Joseph Stevens v. Santander Holdings USA Inc Sel

799 F.3d 290, 60 Employee Benefits Cas. (BNA) 1715, 2015 U.S. App. LEXIS 14838, 2015 WL 5000809
CourtCourt of Appeals for the Third Circuit
DecidedAugust 24, 2015
Docket14-1481
StatusPublished
Cited by3 cases

This text of 799 F.3d 290 (Joseph Stevens v. Santander Holdings USA Inc Sel) is published on Counsel Stack Legal Research, covering Court of Appeals for the Third Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Joseph Stevens v. Santander Holdings USA Inc Sel, 799 F.3d 290, 60 Employee Benefits Cas. (BNA) 1715, 2015 U.S. App. LEXIS 14838, 2015 WL 5000809 (3d Cir. 2015).

Opinion

OPINION OF THE COURT

GREENBERG, Circuit Judge.

I. INTRODUCTION

This matter comes on before this Court on an appeal from an order entered in an action that plaintiff-appellee Joseph Stevens, a former employee of a subsidiary of defendant-appellant Santander Holdings USA Inc. (“Santander”), brought against Santander seeking to recover benefits from two disability benefit plans that Santander provided for its eligible employees. As an employee of a Santander subsidiary, Sovereign Bank, Stevens participated in these plans, a short-term disability plan *292 (“STD”) and a long-term disability plan (“LTD”). In October 2010, Stevens sought STD benefits through the administrator of Santander’s plans, defendant-appellant Liberty Life Assurance Company of Boston, doing business as Liberty Mutual (“Liberty Mutual”). After it initially awarded STD benefits to Stevens, Liberty Mutual determined that Stevens no longer suffered from a qualifying disability, a determination that led it to terminate his STD benefits. Stevens responded by bringing this action pursuant to the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1001 et seq., seeking reinstatement of the payment of benefits. The District Court found that Liberty Mutual’s decision to terminate Stevens’s STD benefits was arbitrary and capricious and remanded the case to the plan administrator with instructions to reinstate Stevens’s STD benefit payments retroactively and to determine his eligibility for LTD benefit payments.

Santander and Liberty Mutual appealed to this Court, but Stevens moved to dismiss the appeal for lack of jurisdiction, arguing that the District Court’s remand order to the plan administrator was not a “final decision” appealable pursuant to 28 U.S.C. § 1291 at that time. Before reaching the merits of this appeal, we must determine whether the District Court’s remand order is presently final and appealable under § 1291 or is otherwise appealable. Upon review, we hold that the District Court has retained jurisdiction over the case and that the order from which appellants have appealed is not yet appealable. We therefore will dismiss this appeal for lack of jurisdiction.

II. BACKGROUND

A. Factual Background and Administrative Proceedings

Sovereign Bank employed Stevens as a Retail Investment Financial Consultant II from October 2, 2006, through October 5, 2010. During his employment, Stevens received treatment for ankylosing spondylitis, a chronic inflammatory disease. As we have indicated, Santander sponsored and funded an STD benefits plan for its employees and engaged Liberty Mutual as the plan’s administrator. But even though Liberty Mutual was the plan administrator, Santander retained final decision-making authority in the review of STD claims and Santander paid any benefits awarded. Under the STD plan, a covered employee, such as Stevens, is considered “disabled” if objective medical evidence demonstrates that he is unable to perform the “material and substantial” duties of his own occupation, in Stevens’s case as a Retail Investment Financial Consultant II. “Material and substantial” duties are those normally required to be performed that cannot be eliminated or modified.

Santander also purchased an LTD benefit plan from Liberty Mutual. The administration and funding of the LTD plan differed from that of the STD plan because Liberty Mutual both administered and had final decision-making authority under the LTD plan and paid benefits awarded under the plan. To qualify for LTD benefits, an employee needs to show that he is “unable to perform the Material and Substantial duties of his Own Occupation” for an “elimination period” of 180 days, and thereafter cannot perform these duties for the next 24 months. During the “elimination period,” an employee does not receive benefits under the LTD plan, but he can receive LTD benefits during the 24-month “Own Occupation” period that follows. However, during the elimination period the employee may be eligible for STD benefits, and thus the two plans complement each other as LTD benefits can start when STD *293 benefits stop. 1 After the expiration of the 24-month “Own Occupation” period, an employee will be eligible for LTD benefits only if he demonstrates that he is “unable to perform, with reasonable continuity, the Material and Substantial Duties of Any Occupation.” (J.A. 67.)

On or about October 5, 2010, Stevens began a leave of absence from Sovereign Bank due to worsening symptoms related to his medical condition. Consequently, Stevens filed a claim with Liberty Mutual for STD payments as he asserted that he was subject to qualifying physical restrictions and cognitive impairments. Liberty Mutual reviewed records of Stevens’s treating rheumatologist and approved his request for STD benefits through December 21, 2010. 2 In December, Liberty Mutual reviewed updated medical information and approved payment of STD benefits through February 5, 2011.

Liberty Mutual again reviewed Stevens’s updated records in February 2011, this time determining that his medical reports did not substantiate Stevens’s subjective complaints of pain. Accordingly, it forwarded the case for review to an independent physician, Dr. Sara Kramer, a board certified physician in internal medicine and rheumatology. After Dr. Kramer reviewed Stevens’s records and spoke with Stevens’s treating rheumatologist, she concluded that Stevens could return to work provided that he was allowed certain accommodations, including being permitted to stretch and change positions as needed throughout the course of an eight-hour day. 3 Liberty Mutual subsequently informed Stevens that his condition no longer met the definition of disability and therefore it would not award him additional STD benefits. The termination of Stevens’s eligibility for STD benefits effectively rendered Stevens ineligible for LTD benefits as he could not demonstrate that he was unable to perform his own occupation’s duties throughout the 180-day elimination period.

After Liberty Mutual notified Stevens that he was not eligible for further STD benefits, Stevens filed a series of administrative appeals with Liberty Mutual that he supported with medical records and additional documentation. In response to each of Stevens’s requests for review of additional information, Liberty Mutual enlisted medical professionals to evaluate the information in his record and the new information that he provided. On November 10, 2011, Liberty Mutual made a final determination that Stevens was no longer eligible for STD benefits, and it provided its final recommendation and analysis to that end to Santander, which, in turn, approved the decision a short time thereafter. Liberty Mutual then notified Stevens of the final decision to deny him further STD benefits.

B. District Court Proceedings

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Bluebook (online)
799 F.3d 290, 60 Employee Benefits Cas. (BNA) 1715, 2015 U.S. App. LEXIS 14838, 2015 WL 5000809, Counsel Stack Legal Research, https://law.counselstack.com/opinion/joseph-stevens-v-santander-holdings-usa-inc-sel-ca3-2015.