Pettaway v. Teachers Insurance & Annuity Ass'n of America
396 U.S. App. D.C. 40
| D.C. Cir. | 2011Background
- Pettaway, employed by the National Academy of Sciences, participated in the Academy Plan, an ERISA-governed long-term disability plan.
- The Plan comprises Plan Document, Summary Plan Description (SPD), and Policy Document; TIAA is the plan underwriter and administrator.
- Initial disability benefits were awarded under the Plan after Pettaway’s January 2000 back injury, covering the first 24 months.
- After the initial 24 months, TIAA determined Pettaway did not meet the more rigorous post-24-month disability standard and stopped benefits in December 2002.
- Pettaway requested internal review; in 2003–2005 TIAA reevaluated, reinstating benefits after Pettaway resumed regular medical care and suffered subsequent injuries.
- In August 2004 TIAA again terminated benefits; Pettaway pursued additional administrative reviews, including independent medical examinations arranged in 2005, which ultimately upheld termination.
- DOI inquiry occurred in 2005–2007, and Pettaway filed suit in September 2007 challenging ERISA compliance and denial of benefits; the district court granted summary judgment to defendants in 2010.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standard of review for ERISA denial of benefits | Pettaway argues only the Policy Document contains discretionary authority | Academy Plan documents collectively show discretionary authority | Deferential (Firestone) review applied after considering Plan Document, SPD, and Policy Document |
| Full and fair review requirement | TIAA’s procedures, including late-stage tests, violated full and fair review | Review process was reasonable and sufficient; no improper cycle of appeals | TIAA satisfied ERISA’s full and fair review requirement |
| Whether the district court erred by not requiring the full administrative record | Local rule 7(h) requires filing entire record; issue preserved | Argument not preserved; normal practice applies; no error | No reversible error; argument waived under circuit practice |
| Scope of administrative review post-September 2005 decision | September 2005 decision should have been appealable as a new adverse decision | September 2005 decision merely confirms earlier denial; not a new adverse determination | No new adverse determination; review remained full and fair |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989) (establishes deferential Firestone standard when plan grants discretionary authority)
- Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003) (courts may credit reliable evidence over treating physicians' opinions without special deference)
- Fitts v. Fed. Nat'l Mortgage Ass'n, 236 F.3d 1 (D.C.Cir. 2001) (de novo review unless plan grants discretion; discusses standard of review in ERISA)