Donya Leigh Anderson v Unum Provident Corp.

369 F.3d 1257, 21 I.E.R. Cas. (BNA) 669, 32 Employee Benefits Cas. (BNA) 2318, 2004 U.S. App. LEXIS 9360, 2004 WL 1067788
CourtCourt of Appeals for the Eleventh Circuit
DecidedMay 13, 2004
Docket03-13765
StatusPublished
Cited by37 cases

This text of 369 F.3d 1257 (Donya Leigh Anderson v Unum Provident Corp.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Donya Leigh Anderson v Unum Provident Corp., 369 F.3d 1257, 21 I.E.R. Cas. (BNA) 669, 32 Employee Benefits Cas. (BNA) 2318, 2004 U.S. App. LEXIS 9360, 2004 WL 1067788 (11th Cir. 2004).

Opinion

MARCUS, Circuit Judge:

The Plaintiff Donya Leigh Anderson appeals from the district court’s order granting final summary judgment to the defendant, UNUM Provident Corporation (“UNUM”) in this diversity action for breach of contract, fraud, suppression, and bad faith because UNUM denied Anderson’s claim for long term disability benefits. The district court held that UNUM’s long term disability plan was governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001-1461, and, therefore, that Anderson’s state law claims were wholly preempted by ERISA. After thorough review of the record and careful consideration of the parties’ briefs and oral presentations we agree and, accordingly, affirm.

I.

The relevant facts and procedural history are straightforward. Since 1990 until at least the filing of her lawsuit against UNUM on June 18, 2001, Anderson was employed by Shaw Industries, Inc. (“Shaw”). In 1997, Shaw first contracted with UNUM to provide a long term disability plan (the “UNUM Plan”) to its hourly employees. In March 2000, Shaw renewed this contract with UNUM. Shaw, the largest carpet manufacturer in the world, conducts its business nationwide and the UNUM Plan is available to its hourly employees throughout the nation. Anderson participated in the UNUM Plan at all relevant times.

Upon commencing employment at Shaw, every employee receives the “Employee Information and Benefits Portfolio” (the “Benefits Portfolio”), which identifies all employee benefits provided by Shaw, including the “Optional Long Term Disability Plan.” The cover of the Benefits Portfolio features a corporate logo (the “Shaw Emblem”) which features the words “Shaw Industries, Inc. Benefits & You” and a caption below stating “Corporate Employee Benefits Department.” The Benefits Portfolio does not refer to UNUM by name, but the UNUM Plan is the sole long term disability plan offered by Shaw.

As the Benefits Portfolio explains, only hourly employees who have worked for at least 90 days are eligible to purchase the UNUM Plan. During the 90-day waiting period, employees are covered by the Short Term Disability Plan, which Shaw *1260 provides at no cost to its employees. The Benefits Portfolio includes a comprehensive description of this Short Term Disability Plan, which explains in part that no benefits shall be payable under this plan if the disability entitles the participant to any benefits “under the Shaw Optional Long Term Disability Plan.”

Every year, Shaw sends letters to its employees and posts notices in the workplace reminding the employees of the open enrollment period for its benefit plans, notably including the UNUM Plan. If employees do not enroll in the UNUM Plan when they first become eligible, they must wait until the next open enrollment period. To enroll, employees complete a form that bears the Shaw Emblem and is titled “Optional Long Term Disability Plan.” There is no UNUM corporate logo on the form, but a sentence in the middle of the page, in regular font, informs the applicant that “[t]his is an insured Plan by ‘Unum/Provi-dent.’” The form notes that the 90-day eligibility period is the “period covered by Shaw Short Term Disability.” By signing the document, the employee instructs Shaw to deduct the insurance premiums from the employee’s payroll. Employees file the form at the human resources office of the Shaw facility where they work, and the form is then forwarded to the Shaw corporate office.

Payroll deduction is the only method available to pay the UNUM Plan premiums. After an employee enrolls, Shaw enters the payroll deduction into its payroll system and sends a monthly remittance to UNUM of all premiums withheld from the employees’ paychecks, along with a total number of employees enrolled. Employees pay premiums to the UNUM Plan according to their age bracket and Shaw monitors increases in premium amounts as employees reach certain ages. When the UNUM Plan first was used by Shaw employees, employees paid a flat rate, but in 2000, on UNUM’s recommendation, Shaw made the decision to use an age-graded rate. Shaw does not decide claims or review denials of claims, but the Shaw Emblem is found at the top of the claim forms and Shaw’s human resources offices maintain supplies of the claim forms. Moreover, when an employee files a claim, Shaw must fill out the employer portion of the claim form and, because enrollment forms are not forwarded to UNUM and UNUM does not maintain a list of all enrolled employees, Shaw must confirm the employee’s coverage. Shaw then is responsible for submitting the completed claim form to UNUM. Indeed, Shaw employees direct any questions about the UNUM Plan to the human resources office at the Shaw facility where they work. The human resources staff explains the available benefits and answers any questions about the UNUM Plan.

Moreover, all Shaw hourly employees who enroll in the UNUM Plan are provided with an information booklet describing the nature of the long term disability plan. The cover sheet of the booklet (the “UNUM Plan Booklet”) is emblazoned with the Shaw Emblem and the title, “Hourly Long Term Disability Plan.” The UNUM Plan Booklet is created by UNUM, but before distribution to employees, the Benefits Manager at Shaw’s corporate headquarters in Dalton, Georgia, Anita Thornton, reviews a draft to ensure its features are understandable to Shaw employees.

At the time Anderson enrolled in the UNUM Plan, the UNUM Plan Booklet included a four-page section entitled “ERISA Summary Plan Description” (the “SPD”). This SPD names Shaw as the plan administrator and gives its address and telephone as the plan administrator’s contact information. The SPD also identi- *1261 fíes Shaw as the agent for legal service of process on the plan. Furthermore, the SPD explains that the insured was “entitled to certain rights and protections under Employee Retirement Income Security Act of 1974 (ERISA)” and outlines those rights.

The Summary Plan Description also delineates Shaw’s rights and responsibilities under the plan. It observes: (1) Shaw may request changes to the policy in whole or in part, and, subject to UNUM’s approval, the change may be made so long as it is in writing and endorsed on or attached to the ERISA plan; and (2) Shaw may cancel the policy or a plan under the policy by written notice to UNUM at least 31 days prior to the cancellation date. According to the SPD, UNUM can cancel the policy or a plan under the policy if: (1) there is less than 25% participation of eligible employees; (2) Shaw fails to provide reasonably required information, including employee eligibility and coverage information; (3) fewer than 10 employees are insured under the plan; (4) the premium is not paid in accordance with the policy provisions; (5) Shaw does not promptly report to UNUM the names of the employees who are added or deleted from the group; (6) Shaw fails to pay any portion of the premium within the 45-day grace period; or (7) Shaw otherwise fails to perform any of its obligations related to the policy. If UNUM modifies the policy in a way that was unacceptable to Shaw, Shaw can cancel the policy.

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Bluebook (online)
369 F.3d 1257, 21 I.E.R. Cas. (BNA) 669, 32 Employee Benefits Cas. (BNA) 2318, 2004 U.S. App. LEXIS 9360, 2004 WL 1067788, Counsel Stack Legal Research, https://law.counselstack.com/opinion/donya-leigh-anderson-v-unum-provident-corp-ca11-2004.