M. v. Premera Blue Cross

992 F.3d 1051
CourtCourt of Appeals for the Tenth Circuit
DecidedApril 5, 2021
Docket18-4098
StatusPublished

This text of 992 F.3d 1051 (M. v. Premera Blue Cross) 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
M. v. Premera Blue Cross, 992 F.3d 1051 (10th Cir. 2021).

Opinion

FILED United States Court of Appeals PUBLISH Tenth Circuit

UNITED STATES COURT OF APPEALS April 5, 2021

Christopher M. Wolpert FOR THE TENTH CIRCUIT Clerk of Court _________________________________

LYN M.; DAVID M., as Legal Guardians of L.M., a minor,

Plaintiffs - Appellants,

v. No. 18-4098 (D.C. No. 2:17-CV-01152-BSJ) PREMERA BLUE CROSS; MICROSOFT (D. Utah) CORPORATION WELFARE PLAN,

Defendants - Appellees. ----------------------- AMERICAN BENEFITS COUNCIL,

Movant. _________________________________

ORDER _________________________________

Before BRISCOE, LUCERO, HARTZ, HOLMES, BACHARACH, PHILLIPS, MORITZ, EID, and CARSON, Circuit Judges*† ________________________________

This matter is before us on the Petition for Panel Rehearing and Rehearing En

Banc filed by Premera Blue Cross (“Premera”). We also have a response from Appellant.

* The Honorable Timothy M. Tymkovich, the Honorable Scott M. Matheson, and the Honorable Carolyn B. McHugh are recused and did not participate in the consideration of the rehearing petition. † Although the Honorable Mary Beck Briscoe and the Honorable Carlos F. Lucero took senior status prior to the entry of this order, voting in the poll called on the rehearing petition was completed while they were in active status. Pursuant to Federal Rule of Appellate Procedure 40, Premera’s request for panel

rehearing is denied by a majority of the original panel members. Judge Eid would grant

panel rehearing.

Both the petition and the response were transmitted to all non-recused judges of

the court who are in regular active service. A poll was called and did not carry.

Consequently, Premera’s request for en banc rehearing is denied pursuant to Federal Rule

of Appellate Procedure 35.

Judges Hartz, Eid and Carson would grant en banc rehearing. Judge Bacharach has

filed a separate concurrence in support of the denial of en banc rehearing, which is joined

by Judges Briscoe and Lucero. Judge Eid has filed a separate dissent, which is joined by

Judges Hartz and Carson.

The American Benefits Council’s motion for leave to file an amicus curiae brief in

support of Premera’s rehearing petition is granted.

Entered for the Court,

CHRISTOPHER M. WOLPERT, Clerk

2 Lyn M., et al. v. Premera Blue Cross, et al., No. 18-4098 BACHARACH, J., concurring in the denial of en banc rehearing, joined by BRISCOE, J., and LUCERO, J.

Our dissenting colleague urges en banc consideration, expressing

concern that the panel majority has “imposed a new duty of ERISA plan

administrators to notify plan members ‘that undistributed, inspectable

documents could affect the scope of judicial review.’” Dissent from Denial

of En Banc Rehearing at 1 (quoting Lyn M. v. Premera Blue Cross, 966

F.3d 1061, 1067 (10th Cir. 2020) (Eid, J. dissenting)). This concern

reflects a misconception of the panel opinion.

1. The panel opinion does not expand a plan administrator’s duties under ERISA.

The panel never addressed a plan administrator’s duty under ERISA

to notify members about a plan’s provisions. The majority instead

addressed only (1) the standard of review when a member sues and (2) the

plan administrator’s error under any standard of review by failing to apply

the medical policy’s criteria. Our dissenting colleague addresses the first

issue, having expressed no opinion in her panel dissent on the second

issue.

That standard of review comes from federal common law, not ERISA.

See Gilbertson v. Allied Signal, Inc., 328 F.3d 625, 632 (10th Cir. 2003)

(“Because ERISA is silent with respect to the standard of review, the court

[in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989)] looked to applicable common law principles to decide the question.”). Under the

federal common law, a reservation of discretionary authority requires

notice to plan participants. See, e.g., Rodriguez-Lopez v. Triple-S Vida,

Inc., 850 F.3d 14, 20 (1st Cir. 2017) (stating that the arbitrary–and–

capricious standard applies “[i]f the plan gives the plan participant or

covered beneficiary adequate notice of [a reservation of discretionary

authority]”).

The plan administrator packed discretion into a document called the

“Microsoft Corporation Welfare Plan.” But this document was never

mentioned in any of the materials supplied to participants. So they had no

way of knowing that this document existed.

Our dissenting colleague argues that participants could have learned

about the Microsoft Corporation Welfare Plan by asking to examine any

documents relevant to the claims. But how would participants have known

to ask for this document? The summary plan description never mentioned

the existence of the Microsoft Corporation Welfare Plan (the document

providing for discretionary authority) or suggested that another document

existed that might reserve discretionary authority. And even if a participant

had requested examination of all relevant documents, the request may have

lacked enough specificity to trigger production of any documents. See Lyn

M. v. Premera Blue Cross, 966 F.3d 1061, 1066 (10th Cir. 2020) (stating

2 that to exercise the right to examine plan documents, participants “must

clearly identify whatever they want to examine”).

The panel majority thus concluded that the plan administrator had not

provided notice of the reservation of its discretionary authority. Lyn M. v.

Premera Blue Cross, 966 F.3d 1061, 1068 (10th Cir. 2020). Given the lack

of notice, the panel majority determined that on remand, the district court

should conduct de novo review of the denial of plan benefits. Id.

Our dissenting colleague disagrees, chiding the panel majority for

expanding the plan administrator’s statutory duties to provide notice. But

the majority has not addressed the plan administrator’s statutory duties to

provide notice. Given the absence of any discussion of the issue, the panel

majority could not possibly have expanded the plan administrator’s

statutory duties.

The panel opinion simply holds that

 the federal common law’s arbitrary–and–capricious standard of review applies only if participants obtain notice of the plan administrator’s discretionary authority,

 notice requires at least something that would alert participants to the existence of a document reserving discretion to the plan administrator, and

 such notice was absent here.

This case–specific, fact–bound opinion does not expand a plan

administrator’s duties under ERISA.

3 2. The panel appropriately considered existing case law to determine whether the plan administrator can furnish notice through a secret document containing clear language.

Our dissenting colleague also criticizes the panel majority for relying

on cases addressing the sufficiency of notice as to discretionary authority.

As our colleague notes, other circuits have held that the nature of

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Related

Alessi v. Raybestos-Manhattan, Inc.
451 U.S. 504 (Supreme Court, 1981)
Firestone Tire & Rubber Co. v. Bruch
489 U.S. 101 (Supreme Court, 1989)
Curtiss-Wright Corp. v. Schoonejongen
514 U.S. 73 (Supreme Court, 1995)
Aetna Health Inc. v. Davila
542 U.S. 200 (Supreme Court, 2004)
Stamper v. Total Petroleum, Inc. Retirement Plan
188 F.3d 1233 (Tenth Circuit, 1999)
Gilbertson v. Allied Signal, Inc.
328 F.3d 625 (Tenth Circuit, 2003)
EUGENE S. v. Horizon Blue Cross Blue Shield
663 F.3d 1124 (Tenth Circuit, 2011)
Thurber v. Aetna Life Insurance
712 F.3d 654 (Second Circuit, 2013)
Gross v. Sun Life Assurance Co. of Canada
734 F.3d 1 (First Circuit, 2013)
Rodriguez-Lopez v. Triple-S Vida, Inc.
850 F.3d 14 (First Circuit, 2017)
M. v. Premera Blue Cross
966 F.3d 1061 (Tenth Circuit, 2020)

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Bluebook (online)
992 F.3d 1051, Counsel Stack Legal Research, https://law.counselstack.com/opinion/m-v-premera-blue-cross-ca10-2021.