Opinion ID: 2829974
Heading Depth: 2
Heading Rank: 1

Heading: Case Law Applicable to Our

Text: Jurisdictional Analysis
In Papotto, an ERISA case involving a claim for accidental death benefits under an accidental death and dismemberment (“AD&D”) policy, the plan administrator denied benefits because the plaintiff’s decedent was intoxicated at the time of his accidental death. 731 F.3d at 267-68. After both parties filed summary judgment motions, the district court found that a provision in the AD&D policy precluding recovery for accidental death or injury if the decedent was intoxicated at the time of his death or injury was applicable only if there was a causal connection between the intoxication and the death or injury. Id. at 268. As a result, the court denied both parties’ summary judgment motions and remanded the case to the plan 9 administrator for consideration of whether the decedent’s intoxication caused or contributed to his death. Id. The insurer appealed, and the plaintiff cross-appealed. Id. at 268-69. We raised the issue of jurisdiction sua sponte and considered whether the district court’s order remanding the case was final under 28 U.S.C. § 1291. 731 F.3d at 269-70. We noted that the remand order directed the plan administrator to take two actions: “(1) to consider additional evidence, and (2) to read a causation requirement into the intoxication exclusion provision and determine whether [the decedent’s] intoxication caused or contributed to his death.” Id. at 272. We considered the case to be analogous to cases dealing with appeals from orders remanding cases to administrative agencies. This conclusion led us to “distill” a three-prong test for determining the finality of the order in that case. Id. at 270. Under that test, we may exercise jurisdiction over remand orders in ERISA benefit cases when “(1) the remand ‘finally resolves’ an issue, (2) the legal issue is ‘important,’ and (3) denial of immediate review will ‘foreclose appellate review’ in the future.” Id. at 270.5 In fashioning this test, we noted that we “consistently [have] accorded significant weight to the third factor—i.e., potential for evasion of future review.” Id. Applying that test in Papotto, we “easily determine[d]” that we lacked appellate jurisdiction over the first portion of the order remanding for consideration of additional evidence. Id. at 272. Not only had we held previously that “orders directing remands to [administrative agencies] to consider additional evidence [are] nonfinal,” but we also reasoned that the 5 We understand the Papotto third prong to mean that it is necessary to allow an immediate appeal because there will not be an opportunity for an appeal in the future. 10 order failed the first prong of the test that we had distilled because it did not “finally resolve” anything. Id. (alterations in original) (internal quotation marks omitted). The second portion of the order for remand in Papotto directing the plan administrator to read a causation requirement into the intoxication exclusion provision when evaluating Papotto’s case required a separate analysis. Beginning with the first prong of our test—whether the order “finally resolve[d]” the underlying issue of the case—we followed the lead of other courts of appeals by asking: “Does the remand order make an ultimate determination as to eligibility, thus leaving the plan administrator with nothing left to do but issue an order?” Id. at 273. We held the order did not “finally resolve[]” the issue of the plaintiff’s eligibility and therefore required further action by the plan administrator. Id. at 274. After noting that the second Papotto prong—importance— was met, id. at 274 n.7, we addressed the third prong, stating that “no provision in the ERISA statute permit[s] an insurance company to challenge the decision of its own plan administrator in district court.” Id. at 274-75 & n.8. We nevertheless held that the insurer was not left without recourse because the district court retained jurisdiction over the case, inasmuch as “administrative closings do not end the proceeding. Rather, they are a practical tool used by courts to ‘prune . . . overgrown dockets’ and are ‘particularly useful in circumstances in which a case, though not dead, [is] likely to remain moribund for an appreciable period of time.’” Id. at 275 (first alteration in original) (quoting Freeman v. Pittsburgh Glass Works, LLC, 709 F.3d 240, 247 (3d Cir. 2013)). We also pointed out that a court may reopen an administratively closed case—“either on its own or at the request 11 of a party—at any time.” Id.6 We concluded that the district court’s order in Papotto administratively closed the case but did not dismiss it. Overall, we were satisfied that the third Papotto test prong for allowing immediate appeal was not met. We further held that the order was not appealable under the collateral order doctrine because it did not conclusively determine the disputed question, was not effectively unreviewable on appeal from a final judgment, and was not separate from the merits of the action as it “directly implicate[d] the heart of [the] case—whether Mr. Papotto’s death [was] an eligible event for distribution of benefits.” Id. We therefore dismissed the appeal for lack of jurisdiction. Id. at 277.
A recent ERISA case from the Court of Appeals for the Second Circuit, Mead v. Reliastar Life Insurance Co., 768 F.3d 102 (2d Cir. 2014), is useful in our consideration of the finality of the remand order now on appeal. Mead concerned an employee disability benefits claim in circumstances factually similar to those that we address now. There, the employer, Reliastar, provided a group insurance policy to its employees that included two kinds of benefits comparable to the STD and LTD benefits that Santander provided: own-occupation benefits for up to 24 months and any-occupation benefits thereafter. Id. at 104. Mead filed suit under ERISA after Reliastar denied her claim for 6 See also Bullard v. Blue Hills Bank, 135 S.Ct. 1686, 1691 (2015) (describing a final decision as “a ruling ‘by which a district court disassociates itself from a case’” (quoting Swint v. Chambers Cnty. Comm’n, 514 U.S. 35, 42, 115 S.Ct. 1203, 1208 (1995))). 12 disability benefits under its group policy. Id. at 104-05. The district court entertained Mead’s suit twice and both times remanded it for reconsideration, first because Reliastar’s reason for denial of own-occupation benefits did not identify the evidence that Reliastar credited and the evidence that it rejected in arriving at its decision, and second because the court believed that Reliastar “ignored” several physical requirements of Mead’s former position, refused to recognize the “ample” objective evidence supporting her subjective complaints of pain, and provided what the district court believed were “obviously false or misleading reasons” for discrediting the conclusions of its own neurologist. Id. at 105 (internal quotation marks omitted). After issuing its second remand order instructing Reliastar to “calculate and award” the own-occupation benefits and to determine whether Mead was entitled to any-occupation benefits, the district court directed its clerk to “close the case,” though it indicated that it would entertain a separate motion from Mead for prejudgment interest, attorneys’ fees, and costs. Id. at 106 (internal quotation marks omitted). Reliastar appealed from this second remand order to the Court of Appeals for the Second Circuit. The court of appeals in its analysis of its jurisdiction observed that “remands to ERISA plan administrators generally are not ‘final’ because, in the ordinary case, they contemplate further proceedings by the plan administrator.” Id. at 108. The court explained that it nonetheless would “examine the content of the particular ERISA remand in order to determine its appealability,” citing Papotto with approval. Id. Further, “to preserve an ERISA plan administrator’s ability to obtain appellate review of a nonfinal remand order,” the court decided that it 13 generally would “interpret a district court’s remand order as [retaining] jurisdiction over the case such that, after a determination by the plan administrator on remand, either party may seek to reopen the district court proceeding and obtain a final judgment.” Id. at 108-09. The court of appeals concluded that the district court’s remand order was not final and appealable under either a conventional application of § 1291 or pursuant to the collateral order doctrine. Id. at 113.7 In determining that the remand order was not final and appealable, the court reasoned that by remanding the issue of Mead’s eligibility for any-occupation benefits without addressing the merits of that issue, the district court’s order did not “conclusively determine” Reliastar’s liability to Mead under her ERISA claim.8 Id. at 209. Importantly, the 7 As we noted in Papotto, when considering the collateral order doctrine, the Supreme Court in Will v. Hallock, 546 U.S. 345, 349, 126 S.Ct. 952, 957 (2006), applied a practical construction of rather than an exception to § 1291 to bring a collateral order appeal within that section. Papotto, 731 F.3d at 271 n.4. 8 Appellants posit that Mead rejected the approach that Papotto adopted when Papotto formulated the test for deciding whether remands to ERISA plan administrators are appealable. This view is an overstatement; Mead ultimately declined to decide whether to apply its own precedent governing the finality of orders remanding cases to administrative agencies, but its analysis mirrored our own in Papotto. See Mead, 768 F.3d at 108-09, 111-12, 114 (analyzing whether the remand order contemplated further proceedings by the plan administrator and whether the district court retained jurisdiction over the case, permitting later 14 court rejected Reliastar’s argument that the any-occupation and own-occupation portions of the order were separable, reasoning that “[w]hile it may be true that Mead’s eligibility for ‘any occupation’ benefits has no practical effect on whether she is entitled to receive ‘own occupation’ benefits, this has no impact on [the court’s] jurisdiction because a district court’s decision that does not dispose of all of the plaintiff’s claims for relief is not ‘final.’” Id. at 110 (citing Liberty Mut. Ins. Co. v. Wetzel, 424 U.S. 737, 744, 96 S.Ct. 1202, 1206 (1976)). Moreover, the court determined that even the own-occupation portion of the order was not final, as the amount of benefits due had not yet been determined, and calculation of that amount was more than a “ministerial task.” Id. at 110-11 & n.5.