32 F. App'x 645 | 3rd Cir. | 2002
FUENTES, Circuit Judge: (cid:13) Lois Marx appeals the District Court’s decision to grant the Defendants’ summary(cid:13) judgement motion, in opposition to Marx’s suit for long-term disability benefits under the(cid:13) Employee Retirement Income Security Act of 1974 ("ERISA"). For the reasons stated(cid:13) below, we will affirm. (cid:13) Lois Marx began working as a secretary for Meridian Bancorp, Inc. ("Meridian") (cid:13) ________________________(cid:13) * The Honorable John R. Gibson, United States Circuit Judge for the Eight Circuit, sitting(cid:13) by designation. (cid:13) in 1991. In January 1995, Marx requested a leave of absence on account of back pain(cid:13) which she claimed affected her ability to sit or stand for extensive periods of time. With (cid:13) the support of her treating physician, Dr. Mark Kender, Marx filed a claim for long-term(cid:13) disability ("LTD") benefits with Defendants under the Meridian Bancorp, Inc. Long-Term(cid:13) Disability Plan (the "Plan"), alleging an inability to work on account of the pain and the(cid:13) depression it caused her. (cid:13) The LTD Plan is an ERISA-regulated employee welfare benefit plan established(cid:13) by Meridian. Under the Plan, the Administrative Services Committee of Meridian has(cid:13) been designated as the "Plan Administrator," and is responsible for the day-to-day(cid:13) operation and management of the Plan. See, Meridian Bancorp Long Term Disability(cid:13) Plan, Art. I, (cid:21)1.24.. Significantly, Meridian had entered into an Administrative Services(cid:13) Agreement (the "Agreement") with Metropolitan Life Insurance Co. ("MetLife") to carry(cid:13) out many of its responsibilities under the Plan. Generally, as the "Claim Administrator,"(cid:13) MetLife was required to provide "claim adjudication services at the direction of the Plan(cid:13) Administrator." Id., at (cid:21)1.06.(cid:13) To establish a claim for LTD under the Plan, a claimant must show that she is(cid:13) unable to perform the duties of her own job. See, the Plan (cid:21)1.32 (defining a Participant’s(cid:13) ’total disability’ as being "unable to engage in the material and substantial duties of his or(cid:13) her Regular Occupation immediately prior to the Date of Disability."). If a claimant can(cid:13) establish disability under this standard, she may receive benefits during a two year(cid:13) "Waiting Period." After the Waiting Period, a claimant’s eligibility is assessed under a(cid:13) more stringent standard, one which requires her to demonstrate that she is unable "to(cid:13) perform any occupation" for which she "is qualified or may reasonably become qualified(cid:13) by training, education or experience." (cid:21) (cid:21) 1.32 & 1.03 of the Plan (defining ’Total(cid:13) Disability’ and ’Any Occupation,’ respectively).(cid:13) Marx succeeded in her claim to receive LTD benefits under the initial standard and(cid:13) received benefits for the two year Waiting Period. During that time, Marx consulted other(cid:13) doctors, underwent surgery for her back and took steps to establish a claim for permanent(cid:13) disability benefits. For instance, she submitted medical records to the Plan Administrator,(cid:13) received an independent medical examination and filed for Social Security Disability(cid:13) Income ("SSDI"), all in accordance with the Plan’s requirements. (cid:13) At the end of the Waiting Period, Defendants reevaluated Marx’s eligibility under(cid:13) the more stringent standard of review and denied Marx’s benefits. Marx appealed this(cid:13) determination and argued that SSA’s 1996 finding of total disability should have resulted(cid:13) automatically in the same decision by Defendants. Marx also criticized the behavior of(cid:13) Dr. O’Brien, the independent medical examiner and hence questioned the credibility of(cid:13) his findings. Despite these arguments, Defendants upheld their decision on appeal.(cid:13) On July 16, 1998, Marx, now represented by counsel, sought a third review of her(cid:13) claim. Marx again argued that the SSA’s findings should have been conclusive. The(cid:13) Claim Administrators, Metropolitan Life Insurance Company ("MetLife"), informed(cid:13) Marx that she could submit additional medical evidence and Marx followed this(cid:13) suggestion. However, on September 23, 1998, MetLife informed Marx that it would not(cid:13) re-open her case.(cid:13) On September 8, 1999, Marx filed a claim with the U.S. District Court for the(cid:13) Eastern District of Pennsylvania under ERISA. See, 29 USC 1132(a)(1)(B) (authorizing,(cid:13) inter alia, suits by a participant or beneficiary in an approved plan "to recover benefits(cid:13) due to him under the terms of his plan"). After the completion of discovery, Defendants(cid:13) filed for summary judgment.(cid:13) On June 20, 2001, the District Court granted the Defendant’s summary judgment(cid:13) motion. See, Marx v. Meridian, 2001 WL 706280. The Court first determined that the(cid:13) appropriate standard for reviewing MetLife’s denial of Marx’ LTD benefits was a(cid:13) deferential ’arbitrary and capricious’ standard. Id. at *2. (cid:13) The Court next applied the Arbitrary and Capricious standard to Marx’ substantive(cid:13) claims. Regarding Marx’ claim that MetLife had denied her LTD benefits on the basis of(cid:13) an incomplete medical file, the District Court found that "temporal discrepancies"(cid:13) between the letters actually submitted by MetLife and Marx’ claims in her affidavit about(cid:13) which letters were missing "[led] the Court to question the integrity of Plaintiff’s(cid:13) affidavit." The Court therefore found that "in the absence of any evidence other than(cid:13) Plaintiff’s assertions that she submitted these materials, the Court does not find that this(cid:13) issue is sufficient to preclude a grant of summary judgment in favor of Defendants."(cid:13) Marx, 2001 WL, at *4.(cid:13) The Court next addressed Marx’ claim that the decision of the Social Security(cid:13) Administration to grant Marx SSDI benefits mandated a parallel finding by MetLife with(cid:13) regard to Marx’ LTD benefits. The Court determined that, according to the Plan, an SSA(cid:13) finding is only one factor among many that may be considered when granting disability(cid:13) benefits and would not mandate receipt of LTD benefits. Id. at *5. (cid:13) Finally, the Court considered Marx’ claim that the decision of the independent(cid:13) medical examiner, Dr. O’Brien, that Marx was not totally disabled, was unfounded. The(cid:13) Court first observed that Marx’ claim only referenced the standard medical check-box(cid:13) questionnaire filled out by the doctor, but ignored the four-page, single-spaced analysis of(cid:13) Marx’ condition submitted by Dr. O’Brien. The Court also noted Dr. O’Brien’s comment(cid:13) that, during the examination, Marx was "uncooperative and recalcitrant." The Court(cid:13) concluded that "in light of [Marx’] behavior, the fact that Dr. O’Brien’s conclusions are(cid:13) supported by other evidence in the record and the fact that the Court places more(cid:13) significance on Dr. O’Brien’s discussion than on the checkmarks on a form, the Court(cid:13) finds that MetLife’s reliance on Dr. O’Brien’s analysis does not render MetLife’s decision(cid:13) arbitrary and capricious. " Id. The Court accordingly granted summary judgement and(cid:13) dismissed Marx’ claim.(cid:13) On July 18, 2001, Marx timely filed for appellate review with this court. (cid:13) Our review of a District Court’s decision to grant summary judgement is plenary.(cid:13) Orvosh v. Program of Group Ins. for Salaried Employees of Volkswagen of America,(cid:13) Inc., 222 F.3d 123, 128-29 (3d Cir. 2000). Therefore, like the District Court, this Court (cid:13) must consider the evidence in the record in the light most favorable to the nonmoving(cid:13) party, See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, (1986). Additionally, we(cid:13) may grant summary judgment only where the moving party has established that there are(cid:13) no genuine issues as to any material fact and that the moving party is entitled to a(cid:13) judgment as a matter of law. Fed.R.Civ.P. 56. However, we may affirm the summary(cid:13) judgment decision of the District Court if it could have been reached on any ground(cid:13) below, including grounds rejected or not reached by the District Court. University of(cid:13) Maryland v. Peat Marwick Main & Co., 923 F.2d 265 (3d Cir. 1991). (cid:13) After a careful review of the briefs and appendices submitted by the parties, we(cid:13) find no basis for disturbing the District Court’s rulings on Marx’ substantive claims. We(cid:13) write only to address Marx initial claim on appeal: that the District Court erred in making(cid:13) its threshold determination, when it decided to use a deferential arbitrary and capricious(cid:13) standard, rather than reviewing MetLife’s denial of Marx’s application for LTD benefits(cid:13) de novo. We exercise plenary review of the standard applied by the District Court. See,(cid:13) Gritzer v. CBS Inc., 275 F.3d 291, 295 (3d Cir. 2002). (cid:13) ERISA explicitly authorizes suits by a participant or beneficiary "to recover(cid:13) benefits due to [her] under the terms of his plan, to enforce [her] rights under the terms of(cid:13) the plan, or to clarify [her] rights to future benefits under the terms of the plan" See, 29(cid:13) USC 1132(a)(1)(B). However, ERISA does not set out the standard of review for an(cid:13) action brought by a plan participant under (cid:21)1132(a)(1)(B). See, Mitchell v. Eastman(cid:13) Kodak Co., 113 F.3d 433 (3d Cir 1997). Nevertheless, the Supreme Court has addressed(cid:13) the question of the appropriate standard for actions challenging "denials of benefits based(cid:13) on plan interpretations." See, Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989).(cid:13) In Firestone, the Court held that "a denial of benefits challenged under (cid:21)1132(a)(1)(B) is(cid:13) to be reviewed under a de novo standard unless the benefit plan gives the administrator or(cid:13) fiduciary discretionary authority to determine eligibility for benefits or to construe the(cid:13) terms of the plan." Id., at 115 [emphasis added]. This Court subsequently held that where(cid:13) de novo review is inappropriate, an arbitrary and capricious standard should be applied in(cid:13) evaluating a claim against a plan administrator for denial of benefits. See, Stoetzner v.(cid:13) U.S. Steel Corp., 897 F2d 115, 119 (3d Cir. 1990); See also, Firestone, 489 US at 114(cid:13) ("[w]here the plan affords the administrator discretionary authority, the administrator’s(cid:13) interpretation of the plan will not be disturbed if reasonable.") [emphasis added].(cid:13) Therefore, we must determine whether the Plan granted discretionary authority to(cid:13) MetLife to determine Marx’ eligibility for LTD benefits. (cid:13) To determine the proper standard of review, we must begin with the language of(cid:13) the plan. See, Luby v. Teamsters Health, Welfare & Pension Trust Funds, 944 F.2d(cid:13) 1176, 1180 (3d Cir. 1991) (instructing that "[w]hether a plan administrator’s exercise of(cid:13) power is mandatory or discretionary depends upon the terms of the plan," and that "the(cid:13) terms of the plan are construed without deferring to either party’s interpretation."); See(cid:13) also, Firestone, 489 US at 115 ("the validity of a claim is likely to turn on the(cid:13) interpretation of terms in the plan at issue"). The District Court below examined the(cid:13) language of Meridian’s LTD Plan and found that the Plan "does not contain an [explicit](cid:13) grant of authority to MetLife."Marx v. Meridian, 2001 WL 706280, at *3. Nevertheless,(cid:13) under ERISA, the discretion required to trigger the deferential arbitrary and capricious(cid:13) standard of review need not be expressly stated in the plan, but can be implied from its(cid:13) terms. See, Luby, 944 F.2d at 1180, quoting, Nobel v. Vitro Corp., 1180, 1187 (4th Cir.(cid:13) 1989) (no "magic words," such as "discretion is granted ...," need be expressly stated in(cid:13) order for the plan to accord the administrator discretion to interpret plan terms and to hear(cid:13) and decide disputes between persons alleging themselves to be beneficiaries, so long as(cid:13) the plan on its face clearly grants such discretion). Accordingly, the District Court found(cid:13) that certain provisions of the Plan, "taken together with the structure of MetLife’s(cid:13) responsibilities,...suggest an almost unavoidable grant of [implicit] discretionary authority(cid:13) by Meridian to MetLife," and therefore reviewed MetLife’s conclusions under an(cid:13) arbitrary and capricious standard. Id. At oral argument, counsel for Meridian relied on(cid:13) one specific provision in asserting that the terms of the Plan make it clear on its face that(cid:13) Meridian had granted discretion to MetLife to determine eligibility for the Plan’s(cid:13) participants. See, the Plan, (cid:21)6.04(j) ("Upon request for review [of a denial of benefits] the(cid:13) Plan Administrator will arrange and supervise a full review of the claim by the Claims(cid:13) Administrator [MetLife], whose decision after such a review shall be final.") [emphasis(cid:13) added].(cid:13) At oral argument, counsel for Marx admitted that the provisions of the Plan (and(cid:13) specifically (cid:21)6.04(j)) grant some discretion to MetLife to determine a Participant’s(cid:13) eligibility for LTD benefits. However, he argued that MetLife’s decision denying Marx’(cid:13) LTD benefits must be reviewed de novo because MetLife had not been specifically(cid:13) designated an "ERISA fiduciary" under the Plan, and only an "ERISA fiduciary" is(cid:13) entitled to the deferential standard of review. See, the Agreement, Article I (stating that(cid:13) "in the discharge of its obligations under this Agreement, MetLife acts solely as an agent(cid:13) of Meridian...and not as a fiduciary as that term is defined under [ERISA])." In addition,(cid:13) he cited a single piece of correspondence between Meridian and MetLife regarding a(cid:13) previous claimant’s application for LTD benefits as demonstrating an "undeniable course(cid:13) of dealing" between the two companies that clearly indicates that Meridian, and not(cid:13) MetLife, had ultimate authority over decisions to deny Plan benefits. See, II Appendix(cid:13) 409, Letter from MetLife to Meridian ("We have completed a review of Ms. Williams(cid:13) LTD claim [and MetLife therefore] recommend[s] termination of benefits. As claims(cid:13) fiduciary, you [Meridian] must inform the claimant of your final decision in this matter.")(cid:13) However, there is no requirement in the jurisprudence of either the Supreme Court(cid:13) or this Court that limits the deferential standard of review to ERISA fiduciaries. As the(cid:13) District Court below pointed out, Firestone explicitly instructed that a Benefit Plan may(cid:13) confer discretionary authority sufficient to trigger the deferential standard of review on(cid:13) either a fiduciary or an administrator. See, Marx, 2001 WL, at *3, note 2, citing,(cid:13) Firestone, 489 U.S. at 115. Furthermore, the Third Circuit case law cited by Marx is(cid:13) inapposite. See, e.g. Gritzer v. CBS, Inc., 275 F.3d 291, 295 (3d Cir. 2002) (holding that(cid:13) an Administrator’s denial of benefits under a pension plan that was governed by ERISA(cid:13) was subject to de novo review, where the administrator did not in fact exercise discretion(cid:13) when making denial of benefits). Neither party contends here that MetLife did not in fact(cid:13) exercise discretion in denying Marx’ benefits in this instance. Additionally, the language(cid:13) of ERISA itself specifically allows a "named [ERISA] fiduciary" to delegate its fiduciary(cid:13) responsibilities to non-fiduciaries. See, 29 U.S.C. 1105(c)(1) (instructing that "[t]he(cid:13) instrument under which a plan is maintained may expressly provide for procedures ...for(cid:13) named fiduciaries to designate persons other than named fiduciaries to carry out fiduciary(cid:13) responsibilities ... under the plan."). (cid:13) Furthermore, Marx’ allegation that the prior correspondence between Meridian and(cid:13) MetLife demonstrates an "undeniable course of dealing" between the parties is far from(cid:13) concrete. The subsequent letter, from Meridian to the claimant, Ms. Williams, informs her(cid:13) that "based on Metropolitan Life’s review of your file...[MetLife] ha[s] no alternative but(cid:13) to uphold their previous decision to terminate your LTD claim." See, II Appendix 411(cid:13) [emphasis added]. Clearly, even in this one instance that Marx offers, one could(cid:13) reasonably assume that Meridian had delegated final decision making authority to(cid:13) MetLife, with regard to the claimant’s right to LTD benefits. This court has previously(cid:13) instructed that "[a]lthough extrinsic evidence can be used to show that a contract is(cid:13) ambiguous ... extrinsic evidence cannot be used to create an ambiguity." U.A.W. v.(cid:13) Skinner Engine Co., 188 F.3d 130 (3d Cir. 1999). (noting also that a party offering such(cid:13) extrinsic evidence "must produce objective facts, not subjective and self-serving(cid:13) testimony, to show that a contract which looks clear on its face is actually ambiguous."). (cid:13) We find that the language of the Plan, and specifically (cid:21)6.04(j), is clear on its face(cid:13) in granting discretionary authority to MetLife to determine eligibility for LTD benefits(cid:13) under the Meridian Plan. Since the language is clear on its face, we reject the extrinsic(cid:13) "course of dealing" evidence offered by Marx. See, Epright v. Environmental Res. Mgt.,(cid:13) Inc. Health & Welfare Plan, 81 F.3d 335, C.A.3 (Pa.),1996 ("[P]ast practice is of no(cid:13) significance where the plan document is clear."). We therefore affirm the District Court’s(cid:13) finding that a deferential arbitrary and capricious standard of review was proper in this(cid:13) instance. (cid:13) Accordingly, we will affirm the Order of the District Court, granting Defendant’s(cid:13) motion for summary judgment, and dismiss Marx’ claim in full. (cid:13) (cid:13) (cid:13) _____________________________(cid:13) TO THE CLERK OF THE COURT:(cid:13) Kindly file the foregoing Opinion.(cid:13) /s/ Julio M. Fuentes(cid:13) Circuit Judg