Hodges v. Life Ins. Co. of N. Am., Ins. Co.

920 F.3d 669
CourtCourt of Appeals for the Tenth Circuit
DecidedApril 2, 2019
Docket18-1279
StatusPublished
Cited by20 cases

This text of 920 F.3d 669 (Hodges v. Life Ins. Co. of N. Am., Ins. Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Tenth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hodges v. Life Ins. Co. of N. Am., Ins. Co., 920 F.3d 669 (10th Cir. 2019).

Opinion

PHILLIPS, Circuit Judge.

Lou Hodges submitted a claim for long-term-disability (LTD) benefits to Life Insurance Company of North America (LINA) through his employer's group-insurance plan. Although LINA approved his claim, Hodges asserted that LINA should have classified him as a "sales" employee under the group-insurance policy, which would have entitled him to more benefits. This led Hodges to sue LINA. The district court remanded for further factfinding, but LINA once again reached the same result. The district court then *672 reversed LINA's decision, concluding that Hodges qualified as a salesperson under the policy. LINA now appeals that ruling. Exercising jurisdiction under 28 U.S.C. § 1291 , we affirm.

BACKGROUND

Until 2012, Hodges worked for Endo Pharmaceuticals, Inc. as a cryotherapy technician. That year a degenerative eye condition forced him to retire. He participated in Endo's employee-welfare-benefit plan, for which Endo had appointed LINA as the administrator. In 2011, LINA issued to Endo a group LTD insurance policy (the Policy), governed by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1000 - 1461. Under "Claims Procedures," the Policy names LINA the fiduciary for deciding claims as well as appeals of denied claims. Appellant's App. vol. 2 at 312. The Policy allows LINA "45 days from the date it receives a claim for disability benefits ... to determine whether or not benefits are payable in accordance with the terms of the Policy." Id.

The Policy divides employees into two classes: Class 1, which includes "[a]ll active, Full-time and part-time Employees of the Employer, excluding Sales personnel, regularly working a minimum of 20 hours per week"; and Class 2, which includes "[a]ll active, Full-time Employees of the Employer classified as Sales Personnel regularly working a minimum of 20 hours per week." Id. at 290 . The Policy entitles all covered employees to monthly disability payments worth 60% of their average pre-disability earnings, but it defines the pay of sales personnel more broadly than that of non-sales personnel. Specifically, the Class 2 definition of earnings includes payments "received from bonuses or target incentive compensation bonus[es]," but the Class 1 definition "does not include amounts received as bonus[es]." 1 Id . Despite favoring sales personnel in the provision of benefits, however, the Policy defines neither "sales" nor "sales personnel."

Before leaving the company, Hodges submitted a claim under the Policy. After granting him short-term-disability benefits, LINA informed Hodges that it would begin evaluating his eligibility for LTD benefits. LINA eventually concluded that Hodges was medically eligible for LTD benefits, but later sought information from Hodges and Endo about Hodges's job description and duties to determine whether he qualified as "sales personnel" under the Policy. In a telephone interview, Hodges explained to a LINA claim manager that "he was a technician, but often times did things to sell the compan[y']s products." Id. at 516 . And in an e-mail to another LINA claim manager, an Endo representative "confirmed" that Hodges "received monthly sales bonuses based on the number of cases he treated," which totaled "$ 9[,]800 for the nine months he worked in 2011." Id. vol. 5 at 1226. But the representative also stated, "These earnings are not part of the overall bonus or [incentive compensation] program at Endo and were not included in the premium calculation." Id.

On March 21, 2012, LINA informed Hodges that it had approved his claim for LTD benefits but that it deemed him a Class 1 employee, not a Class 2 salesperson. Hodges objected to this classification, arguing that he "sold products while out in the field" and that the classification would significantly reduce his benefits. 2 Id. vol. 2 *673 at 494. About 70% of Hodges's earnings came from his base salary, and about 30% came from sales-driven compensation, including bonuses.

In November 2012, Hodges filed an administrative appeal asking LINA to reconsider its decision to classify him as a Class 1 employee. Hodges attached several supporting documents to his appeal. First, he submitted e-mails from two senior Endo officials referring to the "bonuses" that Hodges and other cryotherapy technicians had earned selling the company's products and services. Id. vol. 4 at 1044-46. Second, he submitted e-mails from senior Endo staff emphasizing the importance of marketing the company's products. In one such e-mail, Allyn Chung, Endo's Senior Director of Cryo Operations, wrote to Hodges and other employees, "I cannot stress enough the importance of making regular visits to your physician[s'] offices and helping to market the technology." Id. at 1039 . In another e-mail (subject: "job descriptions and 2011 goals"), Chung declared that cryotherapy technicians' goals for the year included a "requirement to submit a minimum of [one] lead a month for new cryo[therapy] users, new applications for existing cryo[therapy] users, or any other lead for any of our business lines." Id. at 1042

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Bluebook (online)
920 F.3d 669, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hodges-v-life-ins-co-of-n-am-ins-co-ca10-2019.