HEALTHSOUTH REHABILITATION HOSPITAL, Plaintiff-Appellant, v. AMERICAN NATIONAL RED CROSS, d/b/a American Red Cross South Carolina Blood Services Region, Defendant-Appellee, and Aetna Insurance Company of America; Alberta Shaw; Derrick Wagner, individually and as Parents and Natural Guardians of Eric Shaw, a Minor under the age of Eighteen (18) Years, Defendants.
No. 95-2645.
United States Court of Appeals, Fourth Circuit.
Argued Sept. 27, 1996. Decided Dec. 3, 1996.
101 F.3d 1005
The guidelines provide for a reduction in sentencing if the defendant “clearly demonstrates acceptance of responsibility for his offense.”
In addition, “a defendant who falsely denies, or frivolously contests, relevant conduct that the court determines to be true has acted in a manner inconsistent with acceptance of responsibility.”
The lower court held that although Nale pled guilty, his statement did not clearly demonstrate acceptance of responsibility. Nale characterized his actions as an attempt to reconcile with his ex-girlfriend and failed to admit or express remorse regarding many of his actions. He characterized the carjacking as a request for a ride. However, Nale failed to mention that the request for a ride was accompanied by the brandishing of a firearm.
Nale argues that he accepted full responsibility for his actions when he pled guilty to the charges. However, merely pleading guilty is not sufficient to satisfy the criteria for a downward adjustment for acceptance of responsibility. United States v. Harris, 882 F.2d 902, 905 (4th Cir.1989); see also,
Nale‘s comments indicate that he did not fully accept responsibility for his actions. Thus, the trial court‘s decision denying a reduction for acceptance of responsibility was not clearly erroneous.
III. CONCLUSION
Therefore, the sentencing decisions of the district court are affirmed.
AFFIRMED.
ARGUED: Annette Roney Drachman,
Before ERVIN and HAMILTON, Circuit Judges, and SPENCER, United States District Judge for the Eastern District of Virginia, sitting by designation.
Affirmed by published opinion. Judge HAMILTON wrote the opinion, in which Judge ERVIN and Judge SPENCER joined.
OPINION
HAMILTON, Circuit Judge:
This is a suit for damages filed by HealthSouth Rehabilitation Hospital (HealthSouth) pursuant to the Employee Retirement Income Security Act of 1974 (ERISA),
I.
Red Cross maintains “For Your Benefit,” a self-insured ERISA welfare plan (Plan) for its employees. Red Cross is the plan administrator, and Aetna Life Insurance Company (Aetna) provides administrative and ministe
Derrick Wagner (Wagner) is a Red Cross employee and the natural father of Eric Shaw. Red Cross provides all employees with a summary Plan description, and according to practice, one was distributed to Wagner. That summary explains that an employee may enroll himself as a Plan participant and his spouse and dependent children as Plan beneficiaries. In June 1989, Wagner completed a Plan enrollment form in which he elected to obtain medical coverage for himself only. At first, Wagner checked the box “yes” to indicate coverage election for dependent children but then marked through the “yes” box and checked “no” and initialed the change. No premium payments for Eric Shaw‘s coverage under the Plan were ever made by Wagner or received by the Red Cross. Accordingly, Eric Shaw never satisfied the Plan definition of “beneficiary.”
On January 4, 1994, Alberta Shaw, Eric Shaw‘s mother, took Eric Shaw to HealthSouth, in Florence, South Carolina, for rehabilitation therapy. Alberta Shaw represented to HealthSouth that Eric was covered by Wagner‘s Red Cross Plan and signed a document assigning the right to all benefits payable from any and all insurance policies over to HealthSouth. Alberta Shaw also presented HealthSouth with an insurance card which advised health care providers to contact Aetna to certify hospital admissions or verify coverage. That card also states that it does not guarantee coverage.
Before HealthSouth admitted Eric, the hospital‘s Admissions Coordinator called an Aetna representative to verify coverage. That Aetna representative erroneously informed the Admissions Coordinator that Eric Shaw was a covered beneficiary under the Plan with no deductible and one hundred percent coverage for approved charges. A “confirmation fax” was also sent to Aetna by HealthSouth on January 4, 1994, but no response was received by HealthSouth to the confirmation fax until February 15, 1994.
Based on Aetna‘s oral assurances, Eric Shaw was admitted at HealthSouth and underwent treatment for several weeks. Throughout Eric‘s stay at the hospital, Aetna was called on a weekly basis to obtain pre-certification for additional days of treatment. That pre-certification was always orally given. However, on February 15, 1994, an Aetna employee contacted HealthSouth and stated that the earlier oral confirmation of beneficiary status was in error. Aetna also informed HealthSouth for the first time that Eric Shaw was not a beneficiary under the Plan. HealthSouth discharged Eric Shaw on February 17, 1994, after he had incurred $82,967 in expenses. The hospital submitted that bill to Aetna, but Red Cross declined to pay because Wagner had never elected to secure coverage for Eric.
HealthSouth brought an action against Red Cross, Aetna, Derrick Wagner, and Alberta Shaw, seeking to recoup Eric Shaw‘s hospital bills. The hospital alleged two claims against Red Cross in its amended complaint. First, the hospital alleged that Aetna acted as Red Cross‘s designated agent when Aetna orally confirmed Eric Shaw‘s coverage under Wagner‘s health insurance plan with Red Cross. Accordingly, HealthSouth asserted that Aetna‘s “interpretation” modified the Plan and Red Cross was bound by that modification. HealthSouth further maintained that because of the modification, Eric Shaw became a beneficiary and Red Cross was liable for Eric Shaw‘s hospital costs of $82,967. Second, HealthSouth alleged that it had become a valid assignee of any rights Eric Shaw had under the Plan and because Red Cross refused to pay the benefits allegedly owed to Eric as a now “confirmed” beneficiary of the Plan, Red Cross had breached the fiduciary duties it owed to HealthSouth as assignee.
Red Cross filed a motion for summary judgment, claiming that HealthSouth did not have standing to bring the suit because Eric
The district court granted summary judgment to Red Cross and in so doing rejected all of HealthSouth‘s claims, including the attempt to amend its complaint. HealthSouth timely brought this appeal questioning the district court‘s grant of summary judgment on its modification claims, the district court‘s discovery ruling, and the district court‘s refusal to entertain its proposed amendment to the complaint to add a promissory estoppel theory of recovery.
II.
Whether Red Cross was entitled to summary judgment is a matter of law which we review de novo. Higgins v. E.I. DuPont de Nemours & Co., 863 F.2d 1162, 1167 (4th Cir.1988). Granting summary judgment as a matter of law is appropriate when the pleadings, depositions, affidavits, and other documents in the record leave no issue of any material fact which needs to be passed on by a jury.
III.
HealthSouth contends that the district court erred when it concluded that HealthSouth had no standing to bring its ERISA claims. We disagree.
In order to establish its right to derivative standing because of Alberta Shaw and Eric Shaw‘s assignment of rights, HealthSouth would have to show that Eric Shaw was somehow “made” a beneficiary by Aetna‘s oral assurances that Eric Shaw‘s hospital expenses would be covered. Other than the Secretary or a fiduciary, an ERISA action may be brought only by a “participant” or a beneficiary to an ERISA plan.
HealthSouth maintains that because of Aetna‘s agreement with Red Cross, Aetna possessed either actual or apparent authority to confer beneficiary status on Eric Shaw. The district court correctly concluded, however, that any discretionary authority over administration of the Plan rested solely with Red Cross. See
However, even if Aetna were a fiduciary, the oral statements made by it would be insufficient to modify the terms of an established ERISA plan. In Biggers v. Wittek Indus., Inc., 4 F.3d 291 (4th Cir.1993), we held that oral and informal amendments to established ERISA plans are completely incapable of altering the specified terms of the plan‘s written coverage. Id. at 295; see also Coleman v. Nationwide Life Ins. Co., 969 F.2d 54, 58-59 (4th Cir.1992), cert. denied, 506 U.S. 1081, 113 S.Ct. 1051, 122 L.Ed.2d 359 (1993). ERISA requires that a plan be “established and maintained pursuant to a written instrument,”
Appendix I to the Red Cross Plan states that Red Cross‘s Board of Governors is the entity with the power to approve or reject amendments to the Plan after recommendation by the Board of Trustees. Aetna, therefore, does not have the authority to effect unilateral modifications to the Plan by giving erroneous information to potential benefit claimants like HealthSouth. Thus, nothing in the Plan, the Red Cross/Aetna contract, or any other written document before this court indicates that Aetna may unilaterally alter the plan by bestowing beneficiary status upon a previously non-covered individual. In short, if we adopted HealthSouth‘s position, the Plan at issue would be modified such that someone not entitled to benefits would be found entitled to benefits. That result flies in the face of ERISA‘s clear statutory language. See Coleman, 969 F.2d at 59. Accordingly, the district court correctly granted summary judgment to Red Cross on HealthSouth‘s modification claims.
IV.
HealthSouth also contends that it was not given an adequate opportunity to complete discovery. This argument is without merit.
A district court should refuse to grant summary judgment when an opposing party needs additional time to complete discovery and properly respond to the motion. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 251 n. 5, 106 S.Ct. 2505, 2511-12 n. 5, 91 L.Ed.2d 202 (1986). In the instant matter, however, HealthSouth was provided with a copy of the Aetna/Red Cross contract as well as all other documents relevant to its standing to sue Red Cross. Unfortunately for HealthSouth, it simply has no derivative standing to bring an ERISA claim based on any actions taken by Aetna. No amount of discovery could have unearthed information which would contravene the clear language of the Plan and
V.
Apparently realizing the minimal chance of success on its modification claims, HealthSouth further maintains that the district court erred when it refused to allow it to amend its complaint to add an estoppel cause of action against Red Cross. We disagree.
The decision to grant a party leave to amend its pleadings rests within the sound discretion of the district court. See Sandcrest Outpatient Serv. v. Cumberland County Hosp. Sys., Inc., 853 F.2d 1139, 1148 (4th Cir.1988). Nevertheless, it is well settled that, “in the absence of any apparent or declared reason—such as undue delay, bad faith, or dilatory motive on the part of the movant, ... undue prejudice to the opposing party by virtue of allowance of the amendment, futility of amendment, etc.—the leave sought should, as the rules require, be freely given.” Foman v. Davis, 371 U.S. 178, 182, 83 S.Ct. 227, 230, 9 L.Ed.2d 222 (1962). Moreover, delay in requesting the amendment is generally not a sufficient reason, by itself, to deny the requested motion. See Davis v. Piper Aircraft Corp., 615 F.2d 606, 613 (4th Cir.), cert. dismissed, 448 U.S. 911, 101 S.Ct. 25, 65 L.Ed.2d 1141 (1980). Delay, however, can be a sufficient reason for denial of leave when accompanied by futility or prejudice to the non-movant. See Deasy v. Hill, 833 F.2d 38, 40 (4th Cir.1987), cert. denied, 485 U.S. 977, 108 S.Ct. 1271, 99 L.Ed.2d 483 (1988). Lastly, as long as its reasons are apparent, a district court‘s failure to articulate grounds for denying a plaintiff‘s leave to amend does not amount to an abuse of discretion. See Island Creek Coal Co. v. Lake Shore, Inc., 832 F.2d 274, 279 (4th Cir.1987).
According to HealthSouth, because Aetna is Red Cross‘s agent for the purpose of health benefit determinations, Aetna‘s declaration of coverage for Eric Shaw is binding on Red Cross. This is a claim that “sounds” in both state and federal promissory estoppel. HealthSouth concedes that it does not have any state law promissory estoppel claim because any such state claim falls within ERISA‘s broad preemption provision. See
Nor can HealthSouth proceed with a federal common law estoppel claim, for we have already squarely rejected such a contention. See Singer v. Black & Decker Corp., 964 F.2d 1449, 1452 (4th Cir.1992) (“[R]esort to federal common law generally is inappropriate when its application would conflict with the statutory provisions of ERISA, ... or threaten to override the explicit terms of an established ERISA plan.“); see also Degan v. Ford Motor Co., 869 F.2d 889, 895 (5th Cir.1989) (Use of estoppel principles to bring about an oral modification of a written ERISA plan would conflict with ERISA‘s preference for written agreements.). We have never recognized estoppel arguments which would serve to vary the terms of a written plan, see Coleman, 969 F.2d at 54,2 a fact which HealthSouth cannot avoid. We are aware that leaving HealthSouth to bear the cost of Eric Shaw‘s hospital stay is an unsatisfying conclusion. However, ERISA simply does not recognize the validity of oral or non-conforming written modifications to ERISA plans. See
The decisions of Elmore v. Cone Mills Corp., 23 F.3d 855 (4th Cir.1994), and Hall v.
In Elmore, this court, sitting en banc, addressed the question of whether estoppel principles could be used to bind a plan fiduciary to oral modifications made before terms of the plan were written down and became binding. 23 F.3d at 863. The plan at issue in Elmore was adopted subsequent to the contract that formed the basis for the plaintiff‘s estoppel claim. Id. at 868. Thus, the alleged beneficiaries in Elmore did not seek to alter a pre-existing ERISA plan, they merely asked that a contract entered into prior to the ERISA plan‘s adoption be given binding effect. Id. The district court held that an estoppel claim could go forward on those facts. An equally divided en banc court affirmed that decision.
Thus, Elmore carries no precedential weight, see Arkansas Writers’ Project v. Ragland, 481 U.S. 221, 234 n. 7, 107 S.Ct. 1722, 1730 n. 7, 95 L.Ed.2d 209 (1987), and HealthSouth‘s reliance on Elmore fails on that basis alone. In any event, a careful reading of the different opinions in Elmore shows that four of the judges who would have allowed an estoppel claim on the facts presented in Elmore would also reject HealthSouth‘s argument here. Judge Murnaghan took great pains in his concurring opinion, in which three other judges joined, to distinguish Elmore on its facts from Coleman and Singer. See Elmore 23 F.3d at 868-69 (Murnaghan, J., concurring). In determining that the district court was correct when it allowed the estoppel argument to proceed, Judge Murnaghan clearly did not take issue with either Singer or Coleman. Id. at 869. Specifically, Judge Murnaghan stated:
Prior existence of the Plan when the contract was formed might have caused problems to arise. In Coleman v. Nationwide Life Ins. Co., 969 F.2d 54 (4th Cir. 1992), we held that estoppel principles cannot be used to effect a modification of an existing ERISA benefit plan. In such a case, adoption of an estoppel theory “would require this court to rewrite the contract of insurance....” Id. at 56.... I have no quarrel with any of these prior decisions in their proper context. However, here the Plan was created subsequent to the contract, so no such Plan existed when the contract came into existence.
Id. Consequently, even under Judge Murnaghan‘s approach in Elmore, Coleman and Singer mandate the failure of HealthSouth‘s estoppel claim here.
Similarly, Hall v. Cropmate is of no help to HealthSouth. In Hall, the district court for the Southern District of Indiana concluded that an estoppel claim could proceed on facts quite similar to the case before us. 887 F.Supp. 1193. The Indiana district court held that when an individual‘s claim concerns whether coverage is afforded by the plan, no modification need be undertaken, and an estoppel claim is cognizable in that instance. Id. at 1197. Although the district court‘s reasoning in Hall supports HealthSouth‘s argument, we will not, and cannot overturn our clear precedent in order to follow the Southern District of Indiana.3 Again, Coleman made it clear that when a nonbeneficiary seeks to obtain benefits pursuant to an ERISA plan, any change to that plan, or interpretation of that plan, is a modification which is prohibited by ERISA‘s plain language. Coleman, 969 F.2d at 59.
In summary, we affirm the district court‘s refusal to allow HealthSouth to amend its complaint because allowing the amendment would have been futile and would have, at
VI.
For the reasons stated herein, the judgment of the district court is affirmed.
AFFIRMED.
HAMILTON
UNITED STATES CIRCUIT JUDGE