Cooperative Benefit Administrators, Inc. v. Ogden

367 F.3d 323, 2004 WL 811730
CourtCourt of Appeals for the Fifth Circuit
DecidedApril 29, 2004
Docket03-30518
StatusPublished
Cited by37 cases

This text of 367 F.3d 323 (Cooperative Benefit Administrators, Inc. v. Ogden) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cooperative Benefit Administrators, Inc. v. Ogden, 367 F.3d 323, 2004 WL 811730 (5th Cir. 2004).

Opinion

WIENER, Circuit Judge:

Defendant-Appellant Dale Ogden appeals the district court’s grant of the summary judgment motion of Plaintiff-Appel-lee Cooperative Benefit Administrators, Inc. (“CBA”), enforcing terms of an ERISA-governed long-term disability plan against her and dismissing her counterclaim for benefits. Ogden also appeals the district court’s denial of her motion to dismiss for lack of subject matter jurisdiction and for failure to join her daughters as indispensable parties, as well as the court’s denial of her motion for partial summary judgment. For the following reasons, we reverse the district court’s *325 denial of Ogden’s motion to dismiss, albeit not on jurisdictional grounds; we render a judgment of dismissal, but for failure to state a claim in federal common law; and we affirm the district court’s dismissal of Ogden’s counterclaim for benefits.

I. FACTS AND PROCEEDINGS

The National Rural Electric Cooperative Association (“NRECA”) is a trade association for more than 1,000 rural electric cooperatives throughout the United States. CBA is the claims adjudicator for NRE-CA’s Group Benefits Program, a multiple-employer benefits plan sponsored by NRECA for its member cooperatives. This Program consists of five welfare benefits plans, including a self-insured Long-Term Disability Benefits Plan (“the Plan”) governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). 1 As claims adjudicator for the Program, CBA is also an ERISA fiduciary as defined by § 1102(a). 2 Ogden is a former employee of Cajun Electric Power Cooperative, Inc., one of NRECA’s member cooperatives, and was a participant in the Plan at all relevant times. After sustaining non-work related injuries that rendered her totally disabled, Ogden filed a claim in April 1995 seeking long-term disability benefits under the Plan. Within three weeks, CBA approved her request and began paying Ogden the full amount of her benefits under the Plan.

The Plan documents contain a “Benefit Offset” provision that allows CBA, as plan fiduciary, to estimate the amount of benefits a participant is eligible to receive from sources outside the Plan 3 and to deduct— or “offset” — the combined amount of these outside benefits from the amount that the participant is entitled to receive under the Plan. Benefits from outside sources that were subject to offset included “any payments [from other sources] ... whether the payment is made to, or on behalf of, the Participant, the Participant’s spouse or any dependent of the Participant.” As there is often a substantial delay between the time that a participant becomes eligible for outside benefits and the time that such benefits are actually paid to the participant, the Plan also gives CBA the option of advancing to a participant the full amount of his Plan benefits, without offset, conditioned on the participant’s agreeing to reimburse the Plan the amount of the advances attributable to eventual receipts of outside benefits. To reinforce a participant’s reimbursement obligation, the Plan requires him to sign a Reimbursement Agreement (“Agreement”), the terms of which are stated in the plan documents, obligating the participant both to cooperate with CBA in pursuing benefits from outside sources and to reimburse the Plan the amount of the advances within 30 days following receipt of any benefits from outside sources. The Agreement specifies that, if the participant fails to repay the Plan within thirty days for amounts previously advanced, the participant is liable to the Plan for the full amount of the advances, plus interest and any costs or attorney’s fees incurred by CBA in enforcing the Agreement. If a participant refuses to reimburse the Plan in accordance with the *326 provisions of the Agreement, CBA is authorized by the Plan to reduce — “setoff’— reimbursements owed to it by the participant against future monthly benefits as they become due.

In June 1995, CBA learned that Ogden and her two dependent daughters had become eligible to receive Social Security disability benefits, which, as we have noted, are among the types of outside benefits that are subject to the Plan’s offset provisions. 4 Consequently, CBA informed Ogden that it would begin offsetting the estimated amount of her and her daughters’ anticipated Social Security disability benefits against her monthly benefits under the Plan, unless she agreed to provide CBA with a copy of her Social Security application and sign a Reimbursement Agreement as required by the Plan. Ogden opted to sign the Agreement and continue to receive the full amount of her benefits without offset. In the Agreement, Ogden promised

[t]o repay CBA the amounts advanced to [her] in accordance with the offset provisions of the [LTD] plan and this Reimbursement Agreement within 30 days of [her] receipt of the proceeds of any benefits, awards, or payments recovered from Social Security ... The repayment will not exceed the amount of the benefits, awards, or payments recovered from Social Security, except that it shall include interests, costs, and attorney’s fees as provided in this RA.

In October 1996, CBA informed Ogden that she had become eligible to receive her retirement pension and that her total monthly benefits under the Plan would be offset by $66.52, the full amount of her monthly pension payments. Thus, her total monthly benefits from the Plan were reduced from $996.77 to $930.25, starting with her November 1996 payment.

Initially, the Social Security Administration (“SSA”) denied Ogden’s claim. CBA subsequently offered to hire Allsup, Inc. to pursue the claim on Ogden’s behalf. Ogden accepted this offer, and CBA paid all expenses related to Allsup, Inc.’s representation. The SSA finally approved Ogden’s claim for disability benefits in October 1997, more than two years after she had submitted her application. Shortly thereafter, the SSA issued Ogden a Notice of Award, stating that she was entitled to monthly Social Security disability benefits of $844, starting the following month, plus a lump-sum payment of $26,808 for retroactive disability payments for the period April 1995 through October 1997. The SSA also informed Ogden that her two daughters, both of whom had attained majority after Ogden’s application was filed and were thus no longer her dependents, would each receive lump-sum payments totaling $27,624 for the same period.

The present controversy arose when, after receiving her lump-sum Social Security award, Ogden refused to reimburse the Plan $27,291.29 to cover advances that she owed under the terms of the Plan and the Agreement. Although CBA began suspending Ogden’s benefits in December 1998 through the exercise of its setoff rights, it continued to seek reimbursement from Ogden from her lump-sum award. In April 2000, after several attempts to obtain reimbursement failed, CBA filed suit in district court for $27,693.86 in benefit “overpayments.” Because Ogden’s daughters had not, at that time, received their lump-sum Social Security awards, CBA based its demand on the amount of *327

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Cite This Page — Counsel Stack

Bluebook (online)
367 F.3d 323, 2004 WL 811730, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cooperative-benefit-administrators-inc-v-ogden-ca5-2004.