Lead Opinion
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 court
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 multi-speciality 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.
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 preau-thorization. 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 implantfs] secondary to a medical condition,” id. at
On May 25, 2001, Shaw commenced the instant action under § 502(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B), alleging that McFarland’s denial of preauthorization was an abuse of discretion insofar as tissue expander reconstruction surgery was covered under the terms of the Plan. In the alternative, Shaw’s complaint alleged that McFarland’s denial of preau-thorization was a breach of its fiduciary duty owed to her as an individual beneficiary of the Plan. On cross-motions for summary judgment, the district court entered judgment in favor of' Shaw. See Shaw v. McFarland Clinic, P.C.,
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.
ÍI. 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,
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,
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,
“Wages” means compensation owed by an employer for:
c. Ahy 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.
McFarland also claims that-Shaw’s action is one for wages, as that term is defined in § 91A.2(7)(d). This presents a closer question., Although § 91A.2(7)(d) defines wages as “[ejxpenses incurred and
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.,
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.
Notes
. The Honorable Robert W. Pratt, United States District Judge for the Southern District of Iowa.
. As a purely technical matter, an employee submits a claim for preauthorization not to McFarland, but instead to Health Alliance Medical Plans (''HAMP”), a third-party plan administrator to whom McFarland has delegated a majority of its duties. Nevertheless, because McFarland is responsible for the actions of its agent, we refer to correspondence sent to, and actions taken by, HAMP as though McFarland was the primary actor.
. In its notice of appeal, McFarland also raised issues going to the merits of Shaw's claim, arguing that the district court erred in finding that it had abused its discretion as plan administrator in denying Shaw's claim for benefits. See Shaw,
. In all due respect, the dissent is misleading. The dissent argues that simply because "Shaw clearly has not alleged or argued an ordinary breach of contract action,” post, at 12, the Iowa statute of limitations for' a breach of contract is inapplicable. We respectfully disagree. As we have already stated, since
. The dissent basically adopts McFarland's argument on appeal. However, as the district court succinctly observed: "Although McFarland's argument is persuasive at first glance, it fails under close scrutiny.” Shaw,
. McFarland and the dissent argue that our decision in Mead v. Intermec Technologies Corp.,
It is also important to note that Mead was decided on several alternate grounds. First, it was determined that Mead was not eligible for short-term disability benefits. Mead,
The dissent also refers to this court’s opinion in Adamson. We do not believe that Adamson is controlling. First, Adamson involved Minnesota, not Iowa, law; and second, it did not involve a question of whether an individual employee was entitled to a specific benefit under the plan. Rather, Adamson dealt with the termination of a benefit plan that affected all employees, a question clearly covered by the terms of the Minnesota wage statute.
. The IWPCA further defines a "health benefit plan” as "a plan or agreement provided by an employer for employees for the provision of or payment for care and treatment of sickness or injury.” Iowa Code § 91A.2(5).
. The dissent reasons that this reading "renders section 91A.2(7)(d) virtually meaningless,” post, at 14. The dissent somehow construes our holding that an employee such as Shaw has no cause of action under the IWP-CA as working some disadvantage to her. Not true. As the result we reach demonstrates, an employee could do exactly what Shaw attempts to do in this action — bring an ERISA action against the plan administrator for failure to grant preauthorization for a medical procedure. Such an action would be most analogous to one alleging a breach of contract, and thus governed by the ten-year statute of limitations. Furthermore, the dissent's argument concerning the breadth of the IWPCA’s coverage of healthcare expenses is best-suited for the Iowa legislature, not this court. See City of New Orleans v. Dukes,
Dissenting Opinion
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 29 U.S..C. § 1132(e), and states Shaw is bringing “this cause of action pursuant to 29 U.S.C. § 1132(a)(1)(B) (2001).”
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 Shawls 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.,
Iowa Code section 91A.2 defines wages as “[a]ny payments to the employee or to a fund for the benefit of the employee, including ... payments for medical, health, hospital, ... which are due an employee under an agreement with the employer or under a policy of the employer,” Iowa Code § 91A.2(7)(c), and “[ejxpenses incurred and recoverable under a health benefit plan,” id. § 91A.2(7)(d). The unmistakable language of these sections establishes the IWPCA covers Shaw’s claim.
The majority attempts to distinguish section 91A.2(7)(d) by stating the IWPCA only treats as wages those expenses of the employee that are preauthorized by the employer and incurred by the employee. Because McFarland did not authorize payment of the expenses in this case, the majority opines the expenses cannot constitute wages. Such a strained interpretation of the IWPCA would allow the statute to apply only when the plan administrator authorizes payment. This view would result in real anomalies in future cases.
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 IWP-CA, 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 Iowa Code section 91A.3(6), stating it “believe[s] the IWPCA only treats as wages those ‘[ejxpenses by the employee which are authorized by the employer and incurred by the employee.’ ” Supra at 9. Section 91A.3(6), however, is entitled “Mode of payment.” Iowa Code § 91A.3(6). This section does not contain a definition of “wages” and covers the procedures for payment of wages, including expenses. Section 91A.2, on the other hand, is entitled “Definitions,” and contains a specific definition of “wages.” Iowa Code § 91A.2(7)(d). The IWPCA clearly does not treat as wages only those expenses authorized by the employer and incurred by the employee. The IWPCA treats as wages, inter alia, “[ejxpenses incurred and recoverable under a health benefit plan.” Id. The “authorized” and “incurred” language the majority uses to define “wages” has no place in the analysis of Shaw’s claims.
The majority opinion’s logic minimizes the IWPCA’s actual reach and renders section 91A.2(7)(d) virtually meaningless. An employer could avoid the IWPCA, whether inside or outside the ERISA context, by denying authorization under a health benefit plan, making benefits nonrecoverable. Thus, even after an employer’s bad faith refusal to authorize an expense incurred by the employee and recoverable under the plan documents, section 91A.2(7)(d) would not apply under any circumstances.
Our ruling in Mead v. Intermec Technologies Corp.,
The majority’s opinion also runs afoul of this court’s ruling in Adamson v. Armco, Inc.,
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.,
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. 29 U.S.C. § 1109 does not permit an individual beneficiary to recover compensatory damages based on breach of fiduciary duties. See Mass. Mut. Life Ins. Co. v. Russell,
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. 29 U.S.C. § 1113 (“after ... plaintiff had actual knowledge of the breach or violation”).
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.
. Section 1132(a)(1)(B) provides
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 ....