Debra SHAW, Plaintiff-Appellee, v. THE MCFARLAND CLINIC, P.C., Defendant-Appellant.
No. 02-3897, 03-1167.
United States Court of Appeals, Eighth Circuit.
April 13, 2004.
Rehearing and Rehearing En Banc Denied June 1, 2004.
363 F.3d 744
Submitted: Dec. 18, 2003. * Chief Judge Loken and Judge Riley would grant the petition for rehearing en banc.
Withholding of removal involves a higher degree of certainty that persecution will occur than that required for asylum eligibility. Before the government will grant withholding, the alien must present evidence to establish that it is “more likely than not that the alien would be subject to persecution on one of the specified grounds.” INS v. Stevic, 467 U.S. 407, 429-30, 104 S.Ct. 2489, 81 L.Ed.2d 321 (1984). This standard requires an objectively established “clear probability.” Id., at 430, 104 S.Ct. 2489. Because Al Tawm has failed to carry the burden of proof to demonstrate he is eligible for asylum, he also fails under the higher burden of proof required for withholding. See Habtemicael, 360 F.3d at 825.
Al Tawm has also failed to carry the similar burden required under the Convention Against Torture, under which he bears the burden of proof to establish that he is eligible for relief because it is more likely than not that he will be tortured if he returns to Lebanon. See Perinpanathan v. INS, 310 F.3d 594, 599 (8th Cir. 2002);
Finally, Al Tawm challenges the BIA‘s choice to affirm the IJ‘s decision without an opinion. Immigrants denied asylum by the IJ have a right to administrative appeal, See
The petition for review is denied.
Michael W. Thrall, argued, Des Moines, Iowa, for appellant.
Zorica Ilic, argued, Des Moines, Iowa, for appellee.
Before RILEY, LAY, and HEANEY, Circuit Judges.
Debra Shaw brought the present Employee Retirement Income Security Act of 1974 (“ERISA“) action against her employer seeking to recover benefits she alleged were due her under a health benefit plan. The district court1 granted summary judgment in favor of Shaw, and we affirm.
I. BACKGROUND
Debra Shaw is Iowa‘s last known polio victim. Shaw contracted the infectious disease at nineteen months of age in June of 1959, which inhibited the normal growth of the muscles in her left leg. At a young age, Shaw‘s left calf muscle was so severely deformed and undersized that it was unable to support any weight, causing her to resort to the assistance of a full leg brace in order to walk. Throughout the course of her life, Shaw has undergone various medical procedures in an attempt
Sometime in September of 1997, Shaw was seen in consultation by Dr. Marie E. Montag regarding the possibility of reconstructive plastic surgery on her left calf. Dr. Montag determined that a viable treatment option existed, known as tissue expander reconstruction surgery, which would add weight and definition to Shaw‘s calf and thereby reduce her physical pain. Excited by the prospect of living a normal and healthy life, Shaw began the process of obtaining the preauthorization for the surgery from her employer, the McFarland Clinic, P.C. (“McFarland“).
McFarland is one of the largest multispeciality clinics in Iowa, offering a wide array of healthcare services to residents of over thirty communities located in central Iowa. To provide its employees with healthcare coverage, McFarland sponsors the McFarland Clinic, P.C. Health Benefit Plan (the “Plan“), a self-funded health benefit plan covering any expenses incurred by both an employee and his or her dependents for medically necessary services. Before an employee undergoes any hospitalization or medical procedure, however, he or she first must obtain preauthorization from McFarland.2 According to the terms of the Plan, “[p]reauthorization allows [McFarland] to evaluate the medical appropriateness of services and provides [the employee] with assurance that the hospitalization or procedure is medically necessary and will be covered ....” Jt. App. at 121.
On September 24, 1997, Dr. Montag, on Shaw‘s behalf, wrote to McFarland requesting preauthorization for tissue expander reconstruction surgery. On December 15, 1997, McFarland denied Shaw‘s request on the basis that the requested procedure was “cosmetic surgery,” and therefore was not covered by the Plan. Over the next several months, Shaw and several other physicians wrote to McFarland, urging it to reconsider the denial of preauthorization. By letter dated January 9, 1998, Dr. Montag stated:
I do concede that placement of calf implants would indeed improve [Shaw‘s] cosmetic appearance but this increased weight and volume of the affected leg would also improve her balance and thereby cause an improvement in her gait overall. Ms. Shaw has had problems with pain in the left ankle and knee as well. These are quite probably due to abnormal stresses on these areas due to her asymmetric balance and these symptoms also could be helped by placement of prosthetic implants.
Id. at 101.
On January 13, 1998, two of McFarland‘s own physicians, Diane Cardwell, P.A., and Terry McGeeney, M.D., opined that the reconstructive surgery should be covered under the Plan, insofar as it provided coverage for “cosmetic implant[s] secondary to a medical condition,” id. at
On May 25, 2001, Shaw commenced the instant action under
On appeal, McFarland argues that the district court erred in awarding Shaw any relief, including attorney fees and costs, insofar as her action is barred by the statute of limitations.3
II. ANALYSIS
The parties do not dispute that Shaw‘s cause of action for abuse of discretion accrued on May 21, 1998, the date on which McFarland finally denied her request for preauthorization. See Union Pac. R.R. Co. v. Beckham, 138 F.3d 325, 330 (8th Cir. 1998) (“[T]he general rule in an ERISA action is that a cause of action accrues after a claim for benefits has been made and has been formally denied.“). Instead, the parties’ dispute on appeal focuses on whether Shaw commenced her action in a timely manner. Since ERISA does not contain its own statute of limitations governing actions to recover benefits, we must look to Iowa law and borrow the most analogous statute of limitations. See Johnson v. State Mut. Life Assurance Co. of Am., 942 F.2d 1260, 1262 (8th Cir. 1991). Because it arises out of an agreement entered into with McFarland, Shaw‘s action is most analogous to a cause of action for breach of contract. See Adamson v. Armco, Inc., 44 F.3d 650, 652 (8th Cir. 1995) (“At least in this circuit, it is settled that a claim for ERISA benefits is characterized as a contract action for statute of limitations purposes.“).4
In determining which of these two periods of limitation to apply, we may inquire as to how Iowa law would characterize Shaw‘s action. See Johnson, 942 F.2d at 1262; cf. United Auto. Workers v. Hoosier Cardinal Corp., 383 U.S. 696, 706, 86 S.Ct. 1107, 16 L.Ed.2d 192 (1966) (noting that “there is no reason to reject the characterization that state law would impose unless [it] is unreasonable or otherwise inconsistent with national labor policy“). According to McFarland, Shaw‘s action is one that Iowa law would treat as an action for wages under the Iowa Wage Payment Collection Act (“IWPCA“),
Since its enactment, Iowa courts have repeatedly stated that the purpose of the IWPCA is “to facilitate the public policy of allowing employees to collect wages owed to them by their employers.” Hornby v. State, 559 N.W.2d 23, 26 (Iowa 1997). Toward this end, and taking into consideration the highly evolving nature of employee compensation, the IWPCA sets forth an expansive definition of “wages,” encompassing much more than the regularly-issued paycheck. The IWPCA provides in relevant part:
“Wages” means compensation owed by an employer for:
...
c. Any payments to the employee or to a fund for the benefit of the employee, including but not limited to payments for medical, health, hospital, welfare, pension, or profit-sharing, which are due an employee under an agreement with the employer or under a policy of the employer. The assets of an employee in a fund for the benefit of the employee, whether such assets were originally paid into the fund by an employer or employee, are not wages.
d. Expenses incurred and recoverable under a health benefit plan.
Iowa Code § 91A.2(7)(c) and (d) .
If the benefits Shaw presently seeks to recover may be said to fit comfortably within one of these two statutory definitions of wages, McFarland would be correct to assert that Shaw‘s action is time-barred. We believe, however, that neither definition is applicable under the facts presented on appeal.5
McFarland also claims that Shaw‘s action is one for wages, as that term is defined in
In short, because Shaw‘s claim against McFarland does not fit within either of the aforementioned definitions of wages, she has no cause of action under the IWPCA. This being the case, its two-year statute of limitations is inapplicable to limit her ERISA cause of action. Instead, Shaw‘s action against McFarland “most closely resembles an insured party‘s claim against his insurer for denial of coverage and breach of contract,” id., and is governed by a ten-year statute of limitations. This result is consistent with the general principle of Iowa law that when a court has to choose between competing statutes of limitation, any doubt as to which to apply “will generally be resolved in favor of the application of the statute containing the longest limitation.” Halverson v. Lincoln Commodities, Inc., 297 N.W.2d 518, 522 (Iowa 1980) (internal citation and quotation omitted).
Finally, we note that McFarland has not appealed the district court‘s award of damages to Shaw nor its finding that McFarland abused its discretion by denying preauthorization. See supra n. 3. Thus, these issues are not presented for our review. Our holding that Shaw‘s action is not time-barred disposes of McFarland‘s claim that Shaw was not entitled to costs and attorney fees, as McFarland‘s argument to the contrary was premised upon its view that Shaw‘s action was untimely. Furthermore, our affirmance of the district court on Shaw‘s abuse of discretion theory makes it unnecessary for us to reach the issue of her recovery on an alternative theory of breach of fiduciary duty. Nevertheless, to the extent the district court‘s award of damages may have
III. CONCLUSION
Based on the foregoing, we hold that an employee‘s action alleging the improper denial of preauthorization for health benefits by her employer is most analogous under Iowa law to an action for breach of a written contract. Because Shaw instituted the present action against McFarland well within the applicable ten-year statute of limitations, the judgment of the district court is AFFIRMED.
RILEY, Circuit Judge, dissenting.
Because the majority opinion misreads Iowa law and fails to follow circuit precedent, I respectfully dissent.
First, Shaw‘s complaint clearly alleges jurisdiction under
Second, the majority contends Shaw‘s action resembles an insured‘s claim against her insurer for denial of coverage and breach of contract. Shaw obviously did not bring a claim as an insured against an insurer, and, as explained above, did not sue for an ordinary breach of contract. Shaw filed an ERISA lawsuit as an employee covered by an employer‘s ERISA plan, arguing abuse of discretion and breach of fiduciary duty. The resemblance falls short.
I will discuss first the statute of limitations for Shaw‘s abuse of discretion claim, and then address the statute of limitations for Shaw‘s breach of fiduciary duty claim.
A. Statute of Limitations—Abuse of Discretion
Shaw first argues her employer, acting in its capacity as plan administrator, abused its discretion in denying her health benefits under the employer‘s ERISA plan. ERISA does not have an express statute of limitations for a cause of action based on abuse of discretion by the plan administrator. As the majority recognizes, we must look to, and borrow from, the most analogous Iowa statute of limitations. See Johnson v. State Mutual Life Assurance Co. of Am., 942 F.2d 1260, 1262 (8th Cir. 1991). The majority concludes Shaw‘s action is most analogous to a general cause of action for breach of contract, rather than the specific Iowa Wage Payment Collection Act (IWPCA). However,
The majority attempts to distinguish
It is undisputed the expenses here were “incurred.” Based on Shaw‘s reading of the health benefit plan, as well as her doctor‘s reading of the plan, Shaw contends her expenses are “recoverable,” which is precisely the issue for resolution. The terms “incurred and recoverable” in this context mean the expenses are authorized by the plan documents, not authorized by the employer on a case-by-case basis, as the majority contends. The majority opinion is completely contradictory in finding the benefit was not “incurred and recoverable” within the meaning of the IWPCA, and then in awarding Shaw recovery under the plan for the very expenses incurred (i.e., by ultimately finding the expenses were actually incurred and recoverable).
The majority cites
The majority opinion‘s logic minimizes the IWPCA‘s actual reach and renders
Our ruling in Mead v. Intermec Technologies Corp., 271 F.3d 715 (8th Cir. 2001), is
The majority‘s opinion also runs afoul of this court‘s ruling in Adamson v. Armco, Inc., 44 F.3d 650 (8th Cir. 1995). In Adamson, we analyzed the Minnesota law governing claims for recovery of wages and other compensation. Id. at 652-54. Four hundred eighty-seven former employees sued to recover benefits under unfunded welfare benefit plans. Like Iowa, Minnesota has both a general contract statute of limitations (six years) and a specific statute of limitations for the recovery of wages (two years). Id. at 652 (citing
The Third Circuit, citing Adamson, ruled a Delaware one-year statute of limitations for contracts within the employer-employee relationship was analogous to the ERISA case before it. Syed v. Hercules, Inc., 214 F.3d 155, 159-60 (3d Cir. 2000). The statutes at issue in Syed were Delaware‘s three-year statute regarding “general actions on a promise,” and a specific one-year statute that covered employment disputes, particularly actions to recover “upon a claim of wages ... or for any other benefits arising from such work, labor or personal services performed.” Id. at 159 (quoting
Likewise, the IWPCA two-year statute of limitations is reasonable, permitting a claimant enough time to file a claim and also protecting the corpus of the ERISA plan for other employees in the group.
B. Statute of Limitations—Breach of Fiduciary Duty
Finally, the majority notes Shaw cannot recover monetary damages based on the plan administrator‘s breach of fiduciary duty. See supra at 11. While I agree with the majority, due to my opinion that Shaw‘s abuse of discretion claim for recovery of benefits is barred by the statute of limitations, a ruling is necessary as to whether Shaw may bring an action individually to recover monetary damages for a breach of fiduciary duty. She cannot.
Furthermore, even if Shaw could bring an individual breach of fiduciary duty claim to recover compensatory damages, she commenced her lawsuit outside the ERISA three-year statute of limitations for actions arising under section 1109.
C. Conclusion
Because the applicable two and three year statutes of limitations expired before Shaw filed suit, I would reverse the district court‘s grant of summary judgment in Shaw‘s favor.
William J. FEDERER, Appellant, v. Richard A. GEPHARDT, individually; Joyce A. Aboussie, individually; James A. Larrew, individually; and John Does, Appellees.
No. 02-3987.
United States Court of Appeals, Eighth Circuit.
April 13, 2004.
Submitted: June 9, 2003.
Notes
A civil action may be brought—
(1) by a participant or beneficiary—
(B) to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan ....
