Marc Kutten v. Sun Life Assurance Co.

759 F.3d 942, 58 Employee Benefits Cas. (BNA) 2938, 2014 WL 3562784, 2014 U.S. App. LEXIS 13814
CourtCourt of Appeals for the Eighth Circuit
DecidedJuly 21, 2014
Docket13-2559
StatusPublished
Cited by13 cases

This text of 759 F.3d 942 (Marc Kutten v. Sun Life Assurance Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eighth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Marc Kutten v. Sun Life Assurance Co., 759 F.3d 942, 58 Employee Benefits Cas. (BNA) 2938, 2014 WL 3562784, 2014 U.S. App. LEXIS 13814 (8th Cir. 2014).

Opinions

SHEPHERD, Circuit Judge.

Marc Kutten sued Sun Life Assurance Company of Canada, alleging that Sun Life improperly denied him long-term disability benefits under a disability plan governed by the Employee Retirement Income Security Act of 1974 (ERISA). Sun Life and Kutten filed cross-motions for summary judgment. The district court denied Sun Life’s motion for summary judgment and granted Kutten’s motion. We reverse.

I.

Kutten was the president and a co-owner of Property Solutions Group LLC. In 1994, Kutten was diagnosed with retinitis pigmentosa, a progressive eye disease that can eventually lead to blindness. At his doctor’s direction and under his doctor’s supervision, Kutten took 15,000 units a day of a non-prescribed, over-the-counter vitamin A palmitate supplement. J.A. 431. The National Eye Institute supported Kut-ten’s course of treatment, and, though his vitamin A supplements could not cure his retinitis pigmentosa, they could slow the disease’s rate of progression.

Prior to June 2010, Property Solutions Group offered a group disability benefit plan through Aetna. The Aetna plan offered maximum gross benefits of $1,000 a month. Effective June 1, 2010, Property Solutions Group purchased a new policy with Sun Life. The Sun Life Plan (the Plan) offered maximum gross benefits of $6,000 a month. The Plan also included an exclusion for pre-existing conditions:

No LTD benefit will be payable for any Total or Partial Disability that is due to:
6. a Pre-Existing Condition.
Pre-Existing Condition means during the 3 months prior to the Employee’s Effective Date of Insurance the Employee received medical treatment, care or services, including diagnostic measures, or took prescribed drugs or medicines for the disabling condition.1

J.A. 133. If Sun Life determined that an employee had a pre-existing condition according to the Pre-Existing Condition clause, then the employee was not entitled to the benefits under the Plan. The employee was still entitled, however, to the same level of benefits available to the employee under the Aetna plan. J.A. 134.

On September 21, 2010, Kutten’s eye condition forced him to stop working. He applied for long-term disability benefits under the Plan on October 6, 2010. After initially denying Kutten’s claim, Sun Life [944]*944concluded on appeal that Kutten was “Totally Disabled.” Nevertheless, Sun Life determined that Kutten was not entitled to the increased amount of $6,000 a month under the Plan because his retinitis pig-mentosa constituted a pre-existing condition. According to Sun Life, Kutten’s daily use of vitamin A supplements at his doctor’s direction qualified as a “medical treatment.” Because Kutten received his “medical treatment” during the three-month period prior to the Plan’s effective date, the Pre-Existing Condition clause barred full benefits.

Kutten filed suit in February 2012. Kutten and Sun Life filed cross-motions for summary judgment. The district court granted Kutten’s motion for summary judgment, finding that Sun Life abused its discretion in construing the Pre-Existing Condition clause to apply to Kutten’s taking of supplements. According to the court, Sun Life’s broad interpretation of the phrase “medical treatment” was contrary to the Plan’s plain language and rendered portions of the clause meaningless and internally inconsistent. Sun Life appealed.

II.

The parties agree that the Plan grants Sun Life discretionary authority to construe its terms. We therefore review Sun Life’s decision for abuse of discretion. See King v. Hartford Life & Acc. Ins. Co., 414 F.3d 994, 998-99 (8th Cir.2005) (en banc). Applying the abuse-of-discretion standard, an “administrator’s interpretation of uncertain terms in a plan ‘will not be disturbed if reasonable.’” Id. at 999 (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 111, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989)). In Finley v. Special Agents Mut. Ben. Ass’n, 957 F.2d 617, 621 (8th Cir.1992), our court developed factors to assess the reasonableness of an administrator’s decision. Under Finley, we consider whether the “administrator’s interpretation (1) is consistent with the plan’s goals; (2) renders any of the plan language meaningless or internally inconsistent; (3) conflicts with the substantive or procedural requirements of ERISA; (4) has been followed similarly in the past; and (5) is contrary to the clear language of the policy.” Khoury v. Grp. Health Plan, Inc., 615 F.3d 946, 954 (8th Cir.2010) (citing Finley, 957 F.2d at 621). Though these factors “inform our analysis,” “ ‘[t]he dispositive principle remains ... that where plan fiduciaries have offered a “reasonable interpretation” of disputed provisions, courts may not replace [it] with an interpretation of their own — and therefore cannot disturb as an “abuse of discretion” the challenged benefits determination.’ ” King, 414 F.3d at 999 (alterations in original) (quoting de Nobel v. Vitro Corp., 885 F.2d 1180, 1188 (4th Cir.1989)).

This case turns on a narrow question. Was it reasonable for Sun Life to conclude that Kutten’s vitamin A supplements constituted a “medical treatment”? The parties focus their attention on Finley factors two and five: whether the administrator’s interpretation renders language meaningless or internally inconsistent and whether the interpretation is contrary to clear language of the policy. .Because these inquiries are closely related in this case, we will analyze them together.

Kutten urges us to adopt the district court’s rationale, that because the PreExisting Condition clause separates “medical treatment” from “prescribed drugs or medicines” with the conjunction “or,” Sun Life intended to exclude all “drugs or medicines” from the phrase “medical treatment.” Kutten argues if “prescribed drugs or medicines” are excluded from the phrase “medical treatment,” then vitamin A supplements must be excluded from the phrase as well because vitamin supplements require even less medical interven[945]*945tion than “prescribed drugs or medicines.” To construe the phrase “medical treatment” to include vitamin supplements but exclude “prescribed drugs or medicines” would create an internal inconsistency in the Pre-Existing Condition clause, and to construe the phrase “medical treatment” as broad enough to encompass both “prescribed drugs or medicines” and vitamin supplements would render the phrase “prescribed drugs or medicines” meaningless.

We decline to adopt Kutteris rigid construction of the Pre-Existing Condition clause. In Smith v. United Television, Inc. Special Severance Plan, 474 F.3d 1033 (8th Cir.2007), our court refused to “mechanically interpret” every “or” contained in an ERISA plan as disjunctive and instead opted to “interpret the word ‘or’ according to context.” Id.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
759 F.3d 942, 58 Employee Benefits Cas. (BNA) 2938, 2014 WL 3562784, 2014 U.S. App. LEXIS 13814, Counsel Stack Legal Research, https://law.counselstack.com/opinion/marc-kutten-v-sun-life-assurance-co-ca8-2014.