Brown v. J.B. Hunt Transport Services, Inc.

586 F.3d 1079, 48 Employee Benefits Cas. (BNA) 1004, 2009 U.S. App. LEXIS 25128, 2009 WL 3818374
CourtCourt of Appeals for the Eighth Circuit
DecidedNovember 17, 2009
Docket08-3803
StatusPublished
Cited by72 cases

This text of 586 F.3d 1079 (Brown v. J.B. Hunt Transport Services, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eighth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Brown v. J.B. Hunt Transport Services, Inc., 586 F.3d 1079, 48 Employee Benefits Cas. (BNA) 1004, 2009 U.S. App. LEXIS 25128, 2009 WL 3818374 (8th Cir. 2009).

Opinion

RILEY, Circuit Judge.

Barbara Brown (Brown) hurt her knee while working as a truck driver for J.B. Hunt Transport Services, Inc. (Hunt). Prudential Insurance Company of America (Prudential), which insured Hunt’s employee welfare benefits plan (Plan), discontinued Brown’s long-term disability (LTD) benefits and ignored her requests for information about its decision. Brown sued Hunt and Prudential under ERISA 1 for reinstatement of her LTD benefits and penalties, but the district court held she failed to exhaust her administrative remedies and dismissed her lawsuit. Because we hold Prudential failed to afford Brown a reasonable opportunity for a full and fair review of Prudential’s decision to discontinue her LTD benefits, we affirm in part, reverse in part, and remand for further proceedings.

I. BACKGROUND

A. Prudential Discontinues Brown’s LTD Benefits

Brown worked for Hunt as a truck driver and enrolled in the Plan. Hunt sponsored the Plan and served as plan administrator. Pursuant to a group insurance contract with Hunt, Prudential insured the Plan and served as claims administrator. Prudential, not Hunt, was responsible for processing claims, determining eligibility, and paying benefits under the Plan.

In August 2005, Brown stopped working for Hunt due to neck, back, and left knee pain. She made a claim for LTD benefits under the Plan. In September 2005, Prudential awarded Brown LTD benefits based upon her left knee condition. Prudential found Brown met the Plan’s definition of “disabled,” i.e., “unable to perform the material and substantial duties of [one’s] regular occupation due to ... injury.” Brown was a lifelong trucker, and her knee pain made it impossible for her to continue driving a truck.

In June 2007, Prudential discontinued Brown’s LTD benefits. The Plan’s definition of “disabled” changes after the first year of payments. The Plan states: “After 12 months of payments, you are disabled when Prudential determines that due to the same ... injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted *1082 by education, training or experience.” Prudential determined that, even though Brown’s knee pain prevented her from returning to work as a truck driver, there were other jobs she could perform.

Prudential informed Brown it had “obtain[ed] and review[ed] information” about her “medical condition,” “daily activities,” and “education, experience, and other occupations [she] would be qualified to perform.” Prudential explained that, “[b]ased on [its] clinical reviews, the medical documentation supports that [Brown had] sedentary work capacity and [was] limited to lifting up to ten pounds, stooping and bending [was] generally to be avoided, and sitting and standing [could] be alternated as needed.” Prudential indicated one of its vocational rehabilitation specialists had determined Brown was employable as a semiconductor bonder, a surveillance system monitor, a food checker, or an assembler.

Prudential notified Brown of her right to an internal administrative appeal of its decision “in writing ... within 180 days.” Prudential required any appeal to state the reasons for disagreeing with its decision and to contain supporting evidence, including: “[c]opies of therapy treatment notes,” “[a]ny additional treatment records from physicians,” “[a]ctual test results,” and “any other written comments, documents, records, or information related to [her] claim.” Prudential informed Brown of her concomitant right “to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to [her] claim.”

B. Brown Requests Information from Prudential and Hunt

In June 2007, Brown called Prudential and indicated she wanted to appeal. One of Prudential’s representatives told Brown she needed to explain in writing why she disagreed with Prudential’s decision, but Brown never did so. Instead, Brown requested a copy of the Plan from Prudential and, through her attorney, sent Hunt and Prudential a series of letters requesting a wide variety of information. Brown asked Hunt for copies of all employee welfare or pension plans in which she had enrolled and copies of all summary plan descriptions, annual reports, and amendments thereto. Brown asked Prudential for a copy of the Plan and a complete copy of the Administrative Record. Brown also requested Prudential provide her all Plan documents, internal guidelines, and administrative precedents upon which Prudential had relied when deciding to discontinue her LTD benefits, as well as the names and addresses of all individuals who reviewed her personal health information.

At Prudential’s request, Hunt sent Brown a copy of the Plan’s summary plan description and “Wrap” document, a description of the various benefits available to Hunt employees. Hunt sent Brown copies of summary plan descriptions and benefit booklets for every plan in which she had enrolled while working for Hunt. Prudential otherwise ignored Brown’s requests. Thereafter, Brown sent Prudential another letter through her attorney, in which she demanded a response within ten days. Absent a response, Brown stated she would “assume [Prudential had] no intention of responding to [her] letter, and [would] take appropriate action.” Prudential again failed to respond to Brown’s request for information.

In January 2008, Brown’s attorney called Prudential and asked whether Brown had filed an administrative appeal. Prudential informed Brown’s attorney that Brown had not filed a written appeal. Prudential contends Brown’s deadline for filing such an appeal expired in late November 2007.

*1083 In February 2008, Brown’s attorney reminded Hunt he had “previously requested certain documents from Hunt, but ... did not receive certain information.” Brown’s attorney requested all relevant documents under the pertinent regulations, “including but not limited to claims manuals.” On March 21, 2008, Hunt mailed the Administrative Record to Brown. 2 Hunt did not send any claims manuals.

C. Relevant Prior Proceedings

In April 2008, Brown filed a two-count amended complaint against Hunt and Prudential in the district court. 3 In Count I, Brown sought an order reinstating her LTD benefits under the Plan and awarding her back benefits. See 29 U.S.C. § 1132(a)(1)(B). In Count II, Brown sought statutory penalties for the failures of Hunt and Prudential to respond to her requests for information. See id. § 1132(c). The district court dismissed both counts after Hunt and Prudential filed a series of motions for summary judgment.

The district court dismissed Count I because Brown did not file a written administrative appeal of Prudential’s decision to discontinue her LTD benefits. The court held Brown did not exhaust her administrative remedies.

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586 F.3d 1079, 48 Employee Benefits Cas. (BNA) 1004, 2009 U.S. App. LEXIS 25128, 2009 WL 3818374, Counsel Stack Legal Research, https://law.counselstack.com/opinion/brown-v-jb-hunt-transport-services-inc-ca8-2009.