Court Opinion

ID: 9488777
Source: CourtListenerOpinion
Date Created: 2023-08-05 12:55:32.677773+00
Date Added: 2024-06-11T17:53:06.048340
License: Public Domain

CALABRESI, Circuit Judge,
concurring in part and dissenting in part:
ERISA requires that courts give deference to trustees’ discretionary decisions to deny claims for benefits. See Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 956-57, 103 L.Ed.2d 80 (1989). The scope of this deference is substantial. Even when a court finds the trustees’ decision to be arbitrary and capricious, the court typically will not substitute its own judgment for that of the trustees, but will return the claim to them for reconsideration. See Opinion at 1073 (citing Catania v. NYSA-ILA Severance Benefit Fund, No. 91 Civ. 3262, 1992 WL 176502, at *9-10, 1992 U.S.Dist. LEXIS 10985 at *28-29 (S.D.N.Y. July 15, 1992)). This procedure is consistent with Congress’s apparent intent that district courts not “‘function as substitute plan administrators.’ ” Opinion at 1071 (quoting Perry v. Simplicity Eng’g, 900 F.2d 963, 966 (6th Cir.1990)). Thus, returning the claim to *1075the trastees is inappropriate only in those cases in which the full evidentiary record admits of only one possible conclusion, or where reconsideration by the trustees would, for other reasons, be a “ ‘useless formality.’ ” Opinion at 1071 (quoting Wardle v. Central States, S.E. & S.W. Areas Pension Fund, 627 F.2d 820, 828 (7th Cir.1980) (internal citation omitted)).
Thus far, I am in complete agreement with the majority. I also agree with the majority’s determination that the Fund’s denial of Ms. Miller’s claim was arbitrary and capricious. Unlike the majority, however, I believe there is a significant risk that sending the claim back to the trustees would be a useless formality in the case before us.
Reconsideration by the trustees may be a useless formality for at least two different reasons. When a fully developed evidentiary record permits only one conclusion, the district court may properly impose that result itself. The resolution of the claim is indisputable, and requiring the trustees to reconsider their decision would simply be a waste of time. Similarly, when the trustees have demonstrated a manifest unwillingness to give fair consideration to evidence that supports the claimant, the claim should not be returned to the trustees. In such cases, it may well be that the evidence would support either a decision to grant or a decision to deny benefits. But reconsideration by the trustees would nevertheless be inappropriate because the claimant cannot obtain a fair hearing. The requirement that courts defer to the decisions of trustees cannot mean that we must affirm decisions by trustees who are so biased, obstinate, or lazy that they will not hear the claimant. In such situations, the right to a hearing, which is required by the benefit plan, would be wholly illusory.
I cannot say for sure that the Fund in this ease has demonstrated such an unwillingness to consider the merits of Ms. Miller’s claim. But if I had to decide the matter on the record before us, I would disagree with the majority and would find that the trustees exhibited just this sort of unwillingness. The cold record reveals a set of trustees who totally abdicated their fiduciary responsibilities in rendering their initial decision. They made it abundantly clear that all that mattered to them was the conclusion reached by the insurance company, which was anything but a disinterested party. It may be that on reconsideration, properly chastised by this court’s opinion, the trustees will exercise their authority in a more appropriate manner and render a decision based on all the evidence before them. But how can this court, on this record, fairly evaluate that possibility?
The district court has far greater familiarity and experience with both the parties and the circumstances of this case than we do. For example, on one collateral matter, it indicated that the trustees had acted in bad faith. This fact does not, by itself, preclude the possibility that reconsideration by the trustees may be more than a useless formality. But it is the sort of datum the trial court can place in context and evaluate far better than we can. I believe that the district court is far better situated than we are to determine whether sending the claim back to the trustees would be both unfair and a waste of time. For that reason, I would allow the district court to make this decision on the basis of the standard set forth by the majority.
Accordingly, I dissent from that portion of the majority’s opinion that instructs the district court to require the trustees to reevaluate Ms. Miller’s claim.