856 F.3d 541
8th Cir.2017Background
- Lisa E. Jones, a Boeing employee, claimed short-term and long-term disability under Boeing’s plan; Aetna administered and funded benefits for long-term disability and administered short-term benefits.
- Jones stopped working October 16, 2013; treating physicians (rheumatologist Dr. Garriga, pain specialist Dr. Gunapooti, chiropractor Dr. Dent) and a physical-therapy functional capacity evaluation offered mixed reports about her pain, limitations, and inconsistent performance.
- Aetna reviewers (Dr. Swan-Moore and later Dr. Gerstenblitt) concluded Jones could perform at least sedentary work and terminated short-term benefits effective February 17, 2014; Aetna denied her appeal on October 8, 2014.
- Jones submitted an administrative appeal, later provided an SSA disability award letter (after Aetna’s final decision), and then sued under ERISA § 1132(a)(1)(B) (wrongful denial of benefits) and § 1132(a)(3) (breach of fiduciary duty). The district court dismissed the (a)(3) claim as duplicative, struck post-decision evidence, and granted summary judgment for Aetna on the (a)(1)(B) claim.
- The Eighth Circuit affirmed summary judgment on the denial-of-benefits claim but reversed the dismissal of the fiduciary-duty claim (a)(3), holding that the two claims allege distinct theories and Silva controls over prior contrary precedent.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether an ERISA plaintiff who sues under § 1132(a)(1)(B) may also maintain a § 1132(a)(3) fiduciary-duty claim | Jones: (a)(3) permissible because it alleges procedural fiduciary breaches (conflicted examiners, failure to obtain records) distinct from denial of benefits | Aetna: (a)(3) duplicative of (a)(1)(B); plaintiff cannot seek the same relief under both subsections | Court: Silva (post-Amara) controls; plaintiff may plead both where the theories differ — reversal of dismissal of (a)(3) claim |
| Whether Aetna abused its discretion in denying benefits under the plan (standard of review and evidence) | Jones: Aetna’s own reviewer found functional impairment; other evidence (PT eval, treating physicians) supports disability | Aetna: Record supports its reviewers’ conclusions; impairment found was not sufficient to meet plan’s disability definition; conflicting/limited evidence justified denial | Court: Affirmed summary judgment for Aetna — decision was reasonable under abuse-of-discretion review |
| Whether post-decision materials (SSA award letter) may be considered on judicial review | Jones: SSA award and related correspondence should be part of the record | Aetna: Materials were not before administrator at decision time and are therefore outside the administrative record | Court: District court correctly struck post-decision materials — review limited to administrative record |
| Whether district court erred in denying discovery on fiduciary claim after dismissal | Jones: Discovery was necessary to develop (a)(3) claim facts | Aetna: Dismissal made discovery unnecessary | Court: Reversed dismissal of (a)(3); remanded so district court should reconsider discovery request |
Key Cases Cited
- Conley v. Pitney Bowes, 176 F.3d 1044 (8th Cir. 1999) (held (a)(3) claim duplicative when (a)(1)(B) provides adequate relief)
- Silva v. Metropolitan Life Ins. Co., 762 F.3d 711 (8th Cir. 2014) (permitted pleading both (a)(1)(B) and (a)(3) where theories differ; relied on Amara)
- Varity Corp. v. Howe, 516 U.S. 489 (U.S. 1996) (discussed limits on equitable relief under § 1132(a)(3))
- CIGNA Corp. v. Amara, 563 U.S. 421 (U.S. 2011) (clarified relationship between (a)(1)(B) and (a)(3) remedies; permitted equitable relief under (a)(3) in some contexts)
- Ingram v. Terminal R.R. Ass’n of St. Louis Pension Plan for Nonschedule Emps., 812 F.3d 628 (8th Cir. 2016) (review limited to administrative record; procedural breaches can affect standard of review)
- Midgett v. Washington Grp. Int’l Long Term Disability Plan, 561 F.3d 887 (8th Cir. 2009) (administrator may reasonably rely on a reviewing physician who accurately represents the medical record)