Christian v. Dupont-Waynesboro Health Care Coverage Plan

12 F. Supp. 2d 535, 1998 U.S. Dist. LEXIS 9343, 1998 WL 345052
CourtDistrict Court, W.D. Virginia
DecidedJune 18, 1998
DocketCIV.A. 96-0011-H
StatusPublished
Cited by3 cases

This text of 12 F. Supp. 2d 535 (Christian v. Dupont-Waynesboro Health Care Coverage Plan) is published on Counsel Stack Legal Research, covering District Court, W.D. Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Christian v. Dupont-Waynesboro Health Care Coverage Plan, 12 F. Supp. 2d 535, 1998 U.S. Dist. LEXIS 9343, 1998 WL 345052 (W.D. Va. 1998).

Opinion

MEMORANDUM OPINION

MICHAEL, Senior District Judge.

Background

On March 18, 1996 Bettie Christian brought an action against Dupont-Waynes-boro Health Care Coverage Plan (the plan) charging a violation of the Employee Retirement Income Security Act (“ERISA”) for failure to issue a notice of denial of benefits that specified reasons for the denial of medical benefits as required by 29 U.S.C. § 1133 (Count I) and seeking a declaratory judgment under 29 U.S.C. § 1132 that medical treatment received by the plaintiff was medically necessary under the Plan (Count II). This court found that the notice of denial of benefits sent from the Plan Administrator to plaintiff was insufficient as a matter of law because it failed to meet the requirements of 29 U.S.C. § 1133 that the Plan “provide adequate notice in writing to any participant or beneficiary whose claim for benefits under the plan has’ been denied, setting forth the specific reasons for such denial, written in a manner calculated to be understood by the participant.” The court then remanded the matter to the Plan Administrator to correct the procedural deficiencies in the notice of denial of benefits and address the plaintiff’s request for benefits. The plaintiff is currently before the court seeking attorney’s fees and costs under 29 U.S.C. § 1132(g).

The court has considered carefully the file, the pleadings, and the law. It has conducted a de novo review of the analysis and conclusions of the magistrate judge. Orpiano v. Johnson, 687 F.2d 44, 48 (4th Cir.1982). For the reasons set out below, the court adopts the report and recommendation of the magistrate judge with respect to his recommendation to award attorney’s fees and costs.

*537 Discussion

ERISA gives the district court discretion to award reasonable attorney’s fees and costs. 29 U.S.C. § 1182(g)(1); Custer v. Pan American Life Insurance Company, 12 F.3d 410 (4th Cir.1993) (“An award of attorney’s fees under ERISA is discretionary, and our review of the district court’s exercise of discretion is limited to determining whether it abused its discretion.”). To recover fees and costs, Ms. Christian must first establish that she is the “prevailing party” in this litigation. Martin v. Blue Cross & Blue Shield of Va., 115 F.3d 1201, 1210 (4th Cir.1997). The rule that only a “prevailing party” may obtain attorney’s fees in an ERISA action is a relatively new approach in this circuit. The Fourth Circuit has not yet had occasion to consider what constitutes a “prevailing party” where a litigant brings multiple claims and is successful on one, but not on the other(s).

The defendant argues that Ms. Christian can only be a “prevailing party” if she had prevailed on both of her claims and that because Ms. Christian’s claims for benefits has yet to be resolved, it is premature to award attorney’s fees. The plan’s argument is premised on the assertion that the primary goal of Ms. Christian’s claim was to obtain the requested benefits. This approach ignores the important role that procedural protections play in ERISA’s effectiveness. Without a specific letter detailing the plan’s reasons for denying coverage, Ms. Christian cannot know what protections may be afforded by ERISA nor can she know what course of action to pursue.

Though factually different, this court finds the Fourth Circuit’s decision in Davis v. Featherstone instructive. 97 F.3d 734 (4th Cir.1996). In Davis, the plaintiff sought in-junctive relief in order to obtain a detailed copy of his former employer’s disability plan pursuant to 29 U.S.C. § 1024(b)(4). As is the case with § 1133 (requiring a detailed notice of denial of benefits), § 1024 is a safeguard that in part permits a plan member to determine what course of action to take after denial of benefits. In reviewing the district court’s denial of attorneys’ fees, the circuit court noted that it was necessary for Davis to engage counsel in order to avail himself of this procedural ERISA provision and then instructed the district court on remand to reconsider the imposition of attorney’s fees. Id. 97 F.3d at 739. The defendant attempts to distinguish Davis from the instant cause of action by arguing that Davis only sought injunctive relief and did not ask the court to award him benefits. To adopt the defendant’s approach would produce an anomalous result. Those litigants who bring two separate actions — one under ERISA’s procedural provisions and a second to obtain benefits— would be eligible, if they prevailed, to collect fees at the conclusion of each suit. Conversely, those litigants who consolidate their procedural and substantive claims would risk having to wait what would often be a considerable period of time before becoming eligible to collect fees.

Ms. Christian was compelled to bring suit against the defendant in order to obtain a detailed notice of denial as required by 29 U.S.C. § 1133. Denial of this important procedural safeguard presented a significant issue and Ms. Christian’s success achieved some of the benefit sought in bringing suit. The fact that this court remanded the plaintiffs request for benefits does not prohibit her status as a “prevailing party.”

Having determined that Ms. Christian is a “prevailing party,” this court must now consider whether to grant Ms. Christian’s request for attorney’s fees and costs. The Fourth Circuit has established a five-factor test for awarding fees under ERISA. Quesinberry v. Life Ins. Co. of North America, 987 F.2d 1017, 1030 (4th Cir.1993). The district court must consider:

(1) the degree of the opposing party’s culpability or bad faith;
(2) the ability of the opposing party to satisfy an award of fees;
(3) whether an award of fees against the opposing parties would deter others from acting under similar circumstances;
(4) whether the parties requesting fees sought to benefit all participants and beneficiaries of an ERISA plan or to resolve a significant legal question regarding ERISA;
*538 (5) the relative merits of the parties’ positions.

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Bluebook (online)
12 F. Supp. 2d 535, 1998 U.S. Dist. LEXIS 9343, 1998 WL 345052, Counsel Stack Legal Research, https://law.counselstack.com/opinion/christian-v-dupont-waynesboro-health-care-coverage-plan-vawd-1998.