Michael Faciane v. Sun Life Asuc Co. of Canada
Opinion
Michael Faciane, a beneficiary of a long-term disability plan governed by the Employee Retirement Income Security Act of 1974 (ERISA) and administered by Sun Life Assurance Company of Canada, alleged that Sun Life had miscalculated his benefits since 2008. Sun Life argued that the contractual limitations period for Faciane's claim had long since lapsed. The district court granted summary judgment to Sun Life, and we affirm.
I
Michael Faciane was employed by Capital One Financial Corporation and was a member of its long-term disability (LTD) benefits plan when he suffered a work-related injury in June 2006. 1 Sun Life Assurance Company of Canada administers the LTD plan, and in March 2008, it determined that Faciane was eligible for benefits. At this point, Faciane and Sun Life had a dispute: whether Faciane had a "buy up plan" or just the standard plan. If he had the buy-up plan, his benefits would pay out 66.67% of his "basic monthly earnings"; if not, just 50%. A "claim control log" maintained by Sun Life shows various calls with Faciane and inquiries by Sun Life employees in early and mid-2008 to determine which percentage should apply.
In a letter dated March 31, 2008, Sun Life said that Faciane was entitled to a benefit amount of 50% of his basic monthly earnings, explaining that it did not have enough information to determine that he had the buy-up plan. 2 The letter also indicated *415 that Sun Life had calculated Faciane's basic monthly earnings as $5,134.16. Due to various offsets, his monthly net benefit was the plan minimum, $100.
According to the claim control log, a phone conversation between Faciane and a Sun Life employee occurred on May 22, 2008. The employee's entry in the log makes three noteworthy points. First, the log shows they discussed Faciane's basic monthly earnings figure, the subject of this appeal. Second, Faciane was disputing just the percentage used in the calculation of his benefits, not the monthly earnings figure to which the percentage would be applied. Third, Faciane seemed to have received the March 31 letter explaining his benefit calculation but had misplaced it.
The percentage dispute was eventually resolved in April 2011, when Sun Life was finally convinced that Faciane had the buy-up plan. A Sun Life employee conveyed this information to Faciane by phone in mid-April and then by an acknowledgment letter posted the same day. The letter confirmed the change to 66.67% of basic monthly earnings, while reiterating the same monthly earnings figure as the March 2008 letter: $5,134.16. Faciane's monthly net benefit remained $100, due to offsets. The letter also informed Faciane of the internal appeal process and his right to sue under ERISA.
On June 26, 2017, six years later, Faciane administratively appealed, raising two issues. First, he argued that his average monthly earnings in the year preceding his injury, counting salary and bonuses, were $8,118.52, not $5,134.16 as Sun Life had determined. He thus argued that his benefits had been miscalculated since 2008. Counting offsets, Faciane believed he should have received $960 per month since 2008, not $100. Second, Faciane had reached a settlement as to worker's compensation, and he contested its implications for his LTD benefits. In a September 2017 letter, Sun Life resolved the settlement issue favorably to Faciane but stood by its calculation of his basic monthly earnings and net monthly benefit from a decade before.
Faciane filed suit under ERISA in the Eastern District of Louisiana in December 2017. His complaint focused on the basic monthly earnings figure, $5,134. Faciane argued that Sun Life should have used his earnings as of June 2006, immediately prior to his disabling injury, not his earnings as of January 1 preceding the injury. Faciane alleged he had received a pay increase *416 after January 1, 2006 but before his injury in June 2006, so Sun Life's decision to use his earlier earnings allegedly deprived him of benefits. Faciane also argued for inclusion of a certain bonus in the earnings figure.
Sun Life moved to dismiss, citing the LTD plan's three-year contractual limitations provision. Following reassignment to a different district judge, 3 the district court converted Sun Life's filing to a motion for summary judgment and called for supplemental briefing. Faciane's new brief advanced an argument not made in his earlier response to Sun Life's motion. While his response had acknowledged the "initial letter" of March 31, 2008, Faciane now argued that he had not actually received the letter and thus that his ERISA claim did not accrue then. Instead, he contended that the accrual of his claim should be dated to the denial of his administrative appeal in 2017. 4
The district court began its analysis with the plan's limitations provision, which provides beneficiaries three years to file suit "after the time Proof of Claim is required." Following Supreme Court precedent, the district court considered whether the contractual provision would permit Faciane a "reasonable" time to file suit.
See
Heimeshoff v. Hartford Life & Acc. Ins. Co.
,
The district court observed that no Fifth Circuit case expressly stated an accrual rule for miscalculation claims, so it looked elsewhere: to a Second Circuit decision pegging accrual to the time at which "there is enough information available to the pensioner to assure that he knows or reasonably should know of the miscalculation,"
Novella v. Westchester County
,
The district court considered the March 31, 2008 letter the accrual event for Faciane's claim. The court applied Fifth Circuit precedent on the presumption that mail is received when it has been properly dispatched, and it concluded there was no fact issue that Faciane had received the letter. The court found that the letter apprised Faciane of the monthly earnings figure Sun Life was using and that this information was adequate for Faciane's miscalculation claim to accrue. The court added that, even if Faciane had not received the letter, his effort to contest the percentage used in the benefit calculation showed he knew and understood the calculation Sun Life had used. The court figured that the contractual limitations period would end in March 2010 because Faciane's proof of claim was required by *417 March 2007. With accrual in March 2008, the workings of the plan's administrative appeals process would still leave Faciane "at least a year, and most likely longer," to sue before the expiration of the limitations period. The court deemed this reasonable, permitting enforcement of the limitations period, so it granted summary judgment to Sun Life, dismissing the suit with prejudice as untimely. 5
Faciane moved for reconsideration, contending that the district court had misapplied the law governing accrual of miscalculation claims. The motion focused on
Withrow v. Halsey
,
II
ERISA permits a plan beneficiary to bring a civil action "to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan."
III
A
ERISA does not provide a statute of limitations for suits to recover benefits.
6
Heimeshoff
,
Heimeshoff is a problem for Faciane because the limitations provision upheld in that case is the same as the one in Faciane's plan: three years from the time required to submit proof of claim. To obtain reversal of the district court, Faciane must demonstrate that the plan's limitations provision would leave him an unreasonably short period to file suit from the time his claim accrued. The question therefore is the accrual date of his miscalculation claim.
Accrual of ERISA claims is a question of "federal common law."
Riley v. Metro. Life Ins. Co.
,
ERISA governs a wide array of plans, which communicate with their beneficiaries in various ways about all manner of plan policy issues. Information is conveyed and disputes are discussed with differing degrees of clarity and formality through letters, phone calls, meetings, and other media. Plans' varying clarity and formality complicate the accrual inquiry for miscalculation claims, which often involve beneficiaries that are regularly receiving benefits, just not in the right amount. That makes them less likely to detect something is amiss than plan participants not receiving benefits at all. Circuit courts deal with these complications through elaboration of the standard discovery rule.
Most commonly, courts apply the "clear repudiation" rule, under which the claim accrues when the plan repudiates a beneficiary's claim to additional benefits in a manner that is clear and made known to the beneficiary.
See, e.g.
,
Witt v. Metro. Life Ins. Co.
,
Miller
, a Third Circuit decision with facts similar to those we confront here, usefully illustrates the clear-repudiation rule. Miller, a casino employee, was making $690 a week as a floor worker and then became a salesman earning $768 per week.
Miller
also illustrates the interests served by the clear-repudiation rule, including "repose for those against whom a claim could be brought, and avoidance of litigation involving lost evidence or distorted testimony of witnesses."
Union Pac. R. Co.
,
Of course, ERISA confers important rights and protects benefits on which people truly depend. Accordingly, courts guard against potential unfairness through a "case-by-case reasonableness inquiry," refusing to find clear repudiation when plan communications involve information or formulae too complex or obscure for the layperson to decipher.
See
Novella
,
Our court has not expressly rejected or adopted the clear-repudiation rule,
8
but we do have a published decision consistent with its approach.
See
Kennedy v. Electricians Pension Plan, IBEW No. 995
,
B
The district court concluded that Faciane's miscalculation claim accrued in March 2008, either through Sun Life's March 31, 2008 letter explaining his monthly benefit calculation or as evidenced by Faciane's contemporaneous understanding of Sun Life's calculation. To conclude that Faciane received the March 31, 2008 letter, the district court applied the "mailbox rule," under which "[p]roof that a letter properly directed was placed in a U.S. post office mail receptacle creates a presumption that it reached its destination in the usual time and was actually received by the person to whom it was addressed."
U.S. v. Ekong
,
To corroborate its mailing of the March 2008 letter, Sun Life supplied an affidavit from Susan Everhart, an administrative-review official at Sun Life, who attested that standard mailing practices were followed in this instance. The claim control log reflects that Sun Life employee Marie Baker spoke with Faciane on March 31, 2008, making it quite probable she issued a letter in his case that day. The log also includes another note the same day, in which Baker recorded information she intended to put in the letter to Faciane. As further corroboration, the district court pointed to the log's May 22, 2008 entry, which recorded Faciane saying that he could not find the letter and Baker saying she would resend it. The district court observed that this note is consistent with receipt, not non-receipt. The district court also pointed out that Faciane seemed to acknowledge receiving the March 2008 letter in his initial response to Sun Life's motion to dismiss. Faciane denied receipt only later, in supplemental briefing.
Against the presumption of receipt, Faciane musters little opposition. He claims that Sun Life's log contains no indication that the letter was sent, but he does not address Baker's note on March 31 about what she intended to put in the letter or the note describing their conversation that day. At best, Faciane's argument shifts the accrual date to the vicinity of May 22, 2008, when a note from Baker records her intention to resend him the letter.
Faciane also cites
Duron v. Albertson's LLC
,
Accordingly, with substantial evidence buttressing the presumption of receipt and only ineffectual rebuttals from Faciane, we affirm the district court's conclusion that no genuine issue of material fact exists as to Faciane's receipt of the March 2008 letter.
We also affirm the district court's conclusion that the March 2008 letter contained enough information for Faciane's miscalculation claim to accrue. The issue Faciane raises here is a simple one. He believes his monthly earnings were nearly
*422
$3,000 higher than the $5,134 figure that Sun Life reported in the letter. The disputed figure was displayed prominently on the first page of the March 2008 letter. Moreover, the alleged discrepancy is so large, and it concerns a matter so fundamental to any working person, that we conclude the letter clearly repudiated Faciane's entitlement to greater benefits. To see the issue, Faciane did not need to decipher complex formulae or piece together inferences from incomplete information, as other circuit courts have observed in declining to find clear repudiation.
See
Osberg
,
In affirming the district court, we reject Faciane's theory that his claim accrued only with Sun Life's formal denial of his administrative appeal in 2017. He bases this argument on
Baptist Memorial Hospital-Desoto Inc. v. Crain Automotive Inc.
,
Faciane chiefly relies on
BMHD
's discussion of ERISA's administrative exhaustion requirement and its regulation of formal denials of benefits.
See
But exhaustion and accrual are different inquiries. Accrual may happen before any administrative review has started, much less ended, as
Heimeshoff
and the clear-repudiation caselaw make clear.
See
Heimeshoff
,
*423
Accrual of miscalculation claims is, and should remain, a "case-by-case reasonableness inquiry."
Novella
,
C
Faciane's main challenge to the district court's ruling is the issue he raised in his motion for reconsideration: that the court did not apply
Withrow v. Halsey
,
As the district court observed, Faciane's motion for reconsideration did not invoke any particular rule of the Federal Rules of Civil Procedure. Because Faciane had filed it within twenty-eight days of final judgment, the court appropriately construed it as a motion to alter or amend the judgment under Rule 59(e).
See
Matter of Life Partners Holdings, Inc.
,
Faciane's brief discusses
Withrow
at length but says nothing about Rule 59(e) or the district court's ruling thereunder. Our court routinely dismisses arguments as abandoned when parties fail to brief them.
See, e.g.
,
Smith v. Green
,
In any event, application of
Withrow
to Faciane's case does not change the result.
Withrow
is part of a line of Ninth Circuit cases applying the same clear-repudiation rule as other circuit courts.
See
Although Withrow knew that Reliance had taken the position its calculation was correct, she was never provided with anything from Reliance that would give her reason to know that her acceptance of continued payment of benefits amounted to an irrevocable or final determination by Reliance of the amount *424 of her benefits and a denial by it of a claim concerning that calculation.
Faciane makes much of Withrow 's "final or irrevocable determination" language. He points to passages in Sun Life's March 2008 letter suggesting that Sun Life had not finally determined the calculation of his benefits. For example, one sentence indicated that the calculation was "based on the information we have currently in your file." Faciane stresses the uncertainty these passages convey, but it is clear from context that the uncertainty concerned Faciane's purchase of a buy-up plan rather than a standard plan. Nothing in the letter suggests uncertainty about his basic monthly earnings.
Withrow
also differs from Faciane's case in that Withrow had diligently pursued the miscalculation issue.
In sum, Withrow does not help Faciane, and the district court did not abuse its discretion by denying Faciane's motion.
IV
For the foregoing reasons, we AFFIRM.
Originally Faciane was employed by Hibernia Bank, which Capital One acquired.
The letter included the following relevant text:
Your benefits have been calculated as follows, based on the information we have currently in your file:
Basic Monthly Earnings $ 5134.16 Monthly Gross Benefit at 50% $ 2567.08 Minus SS Primary Benefit - $ 1505.00 Minus SS Dependent Benefit - $ 728.00 Minus Workers Compensation Benefit - $ 1967.33 Minus Salary Continuation - $ 2026.00 Minimum Net Monthly Benefit $ 100.00
You maybe [sic] eligible for Long Term Disability Benefits under the buy up plan of 60% and your salary continuation may have stopped, [sic] we have made several attempts to your employer [sic] to obtain this information and were unsuccessful. We had to make a decision on your claim therefore [sic] we made a decision on the information we have on file. In order to determine if you are eligible for the buy up Long Term Disability Plan we need from your employer a copy of your enrollment card.
The case was assigned originally to Judge Engelhardt, but after his confirmation to our court, it was reassigned to Judge Africk.
In the alternative, if the court found that he received the March 2008 letter, Faciane argued that Louisiana's ten-year prescriptive period for contractual claims should supplant the contractual limitations period. Faciane also argued that Sun Life should be estopped from invoking the contractual provision. The district court rejected both arguments. Faciane does not press either one on appeal.
The district court also considered and rejected the "continuing violation" theory of accrual, under which each recurring payment by Sun Life would serve as a new accrual date. Faciane does not urge this theory on appeal. We do not rule on its validity now, but we note that other circuit courts have rejected it in the context of "an alleged one-time miscalculation of ERISA benefits."
See
Riley v. Metro. Life Ins. Co.
,
This is in contrast to breach of fiduciary duty claims, for which ERISA does specify a limitations period.
See
Eight circuit courts use this rule.
See
Witt
,
A published decision of the Fourth Circuit said that a formal denial is not required for a claim to accrue; instead, the court employed an "alternative approach" by which "some event other than a denial of a claim should have alerted" the beneficiary.
See
Cotter v. Eastern Conf. of Teamsters Ret. Plan
,
An early decision might seem to require a formal denial of benefits for accrual of an ERISA claim.
See
Paris v. Profit Sharing Plan for Emps. of Howard B. Wolf, Inc.
,
We have applied the mailbox rule to disputes over mail receipt in many contexts.
See, e.g.
,
Gamel v. Grant Prideco, L.P.
,
Because we decide that Faciane's claim accrued with receipt of the March 2008 letter, we do not consider whether accrual may be inferred from contextual evidence of Faciane's contemporaneous knowledge. Also, Faciane has not argued that his disability impeded his ability to understand communications from Sun Life. Given that, we do not have cause to consider the clear-repudiation rule's application to a beneficiary whose disability or other circumstances might affect her ability to understand communications from the plan.
Though unmentioned by Faciane,
BMHD
actually addressed the applicable limitations period and accrual of the hospital's claim. Crain's plan required a claimant to file suit within one year of submitting proof of claim.
Reference
- Full Case Name
- Michael FACIANE, Plaintiff - Appellant v. SUN LIFE ASSURANCE COMPANY OF CANADA, Defendant - Appellee
- Cited By
- 108 cases
- Status
- Published