Amschwand v. Spherion Corp.

505 F.3d 342, 41 Employee Benefits Cas. (BNA) 2697, 2007 U.S. App. LEXIS 24435, 2007 WL 3027072
Court of Appeals for the Fifth Circuit·Decided October 18, 2007·No. 06-20346·Published·Cited by 36 cases

Opinions

EDITH H. JONES, Chief Judge:

This appeal addresses whether, under ERISA § 502(a)(3), 29 U.S.C. § 1132(a)(3), “other appropriate equitable relief’ permits recovery of extracontractual, or “make-whole,” damages in the form of payment of life insurance benefits that would have accrued to a plan beneficiary but for a plan fiduciary’s breach of fiduciary duty. Constrained by the Supreme Court’s decision in Great-West Life & Annuity Insurance Co. v. Knudson, 534 U.S. 204, 122 S.Ct. 708, 151 L.Ed.2d 635 (2002), we must deny relief.

I. BACKGROUND

During Mr. Amschwand’s medical leave for a bout with cancer that he did not survive, his employer Spherion switched insurance companies, replacing Prudential with Aetna Life Insurance Company (“Aet-na”) as the new provider of basic and supplemental life insurance benefits under the company Plan. A “special provision” of Aetna’s group insurance policy covering Spherion employees was entitled the “Active Work Rule” and provided:

If the employee is ill or injured and away from work on the date any of his or her Employee Coverage (or any increase in such coverage) would become effective, the effective date of coverage (or increase) will be held up until the date he or she goes back to work for one full day.

This provision was expressly noted in the “Summary of Coverage” Aetna prepared for Spherion employees.1 As part of the [344] transition to the new policy, Aetna and Spherion agreed that the Active Work Rule requirement would be waived for employees like Mr. Amschwand, who were not currently working full-time due to a medical condition that antedated the switch from Prudential to Aetna. For reasons Spherion has failed to explain, however, Mr. Amschwand was not among those who received coverage despite being on disability leave when the Policy took effect on May 1, 2000. Unlike other similarly situated employees, Mr. Amschwand never received a waiver and, unbeknownst to him, he remained subject to the Active Work Rule.

Spherion, an ERISA fiduciary and plan administrator, notified its employees that they could elect to participate in the Aetna Plan during an “open enrollment” period, which commenced in March 2000. Mr. Amschwand duly enrolled and was informed by Spherion that he could maintain his existing $248,000 basic coverage and his $142,000 level of supplemental coverage under the Policy. On November 6, 2000, a representative of Spherion’s Human Resources Department orally confirmed to Mr. Amschwand that all of his life insurance was convertible under the Policy and that he remained eligible for all benefits.

As his condition deteriorated, Mr. Amschwand repeatedly contacted Spherion to confirm that he was fully covered under the Aetna Policy. Each time, Spherion representatives failed to mention the Active Work Rule requirement and incorrectly assured him that the full spectrum of coverage he enjoyed under the pre-Aetna Plan remained valid. Moreover, in spite of the Amschwands’ repeated oral requests for documentation of the Policy terms and the corresponding Summary of Coverage, Spherion either maintained that informational booklets were not yet available for employees, or simply failed to provide any paperwork describing the conditions of the Policy. Believing himself covered, Mr. Amschwand timely paid the basic and supplemental life insurance premiums while on disability leave until his death in February, 2001. Mr. Amschwand diligently sought to ensure that his wife would be provided for under the Plan. Both parties agree, however, that Spherion never informed him that in order for the Policy to take effect he was required to return to work for at least one full day.

Shortly after her husband’s death, Mrs. Amschwand filed a claim with Aetna only to be informed that because her husband had not satisfied the Active Work Rule, he was ineligible for benefits under the Policy. After being denied recovery in Aet-na’s administrative appeals process, Mrs. Amschwand filed suit seeking relief under ERISA § 502(a)(3) in the form of “monetary losses caused by [the Spherion Defendants’] breach of fiduciary duty.”2 That is, Amschwand sought the equivalent of the combined life insurance benefits that she would have received if her husband had complied with the Active Work Rule. Spherion refunded the premium payments but maintained that the additional demand for money damages did not constitute “appropriate equitable relief’ within the meaning of subsection (a)(3). The district court agreed, granting summary judgment for Spherion. The court also dismissed as moot a third-party complaint filed by Aet-na. Amschwand appeals.

[345] II. STANDARD OF REVIEW

This court reviews the district court’s summary-judgment grant de novo, applying the same standard used below. Chacho v. Sabre, Inc., 473 F.3d 604, 609 (5th Cir.2006). Summary judgment is appropriate “if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.” Fed.R.Civ.P. 56(c).

III. DISCUSSION

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Amschwand v. Spherion Corp., 505 F.3d 342, 41 Employee Benefits Cas. (BNA) 2697, 2007 U.S. App. LEXIS 24435, 2007 WL 3027072 (5th Cir. 2007).

505 F.3d 342 (Amschwand v. Spherion Corp.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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