686 F.3d 1044
9th Cir.2012Background
- Renfro was insured under two Unum-administered long-term disability plans: the Funky Door Plan (FDP) and the Service-Master Plan (SMP).
- Unum deducted Renfro’s Social Security Disability Insurance (SSDI) benefits from each plan, creating a claimed ‘double offset.’
- SSA approved Renfro’s SSDI benefits with retroactive payments; Unum then began offsets and sought overpayments related to an FDP overpayment.
- Unum’s final position in 2009 was that SSDI offsets were deductible under both plans, with a prospective offset rather than recovery of past overpayments.
- Renfro sued, challenging Unum’s offsets; the district court granted summary judgment for the Plans, and Renfro appealed.
- The Ninth Circuit affirmed, holding that the plan language permits double offsets, that the administrator’s decision was not an abuse of discretion, and that equitable estoppel did not apply.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standard of review for plan decisions | Renfro argues strong conflict of interest warrants little deference. | Unum’s discretion under ERISA is preserved, conflict weighed but does not defeat deference. | Abuse of discretion review applies with weight given to conflict. |
| Whether SSDI offsets may be applied separately to FDP and SMP | Double offset is not permitted by plain language or meaning of 'receives or entitled to receive'. | Plain plan language allows deduction of SSDI from each plan; two plans may offset separately. | Unum’s decision to apply SSDI offsets under both plans was not an abuse of discretion. |
| Consistency of Unum’s handling of offsets across plans | Renfro sees inconsistent handling as evidence of bias or mismanagement. | Unum treated the plans separately and acted under the agreement with Renfro’s attorney; no final cross-plan decision premature. | No improper inconsistency; actions consistent with single-plan language and interim status. |
| Equitable estoppel against offset | Renfro should be estopped from offset due to representations about offsets. | No final representations; reliance was unreasonable; no extraordinary circumstance. | Equitable estoppel does not bar the offsets. |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (Supreme Court, 1989) (establishes ERISA standard of review framework)
- MetLife Ins. Co. v. Glenn, 554 U.S. 105 (Supreme Court, 2008) (conflict of interest weighs as a factor in abuse-of-discretion review)
- Montour v. Hartford Life & Accident Ins. Co., 588 F.3d 623 (9th Cir. 2009) (conflict of interest is a factor in abuse-of-discretion review)
- Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955 (9th Cir. 2006) (en banc: conflict relevant to review method, not standard itself)
- Lang v. Long-Term Disability Plan, 125 F.3d 794 (9th Cir. 1997) (inconsistent reasons indicate potential bias; but not necessary in this case)
- Isner v. Minnesota Life Insurance Co., 677 F.Supp.2d 950 (E.D. Mich. 2009) (ERISA permits double offset of SSDI by two plans with language similar to these plans)
- Pisciotta v. Teledyne Indus., Inc., 91 F.3d 1326 (9th Cir. 1996) (equitable estoppel elements in ERISA context)
- Davidian v. S. California Meat Cutters Union & Food Employees Ben. Fund, 859 F.2d 134 (9th Cir. 1988) (equitable estoppel requirements in ERISA plans)