Todd R. ROCHOW and John Rochow, personal representatives of the Estate of Daniel J. Rochow, Plaintiffs-Appellees, v. LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant-Appellant.
No. 12-2074
United States Court of Appeals, Sixth Circuit
March 5, 2015
Argued: June 18, 2014.
The problem, again, is that the Davis line of cases establishes only a right of cross-examination, not a right to introduce evidence. See supra. Thus, the majority‘s reasoning amounts to an extension of the holdings from those cases, rather than an application of them. And that distinction is one the Court has spoken to directly. ”
I respectfully dissent.
McKEAGUE, J., delivered the opinion of the court in which BOGGS, BATCHELDER, GIBBONS, ROGERS, SUTTON, COOK, GRIFFIN, and KETHLEDGE, JJ., joined, and WHITE, J., joined in part. GIBBONS, J. (pp. 376–78), delivered a separate concurring opinion in which BATCHELDER and COOK, JJ., joined. WHITE, J. (pp. 378–82), delivered a separate opinion concurring in part and dissenting in part. STRANCH, J. (pp. 382–95), delivered a separate dissenting opinion in which COLE, C.J., KEITH, MOORE, CLAY, and DONALD, JJ., joined, and WHITE, J., joined in part.
OPINION
McKEAGUE, Circuit Judge.
This is the second time this case has been before the Sixth Circuit. The first time, we affirmed the district court‘s determination that defendant Life Insurance Company of North America (“LINA“) acted arbitrarily and capriciously when it denied Daniel Rochow‘s claim for long-term disability benefits under the Employee Retirement Income Security Act,
I
The facts of this case are adequately summarized in Rochow II and are reproduced here:
In mid-2000, the late Daniel J. Rochow (“Rochow“), a principal of Universico Insurance Company (“Universico“), sold his interest in Universico to Arthur J. Gallagher & Co. (“Gallagher“) and became President of Gallagher. As an employee of Gallagher, Rochow was covered under Life Insurance Company of North America (“LINA“) policy number LK 30214. LINA‘s policy provided for disability benefits if an employee gave “satisfactory proof” that “solely because of Injury or Sickness [the employee is] unable to perform all material duties of [his or her] Regular Occupation or a Qualified Alternative[.]” See Rochow v. LINA (”Rochow I“), 482 F.3d 860, 863-64 (6th Cir.2007).
In 2001, Rochow began to experience short term memory loss, occasional chills, sporadic sweating, and stress at work. Id. In July 2001, Gallagher demoted Rochow from President to Sales Executive-Account Manager because Rochow could no longer perform his duties as President. Id. Rochow continued to have difficulties, and as a result of his inability to perform his job, Gallagher forced Rochow to resign effective January 2, 2002. Id. In February 2002, Rochow experienced periods of amnesia and was hospitalized. Id. During his February 2002 hospital stay, Rochow was diagnosed with HSV-Encephalitis, a
rare and severely debilitating brain infection. Id. On or about December 31, 2002, Rochow filed a claim for long term disability benefits. LINA denied Rochow benefits stating that Rochow‘s employment ended before his disability began. Rochow I, 482 F.3d at 864.
Rochow appealed LINA‘s denial and included medical records from 2001 that stated Rochow was suffering short-term memory loss during 2001. In denying Rochow‘s appeal, LINA noted that Rochow experienced the effects of encephalitis during 2001 but denied coverage because Rochow continued to work and was not disabled until February 2002. Rochow I, 482 F.3d at 864.
Rochow again appealed and included a report from Jack Tellerico, an area vice president for Gallagher, which identified the material duties of Rochow‘s position with Gallagher and stated that during 2001, Rochow was not able to perform all the material duties of those jobs due to his lack of memory. LINA again denied Rochow‘s claims stating, “[s]ince, Mr. Rochow‘s long-term disability claim was not filed until after his termination date; his claim was denied because of, ‘not considered actively working at time of disability.’ It appears no additional documentation was provided which would support that Mr. Rochow was actively working when he became disabled.” (Page ID 4056) (Joint App‘x) (sic).
Rochow appealed the denial a third time. LINA denied his claim for the final time stating Rochow had not presented any medical records to support his inability to work prior to the date he was terminated.
On September 17, 2004, Rochow filed a complaint against Cigna Group Insurance, LINA‘s parent company, in the United States District Court for the Eastern District of Michigan. Compl., ECF No. 1. The complaint states two claims under
ERISA § 502(a)(3), 29 U.S.C. § 1132(a)(3) : one to recover full benefits due to the failure to pay benefits in violation of the terms of the plan and one to remedy the alleged breach of fiduciary duty inERISA Section 404(a), 29 U.S.C. § 1104(a) .Defendant moved for judgment on the record and Plaintiff moved for summary judgment. On June 24, 2005, Judge Tarnow of the United States District Court for the Eastern District of Michigan heard oral arguments on the parties’ motions. At the conclusion of oral argument, Judge Tarnow stated on the record that LINA acted arbitrarily and capriciously in finding Rochow was not disabled while still employed and that Rochow had prevailed. In a one page order which incorporated the reasoning stated on the record, the Court granted Rochow‘s motion and denied LINA‘S motion. The same day, the district court clerk filed a judgment which purported to dismiss the case and was signed by the district court clerk and Judge Tarnow.
LINA appealed the June 24, 2005 Order denying Defendant‘s motion and granting Plaintiff‘s motion. Rochow moved to enforce judgment or require Defendant to post a supersedeas bond pursuant to
Federal Rule of Civil Procedure 62(d) . Eventually this motion was withdrawn and Defendant deposited a supersedeas bond in the amount of $250,000.On April 3, 2007, a panel of this Court affirmed Judge Tarnow‘s Order. Rochow I, 482 F.3d at 866. The Rochow I panel held the record supported the district court‘s decision that LINA‘s denial of Rochow‘s claims was arbitrary and capricious, was not the result of a delib-
erate, principled reasoning process, and did not appear to have been made “solely in the interest of the participants and beneficiaries and [] for the exclusive purpose of [] providing benefits to participants and their beneficiaries” as required by ERISA. 29 U.S.C. § 1104(A)(1) . Id. The opinion noted, “there is no ‘logical incompatibility between working full time and being disabled from working full time‘” and that the policy required only “satisfactory proof of disability, not medical evidence.” Id. (internal citations omitted). On the same day, the clerk for this Court entered judgment stating “the order of the district court is AFFIRMED.” The clerk of this Court issued the mandate on April 26, 2007, and it was filed May 3, 2007.On May 10, 2007, the parties filed a stipulation “to toll the time for all parties and counsel to bring any post-remand motions,” and the district court entered an Order tolling the filing deadlines for post-remand motions until further order of the court. On April 3, 2008, the district court referred the remaining issues in dispute to United States Magistrate Judge Whalen. Over the next few months, Judge Whalen held several status conferences.
On November 10, 2008, LINA filed a statement of resolved and unresolved issues and Plaintiff1 filed motions for attorneys’ fees and costs and equitable accounting. LINA‘s statement of issues represented that the parties still disputed several issues, including whether Plaintiff was entitled to a disgorgement of profits.
Plaintiff also filed a motion seeking an equitable accounting and a request for disgorgement. In that motion, Plaintiff argued Rochow‘s estate was entitled to disgorgement of profits because LINA breached its fiduciary duties, and disgorgement was necessary to prevent LINA‘s unjust enrichment resulting from profits it earned on the wrongfully retained benefits. Plaintiff supported the motion with the report of his expert, Dr. David C. Croson. In calculating LINA‘s “Return on (Average) Equity” (“ROE“), Dr. Croson determined LINA used Rochow‘s benefits to earn between 11 percent and 39 percent annually and, therefore, made approximately $2.8 million by retaining Rochow‘s benefits.
In June 2009, the district court granted Plaintiff‘s motion for an equitable accounting of profits and disgorgement of the same. LINA then moved to strike Croson‘s report and to preclude him from testifying as an expert on the ground that his principles and methods were unreliable under
Federal Rule of Civil Procedure 702 and Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 589 [113 S.Ct. 2786, 125 L.Ed.2d 469] (1993). The motion was referred to the magistrate judge, who issued a report recommending that the motion be denied, noting that the matter was being tried to the court rather than a jury and finding that many of LINA‘s objections went to the weight of Croson‘s opinions, not their admissibility. The district court adopted the magistrate judge‘s recommendation over LINA‘s objections.After the parties briefed the issue, the district court conducted an evidentiary
hearing in November 2011 on the issue of calculation of profits for disgorgement. At the hearing, LINA offered the testimony of its expert, Timothy Holzli, who served as the Chief Accounting Officer for the group insurance division of Cigna. Holzli opined Rochow‘s withheld benefits earned LINA profits of $32,732. He arrived at that figure by treating the withheld benefits as though they were earning interest as part of LINA‘s investment assets. On cross examination, Holzli acknowledged, however, that the account was not a separate or segregated account. He also conceded that LINA payed [sic] its operating expenses and benefits from the account, and the money in the account formed a basis for LINA to write insurance coverage.
Following additional briefing and oral argument, the district court issued its decision on calculation of profits for disgorgement in March 2012.2 The district court adopted Croson‘s ROE metric as the basis for determining the profits LINA gained from the wrongfully withheld funds, and it rejected Holzli‘s retained investment margin metric. It did so, in part, based upon its factual finding that the subject money was not placed in a separate investment account, but rather was available for LINA to use for any business purpose. In the last paragraph of its decision, the district court stated:
Plaintiff will, within two weeks from this order, submit a final amount to be disgorged by Defendant based upon the Court‘s rulings, above. Defendant may then submit a memorandum in response within seven days. This memorandum is limited only to any objections regarding the accuracy of Plaintiff‘s calculations based on this order, and is not an invitation to relitigate issues already decided by this Court.
(Page ID 3576).
On May 4, 2012, in its response brief to Plaintiff‘s final calculation of disgorgement, LINA argued for the first time that permitting disgorgement was outside the scope of the mandate in the first appeal. Nonetheless, on July 24, 2012, the district court ordered disgorgement of $3,797,867.92. The court noted, “Defendant has, in response to a proposed order submitted by Plaintiff, raised objections. To the extent that these objections do not simply repeat arguments already rejected by the Court, and raise new issues in Defendant‘s argument concerning the ‘mandate rule,’ they are untimely and will not be considered.” (Page ID 3907). LINA timely appealed.
Rochow II, 737 F.3d at 417-20 (alteration in original).
On December 6, 2013, a panel of this court affirmed the disgorgement award, holding that disgorgement was properly ordered under
II
There is essentially one issue before us: Is Rochow entitled to recover under both
ERISA has six remedial provisions. The remedial provisions relevant to this action are
(a) Persons empowered to bring a civil action
A civil action may be brought—
(1) by a participant or beneficiary—
...
(B) to recover benefits due him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights under the terms of the plan;
...
(3) by a participant, beneficiary, or fiduciary (A) to enjoin any act or practice which violates any provision of this subchapter or the terms of the plan, or (B) to obtain other appropriate equitable relief (i) to redress such violations or (ii) to enforce any provisions of this subchapter or the terms of the plan.
Unfortunately for Rochow, Supreme Court precedent construing the interplay of these provisions dictates a result contrary to that reached by the district court. In Varity Corp. v. Howe, 516 U.S. 489, 116 S.Ct. 1065, 134 L.Ed.2d 130 (1996), the Supreme Court allowed a group of plaintiffs, who were unable to bring a claim under
The Varity Court thus emphasized that ERISA remedies are concerned with the adequacy of relief to redress the claimant‘s injury, not the nature of the defendant‘s wrongdoing. The district court‘s use of equitable relief under
If an arbitrary and capricious denial of benefits implicated a breach of fiduciary duty entitling the claimant to disgorgement of the defendant‘s profits in addition to recovery of benefits, then equitable relief would be potentially available whenever a benefits denial is held to be arbitrary or capricious. This would be plainly beyond and inconsistent with ERISA‘s purpose to make claimants whole. Tellingly, the appellate briefing contains citation to no case that allowed disgorgement of profits under
Here in the Sixth Circuit we have had occasion to apply Varity ‘s teaching on the relationship between
Because [
§ 502(a)(1)(B) ] provides a remedy for Wilkins‘s alleged injury that allows him to bring a lawsuit to challenge the Plan Administrator‘s denial of benefits to which he believes he is entitled, he does not have a right to a cause of action for breach of fiduciary duty pursuant to [§ 502(a)(3) ].
Id. at 615. Just like the plaintiff in Wilkins, Rochow is not entitled to relief under the catchall provision: such relief is unnecessary and unavailable because he has an adequate remedy under
LINA thus contends the district court‘s disgorgement award contravenes Wilkins and allows a claimant to improperly repackage a claim for benefits wrongfully denied as a cause of action for breach of fiduciary duty. Rochow insists that Wilkins provided a way to ensure only that claimants do not attempt an “end run” around ERISA‘s limitations by repackaging an unsuccessful claim for benefits as a claim for “appropriate relief” based on an alleged breach of fiduciary duty. Rochow claims that Wilkins bars relief sought under
Rochow mischaracterizes Wilkins. A claimant can pursue a breach-of-fiduciary-duty claim under
Rochow contends there is no legitimate concern about impermissible claim “repackaging” when a benefits-claimant prevails and seeks “other appropriate equitable relief.” We disagree. Impermissible repackaging is implicated whenever, in addition to the particular adequate remedy provided by Congress, a duplicative or redundant remedy is pursued to redress the same injury. Because Rochow was able to avail himself of an adequate remedy for LINA‘s wrongful denial of benefits pursuant to
In Hill v. Blue Cross and Blue Shield of Michigan, 409 F.3d 710 (6th Cir.2005), we further clarified the interplay of
The present case does not fall within the Hill exception to Varity and Wilkins. Hill distinguished between the denial of individual claims and plan-wide mishandling of claims as two distinct injuries.
Rochow continues to claim that the disgorgement award (“equitable accounting“) remedies an injury entirely distinct from the injury remedied by recovery of his benefits, and that he has therefore suffered two distinct injuries. Rochow contends that he suffered his first injury when LINA improperly denied his benefits, and he suffered his second “injury” when LINA used the funds it owed him to generate $3.7 million in profits for its own
Nor can it be said that Rochow suffered a second injury, or that his injury was exacerbated, as a result of any gain realized by LINA before it paid the wrongfully withheld benefits. Rochow‘s loss remained exactly the same irrespective of the use made by LINA of the withheld benefits. Despite Rochow‘s creative use of semantics, the reality remains clear: Rochow suffered one injury, the denial of his benefits. And neither Rochow nor the dissent has succeeded in identifying any way in which the remedy available under
Rochow cites two cases to support his claim that he is entitled to equitable relief under
Rochow also relies on CIGNA Corp. v. Amara, — U.S. —, 131 S.Ct. 1866, 1881, 179 L.Ed.2d 843 (2011), to support his argument that the failure to show a second, distinct injury is not fatal to his disgorgement award under
Rochow insists that Varity and Amara, read together, indicate that a plaintiff may obtain relief under both
Rochow‘s reading misses a logical step: “other appropriate equitable relief” is not necessary to make him whole. While Varity certainly acknowledges the possibility of equitable relief, and Amara outlines the scope of potential equitable relief, when appropriate, the Supreme Court has never stated that recovery under both
Rochow‘s final argument is that even if the disgorgement relief is not available under
Prejudgment interest cannot be awarded, however, at a rate so high that the award amounts to punitive damages: Although prejudgment interest is typically not punitive, an excessive prejudgment interest rate would overcompensate an ERISA plaintiff, thereby transforming the award of prejudgment interest from a compensatory damage award to a punitive one in contravention of ERISA‘s remedial goal of simply placing the plaintiff in the position he or she would have occupied but for the defendant‘s wrongdoing. Ford v. Uniroyal Pension Plan, 154 F.3d 613, 616 (6th Cir.1998). An interest award should “simply compensate a beneficiary for the lost interest value of money wrongfully withheld from him or her.” Rybarczyk v. TRW, Inc., 235 F.3d 975, 985 (6th Cir.2000) (quoting Ford, 154 F.3d at 618). An excessive prejudgment interest rate would “contravene ERISA‘s remedial goal of simply placing the plaintiff in the position he or she would have occupied but for the defendant‘s wrongdoing.” Schumacher v. AK Steel Corp. Retirement Accumulation Pension Plan, 711 F.3d 675, 686 (6th Cir.2013). Conversely, an exceedingly low award would fail to make the plaintiff whole. Id.
Rochow‘s request for prejudgment interest appears to be a remedy the district court could have granted, though not at an excessive rate. In his initial complaint, Rochow requested various forms of relief, including an “[o]rder compelling Defendant to pay Plaintiff forthwith the full amount of employee benefits due him and to continue such payments for a period set forth in the Plan, including interest on all unpaid benefits.” R. 1, Compl. at 6, Page ID 6. Rochow also requested “[r]easonable attorney fees and costs” and “[s]uch other relief as may be just and appropriate.” Id. When the case was remanded to the district court following Rochow I, the parties treated prejudgment interest as a live issue, fully briefing the issue in connection with the proceedings on equitable remedies. Yet when disgorgement of profits was ordered, the question of prejudgment interest was given no further consideration. Rochow thus prayed for such relief in his complaint and has preserved his request throughout the proceedings. The issue having been thus far been pretermitted through no fault of the parties, we remand the case once more to the district court for fresh consideration of Rochow‘s entitlement to prejudgment interest.
III
For the reasons stated above, we VACATE the district court‘s disgorgement award under
JULIA SMITH GIBBONS, Circuit Judge, concurring.
If one accepts the rather charitable assumptions made in footnote 1 of the major-
Rochow‘s complaint stated two claims: He alleged that LINA wrongfully denied him benefits under
The parties filed cross-motions for summary judgment. LINA requested that the district court affirm its denial of Rochow‘s claim for benefits. Rochow asserted only that LINA erroneously denied him benefits pursuant to
Were there any doubt that Rochow‘s
Pursuant to the parties’ stipulation, however, the district court agreed to accept “post-remand” motions. But the case had never been remanded, and, of course, the parties could not stipulate to the district court‘s retention of jurisdiction. Still, the district court permitted Rochow to resuscitate his abandoned disgorgement claim, after Rochow moved for the court “to supervise the equitable accounting granted with summary judgment.” This motion was highly problematic. For starters, the district court never granted equitable accounting as part of its summary judgment order. And to the extent Rochow mentioned “accounting” in his motion for summary judgment, he sought an accounting of the amount of benefits due so that he could ensure “that his benefits [we]re being paid in the proper amount,” not equitable accounting tantamount to disgorgement. LINA is not without fault either. It spent years litigating the case without bringing these procedural defects to the district court‘s attention.
When the district court finally granted Rochow‘s motion for equitable accounting and ordered LINA to disgorge profits, it
Here, the Rochow I panel did not remand the case to the district court, so any “post-remand” litigation was contrary to this court‘s mandate. See United States v. Hamilton, 440 F.3d 693, 697-98 (5th Cir.2006); Green v. Nevers, 196 F.3d 627, 632 (6th Cir.1999). Even if Rochow I could be read as remanding the case to the district court for the issuance of a remedy, a district court violates the mandate rule when it orders an additional remedy beyond that contemplated by the appellate panel‘s opinion. See Briggs v. Pa. R.R. Co., 334 U.S. 304, 306, 68 S.Ct. 1039, 92 L.Ed. 1403 (1948); Schake v. Colt Indus. Operating Corp. Severance Plan for Salaried Emps., 960 F.2d 1187, 1191 (3d Cir.1992); Stiller v. Squeez-A-Purse Corp., 296 F.2d 504, 506 (6th Cir.1961). Since Rochow had abandoned his claim for disgorgement under
Our mandate issued on May 3, 2007. Over seven years later this case is still being litigated. The majority‘s charitable view of the case‘s procedural history allows that unfortunate history to continue with some legitimacy. In short, while I agree with the majority‘s analysis if one accepts its accommodations in footnote 1 to reposition the case for en banc review, I am unable to refrain from presenting another take on the history of this case, one which would preclude the district court‘s jurisdiction to order any further relief, except the prejudgment interest directed by the majority opinion.
HELENE N. WHITE, Circuit Judge, concurring in part and dissenting in part.
I write separately because I do not entirely agree or disagree with either the majority or dissenting opinion. I would vacate the judgment on the basis that the order of disgorgement is not adequately supported. I would, however, permit consideration of a refashioned disgorgement remedy on remand if properly supported.1
There is less light between the two opinions than might appear on the surface. The majority understands Rochow‘s fiduciary-duty claim as a repackaging of his benefits-denial claim, for which it believes Rochow obtained adequate relief as a result of Rochow I, 482 F.3d 860 (6th Cir.2007), and a potential award of prejudgment interest on remand. Operating un-
I do not agree that the dispositive inquiry governing the availability of equitable relief under
The statutory framework that authorizes “other appropriate equitable relief” confides the determination whether and what equitable relief is appropriate to judges, who presumably are well equipped to determine when a particular set of circumstances warrants additional relief by focusing on ERISA‘s objectives. This understanding of and respect for the discretionary role of the courts in evaluating claims for equitable relief is consistent with the Supreme Court‘s statements in Varity Corp. v. Howe, 516 U.S. 489, 116 S.Ct. 1065, 134 L.Ed.2d 130 (1996), which contemplate courts’ sound exercise of their discretion in fashioning appropriate equitable relief:
We should expect that courts, in fashioning “appropriate” equitable relief, will keep in mind the special nature and purpose of employee benefit plans, and will respect the policy choices reflected in the inclusion of certain remedies and the exclusion of others. Thus, we should expect that where Congress elsewhere provided adequate relief for a beneficiary‘s injury, there will likely be no need for further equitable relief, in which case such relief normally would not be appropriate.
Id. at 515, 116 S.Ct. 1065 (citations and internal quotation marks omitted). Varity does not require a showing of a “separate and distinct” injury. Maj. Op. 372; cf. id. at 371 (recognizing that Varity “emphasized that ERISA remedies are concerned with the adequacy of relief to redress the claimant‘s injury“). Rather, it speaks of injury for which adequate relief has not been elsewhere provided, uses the qualifying terms “likely” and “normally,” and ultimately focuses on the governing word “appropriate.” We should, therefore, address whether additional equitable relief is appropriate here, even discuss the types of considerations that should guide the determinations whether and what equitable relief is appropriate, but we should not preemptively disallow equitable remedies in particular circumstances where ERISA has not done so.
Nevertheless, the majority fashions a bifurcated standard, holding that a breach-of-fiduciary-duty claim is actionable under
Further undermining the separate-and-distinct-injury requirement for relief under
There is a valid distinction between the two equitable remedies that has nothing to do with whether there is an injury separate and distinct from the denial of benefits: Interest is generally compensatory, while disgorgement is generally geared toward deterring future misconduct. See Drennan v. Gen. Motors Corp., 977 F.2d 246, 253 (6th Cir.1992); The Law of Trusts and Trustees § 484. I share the majority‘s concern that Congress did not intend to turn the routine denial of benefits into the basis for a recovery of benefits and also an array of equitable relief, but I would direct that concern to the question whether, in light of the historic distinction between the two equitable remedies, disgorgement constitutes “other appropriate equitable relief” under the facts of a particular case, and would refrain from announcing what appears to be a blanket
Turning to the instant case, the district court did not find that disgorgement of profits is necessary to make Rochow whole, or that Rochow could have earned the same rate of return had he been paid his benefits on time.2 Rather, the court‘s primary basis for awarding further equitable relief was LINA‘s unjust enrichment, Order, R. 67 at 5-6, and the disgorgement of profits was largely based on the finding that LINA did not segregate Rochow‘s wrongfully withheld benefits and instead left the amount in its general fund to be used for general operating expenses, Rochow v. Life Ins. Co. of N. Am., 851 F.Supp.2d 1090, 1097-98 (E.D.Mich.2012). The district court reasoned that LINA earned a rate of return on Rochow‘s benefits that it would not have earned had it segregated the funds in an investment account, and that because Rochow‘s money was inseparable from LINA‘s money, he is entitled to a percentage of LINA‘s return on its investments during this period. However, the district court did not find that either the Plan or ERISA required that Rochow‘s disputed benefits be segregated pending resolution of the claim. Nor is it apparent on what basis the dissent concludes that LINA engaged in prohibited self-dealing under
In the absence of such justifications, disgorgement as an equitable remedy in a denial-of-benefits case should be premised on a finding that the decision to deny benefits was not only arbitrary and capricious but also based on impermissible considerations that call for an equitable judicial response geared toward deterring similar decision making in the future, as, for example, where the denial of benefits is not the product of particular claims evaluators’ misguided evaluations, but rather, an organizational policy to delay paying valid claims for as long as possible; or where repeated wrongful denials lead to the conclusion that disgorgement is necessary to assure proper claims processing in the future. See Hill v. Blue Cross & Blue Shield of Mich., 409 F.3d 710, 718 (6th Cir.2005); Parke v. First Reliance Standard Life Ins. Co., 368 F.3d 999, 1008 (8th Cir.2004) (quoting 1 Dobbs § 4.3(5), at 611 n.16); Restatement (Third) of Restitution and Unjust Enrichment § 51 (2011). Further, even when these types of considerations support disgorgement, the court should consider the effect of disgorgement on innocent participants in the plan and tailor the remedy accordingly.
To be clear, a finding that disgorgement is an appropriate remedy in such circumstances would be based on the totality of the circumstances of the denial, as well as the consequences of disgorgement, and would not depend on a finding of a separate and distinct injury, which, although relevant, may or may not be present.
In sum, to the extent the majority‘s bifurcated rule identifies two circumstances or considerations that might justi-
STRANCH, Circuit Judge, dissenting.
The issue before us arises under a remedial statute, fashioned on the precepts of equity, which empowers a plan participant to bring a civil action to “recover benefits due” and “to obtain other appropriate equitable relief.”
Rochow sought, and the district court awarded, a make-whole remedy for two ERISA violations committed by LINA, failure to pay benefits due and breach of fiduciary duty. Based on evidence presented, the district court found that LINA engaged in deliberate and willful wrongful acts, created non-existent insurance policy requirements, concocted a knowingly false rationale for its second denial of benefits, closed the administrative record without medical input or evidence, and acted in bad faith. R. 67, Order; Rochow v. Life Ins. Co. of N. Am., 851 F.Supp.2d 1090, 1101 (E.D.Mich.2012). Proceedings in the district court confirmed that LINA also engaged in prohibited self-dealing under
The majority avers that such equitable remedies are prohibited under ERISA jurisprudence because obtaining a remedy under both
I will demonstrate below that Varity Corp. and numerous cases decided after it fully support Rochow‘s recovery of benefits under
In contrast to the facts of Wilkins, LINA injured Rochow in two distinct ways: by arbitrarily and capriciously denying his disability benefits claim and by breaching its fiduciary duties to him. LINA‘s denial of benefits breached the Plan terms; LINA‘s breach of its fiduciary obligations violated ERISA statutes and added the element of wrongdoing to the contract breach. Equity has long recognized that “[a] trustee (or a fiduciary) who gains a benefit by breaching his or her duty must return that benefit to the beneficiary.” Skinner v. Northrop Grumman Retirement Plan B, 673 F.3d 1162, 1167 (9th Cir.2012). Unlike Wilkins, Rochow sued under
By falsely characterizing the wrongs Rochow suffered and by denying the availability of equitable remedies, the majority opinion stands at odds with governing law and with the facts before us. Supreme Court opinions, our precedent, and cases from our sister circuits support the availability of dual ERISA remedies where two distinct injuries exist and two remedies are necessary to make the plan participant or beneficiary whole. I would affirm the district court, but I would remand the case for a recalculation of the amount of profit LINA must disgorge. Accordingly, I must respectfully dissent from the majority opinion.
I. ERISA DEFINES LINA‘S DUTIES AS A FIDUCIARY
“ERISA is a comprehensive statute designed to promote the interests of employees and their beneficiaries in employee benefit plans.” Shaw v. Delta Air Lines, Inc., 463 U.S. 85, 90, 103 S.Ct. 2890, 77 L.Ed.2d 490 (1983). Congress imposed fiduciary duties on ERISA plan sponsors and administrators that are the highest known to the law, Gregg v. Transp. Workers of Am. Int‘l, 343 F.3d 833, 841 (6th Cir. 2003), and in doing so, Congress drew much of ERISA‘s content from the common law of trusts. Varity Corp., 516 U.S. at 496, 116 S.Ct. 1065. These fiduciary duties attach to particular persons or entities engaged in the performance of specific ERISA functions. Edmonson v. Lincoln Nat‘l Life Ins. Co., 725 F.3d 406, 413 (3d Cir. 2013).
A fiduciary‘s first obligation is to “discharge his duties with respect to a plan solely in the interest of the participants and beneficiaries.”
II. ERISA DEFINES REMEDIES FOR BREACH OF FIDUCIARY DUTY
A. Congress authorized equitable remedies in § 1132(a)(3)
Congress designed ERISA to include equitable remedies that run directly to the individual plan participant or beneficiary who is injured by a fiduciary breach. The Supreme Court tells us that the “words of [§ 1132(a)(3)]—‘appropriate equitable re
In the majority‘s view, Varity Corp. emphasizes “that ERISA remedies are concerned with the adequacy of relief to redress the claimant‘s injury” and that “equitable relief is not ordinarily appropriate where Congress has elsewhere provided adequate means of redress for a claimant‘s injury. In other words, a claimant cannot pursue a breach-of-fiduciary-duty claim under
This unfounded fear is allayed by a proper interpretation of Varity Corp., the cases following it, and the Supreme Court‘s recent decision in CIGNA Corp. v. Amara, — U.S. —, 131 S.Ct. 1866, 179 L.Ed.2d 843 (2011). These cases demonstrate that a participant or beneficiary may recover under
In Varity Corp., the plaintiffs’ employer, serving also as administrator of a self-funded employee welfare benefit plan, persuaded the plaintiffs by deception to transfer their employment to a newly-formed subsidiary, thereby withdrawing voluntarily from the welfare benefit plan and forfeiting benefits under it in exchange for the employer‘s assurances that the plaintiffs would receive the same benefits following transfer. 516 U.S. at 491-94, 116 S.Ct. 1065. Just as Varity Corporation had planned, the insolvency of the new subsidiary stripped the employees of welfare benefits. Id. at 494, 116 S.Ct. 1065. The employees could not sue under
The Supreme Court affirmed the reinstatement, holding that individuals may sue under the catchall provision of
Like the majority here, the amici in Varity Corp. worried that an individual would be able to “repackage” a denial of benefits claim that is normally reviewed deferentially under the arbitrary and ca
The Supreme Court dismissed their concern. “[C]haracterizing a denial of benefits as a breach of fiduciary duty does not necessarily change the standard a court would apply when reviewing the administrator‘s decision to deny benefits.” Id. at 514, 109 S.Ct. 948. “After all, Firestone . . . based its decision upon the same common-law trust doctrines that govern standards of fiduciary conduct.” Id. at 514-15, 109 S.Ct. 948. Dismissing amici‘s concern that “lawyers will complicate ordinary benefit claims by dressing them up in ‘fiduciary duty’ clothing,” id. at 514, 109 S.Ct. 948, the Court explained “that where Congress elsewhere provided adequate relief for a beneficiary‘s injury, there will likely be no need for further equitable relief, in which case such relief normally would not be ‘appropriate.‘” Id. at 515, 109 S.Ct. 948 (emphasis added).
The majority transforms the Supreme Court‘s conditional language into an absolute bar to Rochow‘s claims, misconstruing the Court‘s instruction that ERISA authorizes “further equitable relief” if relief available “elsewhere” is inadequate. This may be the unusual case that entails two injuries, but Varity Corp. provides no basis for denying an equitable remedy necessary to accomplish make-whole relief. The repackaging fears the majority expresses, like those raised by amici in Varity Corp., should be met with the same response: there is not “any ERISA-related purpose that denial of a remedy would serve. Rather, . . . granting a remedy is consistent with the literal language of the statute, the Act‘s purposes, and pre-existing trust law.” Id.
B. Remedies under § 1132(a)(3) were traditionally available in equity
Section 1132(a)(3) “countenances only such relief as will enforce” ERISA‘s provisions or the terms of the plan, and it “authorizes the kinds of relief ‘typically available in equity’ in the days of ‘the divided bench,’ before law and equity merged.” US Airways, Inc. v. McCutchen, — U.S. —, 133 S.Ct. 1537, 1544, 1548, 185 L.Ed.2d 654 (2013) (quoting Mertens v. Hewitt Assoc., 508 U.S. 248, 256, 113 S.Ct. 2063, 124 L.Ed.2d 161 (1993)). The most definitive explanation of the types of equitable remedies available under
In explaining the scope of equitable remedies available under
Reading Amara and Varity Corp. together, we see that the remedies awarded to Rochow comport with the statute, its purposes, and trust law. The principle is clear that a plaintiff may pursue relief under both
Our sister circuits recognize that Amara corrects misunderstandings of the lower courts that have led to the denial of equitable remedies authorized by
Members in the majority here have read Amara to leave “open the possibility that ‘appropriate equitable relief’ could potentially be awarded” under
III. LINA BREACHED ITS FIDUCIARY DUTY TO ROCHOW
The majority nonetheless denies relief on the ground that “Rochow did not suffer an injury remediable” under
We previously recognized that LINA breached its fiduciary duties, Rochow v. Life Ins. Co. of N. Am., 482 F.3d 860, 866 (6th Cir. 2007) (”Rochow I“), and the majority acknowledges as much. Maj. Op. at 366-67. We ruled in the earlier appeal that LINA‘s decision to deny Rochow disability benefits was not made solely in Rochow‘s interest—in other words, LINA breached its duty of loyalty to Rochow—and LINA‘s decision to deny benefits was not made for the exclusive purpose of providing benefits to Rochow as required by
The majority opinion and the concurrence point out that this case comes to us with a complex procedural history, pockmarked by irregularities. While I don‘t disagree that the case is procedurally complex, I do disagree with the conclusion that the district court reached a final judgment prior to our decision in Rochow I and that it violated the mandate rule by permitting the parties to litigate the disgorgement
Moreover, the document purporting to be a final judgment “was not legally sufficient to constitute a final judgment.” Philhall Corp., 546 F.2d at 213. The Supreme Court has instructed that “it is necessary to determine whether the language . . . (of any purported judgment) embodies the essential elements of a judgment for money and clearly evidences the judge‘s intention that it shall be his final act in the case. If it does so, it constitutes his final judgment.” Id. (quoting United States v. F. & M. Schaefer Brewing Co., 356 U.S. 227, 232, 78 S.Ct. 674, 2 L.Ed.2d 721 (1958)). “[A] final judgment for money must, at least, determine or specify the means for determining, the amount.” F. & M. Schaefer Brewing Co., 356 U.S. at 233, 78 S.Ct. 674. As in Philhall Corp., the document entered by the clerk below “did not have the indicia of a final judgment” because it failed to state that Rochow had prevailed and it did not memorialize any monetary award. Instead, the document, erroneously “dismissed” the case, clearly contradicting the district court‘s summary judgment order finding in favor of Rochow on liability. LINA filed a notice of appeal, effectively divesting the district court of jurisdiction to proceed with the litigation pending resolution of the appeal.
After our mandate issued in Rochow I, the concurrence posits, the district court lacked jurisdiction to take any further action in the case by operation of the mandate rule. The Hamilton case cited in the concurrence points out that the mandate rule is “discretionary, rather than jurisdictional,” United States v. Hamilton, 440 F.3d 693, 697 (5th Cir. 2006), and we have said the same thing, albeit in an unpublished case. Mylant v. United States, 48 Fed.Appx. 509, 512 (6th Cir. 2002) (observing that the mandate rule is one of “policy and practice, not a jurisdictional limitation“). “The basic tenet of the mandate rule is that a district court is bound to the scope of the remand issued by the court of appeals.” United States v. Campbell, 168 F.3d 263, 265 (6th Cir. 1999). The concurrence recognizes that the Rochow I panel affirmed the district court‘s summary judgment order on liability and did not issue any type of remand to the district court. Although the district court was bound to honor our Rochow I decision in completing the litigation, as “with all applications of the law of the case doctrine,” the district court could “consider those issues not decided expressly or impliedly by the appellate court.” Jones v. Lewis, 957 F.2d 260, 262 (6th Cir. 1992). Taking up the case again after the Rochow I appeal, the district court determined with finality a monetary award for Rochow that included disgorgement for LINA‘s fiduciary breach. The court‘s final decision in no way con
Contrary to the majority‘s assertion that the district court failed to identify any grounds to support a breach of fiduciary duty claim, Rochow asks us to affirm the district court‘s findings that LINA‘s conduct involved a number of deliberate and willful wrongful acts, including requiring Rochow to meet insurance policy requirements that did not exist, devising a knowingly false rationale for denying his benefits appeal, and acting without appropriate medical input or evidence. R. 67, Order; Rochow, 851 F.Supp.2d at 1101. On the record before us, these findings are not clearly erroneous. See Cultrona v. Nationwide Life Ins. Co., 748 F.3d 698, 706 (6th Cir. 2014). LINA‘s fiduciary wrongdoing, separate from its arbitrary and capricious denial of plan benefits, warrants an equitable remedy under
IV. BREACH OF FIDUCIARY DUTY REQUIRES A REMEDY
Persisting in the fiction that Rochow seeks to recover twice for the same injury, the majority incorrectly posits that “the district court thus treated its finding of an arbitrary and capricious denial of benefits, in and of itself, as a breach of fiduciary duty,” and claims to be unaware of any “persuasive authority for the proposition that a wrongful denial of benefits in and of itself constitutes a breach of fiduciary duty.” Maj. Op. at 370 n. 1. Even if that were the issue—and it is not because LINA engaged in fiduciary misconduct in addition to denying Rochow‘s benefits—at least four circuits besides our own (the Second, Third, Seventh, and Eighth) recognize that a fiduciary‘s arbitrary and capricious delay in paying benefits due under a plan in itself can constitute a breach of fiduciary duty. I begin with our own precedent.
More than twenty years ago we stated the well-established principle that “ERISA requires that a retirement plan be operated for the exclusive benefit of the employees and beneficiaries.” Sweet v. Consol. Aluminum Corp., 913 F.2d 268, 270 (6th Cir. 1990). Although we assumed there that a trustee acted prudently in withholding pension funds until a certain date, we nonetheless held that the delay in payment conferred a benefit on the trustee. Id. “Any additional time one gains, rightfully or wrongfully, in not having to submit payment of a sum of money owed another is without doubt a benefit. Moreover, the payee . . . has been deprived of the benefit of those payments.” Id. We expressly held that “[t]o allow the Fund to retain the interest it earned on funds wrongfully withheld from a beneficiary would be to approve of an unjust enrichment. Further, the relief granted would fall short of making the beneficiary whole because he has been denied the use of money which was his.” Id. (internal quotation marks omitted).
Ten years after Sweet we upheld a district court‘s decision requiring an ERISA fiduciary to pay to the plan participant class certain benefits along with the rate of return the fiduciary actually realized on the use of that withheld money. Rybarczyk v. TRW, Inc., 235 F.3d 975, 977-78, 986 (6th Cir. 2000). TRW argued that imposing the actual rate of return was “unprecedented,” id. at 986, but we disagreed, pointing to the Seventh Circuit‘s decision in Lorenzen v. Employees RetirementPlan of Sperry & Hutchinson Co., 896 F.2d 228 (7th Cir. 1990). In that case an employee‘s widow contended that the administrator of a retirement plan violated its fiduciary duties to her and to her deceased husband causing a loss in retirement benefits. Id. at 230. The Seventh Circuit held that
Sweet and Rybarczyk align closely with the law of our sister circuits. The Second Circuit considered a case in which MetLife denied benefits for nearly five years after submission of a claim, but then reversed its prior denials without explanation and paid retroactive benefits in a lump sum without compensating the claimant for the delay in payment. Dunnigan v. Metro. Life Ins. Co., 277 F.3d 223, 226 (2d Cir. 2002). Having received disability payments after almost five years of delay, Dunnigan filed suit under
The Seventh Circuit reached similar decisions in two cases, Clair v. Harris Trust & Savings Bank, 190 F.3d 495 (7th Cir. 1999), and May Department Stores Co. v. Federal Insurance Co., 305 F.3d 597 (7th Cir. 2002), both involving
In May Department Stores Co., 305 F.3d at 603, the Seventh Circuit followed Clair and the Second Circuit‘s Dunnigan opinion to conclude that the “wrongful withholding of benefits due can entitle the beneficiary to impose a constructive trust on interest on the withheld benefits, an equitable remedy that results in a money payment to the plaintiff” under
By withholding benefits, a plan can obtain interest that would otherwise be obtained by the beneficiary. That interest is not itself a benefit, and so the beneficiary cannot bring a suit under
(a)(1)(B) to recover it. But he can sue to recover it under(a)(3) , because it is an amount by which the plan has unjustly enriched itself, and unjust enrichment is a basis, indeed the usual basis, for imposing a constructive trust on a sum of money.
Id. at 603 (citing Wsol v. Fiduciary Mgt. Assoc., Inc., 266 F.3d 654, 656 (7th Cir. 2001), and Fisher v. Trainor, 242 F.3d 24, 31 (1st Cir. 2001)).
The same principles govern in the Third Circuit. In Fotta v. Trustees of United Mine Workers of America, 165 F.3d 209, 211 (3d Cir. 1998), a plan participant invoked
Significantly, Supreme Court Justice Alito, then a circuit judge on the Third Cir
If the plaintiff in this case can establish that the trustees violated the plan by failing to pay his benefits on time, an award of interest would constitute “appropriate equitable relief.” Such an award is recognized as appropriate equitable relief in comparable circumstances under the law of trusts. See Restatement (2d) of Trusts § 207 at 470 (1959); 3 Austin Wakeman Scott and William Franklin Fratcher, The Law of Trusts § 207.1 at 262-63 (4th ed. 1987); Nedd v. United Mine Workers of America, 556 F.2d 190, 207 (3d Cir. 1977); Toombs v. Daniels, 361 N.W.2d 801, 810 (Minn. 1985). Thus, this is not a case like Massachusetts Mutual Life Ins. Co. v. Russell, 473 U.S. 134, 105 S.Ct. 3085, 87 L.Ed.2d 96 (1985), in which we were asked to supplement the remedies specified in the statute.
In addition to the Second, Third and Seventh Circuits, the Eighth Circuit also adheres to the proposition that a fiduciary‘s delay in paying benefits due under a plan constitutes a breach of fiduciary duty that may be rectified through an action filed under
Significantly, “[u]nder traditional rules of equity, a defendant who owes a fiduciary duty to a plaintiff may be forced to disgorge any profits made by breaching that duty, even if the defendant‘s breach was simply a failure to perform its obligations under a contract. Id. (emphasis added).” If a fiduciary breaches a contract and also breaches a fiduciary duty, that fiduciary can be forced to disgorge the profits he earned as a result of his wrong. Id. (quoting 1 Dobbs § 4.3(5), at 611 n. 16). “The important ingredient added by the fiduciary status, however, is not that status in itself; what is added is wrongdoing as distinct from contract breach.” Id. at 1008-09 (quoting 1 Dobbs § 4.3(5), at 611 n. 16); Valdes v. Larrinaga, 233 U.S. 705, 709, 34 S.Ct. 750, 58 L.Ed. 1163 (1914) (“holding that a ‘proper case for equitable relief’ existed where the defendant breached a fiduciary duty to the plaintiff by failing to pay money owing under the contract“). Based on these principles, the Eighth Circuit held that First Reliance owed a fiduciary duty to Parke, First Reliance breached that duty, and First Reliance could be forced under
Thus, our own cases and a litany of others from four of our sister circuits undermine the majority‘s premise that no
The court below got it exactly right. By arbitrarily and capriciously failing to pay Rochow benefits owed under the terms of the plan and by delaying the payment of full benefits for more than seven years to enrich itself, LINA violated both the plan terms and its fiduciary duties under ERISA. LINA‘s wrongful gain of profit, earned through breach of its fiduciary duties, can be equitably remedied under
V. THE DISGORGEMENT AWARD MUST BE RECALCULATED
I would return the case to the district court, however, for a recalculation of the award to Rochow. The figure awarded by the district court seems to derive from the total shown on Rochow‘s corrected Exhibit A filed on May 25, 2012, plus daily interest the court added until July 24, 2012, when the court filed its Order Requiring Disgorgement. R. 121-2 Page ID 3712.
LINA objected below to the corrected Exhibit A, pointing out several significant errors in it. The most conspicuous problem is that full profits are calculated through March 2012, R. 121-2 Page ID 3725 (and by the court through July 2012), even though Exhibit A confirms that LINA made all required payments to Rochow or his estate by September 2009, with the exception of $2,065.52. R. 121-2 Page ID 3722. The additional errors LINA identified in its June 2012 filing with the district court, R. 122, may warrant further reductions in the amount of profits ordered disgorged by the district court. I would therefore reverse the award as calculated and remand the case to the district court for reconsideration.
VI. CONCLUSION
We do not create new, double remedies out of whole cloth if we affirm the district
In this case, the disgorgement remedy is appropriate based on the evidence and the district court‘s findings concerning LINA‘s malfeasance, the length of the delay in paying benefits due, and the extraordinary profit LINA reaped from its malfeasance. Practical considerations abound. Allowing LINA to retain its profit creates an incentive for claims administrators to delay paying much-needed benefits to participants and beneficiaries while investing that money for their own gain. LINA‘s conduct undercompensates the participant or beneficiary by forcing him to absorb expenses incurred as a result of the delay in the payment of benefits while LINA gains from delaying the claims process as long as possible. Permitting LINA to keep its profit also encourages fiduciaries to commingle plan assets with company funds.
The courts will not often come across a case as troubling as this one. I recognize, as will district courts, that disgorgement of profit should be used sparingly and only when equity requires it. In the ordinary benefits case—where there is a wrongful denial of benefits but no breach of fiduciary duties like the ones here—an award of prejudgment interest might be sufficient to compensate the beneficiary for the lost time value of money. See, e.g., Schumacher v. AK Steel Corp. Retirement Accumulation Pension Plan, 711 F.3d 675, 679, 686 (6th Cir. 2013); Ford v. Uniroyal Pension Plan, 154 F.3d 613, 616 (6th Cir. 1998). But where an arbitrary and capricious denial of benefits is coupled with a breach of fiduciary duty, as it is here, ERISA provides a make-whole remedy that includes appropriate equitable relief under
Because the majority holds that ERISA bars the make-whole remedy awarded to Rochow, I respectfully dissent.
Kathryn POLLARD, Individually and as the Executrix of the Estate of Abram Bynum, Plaintiff-Appellee,
v.
CITY OF COLUMBUS, OHIO; Nathan Amstutz; Emanuel Edwards; William Edwards; James Estepp; Timothy O‘Donnell; Michael Yinger, Defendants-Appellants.
No. 13-4142.
United States Court of Appeals, Sixth Circuit.
Argued: Jan. 16, 2015.
Decided and Filed: March 5, 2015.
Rehearing En Banc Denied April 7, 2015.
Notes
In Rochow I, similarly, we did not address any claim for breach of fiduciary duty, or even use the terms “fiduciary,” “duty,” or “breach” in the opinion. Admittedly, one could infer from Rochow I that LINA‘s fiduciary duty was alluded to in the observation that LINA‘s decision did not appear to have been made “‘solely in the interest of the participants and beneficiaries and [] for the exclusive purpose of [] providing benefits to participants and their beneficiaries’ as required by
After the district court‘s initial decision was affirmed and the district court took up the motion for equitable accounting, however, the court rejected LINA‘s argument that it had not made the requisite finding of a breach of fiduciary duty to trigger the availability of equitable relief. Citing Varity, the court stated, “an arbitrary or capricious denial of benefits can count as a breach of fiduciary duty.” R. 67, Order at 4, Page ID 935. Further, when the district court set the method of accounting for the disgorgement award, it stated “it has already been determined that Defendant owed Plaintiff a duty of loyalty and breached this duty through its arbitrary and capricious denial of disability benefits to Plaintiff.” R. 113, Order at 2, Page ID 3562. The district court thus treated its finding of an arbitrary and capricious denial of benefits, in and of itself, as a breach of fiduciary duty. The district court never identified any other grounds for finding a breach of a fiduciary duty. In the district court‘s ruling, it was one and the same injury that made out two distinct ERISA violations and justified both remedies.
Though we are aware of no persuasive authority for the proposition that a wrongful denial of benefits in and of itself constitutes a breach of fiduciary duty remediable under both
