Lead Opinion
Opinion by Judge FISHER; Dissent by Judge REINHARDT.
Lyn Everhart appeals the district court’s summary judgment in favor of Allmerica Financial Life Insurance Co. (“Allmerica”). She argues that the district court was incorrect in concluding that ERISA barred her suit against Allmerica, its employee benefit plan’s insurer. Because Everhart may not bring suit to recover benefits against Allmerica in its capacity as a third-party insurer under the applicable ERISA provisions, we affirm.
I.
Appellant was married to Charles Ever-hart, an employee of Credence Systems Corp. (“Credence”). Credence established an employee benefit plan (“the plan”) subject to the terms of the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq., for which it was the plan administrator. In accordance with the terms of the plan, Credence purchased a group life insurance policy (“the policy”) from Allmerica. If a plan participant died, the terms of the policy dictated that his beneficiaries were to receive a death benefit of twice his annual earnings.
Charles died in a plane crash December 5, 1994. As his beneficiary, Appellant sought twice the amount of his base salary plus commissions; rounded up to the nearest thousand (per the terms of the policy), that figure was $480,000. On September 18, 1998, Allmerica sent Everhart a check for $202,829.79 ($170,000 plus interest) to cover its obligation under the policy. It continued to maintain it was required to pay benefits only on Charles Everhart’s stated salary of $84,800.
In addition to the dispute over the policy, Appellant also alleged Credence owed Charles Everhart unpaid benefits and compensation at the time of his death. Credence and Appellant entered into an agreement March 21, 1997, under which she released all claims against Credence in exchange for $230,000.
Everhart filed this action against Allm-erica February 22, 1999 for recovery of benefits under the ERISA, 29 U.S.C. § 1132(a)(1)(B). Thereafter, the district court granted Allmerica’s motion for summary judgment and denied Everhart’s counter-motion for summary judgment, finding that Everhart could not sue Allm-erica for benefits without joining the plan as a party. Everhart filed a timely notice of appeal.
II.
We review a grant of summary judgment de novo. Balint v. Carson City,
III.
An employee welfare benefit plan is a plan an employer establishes or maintains to provide benefits for its participants. The plan provides these benefits “through the purchase of insurance or otherwise.” 29 U.S.C. § 1002(1).
ERISA allows participants or their beneficiaries to bring a civil action “to recover benefits due to [them] under the terms of [their] plan, to enforce [their ] rights under the terms of the plan, or to clarify [their] rights to future benefits under the terms of the plan.” Id. § 1132(a)(1)(B). However, a money judgment for an action brought under § 1132(a)(1)(B) may be enforced “only against the plan as an entity and shall not be enforceable against any other person unless liability against such person is established in his individual capacity.” Id. § 1132(d)(2).
Additionally,' ERISA § 1132(a)(3) allows a beneficiary to bring a civil action “to enjoin any act or practice” which violates any ERISA provision or “to obtain other appropriate equitable relief.” Liability under § 1132(a)(3) is not limited to the plan itself or its fiduciary. Harris Trust & Savings Bank v. Salomon Smith Barney, Inc.,
We held in Gelardi v. Pertec Computer Corp.,
However, under another line of cases, in this circuit and others, claimants may also bring ERISA actions to recover benefits against plan administrators. See Taft v. Equitable Life Assurance Soc’y,
Because Credence, and not Allmerica, was the plan administrator — a fact both parties freely acknowledge — we need not determine which line of cases more accurately states the law.
In support of this argument, Everhart cites Forsyth v. Humana, Inc.,
Everhart contends that in Forsyth the court allowed the action against the insurance company because it recognized that plan beneficiaries could sue to ensure that the insurance company would comply with its contractual obligations. Thus, she argues that the court limited, sub silentio, Gelardi’s broad pronouncement that “ERISA permits suits to recover benefits only against the Plan as an entity.” Gelardi
The distinction Everhart proposes, based on the type of plan at issue, is not compelling. Nowhere does § 1132 explicitly distinguish plan types or indicate that plans utilizing outside insurance carriers permit suits against third parties whereas self-funded plans do not. Moreover, neither Gelardi nor Forsyth turns on this distinction. The statement in Gelardi that “ERISA permits suits to recover benefits only against the Plan as an entity” provides no indication that the type of plan is determinative in confining proper suits to those against the plan. Forsyth did not purport to distinguish Gelardi when it allowed a § 1132(a)(1)(B) suit against Huma-na to proceed; indeed, Forsyth does not cite Gelardi at all. It may have — with or without Taft in mind — extended the definition of permissible suits under § 1132(a)(1)(B) to include actions against plan administrators, but it did not create a new rule for allowable suits premised on the type of plan funding at issue. Nor has Everhart cited any other cases to us that turn on the distinction between self-funded plans and those that purchase insurance from an outside carrier.
We find no reason to depart from the established precedent of this circuit, and of every other circuit that has expressly considered the issue, that § 1132(a)(1)(B) does not permit suits against a third-party insurer to recover benefits when the insurer is not functioning as the plan administrator.
AFFIRMED.
Notes
.Garren is almost directly on point here. The benefit plan at issue was administered by the plaintiffs employer, while an outside insurance company serviced the plan. Garren sued the insurance company, arguing his employment benefit plan wrongfully denied his son’s claim for benefits. The court dismissed the claim because the insurance company was not a plan administrator. Garren,
. For this reason, we disagree with the dissent’s contention that we should only resolve this case through an en banc proceeding.
. The dissent proposes a new test for suits under § 1132(a)(1)(B) whereby suits for benefits could be brought against a party that is neither the plan itself nor the plan administrator, but that makes “the discretionary decisions as to whether benefits were owed.” Dissent at 17345. The dissent cites no authority for this proposition. It is contrary to
Some of the Supreme Court's rationale in Harris may raise questions about Gelardi's continuing vitality. See Harris,530 U.S. at 246 ,120 S.Ct. 2180 (explaining that § 1132(a)(3) "admits of no limit ... on the universe of possible defendants”). But the Court also observed that "ERISA’s comprehensive and reticulated scheme warrants a cautious approach to inferring remedies not expressly authorized by the text,” id. at 247,120 S.Ct. 2180 (quotation marks omitted), and ultimately turned to the language of § 1132(1) as explicitly authorizing suits for breach of fiduciary duty against a fiduciary or "other person.” Id. at 247-48. No similar express authorization to reach third parties exists for § 1132(a)(1)(B). Accordingly, Harris reinforces our view that the dissent's test belongs under § 1132(a)(3), not § 1132(a)(1)(B).
. The district court in this case distinguished Forsyth on the ground that Humana, the insurer, was a fiduciary of the plan. However, Everhart correctly notes that fiduciary status is an improper basis on which to distinguish Forsyth because the district court there explicitly rejected plaintiffs’ attempt to bring a claim for violation of fiduciary duty: "[T]he cause of action provided by ERISA to compensate the [plaintiffs] for the questionable conduct of Humana Insurance is a claim for benefits pursuant to § 1132(a)(1)(B) and not a claim for breach of fiduciary duty under § 1109 or § 1132(a)(3).” Forsyth v. Humana, Inc.,
. That Humana was understood to be the plan administrator is indicated by Forsyth's discussion of Varity Corp. v. Howe, 516 U.S.
While this appeal was pending the Supreme Court issued its decision in Varity Corp. ... The Court held that an individual beneficiary may bring suit against a plan administrator for a breach of fiduciary duty under 29 U.S.C. § 1132(a)(3) ... only where other equitable relief is available.... In the present case, the Co-Payors seek to recover individual relief under section 1132(a)(3) for Humana Insurance’s breach of fiduciary duty. But the Co-Payors have already won a judgment for damages under section 1132(a)(1).... In these circumstances, Varity Corp. does not authorize equitable relief under the catchall provision of section 1132(a)(3).
Forsyth,
. The dissent suggests we misconstrue plaintiff’s argument, and that where third-party insurers are "legally responsible, by contract, for the making of discretionary decisions and for the payment of ERISA benefits, such parties properly can be sued under ERISA.” Dissent at 17347. As we have made clear, Allmerica may well have been subject to suit were it the plan administrator or acting in a fiduciary capacity; but those are not the facts here. Indeed, Everhart did sue, and settle with, the plan administrator — Credence. On the record before us, we decline to speculate as to whether and how she might have resolved any claims she might have had against Allmerica through Credence.
. Although Cisneros v. UNUM Life Ins. Co. of Am.,
Dissenting Opinion
dissenting:
For the reasons explained below, I respectfully dissent. The majority holds that “Everhart may not bring suit to recover benefits against Allmerica in its capacity as a third-party insurer under the applicable ERISA provisions” because “ § 1132(a)(1)(B) does not permit suits against a third-party insurer to recover benefits when the insurer is not functioning as a plan administrator.” Maj. Op. at 752. The majority, however, can point to no provision of ERISA either limiting the parties that may be sued under the statute to ERISA plans and administrators, or prohibiting suits against third-party insurers. Therefore, applying the reasoning of the Supreme Court in Hams Trust and Savings Bank v. Salomon Smith Barney, there is “no limit on the universe of proper defendants”
ERISA permits a participant or beneficiary to bring suit to “recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan.” 29 U.S.C. § 1132(a)(1)(B). The statute does not state, as the majority claims it does, that
a money judgment for an action brought under § 1132(a)(1)(B) may be enforced “only against the plan as an entity and shall not be enforceable against any other person unless liability against such person is established in his individual capacity.” (quoting Id. § 1132(d))
The majority’s incomplete quotation of the statute introduces a significant error into its reading. The statute actually states, in a section entitled “Status of employee benefit plan as an entity,” that an ERISA plan may sue or be sued as an entity, Id. § 1132(d)(1), that service of process upon a trustee or administrator of an ERISA plan constitutes service upon the plan, Id. § 1132(d)(1), and that
[a]ny money judgment under this sub-chapter against an employee benefit plan shall be enforceable only against the plan as an entity and shall not be enforceable against any other person unless liability against such person is established in his individual capacity under the subchapter, (emphasis added) Id. § 1132(d)(2)
This provision clearly applies only to suits against ERISA plans, and not to suits that may be brought against other parties under ERISA. Contrary to the majority’s implication, the provision does not limit the ability of participants or beneficiaries to bring actions against parties other than plans under § 1132(a)(1)(B) or any other part of § 1132. It simply makes clear that when a party does sue a plan, any money judgment it receives against the plan can be enforced only against that plan as an entity, and not against any other person, with the exception noted. This prevents
Similarly, the majority misreads our precedent in Gelardi v. Pertec Computer Corp.,
Following Gelardi, a split developed in this circuit over whether an ERISA beneficiary could sue a third-party insurer. Two cases, Gibson v. Prudential Ins. Co.,
The “recovery of benefits” provision of ERISA permits participants or their beneficiaries to sue only to recover benefits. Under this provision, plaintiffs are not permitted to receive punitive relief or damages. In this sense, recovery under the provision is akin to equitable relief ordering payment of unpaid benefits, and the Court’s reasoning in the recent Harris decision is particularly applicable.
The extensive line of cases permitting suits against plan administrators supports the proposition that ERISA does not limit § 1132(a)(1)(B) suits to suits against the plans themselves, but permits suit against parties responsible for providing or administering ERISA benefits and making discretionary decisions as to whether benefits were owed. See Taft v. Equitable Life Assurance Soc’y,
A party that is legally responsible for paying ERISA benefits can also properly be sued under § 1132(a)(1)(B). That third-party insurers in particular can be sued when they are legally responsible, by contract, for the payment of ERISA benefits is confirmed by several cases in this circuit in which ERISA beneficiaries have been permitted to bring suit against third party insurers under that provision. In Forsyth v. Humana, Inc.,
I would also point out that at no point in the Supreme Court decision, the appeals court decision, or the district court decision in Forsyth is it held, asserted, suggested or even implied that Humana was the plan administrator. The majority’s distinguishing of Forsyth on that basis is simply unsupportable. The relevance of Forsyth to the issue before us is that the suit was allowed to proceed because in that case, as in this, the third-party insurer was legally responsible for paying the ERISA benefits the plaintiffs sought to recover. Moreover, in at least two other instances, this circuit has permitted ERISA beneficiaries to sue third-party insurers. In Cisneros v. UNUM Life Insurance Company of America,
The majority misconstrues the distinction the plaintiff claims is made under the statute between suits against self-funded
Finally, permitting suits such as Ever-hart’s furthers the policies of ERISA, and is consistent with our duty to develop a body of federal common law applicable to ERISA. “Under ERISA, Congress has authorized the courts ‘to formulate a nationally uniform federal common law to supplement the explicit provisions and general policies set out in[the Act].’ ” Sec. Life Ins. Co. of Am. v. Meyling,
Normally under state common law, insurers such as Allmerica can be sued by parties, such as Everhart, who qualify as third-party beneficiaries, see Restatement (Second) of Contracts § 302(1)(b) and comm, c, illustration 4, and § 304 (1979); 46A C.J.S. Insurance § 1520 et seq. In developing a federal common law to govern ERISA suits, courts are expected to “refer[ ] to [and] be[ ] guided by principles of state law.” Menhorn v. Firestone Tire & Rubber Co.,
There is no statutory prohibition in ERISA on suits against third-party insur
. Similarly, the statute does not permit the artifice of suing a Plan's employee in his individual capacity as a means of suing the Plan. Such were the circumstances in Jass v. Prudential Health Care Plan, Inc.,
. The intra-circuit split discussed in the majority opinion — whether only the plan itself may be sued or whether plan administrators may also be sued — demonstrates the confusion and disagreement in our case law on the question of standing under the ERISA provision at issue. Maj. Op. at 753-54. It provides further support for the argument that the instant case should not be resolved by this panel but by an en banc court.
