Rema Dawson-Murdock v. National Counseling Group, Inc
Rema Dawson-Murdock v. National Counseling Group, Inc
Opinion
Plaintiff Rema Dawson-Murdock ("Rema") appeals from the dismissal of her civil action in the Eastern District of Virginia. Rema sued National Counseling Group, Inc. ("NCG"), alleging two claims under the Employee Retirement Income Security Act of 1974 ("ERISA") (codified primarily in Title 29 of the United States Code).
See
Dawson-Murdock v. Nat'l Counseling Grp., Inc.
, No. 3:18-cv-00058 (E.D. Va. Jan. 26, 2018), ECF No. 1 (the "Complaint").
1
More specifically, the Complaint alleges that NCG contravened ERISA by breaching its fiduciary duties in the administration of a group life insurance plan in which Rema's late husband had enrolled and for which NCG is the "named fiduciary." The district court dismissed Rema's ERISA claims pursuant to Federal Rule of Civil Procedure 12(b)(6), concluding that NCG's relevant actions were not taken in a fiduciary capacity.
See
Dawson-Murdock v. Nat'l Counseling Grp., Inc.
, No. 3:18-cv-00058,
I.
A.
Because this appeal stems from a Rule 12(b)(6) dismissal, we accept the facts
alleged in the Complaint as true and recite them in the light most favorable to Rema.
See
Feminist Majority Found. v. Hurley
,
The Summary of Benefits explains that an NCG employee who desires to enroll in the Plan must pay a premium to NCG, which in turn sends the premium payment to Unum. In addition to transmitting premiums, NCG is obliged to "regular[ly]" provide Unum with information about employees "who are eligible to become insured; whose amounts of coverage change; and[ ] whose coverage ends." See J.A. 28. 3
The SPD specifies that, for the purposes of ERISA, NCG "is the [p]lan [a]dministrator and named fiduciary of the Plan," and that benefits under the Plan are "administered" by Unum. See J.A. 65 (emphasis added). The SPD also explains that "ERISA imposes duties upon the people who are responsible for the operation of the ... [P]lan," and that "[t]he people who operate [the] Plan, called 'fiduciaries' of the Plan, have a duty to do so prudently and in the interest of ... Plan participants and beneficiaries." Id. at 71. And the SPD instructs Plan participants and beneficiaries to contact NCG if they have questions about the Plan.
B.
While working full-time for NCG, Rema's late husband, Wayne Murdock ("Wayne"), elected $150,000 in life insurance coverage through the Plan. Wayne identified Rema as his primary beneficiary for any benefits resulting from the coverage. To secure that coverage, Wayne paid premiums to NCG, which forwarded those payments to Unum.
On March 21, 2016, Wayne stopped working full-time for NCG and began working part-time for it. Although enrollment in the Plan is limited to full-time NCG employees, NCG either never informed or misinformed Wayne about whether he remained eligible to participate in the Plan. Additionally, although Wayne could have converted or ported his life insurance coverage after transitioning to part-time status, NCG never notified him of those options. 4 The parties have not disputed that Wayne continued to pay premiums to NCG after March 21, 2016, despite his apparent ineligibility.
On August 30, 2016, Wayne died. Rema, as Wayne's widow and beneficiary, thereafter submitted a life insurance benefits claim for $150,000 to Unum pursuant to Wayne's participation in the Plan. On October 24, 2016, before Rema heard anything from Unum regarding her claim, Christopher Baham - NCG's Vice President of Human Resources - emailed Rema to notify her that Unum had denied it. Baham assured Rema, however, that NCG would directly pay her the claim amount and work with Unum to recoup the payment. Baham also advised Rema that she would "not have to deal with Unum insurance company going forward." See Complaint ¶ 16. Three days later, on October 27, 2016, she received a letter from Unum stating that it had denied her benefits claim because Wayne "was not eligible for coverage due to his part-time status and [he] failed to convert or port his coverage." Id. ¶ 17.
During the next four months, Rema and Vice President Baham communicated regularly regarding her life insurance benefits claim. Those communications included the following:
• On November 7, 2016, Rema emailed a copy of Unum's denial letter to Baham and asked him for advice regarding her next steps;
• The following day, Baham responded via email and told Rema that she did not need to do anything else, such as appeal the claim denial, and that NCG was "working through the details," see Complaint ¶¶ 20, 39;
• On November 15, 2016, Baham emailed Rema and said that NCG was still working on her claim;
• About two weeks later, Baham again emailed Rema, stating that NCG was "working through a separate insurance company to pay out Wayne's benefits," and that Unum would "not be involved at all." Id. ¶ 22. He again reassured her that "the claim" would be paid, id. ;
• On December 8, 2016, Baham told Rema that he was "making progress toward resolution of the payment," id. ¶ 23;
• Later that month, Baham wrote to Rema that "NCG was still moving forward," id. ¶ 24;
• On January 19, 2017, Baham emailed Rema to advise her that he had "escalated [her claim] to another level so [he] hope[d] to soon have [a] resolution on [NCG's] side," id. ¶ 25;
• During the first two weeks of February 2017, Baham told Rema that he was still working on the claim, that it appeared a resolution was "close," and that there had been "some slow progress" on the claim, id. ¶¶ 27, 28; and
• Finally, on February 21, 2017, Baham emailed Rema and asked to speak with her by telephone. During the ensuing phone call, Baham informed her that NCG would not pay her any money on the claim.
Based on the representations made to her by Vice President Baham from October 2016 through February 2017, Rema did not appeal Unum's denial of her benefits claim. By the time Baham informed Rema that NCG would not pay her claim, the ninety-day window for her to file an appeal with Unum had closed. 5
C.
In January 2018, Rema filed her Complaint against NCG in the Eastern District
of Virginia. Pertinent to this appeal, the Complaint alleges two causes of action under a provision of ERISA that authorizes a participant or beneficiary of an employee benefit plan subject to ERISA to pursue a civil action to obtain "appropriate equitable relief" for violations of certain ERISA provisions "or the terms of the plan."
See
On March 30, 2018, NCG moved the district court for dismissal of the Complaint pursuant to Federal Rule of Civil Procedure 12(b)(6). In support of its dismissal motion, NCG argued that neither it nor Vice President Baham was acting as a fiduciary when they took the actions underlying Rema's ERISA claims. That is, NCG maintained that it and Baham were acting only in an administrative capacity for the Plan, which did not satisfy ERISA's definition of a "fiduciary," as codified in
On August 7, 2018, the district court granted NCG's motion to dismiss and dismissed Rema's claims. In its accompanying Opinion, the court ruled that the Complaint failed to sufficiently allege that NCG satisfies ERISA's definition of a fiduciary. The Opinion explained that, in order to qualify as a fiduciary under ERISA, an employer must have some "discretionary control over" the employee benefit plan.
See
Opinion 5. And the Opinion concluded that the Complaint did not adequately allege that NCG (and its high-ranking employee, Vice President Baham) exercised "discretionary control regarding benefits decisions" under the Plan.
II.
We review de novo a district court's dismissal of a complaint pursuant to Federal Rule of Civil Procedure 12(b)(6).
See
Feminist Majority Found. v. Hurley
,
III.
On appeal, Rema contests the district court's dismissal of her two ERISA claims. She contends that NCG's alleged conduct necessarily constitutes fiduciary activity because NCG is both the plan administrator and the named fiduciary. Even if those roles are insufficient to establish that NCG's conduct in relation to the Plan is fiduciary in nature, Rema maintains that NCG and Vice President Baham functioned as fiduciaries in taking the actions alleged in the Complaint, and that the Opinion erred in ruling otherwise. 9 Specifically, she maintains that NCG acted in a fiduciary capacity by: (1) failing to inform or misinforming Wayne about his continued eligibility under the Plan and neglecting to notify Wayne that he had the option to convert or port his life insurance coverage; and (2) advising Rema not to appeal Unum's denial of her benefits claim. Before assessing the alleged fiduciary misconduct, we will identify and discuss some pertinent legal principles regarding ERISA fiduciaries.
A.
ERISA specifies several duties, "derived from the common law of trusts," that are imposed on a fiduciary for an employee benefit plan.
See
Tibble v. Edison Int'l
, --- U.S. ----,
ERISA contemplates two general types of fiduciaries.
See, e.g.
,
Mertens v. Hewitt Assocs.
,
The second type of fiduciary contemplated by ERISA has been called a "functional fiduciary."
See
Tatum
,
a person is a fiduciary with respect to a plan to the extent (i) he exercises any discretionary authority or discretionary control respecting management of such plan or exercises any authority or control respecting management or disposition of its assets, (ii) he renders investment advice for a fee or other compensation, direct or indirect, with respect to any moneys or other property of such plan, or has any authority or responsibility to do so, or (iii) he has any discretionary authority or discretionary responsibility in the administration of such plan.
See
In assessing whether a person or entity qualifies as a fiduciary under ERISA, we have consistently utilized an interpretive bulletin published by the Department of Labor in 1975.
See
B.
1.
We begin our analysis of this appeal with Rema's position that NCG's joint
roles as the plan administrator and the named fiduciary definitively answer the fiduciary capacity inquiry. Our precedents on the topic of fiduciary capacity under ERISA have addressed primarily the nature of a functional fiduciary - perhaps because plan administrators and named fiduciaries do not normally disclaim their fiduciary roles and responsibilities in the federal courts.
See, e.g.
,
Gordon v. CIGNA Corp.
,
Calling NCG's assertion into substantial doubt, the Supreme Court has itself recognized that, as logic would suggest, a named fiduciary is "an ERISA fiduciary."
See
Mertens
,
To the extent that our decisions have said that "being a fiduciary under ERISA is not an all-or-nothing situation," our Court has never done so in the context of assessing whether a plan administrator and a named fiduciary is, in fact, a fiduciary.
See
Gordon
,
Our precedents should not, however, be unduly expanded to suggest that an entity that serves as both the plan administrator and the named fiduciary for an ERISA-covered plan is
not
an ERISA fiduciary. Doing so would ignore ERISA's undisputable recognition of named fiduciaries.
12
And such a ruling would create conflicts with controlling Supreme Court precedent,
see
Mertens
,
Custer
,
In concluding that the Complaint fails to sufficiently allege NCG's fiduciary status, the Opinion failed to consider and assess the relevant decisions on plan administrators and named fiduciaries and their application to these ERISA claims. Indeed, it did not recognize the significance of NCG's status as the joint plan administrator and named fiduciary, and it erroneously focused on our precedents addressing functional fiduciaries. Although those errors alone support a vacatur and a remand, the Opinion also erred in making its functional fiduciary analysis.
2.
Aside from NCG's plausibly alleged fiduciary status resulting from its joint roles as the plan administrator and the named fiduciary, we are satisfied that the Complaint sufficiently alleges that NCG is a fiduciary with respect to the particular conduct giving rise to Rema's ERISA claims. That is, the Complaint shows that NCG acted as a functional fiduciary, within the meaning of section 1002(21)(A) of Title 29, with respect to each of the ERISA claims. We will address separately the facts that support those two claims.
a.
In her first ERISA claim, Rema alleges that NCG failed to inform or misinformed Wayne about his continued eligibility under the Plan. She further alleges that NCG neglected to notify Wayne that he had the option to convert or port his life insurance coverage. Based on the relevant precedents and the Department of Labor's 1975 bulletin, we are satisfied that this claim adequately pleads NCG's status as a functional fiduciary.
In
Griggs v. E.I. DuPont de Nemours & Co.
,
In our 2018
Gordon
decision, we were again confronted with a breach of fiduciary duty claim predicated on the defendant's silence. There, an employee had paid supplemental life insurance premiums to his employer for coverage under a group life insurance plan, and the employer submitted the premium payments to the insurer for the plan.
See
Gordon
,
On appeal from a summary judgment award to the insurer, we observed that the plan documents designated the insurer as the claim administrator and the employer as the plan administrator.
See
Gordon
,
Our
Griggs
and
Gordon
precedents undermine the Opinion 's ruling that the first ERISA claim fails to allege NCG's fiduciary capacity. That is, when a plan administrator is responsible for verifying employee eligibility for participation in an employee benefit plan, that administrator acts in a fiduciary capacity with regard to that obligation.
See
Gordon
,
If there were any doubt about whether the allegations in support of the first ERISA claim establish NCG's status as a
functional fiduciary pursuant to section 1002(21)(A), it is entirely assuaged by NCG's role as the plan administrator. As the Department of Labor has explained, a plan administrator by "the very nature of [its] position, ha[s] discretionary authority or discretionary responsibility in the administration of the plan within the meaning of section [1002(21)(A) ]," and is therefore a functional fiduciary.
See
b.
Turning to Rema's second ERISA claim, she alleges therein that NCG breached the fiduciary duty that it owed to her as a beneficiary when Vice President Baham advised her not to appeal Unum's denial of her benefits claim. Pertinent to this claim, the Supreme Court and our Court have both recognized that conveying information about plan benefits to a beneficiary in order to assist plan-related decisions can constitute fiduciary activity.
See
Varity Corp. v. Howe
,
In these circumstances, we are satisfied that the Complaint plausibly alleges that Vice President Baham engaged in a fiduciary activity when he instructed Rema that she need not appeal Unum's decision denying her benefits claim. In so instructing Rema, Baham was not merely "advising [a] participant[ ] of [her] rights and options under the [P]lan."
See
IV.
Pursuant to the foregoing, we vacate the district court's dismissal of the ERISA claims and remand for such other and further proceedings as may be appropriate.
VACATED AND REMANDED
The Complaint also names a second defendant, the National Counseling Group, Inc. Plan, but it contains no allegations against that defendant.
See
A summary plan description (or SPD) has been defined as an "outline of an employee benefit plan, containing such information as the identity of the plan administrator, the requirements for eligibility and participation in the plan, circumstances that may result in disqualification or denial of benefits, and the identity of any insurers responsible for financing or administering the plan."
See
Black's Law Dictionary (10th ed. 2014). In this appeal, we consider the SPD and the Summary of Benefits - which are attached to the Complaint - because those documents are integral to the ERISA claims and neither party questions their authenticity.
See
Rockville Cars, LLC v. City of Rockville
,
Citations herein to "J.A. ----" refer to the contents of the Joint Appendix filed by the parties in this appeal.
Under the Plan, to convert coverage means to change from a group insurance policy to an individual insurance policy. On the other hand, to port coverage means to maintain coverage under the group insurance policy.
According to the SPD, a participant or beneficiary must appeal a denial of a claim within ninety days of receiving Unum's denial letter. Because Rema received her denial letter on October 27, 2016, she had until January 25, 2017, to lodge an appeal with Unum.
The parties in these proceedings do not dispute that the Plan is subject to the provisions of ERISA.
See
The Complaint also alleged two state law claims, which the district court dismissed as preempted by ERISA. Rema does not contest on appeal the dismissal of those two claims.
Although neither the dismissal order nor the Opinion specified whether the Complaint was dismissed with prejudice, nothing in the record rebuts the presumption that it was so rendered.
See
McLean v. United States
,
Except when describing Baham's individual actions, our discussion of the ERISA claims hereinafter refers to NCG and Vice President Baham collectively as "NCG." The parties do not dispute that we can consider Baham's conduct against NCG in assessing the ERISA claims.
See
Deschamps v. Bridgestone Ams., Inc. Salaried Emps. Ret. Plan
,
A "named fiduciary" also includes "a fiduciary ... who, pursuant to a procedure specified in the plan, is identified as a fiduciary (A) by a person who is an employer or employee organization with respect to the plan or (B) by such an employer and such an employee organization acting jointly."
See
ERISA authorizes the Secretary of Labor to "prescribe such regulations as he finds necessary or appropriate to carry out the provisions of [the Act]."
See
ERISA employs the terms "named fiduciary" and "named fiduciaries" in five separate sections.
See
We are not suggesting that a plan administrator and named fiduciary (serving in those dual roles) will be subject to suit for breach of fiduciary duty as to all plan-related actions. For example, liability might be limited by the exercise of authority or control over only certain plan-related activities.
See
In dismissing Rema's first ERISA claim, the Opinion relied primarily on an unpublished decision ruling that an employer was not acting as a fiduciary when it accepted an employee's life insurance premiums "without advising him that he was not eligible for group life insurance" under the employer's group life insurance plan.
See
Opinion 4-5 (citing
Moon v. BWX Tech., Inc.
,
The Opinion relied on another unpublished decision in dismissing the second ERISA claim.
See
Opinion 4-5 (citing
Estate of Weeks v. Advance Stores Co.
,
Reference
- Full Case Name
- Rema DAWSON-MURDOCK, Plaintiff - Appellant, v. NATIONAL COUNSELING GROUP, INC.; National Counseling Group, Inc. Plan, Defendants - Appellees.
- Cited By
- 31 cases
- Status
- Published