534 F. App'x 162
3d Cir.2013Background
- Lemons was employed by Amerisafe, Inc. (1999–Jan 15, 2001) and participated in the Amerisafe Plan, ERISA-governed; Reliance is the claim fiduciary and Plan insurer.
- Lemons became disabled Jan 1, 2001 and applied for long-term disability benefits, which Reliance initially approved and later terminated (effective July 2, 2001).
- Lemons’ SSDI began June 2002 per SSA notice in May 2003.
- In 2005 Lemons sued Amerisafe, Reliance, and the Plan for arbitrary termination of benefits; in Feb 2006 Reliance reinstated benefits and offered to dismiss the suit but would not pay fees.
- May 2006 Reliance informed Lemons of reinstatement and retroactive payment totaling $66,443.89 for July 2, 2001–May 2, 2006, offset by SSDI; payments began May 2006.
- In 2011 the District Court denied summary judgment and held the case moot; Lemons sought reconsideration and attempt to pursue attorney’s fees under Ursic analysis, which the court denied; on appeal the district court’s mootness ruling was affirmed, and Ursic-based fees remanded.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Is the case moot after reinstatement of benefits? | Lemons argues mootness is not complete since amounts were miscalculated. | Defendants contend reinstatement resolves the dispute and monetary offset is a separate claim. | Yes, moot; reinstatement resolves the core dispute. |
| Whether Lemons may pursue attorney’s fees and which test applies (Ursic multi-factor vs prevailing party) | Lemons contends Ursic applies and he should be allowed to file for fees. | Defendants argue no fees under Ursic and that the case is moot, making fee motion inappropriate. | Remanded for full Ursic analysis; fee motion to be considered on remand. |
Key Cases Cited
- Silk v. Metro. Life Ins. Co., 310 F. App’x 138 (9th Cir. 2009) (mootness when benefits reinstated can dispose of ERISA dispute)
- Ursic v. Bethlehem Mines, 719 F.2d 670 (3d Cir. 1983) (multifactor Ursic test for fees in ERISA actions)
