Emery v. American Airlines, Inc.

56 F. Supp. 3d 1284, 2014 U.S. Dist. LEXIS 148656, 2014 WL 5341881
CourtDistrict Court, S.D. Florida
DecidedOctober 20, 2014
DocketCase No. 08-22590-CIV
StatusPublished
Cited by1 cases

This text of 56 F. Supp. 3d 1284 (Emery v. American Airlines, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Emery v. American Airlines, Inc., 56 F. Supp. 3d 1284, 2014 U.S. Dist. LEXIS 148656, 2014 WL 5341881 (S.D. Fla. 2014).

Opinion

ORDER GRANTING DEFENDANTS MOTION FOR SUMMARY JUDGMENT, IN PART, AND DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT, IN PART

WILLIAM M. HOEVELER, Senior District Judge.

THIS CAUSE comes before the Court on the parties’ motions for summary judg[1287]*1287ment and Plaintiffs motion for leave to file newly acquired evidence. The Court has reviewed the parties’ arguments and evidence — including the supplemental briefs, and has reviewed pertinent portions of the file; based on that review, the Court finds that Plaintiff has not established that she is entitled to reinstatement of disability benefits. The Court has concluded, however, that a civil penalty shall be imposed against Defendant for the failure to timely provide a copy of the subject pension plan to Emery.1

BACKGROUND

This lawsuit was filed pursuant to the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1001 et seq., on September 18, 2008, seeking to recover benefits pursuant to the American Airlines, Inc., Pilot Retirement Benefit Program (the “Plan”). Plaintiff Emery was employed by Defendant as an airline pilot and eligible to participate in the benefits of the Plan.

The Plan2 provides retirement, disability, and related benefits to eligible pilots and their beneficiaries and is an employee benefit plan subject to ERISA. Benefits awarded under the Plan are funded by payments from a trust, which American Airlines funds through yearly contributions; while such payments are not eligible to be refunded to American Airlines, future required contributions may be reduced in the event that a participating member of the Plan (i.e., an employee) dies or their right to benefits is forfeited. AA38.3 The Plan is administered by American Airlines, and also by a Pension Benefits Administration Committee (“PBAC”) created by American Airlines, as described in more detail, below.

From March 18, 2003, until January 25, 2007, Emery received long term disability benefits from Defendant as a result of her suffering from depression and performance anxiety; in early 2007 Emery’s benefits were terminated when Defendant determined that “verification of [Emery’s] continued disability and necessity of continued medical treatment cannot be established.” AA541. Emery administratively appealed that decision and the appeal was submitted to an independent clinical authority, Western Medical Evaluators (“WME”), which had been jointly selected by Defendant and the pilots7 union to handle such disputes. As the pilots’ union and American Airlines had agreed that the medical opinions of WME would be final and binding, the PBAC was bound to accept WME’s ultimate determination that Emery had not submitted evidence that she was disabled. After the denial of her appeal by the PBAC, Emery then filed this action.

[1288]*1288This Court heard oral argument on the parties’ cross-motions for summary judgment on March 23, 2011.4

STANDARD OF REVIEW

The Eleventh Circuit has adopted a six-step test for the review of ERISA disputes:

1. Apply the de novo standard of review to determine whether the Administrator’s decision to deny benefits was “wrong” (i.e., the court disagrees with the conclusion); if it is not, then end the inquiry and affirm the decision.
2. If the Administrator’s decision is wrong, then determine whether the Administrator had discretion in reviewing claims; if not, then end the inquiry and reverse the decision.
3. If the Administrator’s decision is wrong, and the Administrator was vested with discretion in reviewing claims, then determine whether “reasonable” grounds supported the decision (i.e., review the decision under the deferential “arbitrary and capricious” standard).
4. If no reasonable grounds exist- for the decision, then end the inquiry and reverse the Administrator’s decision; if reasonable grounds do exist, then determine whether the Administrator operated under a conflict of interest.
5. If there is no conflict of interest, then end the inquiry and affirm the decision.
6. If there is a conflict of interest, the conflict is merely a factor for the court to consider when determining whether an Administrator’s decision was arbitrary and capricious.

Blankenship v. Metro. Life Ins. Co., 644 F.3d 1350, 1355 (11th Cir.), cert. denied, — U.S. -, 132 S.Ct. 849, 181 L.Ed.2d 549 (2011).

In this case, the Plan specifies that its Administrator is American Airlines.5 In addition, the Plan establishes the PBAC, appointed pursuant to Section 11.3 of the Plan, which has the power to “administer the claims appeal procedures of the Plan.” Plan, § 11.3(c)(v) (as amended by the Fifth Amendment6).7 The Plan provides that American Airlines is the Administrator with “responsibility and authority to control the operation and administration of the Plan, except to the extent such responsibility and authority has specifically been assigned herein to [the PBAC].” Plan, § 11.1 (as of the Sixth Amendment to the Plan, adopted December 20, 2006) (emphasis added). In other words, as acknowledged by the parties, the Plan grants discretion to the Administrator (American Airlines) to decide claims and grants the [1289]*1289PBAC (as assigned by American Airlines) discretion to review claims on appeal.

In light of this grant of discretion, even if the Court finds that the decision to deny benefits to Emery was “wrong,” (step one of the relevant test) the Court will not disturb that decision if the record reveals a reasonable basis for that decision (step three of the test), unless the Court determines that a conflict of interest was present (step four) and that the decision was arbitrary and capricious (step six).8 Emery bears the burden of establishing that the Defendant’s decision—whether or not the decisionmaker operated under a conflict of interest—was arbitrary and capricious.

The Court has, for the purposes of analysis, assumed that the decision by American Airlines to discontinue Emery’s benefits was wrong; as such, and in light of the clear evidence that the Administrator (American-Airlines or PBAC) had discretion in reviewing claims, the Court proceeds directly to the question of whether there exist reasonable grounds for the Administrator’s decision, i.e. the Court proceeds to the third step of the test adopted in this Circuit. In making my determination, I am limited to reviewing the evidence in the administrative record,9 unless specific evidence as to a conflict of interest is presented,10 and I must uphold the Plan’s decision if there is a reasonable basis for the Plan’s denial of benefits, even if there is evidence supporting a contrary result.11

Was there a conflict of interest?

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Cite This Page — Counsel Stack

Bluebook (online)
56 F. Supp. 3d 1284, 2014 U.S. Dist. LEXIS 148656, 2014 WL 5341881, Counsel Stack Legal Research, https://law.counselstack.com/opinion/emery-v-american-airlines-inc-flsd-2014.