Donachie v. Liberty Mutual Ins. Co.

Court of Appeals for the Second Circuit·Decided March 11, 2014·No. 12-2996-cv (L)·Published

Opinion

12‐2996‐cv (L) Donachie v. Liberty Mutual Ins. Co. et al.

In the

United States Court of Appeals For the Second Circuit

AUGUST TERM 2013

Nos. 12‐2996‐cv (Lead), 12‐3031 (XAP)

JOHN J. DONACHIE,

Plaintiff‐AppelleeCross‐Appellant,

v.

LIBERTY LIFE ASSURANCE COMPANY OF BOSTON, Defendant‐AppellantCross‐Appellee,

LIBERTY MUTUAL INSURANCE COMPANY, LIBERTY MUTUAL HOLDING COMPANY, INC.,

Defendants.*

Appeal from the United States District Court for the Eastern District of New York.

No. 4 CV 2857 (RRM) ― Roslynn R. Mauskopf, Judge.

ARGUED: JANUARY 29, 2014 DECIDED: MARCH 11, 2014

* The Clerk of Court is directed to amend the caption to conform to the listing of the parties shown above.

Before: CABRANES, CARNEY, and DRONEY, Circuit Judges.

In this appeal, we write primarily to clarify the scope of a district court’s discretion in deciding whether to award attorneys’ fees to a prevailing plaintiff under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et seq., and the proper standard to be applied in exercising that discretion. We consider whether the United States District Court for the Eastern District of New York (Roslynn R. Mauskopf, Judge) (1) erred by sua sponte entering summary judgment for plaintiff on his claim for long term disability benefits pursuant to ERISA; or (2) “abused its discretion” by denying prevailing plaintiff’s request for attorneys’ fees, based on the conclusion that defendant did not act in bad faith.

We conclude that the District Court properly entered summary judgment for plaintiff on his claim for disability benefits, but that it erred in denying his request for attorneys’ fees, inasmuch as it failed to identify a “particular justification” for not awarding such fees. Accordingly, we AFFIRM the judgment of the District Court insofar as it entered summary judgment for plaintiff on his claim for long term disability benefits, VACATE the judgment insofar as it denied plaintiff’s request for attorneys’ fees, and REMAND the cause with instructions that the District Court award plaintiff reasonable attorneys’ fees, to be determined on remand.

MICHAEL F. MONGELLI II, Michael F. Mongelli II, P.C., Flushing, NY, for Plaintiff.

MICHAEL J. ZARETSKY, Chorpenning, Good, Carlet & Garrison, New York, NY, for Defendant.

JOSÉ A. CABRANES, Circuit Judge:

In this appeal, we write primarily to clarify the scope of a district court’s discretion in deciding whether to award attorneys’ fees to a prevailing plaintiff under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et seq., and the proper standard to be applied in exercising that discretion. We consider whether the United States District Court for the Eastern District of New York (Roslynn R. Mauskopf, Judge) (1) erred by sua sponte entering summary judgment for plaintiff on his claim for long term disability benefits pursuant to ERISA; or (2) “abused its discretion” by denying prevailing plaintiff’s request for attorneys’ fees, based on the conclusion that defendant did not act in bad faith.

We conclude that the District Court properly entered summary judgment for plaintiff on his claim for disability benefits, but that it erred in denying his request for attorneys’ fees, inasmuch as it failed to identify a “particular justification” for not awarding such fees. Accordingly, we AFFIRM the judgment of the District Court insofar as it entered summary judgment for plaintiff on his claim for long term disability benefits, VACATE the judgment insofar as it denied plaintiff’s request for attorneys’ fees, and REMAND the cause with instructions that the District Court award plaintiff reasonable attorneys’ fees, to be determined on remand.

BACKGROUND

In December 2001, while employed at FleetBoston Financial Corporation (“Fleet”), plaintiff John J. Donachie (“Donachie”) underwent surgery to replace his aortic valve. An unanticipated side effect of the surgery was that he could feel and hear the compressions of the prosthetic valve with each beat of his heart. Indeed, the sounds were audible to persons sitting in the same room with Donachie.

Donachie’s treating cardiologist, Stephen J. Gulotta, M.D.

(“Dr. Gulotta”), opined that the surgery had been a success, but that the noise from the prosthetic valve caused Donachie “a great deal of anxiety,” resulting in physical and mental exhaustion from lack of sleep, and rendering him unable to perform his current job. Donachie’s treating psychiatrist, Robert Gordon, M.D. (“Dr. Gordon”), whom he saw in connection with the side effects of the valve replacement, stated that the audible clicking added significantly to the anxiety Donachie experienced in his employment and ultimately diagnosed Donachie with ”major depression.”

On June 19, 2003, after attempting to return to his regular work schedule, Donachie submitted a claim for disability benefits to Liberty Life Assurance Company of Boston (“Liberty”) ―administrator of Fleet’s long‐term disability (“LTD”) plan.1 In

1 In July 2003, Liberty approved Donachie’s request for short‐term disability

benefits, which were administered by Liberty but paid by Fleet. Donachie continued to receive these benefits until at least December 2003, when his claim for long‐term disability benefits was denied.

evaluating Donachie’s claim for LTD benefits, Liberty requested medical records and information about Donachie’s physical condition, and arranged for an independent medical examination by cardiologist George Brief, M.D. (“Dr. Brief”). Dr. Brief concluded that, from a cardiology standpoint, the valve replacement had been a success, and that, physically, Donachie could return to work. He noted, however, that Donachie’s present complaints “should be evaluated by an expert in the field of psychology.” Upon review of Dr. Brief’s report, Dr. Gulotta clarified that the source of Donachie’s current disability was not primarily physical, and that Donachie was ”psychologically crippled.” Dr. Gulotta echoed Dr. Brief’s recommendation that Donachie be evaluated by one of Liberty’s psychologists or psychiatrists.

In response to these recommendations, Liberty engaged its own consulting psychiatrist, Andrew O. Brown, M.D. (“Dr. Brown”), to review Donachie’s claim. Dr. Brown reviewed Donachie’s medical file and Dr. Gordon’s records, but he never spoke directly with either individual. On December 22, 2003, on the basis of Dr. Brown’s recommendation, Liberty denied Donachie’s claim for LTD benefits.

After exhausting the internal appeals process, Donachie appealed the denial of his claim for LTD benefits to the District Court in a Complaint filed on July 8, 2004. Liberty moved for summary judgment. In a March 10, 2009 Report and Recommendation (“R&R”), Magistrate Judge Arlene Rosario Lindsay recommended denying Liberty’s motion, and granting

summary judgment sua sponte for Donachie on his request for LTD benefits. On June 27, 2012, approximately nine years after Donachie first requested benefits, the District Court adopted the R&R, and entered summary judgment for Donachie,2 but denied Donachie’s request for attorneys’ fees. This timely appeal followed.

DISCUSSION

A. Denial of LTD Benefits

Judge Mauskopf reviewed the R&R de novo and adopted its disposition, denying Liberty’s motion for summary judgment and sua sponte granting summary judgment for Donachie,3 on the basis that the denial of LTD benefits had been arbitrary and capricious.4 We review the District Court’s order entering summary judgment de novo. Pagan v. NYNEX Pension Plan, 52 F.3d 438, 441 (2d Cir. 1995); cf. Celardo v. GNY Auto. Dealers Health & Welfare Trust, 318 F.3d 142, 145 (2d Cir. 2003) (“[D]etermination that the Trustees’ decision was

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