Syed v. Hercules Inc.Syed v. Hercules Inc.
Before: BECKER, Chief Judge, and ALITO and BARRY, Circuit Judges.
OPINION OF THE COURT
ALITO, Circuit Judge:
Sajid Syed (“Syed“) injured his back in January 1992, while working as a chemical operator for Hercules, Inc. (“Hercules“). Syed brought this action under
Hercules discharged Syed on March 4, 1992, effective March 31, 1992, as part of a reduction in force. Following his termination, Syed submitted a claim for long-term disability benefits under the Hercules Incorporated Income Protection Plan (the “Plan“). His claim was approved on June 18, 1993, and Syed began receiving benefits retroactive to April 1, 1992.
Benefits are payable under the Plan when a worker becomes totally disabled and remains disabled for six consecutive months.1 See App. at B21. Because Syed was under 62 when he started receiving benefits, he was eligible to receive benefits for as long as he remained totally disabled, up to age 65. See id. at B22. The Plan provides two definitions of total disability, one that applies for the first 24 months after the “elimination period” and another that applies thereafter. The Plan states:
During the elimination period, normally 6 months, and the first 24 months of benefit payments, you are considered totally disabled if you are not able to perform your job. You must not engage in any work for wages or profit during this time.
After receiving 24 monthly payments, you are considered totally disabled for as long as you are not able to engage in any employment for wage or profit for which you are reasonably qualified by training, education, or experience.
App. at B24.
After paying benefits to Syed for almost two years, Provident Life and Accident Insurance Co. (“Provident“), the Claims Fiduciary under the Plan, asked Syed to undergo an independent medical evaluation in February 1994 to determine if he was totally disabled under the latter definition. Dr. Joson, who performed the examination in March 1994, reported that Syed could not do heavy work, but that he could do “sedentary to light” work. App. at A4. Because Syed would no longer qualify for benefits after the 24-month period lapsed, Provident notified Syed that his benefits would be terminated as of March 31, 1994. See id. at A6-7.
Syed appealed the decision to terminate his disability benefits to Provident‘s ERISA Committee, which upheld its previous decision. See App. at A19-20. Syed renewed his appeal to the ERISA Committee on July 27 and October 28, 1994, each time including updated medical reports. The ERISA Committee sent its final denial of benefits to Syed by letter dated November 9, 1994. On February 24, 1995, Syed requested a copy of the plan document that was effective as of the date he began receiving benefits. Hercules sent him a document entitled “Summary Plan Description” (SPD). App. at B15-32.
Syed filed suit on February 6, 1996 - one year and eleven months after the initial denial of benefits on March 31, 1994, and one year and three months after the final letter from Provident dated November 9, 1994. Shortly thereafter, he filed a motion for summary judgment seeking recovery of benefits under
The District Court denied Syed‘s motion. As the Plan gave the Claims Fiduciary the exclusive discretion to deny claims for benefits, the District Court reviewed Syed‘s § 502(a)(1)(B) claim under the abuse of discretion standard in accordance with Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989); see also Abnathya v. Hoffman-La Roche, Inc., 2 F.3d 40, 45 (3d Cir. 1993). After reviewing the medical evidence, the District Court found that there was a genuine issue as to whether Provident acted arbitrarily and capriciously in terminating Syed‘s medical benefits. Nonetheless, after borrowing Delaware‘s one-year statute of limitations applicable to claims for “other benefits arising from . . . work, labor or personal services performed,”
Next, the Court dismissed Syed‘s § 502(c) claim.
ERISA § 502(a)(1)(B): Statute of Limitations
The chief issue in this appeal concerns the statute of limitations that is applicable to Syed‘s claim for benefits under
No action to recover damages for trespass, no action to regain possession of personal chattels, . . . no action based on a promise, . . . shall be brought after the expiration of 3 years from the accruing of the cause of such action.
No action for recovery upon a claim of wages, salary, or overtime for work, labor or personal services performed, . . . or for any other benefits arising from such work, labor or personal services performed . . . shall be brought after the expiration of one year from the accruing of the cause of action on which such action is based.
In Mitchell, the Delaware Supreme Court applied
The Eighth Circuit dealt with a similar issue in Adamson v. Armco, 44 F.3d 650 (8th Cir. 1995). There, the Court had to choose between Minnesota‘s six-year statute of limitations governing general contract disputes and the state‘s two-year statute of limitations for wage claims. The Court reasoned that the wage-claim statute of limitations was the most analogous to the appellant‘s § 502(a)(1)(b) claim because Minnesota courts had uniformly applied that statute broadly to cover all damages arising out of the employment relationship. See Adamson, 44 F.3d at 652. In support of its conclusion, the Court noted that pre-ERISA case law in Minnesota had applied the two-year statute of limitations to cases of unpaid benefits. See id. (citing Kohout v. Shakopee Foundry Co., 162 N.W.2d 237 (Minn. 1968)).
Syed relies primarily on two cases to bolster his argument for application of
In Shaw, the Delaware Superior Court refused to apply
Although Syed‘s § 502(a)(1)(B) claim comes within Delaware‘s more specific statute of limitations for claims arising out of the employer-employee relationship, that does not conclusively resolve the issue. After all, the selection of an appropriate statute of limitations is a question of federal law. See United Auto Workers v. Hoosier, 383 U.S. 696, 706 (1966).
Generally, we presume that Congress intended courts to apply the most closely analogous state statute of limitations. See DelCostello, 462 U.S. at 158. This principle rests on the assumption that “Congress would likely intend that courts follow their previous practice of borrowing state statutes.” Id. at 158-59 n.12. We remain mindful of the Supreme Court‘s warning not to apply state statutes of limitation mechanically since “[s]tate legislatures do not devise their limitations periods with national interests in mind, and it is the duty of the federal courts to assure that the importation of state law will not frustrate or interfere with the implementation of national policies.” Occidental Life Ins. Co. v. EEOC, 432 U.S. 355, 367 (1977). Nonetheless, there is no reason to reject the state statute unless we find it “inconsistent with national labor policy.” Auto Workers, 383 U.S. at 706.
We are not persuaded by the arguments advanced by the dissent in support of its position that Syed‘s claim for disability benefits is more analogous to an ordinary contract claim, subject to
ERISA § 502(c)
Syed urges the Court to impose sanctions on Hercules for failing to provide the Plan document pursuant to a written request.
Hercules sent Syed the SPD on March 22, 1995, in response to his February 24, 1995, written request for “a complete copy of LTD Plan document effective as of March 4, 1992.” App. at A28. Syed contends that a different document was in effect at the time he was injured and at the time his benefits were denied. Specifically, he points to the insurance policy used to fund Hercules‘s long-term disability plan (LTD). App. at B35-72.
A comparison of the SPD and LTD reveals no material differences between the two documents. Syed complains that he was not able to verify “whether the definition of disability is based on official plan language, SPD language, or some internal policy, written or unwritten.” Appellant‘s Br. at 20. This argument lacks merit. For example, the March 31, 1994, letter denying Syed‘s benefits, see App. at A6, quotes the definition of total disability found at page 8 of the SPD, see App. at B24. This definition is exactly the same as the definition of total disability found on page 3 of the LTD, see App. at B43, thus belying Syed‘s assertion that the two-tier definition of disability did not exist in the SPD, see Appellant‘s Br. at 22. The affidavit of Douglas Hill, Director of Employee Benefits for Hercules, makes clear that the document Hercules allegedly refused to send to Syed pursuant to his March 1995 request was, in fact, not executed until October 1995 (although it was effective retroactively to July 1990). Because the SPD and the LTD are identical in all respects material to this dispute, the District Court properly refused to impose sanctions against Hercules under
ERISA § 503
provide adequate notice in writing to any participant or beneficiary whose claim for benefits under the plan has been denied, setting forth the specific reasons for such denial, written in a manner calculated to be understood by the participant.
provide to every claimant who has been denied a claim for benefits written notice setting forth in a manner calculated to be understood by the claimant:
(1) The specific reason or reasons for the denial;
(2) Specific reference to pertinent plan provisions on which the denial is based;
(3) A description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material or information is necessary; and
(4) Appropriate information as to the steps to be taken if the participant or beneficiary wishes to submit his or her claim for review.
We have previously held that
The March 31, 1994, letter from Provident to Syed began with a quotation from the Plan‘s definition of total disability. See App. at A6. Next, the letter explained that Syed‘s benefits were being terminated because the results of Dr. Joson‘s independent medical evaluation demonstrated that Syed was no longer totally disabled as the term was defined in the Plan. See App. at A6-7. The letter went on to identify several jobs for which Syed would be qualified given his present physical condition. See App. at A7. Provident stated that Syed could submit a request for reconsideration of the decision, accompanied by documents from Syed‘s physician. See id. Lastly, the letter noted that any information to be considered in connection with an appeal would have to be received within 60 days of Syed‘s receipt of the letter. See id. In short, Provident fully complied with the statutory and regulatory requirements for notice under
BARRY, Circuit Judge, concurring and dissenting.
While I agree with much of the majority‘s opinion, I cannot agree with the conclusion that the most analogous state statute of limitations for a
First, it is clear, as the majority notes, that every circuit which has addressed this issue has applied the statute of limitations for a state contract action as most analogous to an ERISA claim for the denial of benefits. As the majority also notes, we, too, have suggested, albeit in dicta, that the state statute of limitations for a contract action would apply to claims under
Delaware courts restrict
In Mitchell, a pre-ERISA case, the Supreme Court of Delaware determined that Mitchell‘s action under Delaware‘s Disability Wage Plan was governed by
Syed‘s claim, however, has little or nothing to do with work or services performed or fringe benefits and has everything to do with benefits for disability based on an interpretation and analysis of the Plan documents, akin to the analysis required in a traditional breach of contract claim:
The [claimant] has brought this action to recover benefits allegedly due him under the terms of the employee pension benefit plan and to enforce and/or clarify his rights under the terms of that Plan. The employee pension benefit plan and its predecessor . . . are in written form. Each of the Plans contain extensive and detailed terms and conditions governing the rights and duties of all participants in the fund.
Jenkins v. Local 705 Int‘l Bd. of Teamsters Pension Plan, 713 F.2d 247, 252-53 (7th Cir. 1983); see also Hogan v. Kraft Foods, 969 F.2d 142, 145 (5th Cir. 1992) (“[The] claim involves the interpretation of the annuity contract[.]“); Meade v. Pension Appeals and Review Comm., 966 F.2d 190, 195 (6th Cir. 1992) (“[T]he Plan at issue in this case constitutes a written contract [for disability benefits].“); Johnson v. State Mut. Life Assur. Co. of America, 942 F.2d 1260, 1264 (8th Cir. 1991) (noting that life insurance policy governed by ERISA “is a written promise to pay money if a specified condition, accidental death, occurs in the future“).
Mitchell aside, the majority also invokes a 1956 District of Delaware case which states that
§ 8111 and its one year statute of limitations for wage, salary and benefit claims should not be read as being so comprehensive as to bar all claims arising out of the employer-employee relationship. Rather [Section 8111] is directed to claims alleging a breach of a duty to pay wages, salary or overtime for work performed. Where, as here, a plaintiff alleges that a defendant has breached a different duty arising out of the employer employee relationship, another statute of limitations may apply to the plaintiff ‘s claim.
Rich, 845 F. Supp. at 165. The Court concluded that Rich‘s claims were most analogous to the breach of contract and breach of promise claims asserted in Goldman and Brown and, thus, subject to the
If a plaintiff alleges a breach of a duty to provide benefits or to pay wages for work already performed, then the one year statute of limitations in section 8111 governs. On the other hand, if plaintiff alleges that his employer breached a different duty arising out of the employment agreement, then the three year statute of limitations in section 8106 applies.
Compass, 72 F. Supp. 2d at 467. Just such a “different duty” has been alleged here. See also DeWitt v. Penn-Del Directory Corp., 872 F. Supp. 126, 134-35 (D. Del. 1994) (
Finally, the majority cites a 1995 Eighth Circuit case which applied Minnesota‘s two-year statute of limitations for wage claims as more analogous to a
It is, thus, clear, at least to me, that
[I]t would be anomalous to characterize this suit as a contract action and then borrow Nebraska‘s generic contract statute of limitations rather than the specific section of the Nebraska insurance laws permitting the contractual limitation in question.
The majority, after concluding that Syed‘s claim comes within
In enacting ERISA, “Congress sought to protect the interests of participants in employee benefits plans by regulating the administration of such plans and by providing participants and beneficiaries with a variety of remedies to assure compliance with the statutory framework.” Harrison, 183 F.3d at 1239; see also Held v. Manufacturers Hanover Leasing Corp., 912 F.2d 1197, 1202 (10th Cir. 1990) (“The principal purpose of ERISA is to protect employees’ rights to benefits under a covered plan.“). While I cannot say that applying