John Halpin v. W.W. Grainger, Incorporated

962 F.2d 685, 15 Employee Benefits Cas. (BNA) 1500, 1992 U.S. App. LEXIS 9264, 1992 WL 91439
CourtCourt of Appeals for the Seventh Circuit
DecidedMay 6, 1992
Docket91-1153
StatusPublished
Cited by233 cases

This text of 962 F.2d 685 (John Halpin v. W.W. Grainger, Incorporated) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
John Halpin v. W.W. Grainger, Incorporated, 962 F.2d 685, 15 Employee Benefits Cas. (BNA) 1500, 1992 U.S. App. LEXIS 9264, 1992 WL 91439 (7th Cir. 1992).

Opinion

RIPPLE, Circuit Judge.

John Halpin’s total disability benefits were terminated by W.W. Grainger, Inc. (Grainger), his employer and the administrator of the long-term disability plan that covered Mr. Halpin. Mr. Halpin brought an action under ERISA challenging Grainger’s termination of his benefits and was granted summary judgment by the district court. Grainger now appeals. For the following reasons, we affirm.

I

BACKGROUND

A. Facts

Grainger, an electrical equipment supplier, hired John Halpin in 1970 as a full-time outside sales representative. In December 1982, after twelve years of service, Mr. Halpin suffered an anterior wall myocardial infarction. On April 19, 1983, Mr. Hal-pin underwent a left ventricular aneurysm re-section. He continues under medication for coronary artery disease. In September of 1984, Mr. Halpin was awarded total disability insurance benefits by the Social Security Administration. ■ Mr. Halpin also received total disability benefits under Grainger’s long-term disability plan (Plan). In the spring of 1988, Thomas L. Jacobs & Associates (TU), which had been hired by Grainger to administer the Plan, notified Mr. Halpin that it was reviewing his eligibility for benefits and asked him to have his doctor fill out a questionnaire which it provided. His doctor did so. On May 30, 1988, TU notified Mr. Halpin that his disability payments were terminated because he no longer met the Plan’s definition of total disability. Mr. Halpin appealed the termination, and Grainger denied his appeal. Mr. Halpin then brought this action for reinstatement of benefits.

B. District Court Proceedings

In the district court, the parties filed cross-motions for summary judgment. The district court determined that Grainger’s termination of Mr. Halpin’s benefits should be reviewed under the arbitrary and capricious standard. It based this determination on the discretionary authority which the Plan gave to Grainger to “determine all questions arising in the administration, interpretation and operation of the Plan.” The district court found that there was no conflict of interest which would mandate a greater degree, of scrutiny.

The district court then determined that the termination of benefits had been arbitrary and capricious: Grainger had not “articulated an explanation for the decision that takes into account all the relevant facts,” gave “no explanation concerning why it did not consider rehabilitative employment together with vocational training, or why it did not make an effort to determine whether a suitable job offer would be *688 made to plaintiff or whether ... employers are unlikely to risk employing a person of plaintiffs age and condition.” Memorandum Opinion and Order, No. 89 C 8700 at 9-10, 1991 WL 1710 (Jan. 4, 1991). The district court granted summary judgment to Mr. Halpin and ordered retroactive reinstatement of his benefits.

II

ANALYSIS

A. Standard of Review

In reviewing the district court’s decision to grant summary judgment, our task is to review de novo the record and the controlling law. 1 Becker v. Tenenbaum-Hill Assocs., Inc., 914 F.2d 107, 110 (7th Cir.1990). The party moving for summary judgment bears the burden of establishing that there is no genuine issue of material fact and that he is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c); see Adickes v. S.H. Kress & Co., 398 U.S. 144, 159, 90 S.Ct. 1598, 1609, 26 L.Ed.2d 142 (1970). A motion for summary judgment is “not an appropriate occasion for weighing the evidence; rather, the inquiry is limited to determining if there is a genuine issue for trial.” Lohorn v. Michal, 913 F.2d 327, 331 (7th Cir.1990). Any doubt as to the existence of a genuine issue for trial is resolved against the moving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255, 106 S.Ct. 2505, 2513-14, 91 L.Ed.2d 202 (1986).

As noted above, the district court determined that the Plan gave the administrator discretionary authority to determine eligibility and that, therefore, the administrator’s decisions were to be reviewed under the arbitrary and capricious standard. See Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 111, 109 S.Ct. 948, 954, 103 L.Ed.2d 80 (1989). Mr. Halpin argues that Grainger did not have discretion under the Plan to construe ambiguous terms and that therefore, under Bruch, Grainger’s determinations under the Plan should have been reviewed de novo. See id. It is plain, however, under our caselaw, that the language of the Plan gave discretion to Grainger to interpret the Plan. The Grainger Plan provides that the administrator “shall determine all questions arising in the administration, interpretation and operation of the Plan.” This language is very close to the language of the plan under review in Foster McGaw Hospital of Loyola University v. Building Material Chauffeurs, Teamsters & Helpers Welfare Fund of Chicago, 925 F.2d 1023, 1026 (7th Cir.) (plan giving trustees authority to “determine all questions arising in the administration, interpretation and application of the Health and Welfare Plan, including questions of eligibility ...” required deferential review), cert. denied, — U.S. —, 112 S.Ct. 74, 116 L.Ed.2d 48 (1991). 2

B. Statutory Procedures and Requirements for Denial of Benefits

ERISA sets certain minimum requirements for procedures and notification when a plan administrator denies a claim for benefits. In a nutshell, ERISA requires that specific reasons for denial be communicated to the claimant and that the claimant be afforded an opportunity for “full and fair review” by the administrator. *689 Section 1133, 29 U.S.C. § 1133, reads as follows:

In accordance with regulations of the Secretary, every employee benefit plan shall—
(1) provide adequate notice in writing to any participant or beneficiary whose claim for benefits under the plan has been denied, setting forth the specific reasons for such denial, written in a manner calculated to be understood by the participant, and
(2) afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim.

The regulations promulgated by the Secretary require that the initial notice of a claim denial contain

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962 F.2d 685, 15 Employee Benefits Cas. (BNA) 1500, 1992 U.S. App. LEXIS 9264, 1992 WL 91439, Counsel Stack Legal Research, https://law.counselstack.com/opinion/john-halpin-v-ww-grainger-incorporated-ca7-1992.