Source: https://docs.justia.com/cases/federal/district-courts/alabama/almdce/3:2011cv00813/46484/62
Timestamp: 2017-01-22 10:39:23
Document Index: 247491409

Matched Legal Cases: ['§ 1001', '§\n1132', '§ 1132', '§ 1132', '§ 1132', '§ 1132', '§ 1132', '§ 1331', '§1132', '§ 1132', '§1132', '§ 1132', '§ 1132', '§ 1132', '§ 1132', '§ 1021', '§ 1021', '§ 1022', '§ 1021', '§ 1021', '§ 3', '§ 1133', '§ 1133', '§ 1333', '§ 1133', '§ 1133', '§ 1332', '§ 2560', '§ 1333', '§ 1332', '§ 2560', '§ 1333']

MEMORANDUM OPINION AND ORDER: Plaintiff Dorothy Snow's Motion for Summary Judgment 31 is due to be and hereby is DENIED, and Defendant Boston Mutual Insurance Company's Motion for Summary Judgment 32 is due to be and hereby is GRANTED as to Count II and DENIED as to Count I of Plaintiff's Amended Complaint for Snow v. Boston Mutual Life Insurance Company :: Justia Dockets & Filings Log In
MEMORANDUM OPINION AND ORDER: Plaintiff Dorothy Snow's Motion for Summary Judgment 31 is due to be and hereby is DENIED, and Defendant Boston Mutual Insurance Company's Motion for Summary Judgment 32 is due to be and hereby is GRANTED as to Count II and DENIED as to Count I of Plaintiff's Amended Complaint. Signed by Honorable Judge Mark E. Fuller on 1/15/2013. (Attachments: # 1 Civil Appeals Checklist)(jg, )
CASE NO. 3:11-cv-813-MEF
Before the Court are (1) Plaintiff Dorothy Snow’s Motion for Summary Judgment
(Doc. #31), and (2) Defendant Boston Mutual Insurance Company’s Motion for Summary
Judgment (Doc. #32). For the reasons set forth below, the Court finds that Plaintiff’s motion
is due to be DENIED, and Defendant’s motion is due to be GRANTED IN PART and
This is an ERISA1 case involving two distinct claims for relief brought by Plaintiff
Dorothy Snow (“Plaintiff” or “Snow”), the widow and designated beneficiary under a life
insurance policy issued to James Francis Snow (“Mr. Snow”), against Boston Mutual
Insurance Company (“Boston Mutual” or “Defendant”) and Mr. Snow’s former employer,
Meadowcraft, Inc. (“Meadowcraft”), for the payment of certain life insurance benefits.
Count I of Plaintiff’s Amended Complaint alleges that Boston Mutual wrongfully denied
ERISA refers to the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001
payment of approximately $115,000 in life insurance benefits in violation of 29 U.S.C. §
1132(a)(1)(B). Count II of Plaintiff’s Amended Complaint asserts an alternative claim for
equitable relief under 29 U.S.C. §§ 1132(a)(3) and 1133 based upon Boston Mutual’s breach
of certain fiduciary duties it purportedly owed to Plaintiff as a Plan Administrator and claims
Plaintiff and Boston Mutual have filed cross-motions for summary judgment, each
arguing in their briefs that they are entitled to judgment as a matter of law on both of
Plaintiff’s claims. Specifically, Plaintiff argues that: (1) under the terms of the policy at
issue, and in accordance with 29 U.S.C. § 1132(a)(1)(B), she is entitled to approximately
$115,000 in life insurance benefits as a matter of law; and (2) Boston Mutual breached
certain fiduciary duties that it owed to her, thus entitling Plaintiff to equitable relief under 29
U.S.C. §§ 1132(a)(3) and 1133. Boston Mutual disagrees with Plaintiff, arguing that: (1)
under the terms of the policy at issue, and in accordance with 29 U.S.C. § 1132(a)(1)(B),
Boston Mutual is not obligated to pay any life insurance benefits to Plaintiff because her
husband was not covered under the policy at the time of his death; and (2) Boston Mutual
neither owed nor breached any fiduciary duties to Plaintiff that would entitle her to equitable
relief under 29 U.S.C. §§ 1132(a)(3) and 1133.
In sum, this case boils down to two issues. First, does Boston Mutual owe Plaintiff
any life insurance benefits under the policy at issue? Second, did Boston Mutual owe any
fiduciary duties to Plaintiff and, if so, did it breach any of those duties, thereby entitling
Plaintiff to any of the equitable remedies she seeks? Each of these issues is addressed in turn
The court has subject matter jurisdiction over this matter pursuant to 28 U.S.C. § 1331
(federal question) and 29 U.S.C. §1132(e)(1) (ERISA). The parties do not contest personal
jurisdiction or venue, and the court finds sufficient factual bases for both.
when the pleadings and supporting materials show that no genuine issue exists as to any
material fact and that the moving party deserves judgment as a matter of law. Fed. R. Civ.
P. 56(c); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). The party moving for
the absence of a genuine issue of material fact.” Celotex Corp. v. Catrett, 477 U.S. 317, 323
(1986). To shoulder this burden, the moving party can present evidence to this effect, or it
can show that the non-moving party has failed to present evidence in support of some
element of its case on which it ultimately bears the burden of proof. Id. at 322–23.
existence of a genuine issue for trial. Jeffery v. Sarasota White Sox, Inc., 64 F.3d 590,
593–94 (11th Cir. 1995). A genuine issue of material fact exists when the non-moving party
produces evidence that would allow a reasonable fact-finder to return a verdict in his or her
favor. Waddell v. Valley Forge Dental Assocs., 276 F.3d 1275, 1279 (11th Cir. 2001). Thus,
summary judgment requires the non-moving party to “do more than simply show that there
is some metaphysical doubt as to the material facts.” Matsushita, 475 U.S. at 586. Indeed,
a plaintiff must present evidence demonstrating that he can establish the basic elements of
his claim, Celotex, 477 U.S. at 322, because “conclusory allegations without specific
supporting facts have no probative value” at the summary judgment stage. Evers v. Gen.
Motors Corp., 770 F.2d 984, 986 (11th Cir. 1985).
to the motion, the court must grant summary judgment if there exists no genuine issue of
Standard of Review Applicable to Count I of Plaintiff’s Amended Complaint
The Court will consider Plaintiff’s claim under 29 U.S.C. § 1132(a)(1)(B), which
arises from Boston Mutual’s decision to deny payment of life insurance benefits, under the
de novo standard of review because the policy at issue does not expressly grant “the
administrator discretionary authority to make eligibility determinations or to construe the
plan’s terms.” Anderson v. Unum Life Ins. Co., 414 F. Supp. 2d 1079, 1094 (M.D. Ala.
2006). The parties do not contest that this is the appropriate standard of review applicable
to Plaintiff’s §1132(a)(1)(B) claim.
On August 26, 2011, Plaintiff filed a Complaint in the Circuit Court of Randolph
County, Alabama against Boston Mutual. (Doc. #1-1.) The case was timely removed to
federal court on September 28, 2011. (Doc. #1.) Plaintiff filed an Amended Complaint on
November 22, 2011 (Doc. #18), and Boston Mutual answered on December 6, 2011 (Doc.
#21). The parties agree that Plaintiff exhausted all of her administrative remedies before
filing this suit, or that exhaustion of any such remedies would be futile.
As of the date of this Order, Meadowcraft, Mr. Snow’s former employer and Boston
Mutual’s co-defendant in this case, has not appeared in or otherwise defended against this
As a result, the Clerk of Court entered a default against it.2
(Doc. #25.)
Meadowcraft is believed to be a defunct company that has ceased operations.3
On October 3, 2012, Plaintiff and Boston Mutual filed cross-motions for summary
judgment (Docs. #31 & 32), which are now before the Court and ripe for disposition.
Although the Clerk of Court has entered default against Meadowcraft, no default judgment
has been entered against it. See Tyco Fire & Sec., LLC v. Alcocer, 218 F. App’x 860, 864 n.5 (11th
Cir. 2007) (“A clerk’s entry of default, pursuant to Rule 55(a), is distinct from a judgment by default
entered by the clerk, pursuant to Rule 55(b)(1), or by the court, pursuant to Rule 55(b)(2).”).
Meadowcraft filed for Chapter 11 bankruptcy on July 3, 2002, and the bankruptcy was
closed as of August 27, 2007. See In re: Meadowcraft, CV-02-06910-TOM11.
The Court has carefully considered all deposition excerpts and other evidence
submitted in support of and in opposition to the parties’ summary judgment motions. The
submissions of the parties, viewed in the light most favorable to the non-moving party,
Plaintiff is the widow of Mr. Snow, who passed away on August 27, 2009. (Affidavit
of Dorothy Snow (“Snow Aff.”), Doc. #33-8, at ¶ 3.) Mr. Snow was sixty-six years and nine
months old at the time of his death. (Certificate of Death, Doc. #33-2, at 16.) Plaintiff is the
primary beneficiary designated to receive the life insurance benefits at issue in this case.
(Snow Aff., Doc. #33-8, at ¶ 3.) Beginning on October 25, 1993, Mr. Snow worked as a
warehouse supervisor for Meadowcraft until he became disabled on May 17, 2002.
The Group Life Insurance Plan
Meadowcraft maintained Group Policy No. 24661 (the “Plan”) for its full-time
employees, which included Mr. Snow. (Doc. #33-1, at 1.) This Plan was underwritten and
issued by Boston Mutual and became effective on August 1, 1999. (Doc. #33-1, at 1.) The
amount of life insurance benefits at issue here is approximately $115,000, and if these
benefits are due to be paid to Plaintiff, Boston Mutual would be solely responsible for paying
Under the Plan, when a disabled employee’s Waiver of Premium claim is approved,
his life insurance:
will be kept in force: (1) with no further premium cost to him or to the
Policyholder; (2) for the life amount in effect at the time; (3) for as long as he
is disabled; (4) whether or not the plan stays in force; (5) but in no event
beyond the Normal Retirement date in effect as of the date of . . . disability.
(Doc. #33-1, at 7) (emphasis added). Additionally, an employee’s insurance under the Plan
on the first of the following dates: (1) when the Plan stops; (2) when he is no
longer eligible for insurance under the Plan; (3) at the end of 31 days from
when the last premium was due and not paid if the employee is required to pay
part or all of the cost of his insurance; (4) when he leaves his job. But if he
leaves his job due to disability, . . . the Policyholder . . . may keep the
employee’s insurance in force until the Policyholder . . . chooses to stop it or
until the employee’s normal retirement date, whichever is earlier.
(Doc. #33-1, at 8) (emphasis added). The Plan defines “Normal Retirement Date” as the
“normal retirement date provided for by the Policyholder’s published or accepted personnel
practices.” (Doc. #33-1, at 3.)
Mary Beth Wilbanks (“Wilbanks”) began working full-time for Meadowcraft as the
Human Resources Coordinator for one of its plants in 1998. In 2002, Wilbanks was
promoted to serve as the Corporate Human Resources and Benefits Manager at
Meadowcraft’s corporate headquarters, where she was responsible for administering benefit
plans Meadowcraft provided to its employees. Wilbanks testified that her responsibilities
included “adding new associates, deleting associates for whatever reason, termination, layoff,
whatever we were experiencing, assisting associates with filling out claims if necessary,
assisting associates with questions about their benefits.” (Deposition of Mary Beth Wilbanks
(“Wilbanks Dep.”), Doc. #35-6, 12:5–11.) Wilbanks also testified that, in her position with
Meadowcraft, she “handle[d] enrollments, provide[d] documents to associates, maintain[ed]
records, handle[d] billing[.]” (Wilbanks Dep., Doc. #35-6, 52:17–53:8) (alterations to
Following his enrollment, Mr. Snow received a Group Insurance Certificate
(“Certificate”) distributed by Meadowcraft. (Snow Aff., Doc. #33-8, at ¶ 6.) Like the Plan,
the Certificate contains language regarding Waiver of Premium and when an employee’s
insurance stops, but the language contained in the Certificate concerning these two
provisions differs in certain respects from that contained in the Plan.
Waiver of Premium language in the Certificate differs from the Plan to the extent it does not
contain language terminating coverage at “the Normal Retirement date in effect as of the date
of total and permanent disability.”4 (Doc. #33-1, at 7.) The Certificate’s language regarding
when the employee’s insurance stops differs in a similar way from the Plan (i.e., the Plan
provides that an employee’s insurance stops whenever Meadowcraft chooses to stop it or
until the employee’s normal retirement date, whichever is earlier).5 (Doc. #33-1, at 8.)
Compare with the Waiver of Premium language in the Certificate, which states:
Once we approve a claim, your life insurance will be kept in force; (1) with no
further premium cost to you or the Policyholder; (2) for the life amount in effect at
that time; (3) for as long as you are disabled; (4) whether or not the Plan stays in
force. However, if the Plan states that your life amount would; (1) stop; (2) or
reduce at a certain age or time, then the same will be true under this disability clause.
(Doc. #33-1, at 19.)
Compare with the language contained in the Certificate, which states:
Despite these differences, the cover page of the Certificate is clear that: “This booklet [i.e.,
the Certificate of Insurance] is not part of the Plan.” (Doc. #33-4, at 1.) Moreover, the
Certificate itself provides that termination of benefits is governed by the terms of the Plan
and not the language of the Certificate.
Boston Mutual did not provide Mr. Snow with a copy of the Plan following his
enrollment. (Def.’s Resp. to Pl.’s Interrog., Doc. #33-7, at No. 8.) Indeed, it was not until
this litigation ensued that Plaintiff requested and received a copy of the Plan from Boston
Mr. Snow’s Disability, Waiver of Premiums, and Meadowcraft’s “Normal
Retirement Age”
While employed with Meadowcraft, Mr. Snow became totally and permanently
disabled with Chronic Obstructive Pulmonary Disease (“COPD”) and hypertension, leaving
him unable to work from May 17, 2002, until the time of his death on August 27, 2009.
(Snow Aff., Doc. #33-8, at ¶ 4.) Boston Mutual approved Mr. Snow’s long-term disability
claim. Mr. Snow applied for a Waiver of Premium under the Plan, which Boston Mutual
approved on October 16, 2002. In its approval letter, Boston Mutual advised Mr. Snow as
Your insurance stops on the first of the following dates: (1) when the Plan stops; (2)
when you are no longer eligible for insurance under the Plan; (3) at the end of 31
days from when your last premium was due and not paid if the Policyholder requires
you to pay part or all of the costs of your insurance; (4) when you leave your job.
If you leave your job due to disability, . . . the Policyholder may keep your insurance
in force until he chooses to stop it.
(Doc. #33-1, at 20.)
[T]his [Waiver of Premium] means that your insurance will remain in force as
if you were still a regular employee except that no further premium payment
will be required. It is important to note that if the [Plan] under which you were
insured provided for a reduction or termination of coverage at a certain time
or age, your coverage will likewise reduce or terminate at such time or age.
(Doc. #35-2, at 2.)
In connection with its processing of Mr. Snow’s Waiver of Premium claim, Boston
Mutual requested that Meadowcraft fill out and return an “Employer’s Statement” form,
which requested information such as the dates of Mr. Snow’s employment, a description of
his job duties, his annual salary at the time of disability, the amount of his insurance
coverage, and the “Current Normal Retirement Age in Company.” (Doc. #33-12, at 3.) On
October 2, 2002, Wilbanks completed and returned the requested Employer’s Statement
form, certifying that the “Current Normal Retirement Age in Company” was 65 years old.
(Doc. #33-12, at 3; Wilbanks Dep., Doc. #35-6, 33:12–33:22, 61:22–63:10.) Notably, on this
form, Wilbanks did not certify or provide any information as to the “Normal Retirement
date” for Meadowcraft employees. (Doc. #33-1, at 7.) Wilbanks testified that there were
Meadowcraft employees who worked past the age of sixty-five and that, ordinarily, it was
the individual employee who decided when to retire. (Wilbanks Dep., Doc. #35-6, 23:5S10;
35:15–17.) Wilbanks further testified that she could not recall how or where she obtained
the age of sixty-five for purposes of the Employer’s Statement form. (Wilbanks Dep., Doc.
#35-6, 33:12–22.)
While the information sought by Boston Mutual in the Employer’s Statement form
was intended to pertain to Mr. Snow’s life insurance coverage under the Plan, Wilbanks
mistakenly listed on the form the policy number for an unrelated long-term disability policy
(also provided through Boston Mutual), instead of the policy number for the group Plan.
(Doc. #33-12, at 3.)
Notice of Termination of Mr. Snow’s Group Life Insurance Coverage and
On November 20, 2007, Boston Mutual wrote to Mr. Snow and notified him that his
group life insurance coverage under the Plan would terminate on November 21, 2007 (Mr.
Snow’s sixty-fifth birthday) “due to having reached the maximum age limit for this plan.”
(Doc. #35-2, at 20.) Boston Mutual further advised Mr. Snow of his right to convert any
amount of his life insurance, up to the total amount of coverage under the Plan, to an
individual policy, and enclosed a Conversion Privilege/Request for Application form. (Doc.
#35-2, at 20–21.)
Mr. Snow completed the Conversion Privilege/Request for Application form on
December 7, 2007, and returned it to Boston Mutual. In the form, Mr. Snow indicated that
he was interested in applying for $100,000 of individual life insurance coverage. (Doc. #352, at 17.) On December 17, 2007, Boston Mutual sent Mr. Snow a letter acknowledging its
receipt of his Conversion Privilege/Request for Application form. In this letter, Boston
Mutual also informed Mr. Snow that $100,000 of individual life coverage would cost
$452.55 per month and that he could enroll by returning an application along with his initial
premium by December 30, 2007. (Doc. #35-2, at 16.) Plaintiff claims that Boston Mutual
never sent the December 17, 2007 letter and that a conversion application was never provided
to Mr. Snow. However, there is no dispute that Mr. Snow did not return a conversion
application or ever submit any premiums to Boston Mutual for an individual policy. As a
result, the Plan was not converted into an individual life policy.
Plaintiff’s Claim for Life Insurance Benefits and Boston Mutual’s Denial of
Mr. Snow died on August 27, 2009. On December 17, 2010, Plaintiff made a claim
to Boston Mutual for payment of benefits under the Plan. (Doc. #33-2, at 15.) Boston
Mutual received this letter on December 28, 2010. (Doc. #33-2, at 13.) On January 4, 2011,
Boston Mutual denied Plaintiff’s claim by letter, stating:
We approved Mr. Snow’s Waiver of Premium claim in October 2002, and his
life insurance was continued without any further premium up until the date he
attained his normal retirement, age 65. He was given the option to convert the
group life insurance to an individual life insurance policy; however, he did not
elect this option. Mr. Snow died after the termination of his Waiver of
Premium benefit, no converted policy was elected, and therefore no insurance
benefit is due.
(Doc. #33-2, at 13.)
Plaintiff made another request to Boston Mutual for payment of benefits on April 29,
2011. In this request, Plaintiff claimed that Boston Mutual’s contention that age 65 was the
normal retirement age was false because “we have located numerous employees who were
working at the plant past age 65.” (Doc. #33-2, at 12.) Boston Mutual denied Plaintiff’s
claim on May 26, 2011, reasserting the same grounds for denial as it did in its January 4th
letter. (Doc. #33-1, at 27.) Boston Mutual’s denial decisions were not subject to review by
Meadowcraft. (Wilbanks Dep., Doc. #33-9, 41:5–11.) Neither of Boston Mutual’s denial
letters notified Plaintiff of her right to sue to enforce the Plan under ERISA.
Count I—Claim for Plan Enforcement Under 29 U.S.C. § 1132(a)(1)(B)
In Count I of the Amended Complaint, Plaintiff seeks to recover life insurance
benefits under the Plan pursuant to 29 U.S.C. § 1132(a)(1)(B).6 In her summary judgment
submissions, Plaintiff contends that she is due approximately $115,000 in life insurance
benefits under the Plan because Boston Mutual’s denial decision was “wrong.” Plaintiff
contends that Boston Mutual’s denial decision was “wrong” for a number of reasons, the
majority of which stem from language in the Certificate differing from that contained in the
Plan, and the Snows’ subjective belief that the Certificate, rather than the Plan itself,
controlled or defined Mr. Snow’s coverage. Boston Mutual contends just the opposite—that
the Plan is clear that Mr. Snow’s life insurance coverage terminated when he reached the
“Normal Retirement Date” of 65 and, because he did not convert his group coverage to an
individual policy, benefits are no longer available to Plaintiff under the Plan. Both parties
have moved for summary judgment on this claim.
While there is evidence that Plaintiff understood the Certificate to be the Snows’
policy, and while Plaintiff has placed significant emphasis on highlighting the differences
between certain language contained in the Certificate and that contained in the Plan,
particularly as to the Waiver of Premium and “When Your Insurance Stops” provisions,7 this
This provision authorizes a civil action to be filed “by a participant or beneficiary . . . to
recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the
plan, or to clarify his rights to future benefits under the terms of the plan.” 29 U.S.C. §
Compare Doc. #33-1, at 7, with Doc. #33-1, at 19 (Waiver of Premium provisions in the
Plan and the Certificate, respectively); compare also Doc. #33-1, at 8, with Doc. #33-1, at 20
(“When Your Insurance Stops” provisions in the Plan and the Certificate, respectively).
does not make obsolete the well-settled rule that “summary documents, important as they are,
provide communication with beneficiaries about the plan[;] . . . their statements do not
themselves constitute the terms of the plan.” CIGNA Corp. v. Amara, 131 S. Ct. 1866, 1878
(2011). Indeed, as the Supreme Court explained in Amara, a claim for benefits under 29
U.S.C. § 1132(a)(1)(B) “speaks of ‘enforc[ing]’ the ‘terms of the plan,’ not of changing
them,” and such a claim must be premised on the terms of the Plan itself and not on summary
or extraneous documents. Id. at 1877. Here, the Certificate Plaintiff relies on expressly
provides that it is not a Plan document or otherwise part of the Plan. (Doc. #33-1, at 1)
(“This booklet is not part of the Plan.”). The Plan itself similarly provides that “[a]ny
conflict between the terms of the certificate and the Plan will be decided in favor of the
Plan.” (Doc. #33-1, at 11.) Therefore, for purposes of this opinion, the Court will confine
its analysis of Count I to the appropriate construction of the terms of the Plan itself, and not
the terms of the Certificate or the Plan’s alleged inconsistency with them.
With that being said, the Court must now determine whether a fact issue exists with
respect to whether Boston Mutual’s decision to deny Plaintiff life insurance benefits under
the Plan was wrong. This requires the Court to interpret Boston Mutual’s denial decision
under a de novo standard of review, with no deference being given to its previous decisions.
Applying that standard, the Court finds that a fact issue exists as to the appropriate
interpretation of “Normal Retirement date” under the Plan.
The Waiver of Premium provision in the Plan provides that once an employee’s
waiver of premium has been approved, the employee’s insurance:
(Doc. #33-1, at 7) (emphasis added). The Plan further provides that if an employee leaves
his job due to a disability, Meadowcraft may keep his insurance in force until it either
chooses to stop it or “until the employee’s normal retirement date, whichever is earlier.”
(Doc. #33-1, at 8.) “Normal Retirement Date” is defined in the Plan as the “normal
retirement date provided for by the Policyholder’s published or accepted personnel
The parties have presented conflicting evidence on what is considered to be
Meadowcraft’s “Normal Retirement date.” According to Boston Mutual, this term is
unambiguous under the Plan. To support this position, Boston Mutual relies on Wilbanks’
certification on the Employer’s Statement form, dated October 2, 2002, that the “Current
Normal Retirement age” at Meadowcraft was “65.” Notably, however, Wilbanks does not
certify on the form the “Normal Retirement date in effect as of the date of . . . [Mr. Snow’s]
disability,” as required by the Plan. (Doc. #33-1, at 7.) While drawing a distinction between
the words “age” and “date” may seem like splitting hairs to some, the Court finds these
differences to be significant. The Plan’s coverage terminates at the “Normal Retirement
date,” not age, of an employee. (Doc. #33-1, at 7.) To a reasonable fact-finder, this could
result in coverage terminating at some age other than sixty-five. Moreover, Meadowcraft’s
“Current Normal Retirement Age,” as represented in the Employer’s Statement form (65),
could just as easily differ from the “Normal Retirement date” in effect as of the date of Mr.
Snow’s disability (May 17, 2002).8 (Doc. #33-1, at 7.)
Additionally, the Plan defines “Normal Retirement Date” as the “normal retirement
date provided for by the Policyholder’s published or accepted personnel practices.” (Doc.
#33-1, at 3.) There is no evidence before the Court of any published personnel policy from
Meadowcraft designating its “Normal Retirement Date.” Plaintiff, however, has presented
substantial evidence that Meadowcraft had an accepted practice of allowing its employees
to work and retire past the age of sixty-five. (Wilbanks Dep., Doc. #35-6, 35:15–17.)
Indeed, Wilbanks testified that the individual employee ordinarily decided when to retire.
(Wilbanks Dep., Doc. #35-6, 23:5S10.) At the very least, this evidence contradicts the
Employer’s Statement form and creates a factual dispute as to what is Meadowcraft’s
“Normal Retirement Date” based upon its “accepted personnel policies.”
In construing life insurance plans governed by ERISA, the Court is guided by the
federal common law rules of contract interpretation. Under those rules, the Court interprets
the terms of a policy in an ordinary and popular sense, as would a person of average
intelligence and experience. When terms in a plan are ambiguous, the Court must construe
them strictly in favor of the insured; contract language is considered ambiguous if it is
subject to more than one reasonable interpretation. See Cannon v. Wittek Companies, Intern.,
60 F.3d 1282, 1284 (7th Cir. 1995). In this case, the Court is satisfied that the term “Normal
Retirement date” as defined in the Plan is ambiguous, as the evidence suggests that there is
For example, an employer’s “normal retirement date” could be 30 years after the
employee’s date of hire, which would result in different retirement ages depending on when a
particular employee was hired.
more than one reasonable interpretation. Accordingly, when construing the Plan language
in favor of the insured, the Court finds that there is a genuine dispute of material fact as to
what constitutes the “Normal Retirement Date” under the Plan. As such, both parties’
motions for summary judgment as to Count I of Plaintiff’s Amended Complaint are due to
Count II—Breach of Fiduciary Duties under ERISA’s “Catchall” Provision, 29
U.S.C. § 1132(a)(3)
In Count II of the Amended Complaint, Plaintiff seeks “equitable relief” for Boston
Mutual’s breaches of alleged fiduciary duties under ERISA’s “catchall” provision, 29 U.S.C.
1132(a)(3).9 Thus, to prevail on Count II, Plaintiff must be able to establish through record
evidence that Boston Mutual owed her a fiduciary duty and that it breached that duty.
Plaintiff alleges that Boston Mutual owed and breached the following fiduciary duties:
(1) the Plan Administrator’s duty to provide summary plan descriptions; (2) the Plan
Administrator’s duty to provide accurate and complete information; (3) the Plan
Administrator’s duty to provide all material information related to benefits and coverage; and
(4) the claims adjudicator’s duty to comply with ERISA’s claims procedures. (Doc. #33, at
42–52.) As to the three Plan Administrator duties, Boston Mutual claims that it never owed
Plaintiff these duties under the Plan. As to claims adjudicator duty, Boston Mutual likewise
claims that it did not owe Plaintiff any such duty and further claims that, even if it did, there
This provision authorizes a civil action to be filed “by a participant, beneficiary, or
fiduciary . . . (A) to enjoin any act or practice which violates any provision of this subchapter or the
terms of the plan, or (B) to obtain other appropriate equitable relief (i) to redress such violations or
(ii) enforce any provisions of this subchapter or the terms of the plan.”
would be no substantive remedy for the breaches Plaintiff alleges.
Plan Administrator Duties under 29 U.S.C. § 1021(a) and CrossReferenced Provisions
Plaintiff alleges that Boston Mutual, as a Plan Administrator, owed her a fiduciary
duty to supply adequate disclosures and properly report under 29 U.S.C. § 1021(a), which
imposes disclosure duties upon Plan Administrators. Accordingly, to resolve this claim, the
Court must first determine whether Boston Mutual is a Plan Administrator under ERISA.
ERISA places responsibility on Plan Administrators to furnish plan participants and
beneficiaries with: (1) a summary plan description (“SPD”) in accordance with § 1022(a)(1);
and (2) other statutorily mandatory information described in §§ 1021(f), 1024(b)(3), 1025(a),
and 1025(c). 29 U.S.C. § 1021(a). Although the parties vigorously dispute in their briefs
whether Boston Mutual is a Plan Administrator under ERISA, the statutory language
provides clear guidance on who is considered a Plan Administrator for purposes of these
ERISA defines the term “administrator” to mean:
(i) the person specifically so designated by the terms of the instrument under
which the plan is operated; (ii) if an administrator is not so designated, the plan
sponsor; or (iii) in the case of a plan for which an administrator is not
designated and a plan sponsor cannot be identified, such other person as the
Secretary [of Labor] may by regulation prescribe.
29 U.S.C. § (3)(16)(A). ERISA defines “plan sponsor” to mean “the employer in the case
of an employee benefit plan established or maintained by a single employer.” 29 U.S.C. §
(3)(16)(B)(i).
Nowhere in the Plan is Boston Mutual designated as the “administrator” (Doc. #33-1,
at 1–15), and Plaintiff does not claim or provide any evidence demonstrating that Boston
Mutual falls within the statutory definition of Plan Sponsor such that it worked to qualify as
the Plan Administrator. See 29 U.S.C. § (3)(16)(A)(i)–(ii). Nor is there any evidence that
the Secretary of Labor has designated Boston Mutual as the Plan Administrator. See 29
U.S.C. § (3)(16)(A)(iii). As such, there is no basis for finding Boston Mutual to be the Plan
Administrator under ERISA.
To the contrary, the undisputed evidence establishes that Meadowcraft, rather than
Boston Mutual, is the Plan Administrator in this instance. There is no dispute that Mr.
Snow’s employer was Meadowcraft. There is also no dispute that the Plan was “established
or maintained by a single employer”—Meadowcraft. Thus, while Meadowcraft may not
have been expressly designated as the administrator in the Plan, it qualifies as such by virtue
of being a “plan sponsor.” Therefore, Meadowcraft, not Boston Mutual, would be the proper
defendant in an action for breaches of Plan Administrator duties under ERISA. See 29
U.S.C. § 3(16)(A)(ii), (B)(i).
It is understandable that Plaintiff wishes to recover from Boston Mutual for alleged
failures to report and disclose material Plan information, especially considering that
Meadowcraft is no longer in operation and will likely be unable to satisfy any judgment that
may be entered against it. This reality, however, still does not alleviate Plaintiff of her
burden to establish the essential elements of her claim, which, when considering the clear
statutory language and the evidence before the Court, she has failed to do as there is
insufficient evidence that Boston Mutual qualifies as an administrator under the Plan.
Claims Adjudicator Duty under 29 U.S.C. § 1133
In addition to her theories of recovery premised upon Plan Administrator duties,
Plaintiff also seeks relief for Boston Mutual’s alleged breach of its duty, as claims
adjudicator, to comply with ERISA’s claims procedure provision. See 29 U.S.C. § 1133.10
Plaintiff claims numerous violations of statutory and regulatory procedures under § 1333 and
requests equitable relief “estopping [Boston Mutual] from enforcement of . . . added terms”
to the Plan. (Doc. #33, at 48–52.) Boston Mutual contends that its denial letters are not
subject to § 1133’s requirements, and even if they were, Plaintiff has not identified a
“substantive harm” to the exercise of her rights under ERISA that was caused by these
alleged violations. (Doc. #40, at 29.)
The Eleventh Circuit has held that while “ordinarily, violations of ERISA’s procedural
requirements do not entitle a claimant to substantive relief[,]” a certain quantity of procedural
violations “may work a substantive harm” by tainting the claim adjudication process such
that a claimant may be entitled to substantive relief. Harris v. Pullman Standard, Inc., 809
F.2d 1495 (11th Cir. 1987) (affirming district court’s finding that defendant’s procedural
violations were so numerous and egregious that they established that defendant “acted
arbitrarily and in bad faith when interpreting and implementing its policy,” thus entitling
plaintiffs to an award of benefits). Plaintiff alleges procedure violations in Boston Mutual’s
This provision states that “every employee benefit plan shall . . . (1) provide adequate
notice in writing to any participant or beneficiary whose claim for benefits under the plan has been
denied, setting forth the specific reasons for such denial, written in a manner calculated to be
understood by the participant, and (2) afford a reasonable opportunity to any participant whose claim
for benefits has been denied for a full and fair review by the appropriate named fiduciary of the
decision denying the claim.”
denial letters, namely, that Boston Mutual did not give Plaintiff required notice of her ERISA
rights.11 (Doc. #33, at 49–50.) However, even if such violations did occur, there is no
evidence of numerous and egregious violations of such an extent that Plaintiff incurred a
substantial harm to her ERISA rights. Indeed, it is absurd for Plaintiff to claim that Boston
Mutual’s failure to notify her of certain ERISA rights in its denial letters somehow
compromised those rights when she fully exhausted her administrative remedies under the
Plan and has timely filed file and fully pursued this action.
Given the lack of any evidence showing an alleged substantive harm to Plaintiff’s
ERISA rights caused by the alleged procedural violations in Boston Mutual’s denial letters,
Plaintiff’s theory of relief premised on violations of 29 U.S.C. § 1133 fails as a matter of law.
Accordingly, for the reasons set forth above, Boston Mutual’s motion for summary judgment
with respect to Count II of Plaintiff’s Amended Complaint is due to be GRANTED, and
Plaintiff’s motion for summary judgment with respect to Count II of the Amended Complaint
In accordance with this Memorandum Opinion and Order, Plaintiff Dorothy Snow’s
Plaintiff claims that the first denial letter failed to include: (1) that Plaintiff has an
opportunity to appeal the adverse claim decision; (2) that an appeal must be made within 180 days;
(3) that Plaintiff has an opportunity to request plan documents or the claim file free of charge; and
(4) that Plaintiff has a right to bring suit under 29 U.S.C. § 1332(a). See 29 C.F.R. § 2560.503–1(g)
(setting forth minimum requirements for denial letters under 29 U.S.C. § 1333). Plaintiff further
claims that the second denial letter failed to include: (1) that Plaintiff has an opportunity to request
plan documents or the claim file free of charge; and (2) that Plaintiff has a right to bring suit under
29 U.S.C. § 1332(a). See 29 C.F.R. § 2560.503–1(j) (setting forth minimum requirements for review
determination letters under 29 U.S.C. § 1333).
Motion for Summary Judgment (Doc. #31) is due to be and hereby is DENIED, and
Defendant Boston Mutual Insurance Company’s Motion for Summary Judgment (Doc. #32)
is due to be and hereby is GRANTED as to Count II and DENIED as to Count I of Plaintiff’s
DONE this the 15th day of January, 2013.