Troiano v. Aetna Life Insurance CompanyTroiano v. Aetna Life Insurance Company
have excused delay based on the actions of a district court, it has been because the district court did not promptly deal with a motion to amend, not because the district court took its time evaluating a motion to dismiss. See Farkas v. Tex. Instruments, Inc., 429 F.2d 849, 851 (1st Cir. 1970). In the motion to amend cases, the delay is attributable to the district court because the motion evidences the movant‘s proactive approach to addressing known weaknesses in the First Amended Complaint.
Second, Hagerty maintains that he could not have known or anticipated the deficiencies that would form the basis of the district court‘s dismissal of his First Amended Complaint. He specifically contends that unlike in other cases where the amended complaints were dismissed due to the plaintiff‘s lack of diligence, see Acosta-Mestre v. Hilton Intern. of P.R., Inc., 156 F.3d 49, 53 (1st Cir. 1998), he has shown “care and attentiveness” towards assuaging the district court‘s concerns about his complaint. But Cyberonics’ motion to dismiss, filed in June 2014, put Hagerty on notice of the deficiencies in the complaint, and he made no attempt to fix these deficiencies until August 2015. See Feliciano-Hernández v. Pereira-Castillo, 663 F.3d 527, 538 (1st Cir. 2011) (upholding district court‘s undue delay determination where motion to amend was filed “nearly a year after the motion to dismiss was filed“); ACA Fin. Guaranty Corp. v. Advest, Inc., 512 F.3d 46, 57 (1st Cir. 2008) (“Plaintiffs may not, having the needed information, deliberately wait in the wings ... with another amendment to a complaint should the court hold the first amended complaint was insufficient. Such an approach would impose unnecessary costs and inefficiencies on both the courts and party opponents.“).
Thus, we conclude both that Hagerty did not meet his burden of providing a valid reason for his delay and that the district court did not abuse its discretion in denying his motion for leave to amend.
III. Conclusion
The judgment
J. Scott Kilpatrick, with whom Mason J. Waring and Chisholm Chisholm & Kilpatrick LTD, Providence, RI, were on brief, for appellant.
Jonathan C. Bond, with whom Miguel A. Estrada, Gibson, Dunn & Crutcher LLP, Washington, DC, Kenneth J. Kelly, Scarlett L. Freeman, and Epstein Becker & Green, P.C., New York, NY, were on brief, for appellees.
Before LYNCH, LIPEZ, and BARRON, Circuit Judges.
LYNCH, Circuit Judge.
This lawsuit arises from a dispute between an ERISA disability plan administrator and a beneficiary over the amount by which the monthly disability payments made to the beneficiary should be offset by her other monthly income from Social Security. The administrator maintains that the disability payments must be offset by the gross (pre-tax) amount of Social Security income, while the beneficiary argues that the payments must be offset by the net (post-tax) amount of Social Security income. The district court found for the administrator, noting that its interpretation of the Plan language to allow for a gross offset was entitled to deference and was, in any event, ultimately reasonable. In addition to contesting this decision, the beneficiary complains that the district court abused its discretion when it denied the beneficiary‘s broad requests for discovery.
I.
Plaintiff Debra Troiano is a former employee of Electric Boat Corporation, a subsidiary of defendant General Dynamics Corporation (“GDC“). While working there from 1988 to 2003, Troiano participated in GDC‘s long-term disability (“LTD“) Plan, which was funded and administered by defendant Aetna Life Insurance Company (“Aetna“).
A. The Plan‘s Structure and Documents
GDC‘s LTD Plan is an employee welfare benefits plan governed by the Employee Retirement Income Security Act of 1974 (“ERISA“),
The Plan itself vests Aetna with broad authority to exercise discretion in administering the Plan. The Group Policy explains that Aetna is a fiduciary under ERISA and has “discretionary authority to ... construe any disputed or doubtful terms of th[e] policy.” The Group Policy further reserves Aetna‘s “right to adopt reasonable policies, procedures, rules, and interpretations of th[e] policy to promote orderly and efficient administration.” The SPD describes Aetna‘s authority in a similarly expansive way, assigning Aetna the “absolute authority and sole discretion” to interpret all terms of the Plan and to resolve ambiguities in the Plan or the SPD.
The relevant documents also provide that a Plan participant who suffers a “total disability” will receive monthly LTD benefits. The amount of such benefits will equal a percentage of the participant‘s “predisability earnings,” up to a monthly maximum of $18,000, “minus all other income benefits” that are “payable for a given month” to the participant or to her spouse, children, or dependents. The Booklet reiterates that “[i]f other income benefits are payable for a given month[,] [t]he monthly benefit payable under th[e] Plan for that month will be the lesser of: the Scheduled Monthly LTD Benefit; and the Maximum Monthly Benefit; minus all other income benefits.” It further defines “other income benefits” to encompass “[b]enefits under the Federal Social Security Act.”
The SPD consistently states that basic monthly earnings are “the gross monthly pay paid to you by the Company for performing your job in effect immediately before the Disability begins.” It clearly provides that “[y]our benefit amount from the LTD Plan is reduced by any payments you are eligible to receive from other sources, such as ... [b]enefits under the Federal Social Security Act.” It further clarifies that the monthly LTD payments will not be reduced by any cost-of-living increases in other income benefits.
Importantly, as “an example of how the benefit reduction works,” the SPD provides a scenario in which Tom, a fictional
The SPD explains that participants can choose between one of two benefit levels: the “base level” of 50% of predisability earnings or the “buy-up” level of 60% of predisability earnings. The employer pays the premiums for 50% of coverage. Participants who choose the buy-up level must pay the premium for the additional 10% of coverage. The SPD explains that the “cost for the additional coverage is deducted from [the participant‘s] paycheck on an after-tax basis.” While the participant is “taxed on both [her own] cost and the Company contributions,” the SPD assures that “the LTD Plan benefit will not be subject to income tax.” Troiano elected the 60% coverage option.
B. Troiano‘s Eligibility for LTD and Social Security Benefits
Troiano became disabled in July 2003 and applied for Plan benefits. From December 2003, when Aetna approved her claim, until April 2010, when Aetna began offsetting her monthly LTD benefits by her gross Social Security income, Aetna issued to Troiano monthly payments of $3,350, which equals 60% of $5,583.33, Troiano‘s monthly gross predisability earnings.
In a letter dated June 10, 2009, Aetna informed Troiano that an application for Social Security Disability Insurance (“SSDI“) benefits on her behalf was warranted. In fact, Troiano had already applied for SSDI benefits in June 2004. After years of administrative wrangling and litigation in federal district court, an administrative law judge determined in October 2009 that Troiano had been “under a disability,” as defined by the Social Security Act, since July 12, 2003. An award letter from the Social Security Administration subsequently confirmed that Troiano had been entitled to baseline monthly payments of $1,783 starting in January 2004 (five calendar months after becoming disabled). It further noted that, in addition to the $1,783, Troiano was entitled to incrementally greater amounts that took into account annual cost-of-living adjustments (“COLAs“) for each year she received SSDI payments. By December 2008, the monthly SSDI benefits with COLAs had risen to $2,131, which was $348 more than the $1,783 baseline. The award letter lastly stated that Troiano would receive a lump-sum payment for the amount that had been due to her through January 2010.
In a letter dated April 16, 2010, Aetna informed Troiano that it had learned of her monthly $1,783 SSDI award, as well as the retroactive lump-sum payment. Aetna‘s letter reminded Troiano that under the provisions of the Plan, her LTD benefits were subject to offset by “other income benefits,” that such benefits included “[b]enefits under the Federal Social Security Act,” and that Aetna had a right to recover overpayments. After recounting the relevant Plan provisions, the letter announced that Aetna would begin offsetting Troiano‘s monthly LTD benefits by $1,783, the gross amount of her SSDI benefit. Aetna consistently used this $1,783 amount in all of its calculations regarding the offset. Aetna also demanded, and has since received from Troiano, full reimbursement of $126,526—the amount by which it had overpaid Troiano between January 2004 and March 2010.
Fifteen months later, in a letter dated July 29, 2011, Troiano, through her counsel,
After another six months, Troiano‘s counsel followed up with a second letter. Styled as an “appeal” of Aetna‘s decision to apply a gross offset and dated May 25, 2012, this letter articulated Troiano‘s argument for why a net offset was proper.1 Troiano also requested in the letter that Aetna turn over numerous documents that she claimed were relevant to Aetna‘s decision to apply a gross offset. She asserted that Aetna was obligated to comply with her request under ERISA and applicable Department of Labor regulations. Although internal emails reveal that Aetna‘s in-house legal team discussed this May 2012 letter, Aetna never responded to Troiano‘s second request.
Aetna continues to offset Troiano‘s monthly LTD benefits by the gross amount of her $1,783 baseline monthly SSDI income, as it has always done.
II.
On November 13, 2014, Troiano filed suit against Aetna and GDC in the U.S. District Court for the District of Rhode Island. She alleged that Aetna had breached its fiduciary duty and sought a declaration “that her past and future LTD benefits should be offset against the SSDI benefits she was awarded minus any income taxes she was assessed on such benefits.” (We do not recount the procedural history surrounding Troiano‘s amended complaint, which is no longer relevant.)
Defendants GDC and Aetna moved for summary judgment in March 2015. On May 8, 2015, the district court held a hearing on Troiano‘s motion for an order compelling production of privileged documents and for discovery under
At the end of the hearing, the court also denied Troiano‘s request for “conflict discovery” under Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008). The court found that Troiano‘s case was not a “denial of benefits,” as explained below, and that Glenn was therefore inapposite.
The district court likewise ruled that the offset was not a reduction of benefits because Troiano continued to benefit from “regular COLA increases which, under the terms of the Plan, do not contribute to a further reduction of her LTD benefits.” Id. at *8. Further, the court reasoned that the extent of Troiano‘s income tax exposure was beyond Aetna‘s control: “[W]hether and to what extent [Troiano‘s] SSDI benefits are taxable is really controlled by her own life‘s activities: whether she‘s married, whether she has children, whether she adopts children, whether she has a home. [I]t‘s all going to be determined by factors that are not within the control of Aetna.” Transcript of Motion Hearing at 36, Troiano, No. 14-496-ML, ECF No. 30 (D.R.I. 2015).
Rather than an appeal of a benefit denial or reduction, the district court viewed the suit as one involving straightforward interpretation of the Plan‘s offset provision—namely, whether that provision should be read as providing for a gross or net offset. In approaching this task, the court rejected Troiano‘s argument that de novo review should apply. The court instead held that Aetna‘s interpretation was reasonable and thus entitled to deference because the Plan‘s “plain language” vested Aetna with “broad discretionary powers and authority to interpret the provisions of the Plan.” Troiano, 2015 WL 5775160, at *7.
First, it observed that the language of the Plan—which stated that “LTD benefits were subject to an offset against any SSDI benefits that were ‘payable to her for a given month,’ or which she was ‘eligible to receive’ “—made no guarantees that Troiano would receive a tax-free monthly benefit equal to 60% of her gross monthly predisability earnings. Id. at *8. The court also noted that the SPD‘s example decreased the fictional beneficiary‘s LTD benefits by $600 in SSDI benefits per month, but that “[n]othing in the example indicates that this is the amount the beneficiary actually receives, nor does the example indicate that the offset includes a calculation of any income tax liability the recipient may incur.” Id. Finally, the court credited Aetna‘s argument that “including a calculation of each Plan participant‘s varying ... income tax liability would be unreasonably burdensome and preclude the orderly and effective administration of the Plan.” Id. All of these considerations counseled in favor of Aetna‘s Plan interpretation.
Troiano now appeals, challenging both the affirmance of Aetna‘s Plan interpretation and the denial of discovery under Glenn and
III.
A. Interpretation of Plan‘s Offset Provision
We review de novo a district court‘s resolution of cross-motions for
The parties’ first point of disagreement is the appropriate standard of review that the district court should have applied in resolving their conflicting interpretations of the Plan language. Troiano maintains that her lawsuit is an appeal of a benefits denial or reduction under
We need not resolve this issue because, even making four key assumptions in Troiano‘s favor and applying de novo review, she still loses. We assume for purposes of adjudicating this suit that (1) Troiano‘s suit is indeed a challenge to a benefit denial or reduction under
The Plan language makes clear that Troiano‘s reading is wrong. The Plan repeatedly states that LTD benefits will be offset by other income benefits that are “payable” to the beneficiary or her dependents: “If other income benefits are payable for a given month: The monthly benefit payable under this Plan for that month will be the lesser of: the Scheduled Monthly LTD Benefit[] and the Maximum Monthly Benefit; minus all other income benefits, but not less than the Minimum Monthly Benefit.” It then defines “[o]ther income benefits” to “include those, due to your disability or retirement, which are payable to: you; your spouse; your children; your dependents.” The SPD, meanwhile, notes that a beneficiary‘s LTD benefits will be reduced by other payments that she is “eligible to receive” from other income sources.
Both the “payable” and the “eligible to receive” language illustrate that the amount that Aetna may permissibly offset is the full SSDI amount that is payable to Troiano or, put another way, that Troiano was eligible to receive from the Social Security Administration. Troiano was eligible for monthly payments of $1,783, notwithstanding the amount of taxes—if any—that she could have to pay on that
The law is not in Troiano‘s favor. The Eighth Circuit has reached precisely the same conclusion as ours after examining similar ERISA plan language. See Parke v. First Reliance Standard Life Ins. Co., 368 F.3d 999, 1005 (8th Cir. 2004) (where an LTD plan allowed the administrator to offset monthly LTD payments by SSDI benefits that the beneficiary “[wa]s eligible to receive because of his/her Total Disability,” the administrator could offset its LTD payments by the gross SSDI amount because the beneficiary was “eligible to receive the full [pre-tax amount] each month” (emphasis added)).
The context in which the relevant provisions appear further confirms that the Plan allows for a gross offset. In the same section that defines “other income benefits” to include Social Security benefits, the Plan expressly limits the amount by which Aetna may offset LTD benefits by other types of income benefits. For instance, only “50% of any award provided under The Jones Act or The Maritime Doctrine of Maintenance, Wages and Cure” can count toward the offset of LTD benefits. Similarly, “retirement benefits for which [one is] or may become eligible under a group pension plan” qualify as offset-eligible income “only to the extent that such benefits were paid for by an employer.” The specificity with which the Jones Act and pension-plan benefits were defined demonstrates that the Plan was written with express limits on Aetna‘s ability to offset, where such limits were actually contemplated. Cognizant of the Plan‘s selective use of explicit limiting language in defining “other income benefits,” we decline to read an implicit net-offset limitation into the Plan where nothing indicates that the Plan includes one.
The accessible example provided in the SPD is also contrary to Troiano‘s net-offset reading. In that example, Tom, a fictional beneficiary, had predisability earnings of $3,000 per month, signed up for the 60% level of coverage, became eligible for LTD benefits, and also “qualifie[d] for a Social Security benefit of $600 per month.” Tom‘s monthly LTD benefit would be $1,200 per the following calculation provided in the SPD:
$1,800 Tom‘s unreduced LTD benefit (60% of $3,000)
— $600 Social Security benefit
$1,200 Tom‘s monthly LTD benefit
This example does not mention taxes in any way. Rather, it states that Tom qualified for monthly SSDI benefits of $600—just as Troiano qualified for monthly SSDI benefits of $1,783—and deducts that full amount from his monthly LTD benefits. In addition to the Plan language, this example put Troiano on notice that her LTD benefits would be offset by any SSDI-benefit
The administrative consequences that would flow from Troiano‘s contrary interpretation only confirm our reading in favor of a gross offset. Troiano‘s interpretation—that Aetna must offset by the net amount of her SSDI benefits—would require Aetna to take in a staggering amount of personal tax information from Troiano and others similarly situated. It would require Aetna to audit that tax information in order to ensure the accuracy of the tax calculations provided by each beneficiary—not to mention the fact that the tax obligations of individual beneficiaries may change on a yearly basis, thereby requiring Aetna to account for and audit tax documents year after year, for beneficiary after beneficiary, on an individual basis. Such a system would result in a tremendous increase in Aetna‘s administrative burden and, perhaps, affect its actuarial accounting.3 We find it implausible that a plan would envision such a complex scheme without a single reference to its implementation. Plan administrators could choose to pass on the added cost of doing business to beneficiaries in the form of higher premiums and lower benefits, ultimately hurting beneficiaries. The cascading adverse effects of Troiano‘s implausible interpretation reinforce the sensible industry standard among ERISA plan administrators to “not get involved in taxation.”
Troiano argues that the SPD‘s assurance that her “LTD Plan benefit [would] not be subject to income tax” supports her contention that any SSDI benefits she receives should be offset on a net, rather than gross, basis. Otherwise, she contends, the Plan would violate its own guarantee that her “Scheduled Monthly LTD Benefit” would be “60% of [her] monthly predisability earnings.”
But the language of the SPD states that Troiano‘s “benefit amount from the LTD plan“—undisputedly, a tax-free benefit—will be “reduced by any payments [a participant is] eligible to receive from other sources,” such as SSDI. Nowhere does the SPD state that “other income benefits” themselves will not be subject to tax. If anything, the SPD suggests the opposite by virtue of its reference to offsetting “payments.”
Nor does the Plan by its terms suggest otherwise. The Plan explicitly states—in accord with the SPD—that “[a]ny benefit actually payable may be reduced by ‘other income benefits.’ ” The Plan does not state that these other income benefits will not be subject to tax or that, after the offset by other income benefits, the benefit actually payable will also necessarily equal 60% of the participant‘s gross monthly predisability earnings. And, for the reasons just given, we do not believe it would be accurate to read the Plan impliedly to have said otherwise.
Finally, Troiano invokes the contra proferentem canon, but that canon does not salvage her losing claim. Contra proferentem counsels “that the policy terms must be strictly construed against the insurer and in favor of the insured ... when courts undertake de novo review of plan interpretations.” Stamp v. Metro. Life Ins. Co., 531 F.3d 84, 93 (1st Cir. 2008). But the canon applies only where the Plan language
guage unambiguously supports Aetna‘s interpretation, the canon has no application.
The Plan‘s plain language, the textual context in which that language appears, the sample SSDI offset provided in the SPD, and the administrative consequences of a net-offset system lead us to conclude that the Plan permits Aetna to offset LTD benefits by the gross amount of SSDI benefits. We reach this outcome even applying de novo review. Simply put, no provision in the Plan or SPD guaranteed Troiano 60% of her predisability earnings after taking into account all relevant offsets and corresponding tax liabilities.
B. Denial of Discovery
Troiano also appeals the district court‘s denial of discovery. She contends that under either
First, and assuming again in Troiano‘s favor that her suit properly falls within the benefits-denial framework, Troiano did not meet her threshold burden of showing that Aetna‘s purported conflict influenced its decision to deny her a benefit. While this circuit has recognized that “courts should take cognizance of structural conflicts in ERISA cases ... whenever a plan administrator, whether an employer or an insurer, is in the position of both adjudicating claims and paying awarded benefits,” Denmark v. Liberty Life Assur. Co. of Bos., 566 F.3d 1, 7 (1st Cir. 2009), we have also emphasized that the same burden-of-proof rules that apply to “any other aspect of an ERISA claim for improper denial of benefits” likewise apply to the conflict-discovery issue, Cusson v. Liberty Life Assur. Co. of Bos., 592 F.3d 215, 225 (1st Cir. 2010), abrogated on other grounds by Montanile v. Bd. of Trs. of Nat‘l Elevator Indus. Health Benefit Plan, — U.S. —, 136 S.Ct. 651, 193 L.Ed.2d 556 (2016). The beneficiary thus bears the burden of showing that the conflict influenced the Plan administrator‘s decision in some way. Troiano has offered nothing to show that Aetna‘s structural conflict influenced its gross-offset decision.
Second, the district court did not abuse its “broad measure of discretion” in denying
The district court did not abuse its discretion or cause Troiano to suffer “manifest injustice” when it concluded that she had not satisfied this heavy burden. Mack, 871 F.2d at 186. At the May 2015 motions hearing, the court noted that Troiano had
IV.
Because there is no ambiguity in the language of the Plan and no error in the district court‘s decision to deny discovery, we conclude that Troiano received all that she bargained for through her monthly LTD benefits that are offset by the gross amount of her monthly SSDI benefits. We affirm.
UNITED STATES of America, Appellee, v. Elizabeth V. TAVARES, John J. O‘Brien, and William H. Burke, III, Defendants, Appellants.
Nos. 14-2313, 14-2314, 14-2315
United States Court of Appeals, First Circuit.
December 19, 2016