48 F.4th 670
6th Cir.2022Background
- Mark Messing, an attorney, received long-term disability (LTD) benefits under a Provident plan from 2000 until Provident terminated benefits in 2018 after an internal review.
- Messing originally claimed disability from major depressive disorder in 1998 and identified specific lawyering duties on his 1998 claim forms; he repeatedly certified inability to perform substantially all such duties and signed annual Individual Disability Status Updates (2010–2017) containing a fraud warning and a repayment acknowledgment.
- Provident obtained medical reviews in 2018: Dr. Laura Franseen (treating psychiatrist) diagnosed recurrent major depression but refused to opine on work capacity; independent examiner Dr. Craig Lemmen concluded Messing’s depression was in remission and there was no objective evidence he could not practice; Dr. Paul Callaghan (retained by Messing) concluded Messing remained unable to tolerate lawyering stress.
- Messing appealed Provident’s termination administratively and submitted attorney affidavits and a vocational evaluation; Provident’s appeals division affirmed termination. Messing sued under ERISA seeking reinstatement; Provident counterclaimed under ERISA § 502(a)(3) for restitution of alleged overpayments after discovering limited legal work Messing performed.
- The district court (1) upheld Provident’s termination of benefits and (2) granted summary judgment to Messing on Provident’s counterclaim (rejecting equitable restitution and equitable lien-by-agreement). On appeal, the Sixth Circuit reversed the termination and affirmed dismissal of Provident’s counterclaims.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standard of review | De novo review applies because the plan gives no discretionary authority to Provident. | Same. | De novo review applied. |
| Whether Messing remains disabled under the Plan (preponderance of evidence) | Messing relied on Dr. Callaghan, Dr. Franseen (neutral but cautious), and attorney affidavits showing lawyering is stressful and Messing cannot tolerate it. | Provident relied on Dr. Lemmen’s independent exam finding remission and no objective evidence Messing cannot practice. | Court held Messing met his burden by a preponderance; reversal of district court—benefits termination was erroneous. |
| Equitable restitution (recovery of overpaid benefits) | Provident argued it may obtain restitution of overpayments based on Messing’s purportedly fraudulent certifications. | Messing argued Provident failed to show inducement or tracing required for equitable restitution. | Court held inducement/tracing is required; Provident failed to show it would have ceased payments earlier, so no equitable restitution. |
| Equitable lien by agreement (IDS repayment acknowledgments) | Provident argued Messing’s signed Individual Disability Status Updates (2010–2017), acknowledging repayment, created an agreement giving rise to an equitable lien. | Messing argued the Plan itself contains no repayment provision and post‑plan forms do not create the contractually identified fund required for an equitable lien. | Court held an equitable lien by agreement under § 502(a)(3) requires the ERISA plan to identify the reimbursable fund; the Plan here contains no such repayment provision—no lien. |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (standard for judicial review of benefit denials)
- Davis v. Hartford Life & Accident Ins. Co., 980 F.3d 541 (6th Cir. 2020) (deference/discretionary authority discussion)
- Javery v. Lucent Techs., Inc. Long Term Disability Plan, 741 F.3d 686 (6th Cir. 2014) (claimant bears burden to prove disability by preponderance)
- McClain v. Eaton Corp. Disability Plan, 740 F.3d 1059 (6th Cir. 2014) (review limited to evidence before administrator)
- Montanile v. Board of Trustees of National Elevator Industry Health Benefit Plan, 577 U.S. 136 (2016) (equitable relief limitations; tracing requirement)
- Sereboff v. Mid Atlantic Medical Services, Inc., 547 U.S. 356 (2006) (equitable lien by agreement where plan identified particular fund)
- Mertens v. Hewitt Associates, 508 U.S. 248 (equitable remedies in ERISA context)
- Gilchrest v. UNUM Life Ins. Co. of Am., [citation="255 F. App'x 38"] (6th Cir.) (plan language required to identify fund for lien)
- Black & Decker Disability Plan v. Nord, 538 U.S. 822 (physician-consultant bias concern when insurers retain repeat examiners)