Opinion ID: 2829974
Heading Depth: 3
Heading Rank: 1

Heading: Papotto’s Three-Prong Test

Text: 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.