Lead Opinion
OPINION
The matter before the en banc court today stems from a panel decision by this Court reversing Aetna Life Insurance Company’s (“Aetna”) decision to terminate disability benefits to Benito Perez, Jr., (“Perez”) under a plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001-1461. The panel held that the language “[Aetna] shall have the right to require as part of the proof of claim satisfae-tory evidence ... that [the claimant] has furnished all required proofs for [receipt of] benefits” did not vest discretion in Aetna to make benefits determinations.
The panel’s decision in Perez conflicted with a prior panel’s decision in Yeager v. Reliance Standard Life Ins. Co.,
To resolve this conflict, we voted to rehear the case en banc to address two specific issues: 1) whether the Plan language grants Aetna discretion; and 2) whether the de novo standard of review announced in Firestone applies to both fact determinations and plan interpretation, or only to plan interpretation. Perez v. Aetna Life Ins. Co.,
I. FACTS
For sixteen years, Perez worked for the Motor Wheel Corporation, a division of Good
In 1987, Perez enrolled in Lansing Community College to pursue an associate’s degree in business management.
On April 8, 1991, Aetna informed Perez by letter that his benefits would extend “through June 30, 1991, or until such time as [he] secured employment, but not beyond June 30, 1991.”' J.A. at 330. In accordance with this letter, Perez has received no disability benefits from Aetna since June 30, 1991.
On June 24, 1991, Perez enrolled in a computer training course scheduled to last 12 weeks. In subsequent letters, Perez sought review of Aetna’s decision to terminate his benefits and requested an extension of his coverage until he could complete additional training to make him employable. J.A. at 291-92, 310. Perez’s rehabilitation counsel- or, in an unsigned March 18, 1992, letter addressed to Aetna, described Perez’s situation as follows:
Initial job placement efforts revealed that Mr. Perez needed computer skills to compete for entry-level jobs in the business field. His Business Management program at Lansing Community College did not include computer skills training, and with his prior work history comprised primarily of factory work, Mr. Perez was not suitably prepared for an entry-level business position.
Since mid-June, 1991, Mr. Perez has been involved with an individualized, hands-on computer skills training program with Smith & Bell Computer Training Institute, Inc. in Lansing, Michigan....
... Th[is] training program has had to be further extended because of major medical problems experienced by Mr. Perez from December 1991 through March 1, 1992.... In summary, it is my professional opinion that Mr. Perez was not yet competitively employable with the completion of his Associate Degree in Business Management. ... [I]n today’s highly competitive job market, Mr. Perez is at a disadvantage without additional short-term [computer] training. It is my understanding that Mr. Perez’ LTD [Long-Term Disability] Benefits were discontinued because of the assumption that he was employable with the Associate Degree in Business Management. However, for the reasons described above, Mr. Perez was not yet employable....
J.A. at 441-42.
In response to Perez’s repeated requests for an extension of his benefits, Aetna wrote to Perez on February 26, 1992:
You ... wrote us on September 9, 1991, and more recently on February 12, 1992.*554 You are requesting an extension of Long-Term Disability benefit coverage in order that you may secure additional training and expertise involving the use of personal computers.... We don’t dispute that this additional training would be helpful but we feel that it is not essential in determining whether or not you presently have the training to pursue some reasonable occupation that others with the same training that you have are engaged in gainful work. We feel that you have acquired sufficient education and skills by virtue of your attaining your Associate of Arts Degree in Business Management and are now able to pursue some reasonable occupation. Therefore, we must refuse your request for extension of Long-Term Disability Benefits beyond June 30, 1991.
J.A. at 125-26.
This letter became Aetna’s final determination that Perez was able to engage in a reasonable occupation and therefore no longer totally disabled under the Plan.
In addition to his benefits from Aetna, Perez collected workers’ disability compensation from the State of Michigan until December 5, 1992. On that date, Perez was offered employment as a lab technician with the Laboratory of Clinical Medicine of Michigan State University. He began working there on December 7, 1992, but quit after only one full week on the job. After quitting, Perez applied for reinstatement of his worker’s compensation benefits. In an administrative hearing, a Michigan worker’s compensation magistrate denied Perez’s request for reinstatement of his benefits, concluding that Perez could and did perform work as a lab technician.
Perez sued Aetna under ERISA “to recover benefits due to him under the terms of his plan — ” Id. § 1132(a)(1)(B). The district court granted summary judgment to Aetna and denied Perez’s cross-motion for summary judgment. Perez then moved to alter or amend the judgment,under Fed.R.Civ.P. 59(e), which the district court denied. Perez appealed the district court’s grant of summary judgment for Aetna and also its denial of his motion to amend the judgment. The original panel of this court reversed the district court’s decision and we granted this en banc review.
II. STANDARD OF REVIEW
We generally review a denial of a motion to alter or amend the judgment under Rule 59(e) for abuse of discretion. Huff v. Metropolitan Life Ins. Co.,
Under Rule 56(c) of the Federal Rules of Civil Procedure, summary judgment is appropriate when there is no genuine issue of material fact for trial, and the moving party is entitled to judgment as a matter of law. Matsushita Elec. Indus. Co. v. Zenith Radio Corp.,
III. COLLATERAL ESTOPPEL
Before turning to the principal issue on appeal, we must dispose of Aetna’s argument that the refusal by a Michigan worker’s compensation magistrate to reinstate Perez’s worker’s compensation benefits collaterally estops Perez from challenging Aetna’s termination of his benefits. Specifically, Aetna contends that the magistrate’s conclusion that Perez could and did perform the lab technician job precludes him from asserting that no reasonable occupation exists for which he is qualified.
Although Aetna raised collateral es-toppel in its motion for summary judgment, the district court granted summary judgment without deciding this issue. Typically, we will not address issues unless ruled upon by the trial court below. Maldonado v. National Acme Co.,
We decline to invoke this extremely narrow exception in this case because it is not “beyond doubt” that Aetna’s collateral estoppel argument would prevail. Under Michigan law, Aetna “must also have been a party, or a privy to a party” in the state court proceeding to invoke the doctrine of collateral estoppel against Perez.
IV. DISCRETIONARY AUTHORITY UNDER THE PLAN
We now reach the primary issue in this case: whether the Plan vests discretionary authority in Aetna, the plan administrator. If it does, we must apply the arbitrary and capricious standard of review to Aetna’s decision to terminate benefits. Wendy’s Int’l, Inc. v. Karsko,
We begin our analysis with the proposition that “ ‘[t]he Court in Firestone ... did not suggest that “discretionary authority” hinges on incantation of the word “discretion” or any other “magic word.” ’ ” Johnson v. Eaton Corp.,
Arguing that the Plan contains the requisite clear grant of discretion to the plan administrator, Aetna points to the following Plan language:
Written proof of total disability must be furnished to [Aetna] within ninety days after the expiration of the [first twelve months of disability]. Subsequent written proof of the continuance of such disability must be furnished to [Aetna] at such intervals as [Aetna] may reasonably require. ...
[Aetna] shall have the right to require as part of the proof of claim satisfactory evidence ... that [the claimant] has furnished all required proofs for such benefits. ...
J.A. at 32 (emphasis added).
Perez counters that this language does not constitute a clear grant of discretion because it does not specify to whom the written proof
Numerous federal courts, including our own, have held that language similar to that contained in the Plan clearly grants discretion to the plan administrator. Yeager,
Because the Plan is governed by ERISA, we apply federal common law rules of contract interpretation in making our determination. Pitcher v. Principal Mut. Life Ins. Co.,
Although many of our prior cases finding a clear grant of discretion involved ERISA plans which explicitly provided that the evidence be satisfactory “to the insurer,” “to the company” or “to us,” it does not automatically follow that in the absence of such language discretion has not been granted to the plan administrator. Both parties acknowledge that the Plan allows for Aetna to request and receive satisfactory evidence of total disability before an individual is entitled to receive continued benefits. We agree with Aetna
In short, reading the contractual language in an ordinary and popular sense as we must, the only reasonable interpretation of the Plan is that Aetna requests the evidence, reviews it, and then makes a benefits determination.
Although the case before us today presents a slight variation, our conclusion that the Plan vests discretion in Aetna follows naturally from our prior Sixth Circuit decisions addressing similar plan language cases.
We can find no meaningful distinction between the language in the present Plan and that in Miller. The critical requirement in Miller is that the evidence of*558 disability be satisfactory. A determination that evidence is satisfactory is a subjective judgment that requires a plan administrator to exercise his discretion. Like the Miller plan, the Plan at issue in this case requires “satisfactory proof of total disability.” It would not be rational to think that the proof would be required to be satisfactory to anyone other than [the insurance company]. Even if the phrase “to us” is interpreted as defining to whom the proof should be submitted, there is no reason to believe that someone other than the party that received the proof would make a determination regarding its adequacy.
Id. at 381.
Thus, in Yeager we concluded that a plan’s failure to designate to whom the submitted proof must be satisfactory did not mean that discretion to determine eligibility benefits had not been clearly granted to the plan administrator. Id. Although the panel in Yeager noted that “the Plan language could have been clearer,” it held that “[t]he mere fact that language could have been clearer does not necessarily mean that it is not clear enough.” Id.
The panel in Yeager reached the only reasonable interpretation of the language at issue in that ease when the panel concluded that “it would not be rational to think that the proof would be required to be satisfactory to anyone other than [the insurance company].” This case presents an issue identical to the one presented in Yeager. In reaching the same conclusion as the panel in Yeager, we reaffirm that decision today.
Given that the Plan clearly grants Aetna discretion to make benefits determinations, we have no occasion to reach the second en banc issue; whether the de novo standard of review announced in Firestone applies to the factual determinations made by Aetna.
Y. CONCLUSION
The prior panel in this case reviewed Aet-na’s decision to terminate benefits under the de novo standard of review. Today we hold that the arbitrary and capricious standard should have been applied. Accordingly, we remand the ease to the original panel to review Aetna’s decision to terminate benefits under the arbitrary and capricious standard.
Notes
. In Firestone Tire & Rubber Co. v. Bruch,
. Since Firestone was decided, the federal courts of appeals have disagreed on whether the de novo standard of review applies to both plan interpretation and fact determinations made by a plan administrator or is limited only to plan interpretation. Compare Pierre v. Connecticut Gen. Life Ins. Co.,
. The Plan defines "total disability” and "totally disabled” as "during the twelve month qualifying period and thereafter during any one period of disability, that the employee is unable, solely because of disease, accidental bodily injury or a pregnancy-related condition to work at any reasonable occupation.” J.A. at 19. “Reasonable occupation” is defined as "any gainful activity for which the employee is, or may reasonably become, fitted by education, training, or experience, and in which other people of similar background are actually employed as their principal means of support.” Id.
. Michigan law requires its residents who suffer work-related injuries and receive disability benefits to obtain retraining where possible. Mich. Comp. Laws Ann. § 418.319(1) (West Supp. 1998). At the time of his accident, Perez had only a General Education Development (GED) diploma obtained while he was in the military.
. Federal law requires us to consult the relevant state law to determine the potential preclusive effect of a prior state court judgment. 28 U.S.C.A § 1738 (West 1994). See also Marrese v. American Academy of Orthopaedic Surgeons,
. Neither party disputes that the Plan empowers Aetna to request receipt of "satisfactory evidence” of disability. The question is not who receives the evidence but rather who determines whether the submitted evidence is "satisfactory."
. The rule of contra proferentum provides that ambiguous contract provisions in ERISA-gov-erned insurance contracts should be construed against the drafting party. Schachner v. Blue Cross & Blue Shield,
. Although we agree with Aetna on the merits, we note that Aetna could easily have obviated this entire controversy over the appropriate standard of review by simply inserting the language "to us" following "satisfactory evidence.” It has long been the law in this circuit that plans containing such language clearly grant discretion to the plan administrator. Miller v. Metropolitan Life Ins. Co.,
Dissenting Opinion
dissenting.
This ease involves a straight-forward interpretation of the meaning of words. The Supreme Court has set out the standard in Firestone: does the document grant discretion to the plan administrator in making decisions under the plan? See Firestone Tire & Rubber Co. v. Bruch,
I
The court’s opinion in this ease carefully and correctly sets out the basic tenets of the law concerning the standard of review for decisions by the administrator of an ERISA plan to deny benefits to a claimant. Fires-iowerequires that there be a grant of discretion to the administrator before such decision will be given the deference of the “arbitrary and capricious” standard of review. See Majority Opinion at 552 n. 1 (citing Firestone,
The majority also correctly notes that when the language of the plan clearly gives discretionary decision-making power to the administrator, courts have upheld such language. See Miller v. Metropolitan Life Ins. Co.,
The court’s opinion also (perhaps over-generously
The court errs in deciding that we may simply assume that the plan must mean that the proof is “satisfactory” to the administrator, for that is the only entity which could be the intended decision-maker. To me the difference between these two phrases, especially the difference to a sophisticated drafter, is enormous. When faced with the language “satisfactory proof’ (or “written proof’ or “due proof’ or simply “proof’), the immediate response of any half-trained lawyer is “satisfactory to whom” (or, “proof’ in whose judgment?). In this case, the Aetna drafter did not supply an answer, and it seems much more plausible that the default reading should be an objective standard, satisfactory to a neutral arbiter, or satisfactory in terms of the over-all meaning of the contract, rather than satisfactory to one of the two interested parties.
While individual ERISA plan participants generally have very little power over the exact terms of their plan, such plans are frequently negotiated in collective bargaining arrangements. In either instance, the worker or the worker’s representatives might well find a significant difference between having their benefits determined wholly at the discretion of the plan administrator, usually a company chosen by the management of the plan, and having a neutral standard of proof. Reasonable participants reading the language of this plan would be quite unlikely to be on notice that they should be meticulous, and wary of the plan administrator, who will have enormous discretion.
II
The majority’s argument based on the structure of the approval process proves too much. Every benefit plan requires the submission of some type of claim. The benefit administrator has to know that one claims benefits. Then the administrator has to match the claim against some type of standard and make a decision. There is no dispute about that. Even in Firestone, itself, the plan required that a claimant apply for benefits when he or she is “physically or mentally unable to perform [his or her] job.” Firestone,
The question at issue here is whether in so doing, the administrator is held to an objective standard upon review, or is to be upheld unless a decision is not only objectively wrong, but also arbitrary and capricious. The majority’s holding virtually eliminates the possibility of de novo review, unless the plan specifically says that de novo review will apply — the exact opposite of the result required by Firestone. See Firestone,
The majority holding, resting as it does primarily on the nature of the application process, also underscores the weakness of its grammatical argument. “Evidence satisfactory to the Insurance Company,” as in Miller,
Finally, it is well to note that the key plan language here does not even require “satisfactory proof,” as in Yeager. Rather, it requires the claimant to furnish “written proof,” and only later states that the claimant must show “satisfactory evidence ... that [he] has jumished all required proofs.... ” Majority Opinion at 555 (emphasis added). Obviously, if a claimant has submitted a claim with support that is objectively sufficient to prove the claim, that would have to be “satisfactory evidence” of his having furnished such proof! The nature of the proof required is itself qualified only by the term “written,” and the grant of discretion, if there is to be one, must be carried simply in the language “written proof.” Thus, only the majority’s structural argument can possibly be a logical basis for its holding today.
III
The large majority of courts that have ruled on language that does not contain, a referent as to who shall decide the quality of proof submitted have held that such language does not grant discretion, and have applied de novo review.
A very recent Ninth Circuit case, Kearney, is the clearest. See Kearney v. Standard Ins. Co.,
In Bounds v. Bell Atlantic Enter.,
Additionally, clear decisions invoking de novo review were issued by district courts in the District of Massachusetts in Cleary v. Knapp Shoes Inc.,
In the 4th Circuit case of Quesinberry v. Life Ins. Co.,
The primary authority to the contrary appears to be the 7th Circuit’s holding in Patterson v. Caterpillar Inc.,
In fact, the Caldwell case, from the District of Kansas, is the only clear holding from
IV
Thus, based both on the ordinary rules of English and the large preponderance of authority from other federal courts, we should hold that the language in Aetna’s policy does not grant to Aetna the type of discretion required by Firestone. I therefore respectfully dissent.
. Caldwell v. Life Ins. Co. does involve a finding of a grant of discretion in a case where there is no indirect object or discretionary language.
. District courts within our own circuit, understandably at something of a loss for guidance following Yeager, Perez, and the en banc rehearing of Perez, have reached mixed results. Judge Gadola in the Eastern District of Michigan (pre-Yeager) held that “receives proof” of loss did not confer discretion, Holsey v. UNUM Life Ins. Co.,
