible claim that might remain is the disputed bill for 212

$1,363.20. 213

On July 11, 1991, Medina answered interrogatories put to her 214

by Anthem. In answer to Interrogatory No. 11, Medina claimed that 215

Anthem owed her $1,363.20 for a medical bill that Medina had paid 216

and for which Anthem had not reimbursed her. 217

In its motion to dismiss for failure to exhaust administrative 2182 See Simmons v. Willcox , 911 F.2d 1077, 1081 (5th Cir. 1990) (ERISA

claimant who failed to file claim with insurance company failed to exhaust

administrative remedies, so no cause of action existed); Meza v. General

Battery Corp. , 908 F.2d 1262, 1279 (5th Cir. 1990) (plaintiff may not make

initial claim for benefits in a lawsuit); Denton v. First Nat'l Bank , 765 F.2d

1295, 1303 (5th Cir. 1985) (Congress intended ERISA claimants to exhaust

administrative remedies before resorting to federal courts).

9 remedies, Anthem responds that it refused to reimburse Medina 219

because she never filed any documentation with Anth em's claims 220

department showing that she had paid the bill. Anthem asserts that 221

it cannot process a claim unless it has received th at claim and 222

that it maintains a reasonable claim submission policy that Medina 223

has ignored. Anthem assures us that if Medina takes the initial 224

step of submitt ing a claim, it will calculate her benefits 225

accordingly. 226

As the magistrate judge noted, we have fully endorsed the 227

prerequisite of exhaustion of administrative remedies in the ERISA 228

context. 2 One of the policies underlying the exhaustion 229

requirement was Congress's desire that ERISA trustees, not federal 230

courts, be responsible for their actions so that not every ERISA 231

action becomes a federal case. Denton , 765 F.2d at 1300. 232

We find that Medina has not exhausted her administrative 233

remedies regarding the unpaid $1,363.20 bill. Medina has never 234

filed a claimfor the disputed sum. She obviously knows how 235

An them's claims procedure operates, as she previously has filed 236

c laims for which Anthem reimbursed her. Medina may not make her 237

first claim for the unpaid $1,363.20 in this lawsuit but must 238

follow proper procedures in filing a claim with Anthem. Since she 239

has not exhausted her administrative remedies, the magistrate judge 24010

correctly dismissed her complaint. 241

IV. 242

In summary, we refuse to fashion federal common law that would 243

allow recovery of extracontractual and punitive damages under ERISA 244

section 502(a)(1)(B). We also find that Medina failed to exhaust 245

her administrative remedies by failing to file a claim with Anthem 246

for the disputed $1,363.20. Consequently, we AFFIRM the judgment 247

of dismissal. 248