Lead Opinion
Swiss Bank Corporation employed Judith Perlman in Chicago as a lawyer until September 1994, when she quit. Ever since, Perlman and Swiss Bank have been contesting whether she is entitled to disability benefits. Perlman has serious medical problems. An automobile accident in 1988 caused trauma to her digestive system and led to some additional problems, such as migraine headaches. Perlman did not work for a year after the accident and received disability benefits during that period. She took shorter leaves in 1991 and 1992, again receiving disability benefits. Perlman regularly sees a psychiatrist for
unum Life Insurance Company administers Swiss Bank’s disability plan, a “welfare benefit plan” covered by ERISA. For short-term disability UNum acts solely as an administrator; payment comes from Swiss Bank’s accounts. For disability after the first 26 weeks unum is both administrator and insurer; it pays any award. Immediately after quitting, Perlman applied for short-term benefits. After seeking and obtaining additional medical records, unum said no: its letter states that the medical conditions documented in the information Perlman had provided “do not prevent you from performing the material duties of your occupation.” Perlman appealed to a higher level of unum’s staff but was unsuccessful. A letter in July 1995 explained: “We do not see a change in your medical condition which necessitated you to stop work. The records do not show a level of impairment which would restrict or limit you from performing the duties of your regular job given that you have worked with these conditions in the past.”
Section 502(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B), makes decisions of this kind reviewable in federal court, and Perl-man asked the district judge to direct unum to pay both short- and long-term disability benefits. The court concluded that it was authorized to consider both short- and long-term claims, even though Perlman had sought only short-term benefits from unum, because an award of short-term benefits is a condition to receipt of long-term benefits; the parties disagree about whether Perlman is disabled, not the duration of any disability..
After stating that unum’s decision was “arbitrary and capricious” because it failed to obtain the assistance of any outside experts, and did not perform a detailed, study of Perlman’s job duties, the judge directed unum to reconsider Perlman’s application in light of the analysis in its opinion. Both sides have appealed—unum because it believes that its decision should have been sustained, Perlman because she believes that the court should have ordered unum to pay benefits without giving it an opportunity to compile a better record. A second set of cross-appeals concerns attorneys’ fees. The district court held that Perlman is the prevailing- party and ordered unum to pay $44,020 under 29 U.S.C. § 1132(g)(1).
Appellate jurisdiction is the first, and potentially the last, issue we need to consider. The district court entered a judgment that reads in full: “IT IS ORDERED AND ADJUDGED that both parties’s motions for summary judgment are denied. The case is remanded to unum for a new determination in accordance with the Memorandum Opinion and Order, and judgment is, therefore, entered accordingly.” “IT IS ORDERED AND ADJUDGED ... [that] judgment is ... entered” is not helpful. A judgment must be self-contained (which this is not) and specify the relief to which the prevailing party is entitled (which this does not). See Massey Ferguson Division of Varity Corp. v. Gurley,
Neither side contends that the judgment is too uncertain to be enforced, however, and it is easy enough to see from the opinion what the judge had in mind. Because the district court obviously does not plan to enter any further orders, here as in Continental Casualty and Health Cost Controls the formal defects do not prevent appellate review. Compare Otis v. Chicago,
One court of appeals has answered “yes” without analysis. Snow v. Standard Insurance Co.,
If the justification for a remand to an ERisa plan’s administrator is that the plan makes the same kind of decisions as the Social Security Administration, then it is important to know the jurisdictional consequences of a remand in a Social Security case. Two sentences of 42 U.S.C. § 405(g) authorize remand in different situations. Sentence four authorizes the district court to enter “a judgment affirming, modifying, or reversing the decision of the Commissioner of Social Security, with or without remanding the cause for a rehearing.” Sentence six allows the court to remand for the receipt of new evidence, but without entering a judgment determining the propriety of the decision previously rendered. Sullivan v. Finkelstein,
Before concluding that ERisa remands are just like Social Security remands, we must consider a second possibility: that an ERisa remand is most similar to a remand to an arbitrator. Like an arbitrator, the administrator of an erisa plan is a private dispute resolver. It therefore may be instructive to explore whether an order declining to enforce an award but directing additional arbitral proceedings is appeal-able.
Our court first considered that question in Shearson Loeb Rhoades, Inc. v. Much,
Neither Much nor Aurora Equipment has been cited since Finkelstein, but for a reason that does not reflect a change of heart about the classification of arbitral remands under § 1291. In 1988 Congress changed the rules for appeals from decisions concerning arbitration. Under 9 U.S.C. § 16(b) any order by a district
Permitting appeals from remand orders does carry a cost—not only because it sets the stage for successive appeals if the decision on remand should be contested, but also because it causes the attorneys’ fees dispute to come to a head prematurely. How is one to tell whether Perlman is a “prevailing party” entitled to fees until we know the final outcome? It is tempting to treat the remand as non-final simply in order to postpone the fee question until the outcome is known.
Once again, however, ERisa remands are functionally identical to Social Security remands. Prevailing parties obtain fees in ERisa cases if the opponent’s position was not substantially justified; the Equal Access to Justice Act, 28 U.S.C. § 2412, applies the same standard to Social Security cases. See Bittner v. Sadoff & Rudoy Industries,
Before turning to the merits, we must decide how searching judicial review is to be. Decisions of ERisa plan administrators presumptively receive de novo review, see Firestone Tire & Rubber Co. v. Bruch,
“When the administrator is a large corporation, the firm has a financial interest, but the award in any one case will have only a trivial effect on its operating results. Corporations act through agents, and these agents usually lack any stake in the outcome. Getting employees to act as if shareholders’ welfare were their own is a daunting challenge for any corporation. See Candice Prendergast, The Provision of Incentives in Firms, 37 J. Econ. Lit. 7 (1999). Nothing in our record suggests that unum has even tried. Large businesses such as Swiss Bank want to maintain a reputation for fair dealing with their employees. They offer fringe benefits such as disability plans to attract good workers, which they will be unable to do if promised benefits are not paid. We have no reason to think that unum’s benefits staff is any more “partial” against applicants than are federal judges when deciding income-tax cases.
A further problem impedes treating unum’s self-interest as a strike against its decision: it may not have any stake in the decision. Although it insures the payment of the long-term benefits, the record does not reveal the terms on which the insurance was written. For many large firms, health and disability insurance on their ' labor forces is retrospectively rated. This means that the employer agrees to reimburse the insurer for all outlays, plus a loading charge and administration fee. Insurance is valuable to workers, who know that even if the employer encounters financial difficulties their benefits will not cease; but as long as the employer continues in business, it bears the full economic cost of its fringe-benefit promises. Perlman has not asked us to probe the terms on which unum’s insurance was written, or to investigate the compensation and promotion opportunities of the benefits staff, just to determine whether to “weigh” an additional “factor” in the calculus of judicial review. Thus we have no reason to think that the actual decisionmakers at unum approached their task any differently than do the decisionmakers at the Social Security Administration, and ordinarily deferential review is the order of the day.
It follows from the conclusion that review of unum’s decision is deferential that the district court erred in permitting discovery into unum’s decision-making. There should not have been any inquiry into the thought processes of unum’s staff, the training of those who considered Perl-man’s claim, and in general who said what to whom within unum—all of which Perl-man was allowed to explore at length by depositions and interrogatories, and on some of which the district judge relied. Deferential review of an administrative de-
At last we reach the question that occupied central ground in the district court: did unum make an arbitrary or capricious decision? Both Perlman and the district court treat the central issue as whether unum correctly understood her abilities in relation to the demands of her job. If Swiss Bank had told Perlman that her performance was unsatisfactory, then these would indeed be the right questions; unum would have needed to determine whether the shortcomings were caused by medical conditions (and thus established disability) or had a non-medical source. But Swiss Bank did not fire Perlman, transfer her to a less demanding and less interesting position (which might have implied constructive discharge), or even suggest that her performance needed improvement. Perlman’s successful performance of the job between 1992 and 1994 shows that the 1988 accident did not prevent her from doing an attorney’s work. And Swiss Bank’s disability plan differs from Social Security to the extent that Swiss Bank does not have any version of “listed impairments”—conditions so serious that a finding of disability follows without any effort to determine whether the applicant is employable. Cf. Cleveland v. Policy Management Systems Corp., — U.S. -,
None of the medical evidence Perlman submitted to unum showed that she had taken a turn for the worse in recent years. Her application contained a physician’s description of her limitations and conditions, but not any effort to evaluate these in relation to her job or to assess how they had changed over time (if they have changed). In response to unum’s request for additional information, Perlman submitted about 800 pages of her personal
We can imagine circumstances under which it would be unreasonable to demand proof of a change in condition. Some disabled people manage to work for months, if not years, only as a result of superhuman effort, which cannot be sustained. Sometimes work beyond one’s limitations is essential to maintain one’s standard of living, or is the result of an effort to disguise one’s limitations from friends and coworkers. Reality eventually prevails, however, and limitations that have been present all along overtake even the most determined effort to keep working. We can imagine a lawyer trying to carry on, to defy her limitations, in order to avoid abandoning the profession in which so much of her human capital and spirit is invested. But Perlman herself was willing to take long periods off from work between 1988 and 1992, and she did not argue to unum (or in this court) that her performance between 1992 and 1994 reflects a dogged effort that could not be continued. If Perlman were devoted to the workforce beyond her abilities, then likely she would have asked Swiss Bank for an accommodation under the Americans with Disabilities Act, but she did not do this. A responsible administrator of Swiss Bank’s disability plan therefore was entitled to deny Perlman’s claim, without obtaining additional medical evaluations, for the simple reason that Perlman has never argued that she was less able to do the job at the end of 1994 (or in 1995) than in the middle of 1993.
Because the district judge should have rejected Perlman’s challenge to unum’s decision, Perlman is not entitled to attorneys’ fees. None of the parties’ other arguments requires discussion in light of our conclusion that unum’s decision is reasonable, on the evidence that Perlman placed before it. The judgment is vacated, and the case is remanded with directions to enter judgment in defendants’ favor.
Dissenting Opinion
dissenting.
In denying Judith Perlman an opportunity to have her claim for disability benefits assessed by the administrator of the Swiss Bank Corporation Comprehensive Disability Plan on the basis of a proper record, the majority has misapplied the standard of review established in Firestone Tire & Rubber Co. v. Bruch,
Because the majority spends a considerable amount of time on the question of our appellate jurisdiction, I begin with a word about that. In the final analysis, I agree that we have jurisdiction over these appeals, but I reach that conclusion in a more straightforward way. The tortured analogy the majority draws to the reviewa-bility of district court decisions in Social Security Act eases that remand proceedings to the Social Security Administration under either sentence four or sentence six of 42 U.S.C. § 405(g) does not work in the end. I note, however, that if we were to take this analogy to its logical conclusion, it would lead to the same final result for which I am arguing, because despite the deferential standard of review to which decisions of the Social Security Administration are entitled, courts regularly remand cases to the agency for further proceedings when the administrative law judge has erroneously excluded relevant evidence or committed some other harmful procedural error. See, e.g., Sarchet v. Chater,
The statutory scheme ERISA creates is different in important ways from both the SSA and the Federal Arbitration Act (“FAA”) § 16(b), the other statute to which the majority analogizes. In order to bring an ERISA suit in the district court, the plaintiff must have a claim that the plan improperly denied some benefit to which she was entitled. 29 U.S.C. § 1132(a)(1)(B). The district court would thus never be in the position of ordering a preliminary determination by the administrator of the plaintiffs eligibility for benefits, because such a plaintiff would be out of court either on ripeness grounds or for lack of statutory standing to sue (since she had not yet been denied a benefit — properly or improperly). Contrast the situation of a party who tries to bring a suit in district court on a tort or contract theory, in the face of a valid arbitration agreement. The district court would issue an order to arbitrate, which would be unre-viewable under 9 U.S.C. § 16(b). In short, under the FAA the orders the district court might issue fall into two classes: those that are immediately reviewable, and those that are not. Under ERISA, all orders will follow final decisions about plan benefits, and thus all will be reviewable immediately, unless the analogy to the SSA works any better.
It does not. The majority correctly notes that immediate review is permitted for a decision remanding a case under sentence four of § 405(g), under which the district court finds error in the Commissioner’s decision. In contrast, a district court order remanding a case under sentence six of § 405(g) is not immediately reviewable, largely because a sentence six remand is ordinarily ordered without any ruling on the propriety of the' former decision. Melkonyan v. Sullivan,
There are other reasons to eschew the analogy between SSA and ERISA review. Most importantly, the SSA is a public agency, whose decisions are subject to the strictures of the Administrative Procedure Act, while ERISA plan administrators are private sector actors subject to regulation under the ERISA statute. A host of federal constitutional rights and statutory rights combine to assure procedural regularity in the case of public agencies that are not available to those who attack private action. In addition, the sources of substantive law differ significantly: in the case of the SSA, agencies and courts deal with an entitlement statute, while under ERISA the Supreme Court has noted that the proper source of guidance is the law of trusts. See Bruch,
If we reject the analogies to SSA sentence four remands and the FAA, then the question remains whether this court has proper appellate jurisdiction. I agree that we do, for the simple reason that the district court’s decision finally resolves the most important question in the litigation: is Perlman’s case over, as UNUM and Swiss Bank argued, or not? Indeed, this is also the question that underlies both the sentence four/sentence six distinction and the difference between § 16(a)(1)(E) and § 16(b), making the majority’s detour through these other areas of law unnecessary. We need not think of the district court’s remand here as “equivalent” to SSA or FAA remands — all are reviewable for precisely the same reasons. UNUM and Swiss Bank are here arguing that they have a right to a final order dismissing the action. Instead, the district court rejected that position and ordered the private parties to take certain action (ie. redo the eligibility determination asking the proper questions and listening to the proper evidence) — in effect, an injunction. A final order mandating private action is an ap-pealable order, whether under 28 U.S.C. § 1291 or perhaps even § 1292(a)(1). As does the majority, I therefore proceed to the merits of Perlman’s case.
I accept the majority’s conclusion that the language in the Swiss Bank plan stating that “[UNUM] will determine whether you are disabled for Plan purposes” and “[you] must give proof [to UNUM], at your own expense, that you are disabled ...” is enough to confer the kind of discretion on plan administrators that leads to deferential review under our cases. See, e.g., Patterson v. Caterpillar, Inc.,
The majority dismisses Bruch’s, admonition, doubting both the existence of such a conflict and a reviewing court’s ability to give it any weight. Regarding the first concern, I note first that the majority’s speculations about long-term reputational effects seem applicable regardless of whether a plan is retrospectively rated, yet Bruch obviously contemplates a conflict in at least some cases. Also, the lower court in this case found a potential conflict of interest. Perlman v. Swiss Bank Comprehensive Disability Protection Plan,
With respect to the difficulties of giving weight to this conflict, “deferential review” has content only in application. It could mean, as the majority suggests, that the plan’s processes are insulated from any meaningful scrutiny. Or it could mean simply that, once all of the relevant facts are in place, the administrator’s final decision in a close (or maybe not-so-close) case should carry the day. Given that the Supreme Court has instructed us to do something with UNUM’s conflict of interest, the second path is the more appropriate one. Guarding against bias in a decision-maker is one way of assuring that the de-cisionmaking process itself was not structured in an unfair manner. It is, by the way, a routine part of review of administrative agency decisions, even when those decisions are entitled to some form of deferential review, such as the substantial evidence standard or the “arbitrary, capricious, and unreasonable” standard. As I discussed above, I think that the analogy to Social Security disability cases is both strained in theory and foreclosed by the Supreme Court. However, even accepting the majority’s conclusion that “we have no reason to think that the actual decision-makers at UNUM approached their task any differently than do the decisionmakers at the Social Security Administration,” ante at 981, there is no justification for refusing to examine how UNUM went about denying Perlman’s claim.
Generalizing from this rule, it follows that deferential review of plan administrator decisions does not preclude all consideration of the process by which the administrator came to its conclusion. To the contrary, that is precisely the point on which a court should be focusing, in order to give content to the rights conferred by § 1132 and at the same time avoid micro managing particular plan decisions. The panel’s approach appears to foreclose such an inquiry, at least as long as the administrator does something other than toss the
On the merits, the majority takes the position that the district court should not have focused on “whether UNUM correctly understood [Perlman’s] abilities in relation to the demands of her job,” ante at 982, but in fact that was precisely the correct inquiry. Perlman’s claim is that her injury reduced her ability to work and that, by 1994, it had disabled her from performing her job. UNUM disagreed, and the district court’s task was to review the reasonableness of this conclusion. Given that the plan defines “disability” as a condition in which “the insured cannot perform each of the material duties of [her] occupation,” it is difficult to see how the relation between what Perlman could do and what her job required was anything but the principal issue before the district court. Later in its opinion, the majority appears to concede that this is indeed the relevant question, when it comments that “[a] person who can do the job at Swiss Bank is not ‘disabled’ as the program uses that term.” Ante at 982.
The fallacy in the majority’s reasoning, like the faEacy afflicting UNUM’s decision, lies in the assumption that the ability to do a job cannot diminish unless physical condition also deteriorates significantly. That assumption is what leads both to conclude that Perlman’s ability to do her job in 1992 necessarily means that she could still do her job in 1994, unless she had evidence indicating that something more had happened to her after the initial injuries and her return to work. This creates an irre-buttable presumption that, after a person returns to work after an injury, there is no way the same injury can give rise to a valid disability claim. Such a conclusion is especially strange given that, under the Social Security disability rules (which until this point the majority has treated as a nearly perfect analogue), an injured claimant may test her ability to work and still be considered disabled. 20 C.F.R. § 404.1592(a) (the “trial work period”).
UNUM and the majority adhere to an approach that makes a sweeping medical assumption that may have no basis in the facts of a particular case. Perhaps a person’s injury, if it renders her disabled at all, makes it impossible to work the day after her accident. But it is equally plausible that some injuries may be events that shorten (but do not immediately end) a person’s useful working life. If this is the case, the plan administrator would certainly be entitled to inquire into the circumstances following an injury to see if the claimant is really unable to work, or is simply unwilling to do so for reasons unrelated to the disability. But this inquiry cannot be conducted without looking at competent medical evidence about the claimant’s ability to work at the time the claim is filed. That evidence might show that the earlier injury set into motion some kind of degenerative process; it might show that the person had continued to work only by engaging in the kind of superhuman efforts the majority concedes are not required by the law (ante at 982-83); it might show that the person’s temporary ability to continue working was made possible only by frequent leaves of absence that had the effect of temporarily extending useful working life.
Perlman was entitled to introduce this type of evidence into the record before UNUM made a final decision on her claim. UNUM’s flat refusal to consider it rendered its final decision arbitrary and capricious for purposes of ERISA review. The district court, having had a more extensive opportunity to consider this case than we
