Tetreault v. Reliance Standard Life Insurance
769 F.3d 49
| 1st Cir. | 2014Background
- Michele Tetreault received long-term disability (LTD) benefits from The Limited; Reliance Standard became the claims administrator and terminated benefits in Dec. 2008, notifying her of a 180-day internal appeal deadline.
- Tetreault (through counsel) requested the "Summary Plan Description and the Plan documents" in Jan. 2009; Reliance produced the 1998 plan document and claim file but not the 2005 plan documents or the 2005 Summary Plan Description (SPD).
- The 2005 SPD, not the 1998 plan instrument, expressly set forth the 180-day appeals deadline; the 2005 formal plan document (the written instrument) expressly incorporated the terms of that 2005 SPD.
- Tetreault’s counsel sent a short letter June 15, 2009 saying she "would be appealing"; Reliance warned the appeal deadline would expire June 19 and later denied Tetreault’s appeal filed nearly a year later as untimely.
- District Court dismissed Tetreault’s suit for failure to exhaust internal remedies, denied statutory penalty claims under 29 U.S.C. § 1132(c)(1)(B), and found a separate fiduciary-duty claim waived; the First Circuit affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether claims procedures must appear in the written instrument (so as to bar reliance on SPD) | Tetreault: ERISA requires the written instrument itself to set claims procedures; SPD terms cannot impose exhaustion | Reliance: The written instrument can expressly incorporate SPD terms, making the 180‑day deadline part of the written instrument | Held: Court rejects Tetreault’s premise on the facts — the 2005 written instrument expressly incorporated the 2005 SPD, so the 180‑day deadline is part of the written instrument and enforceable |
| Whether Amara prohibits incorporation of SPD terms into the written instrument | Tetreault: Amara shows SPDs do not constitute plan terms and thus cannot be enforced as plan terms | Reliance: Amara does not bar express incorporation; written instrument can adopt SPD terms | Held: Amara does not prohibit express incorporation; express incorporation is permissible here because the SPD was expressly incorporated and not later altered |
| Whether estoppel excuses failure to exhaust because Reliance produced only the 1998 document | Tetreault: Reliance’s production of only 1998 documents misled her and estops enforcement of the 180‑day rule | Reliance: Tetreault was warned twice of the 180‑day deadline and counsel’s reliance was unreasonable | Held: Estoppel fails — counsel was warned and should have investigated; reliance was not reasonable |
| Whether Reliance is subject to § 1132(c)(1)(B) penalties or breached fiduciary duty for not producing 2005 documents | Tetreault: Reliance functions as the plan "administrator"/fiduciary and so should face statutory penalties and fiduciary-liability for nondisclosure | Reliance: The written instrument designates a different Plan Administrator; Reliance was only Claims Administrator and not subject to statutory penalties; fiduciary claim was waived | Held: Reliance is not the ERISA "administrator" for § 1132(c)(1)(B) purposes and so not liable for penalties; the fiduciary-duty claim was waived for failure to plead/amend |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989) (ERISA plan construing guided by trust-law principles)
- CIGNA Corp. v. Amara, 131 S. Ct. 1866 (2011) (distinguishes written instruments from SPDs and warns against treating SPDs automatically as plan terms)
- Orndorf v. Paul Revere Life Ins. Co., 404 F.3d 510 (1st Cir. 2005) (standard of review for ERISA plan-document issues)
- Law v. Ernst & Young, 956 F.2d 364 (1st Cir. 1992) (discusses de facto administrator and estoppel concepts under ERISA)
- Pettaway v. Teachers Ins. & Annuity Ass'n of Am., 644 F.3d 427 (D.C. Cir. 2011) (recognizes courts may treat multiple documents, including SPDs, as part of plan terms when appropriate)