McDermott v. GMAC Mortgage Group, LLC Comprehensive Welfare Benefits Plan

389 F. App'x 153
CourtCourt of Appeals for the Third Circuit
DecidedAugust 6, 2010
Docket09-3414
StatusUnpublished
Cited by1 cases

This text of 389 F. App'x 153 (McDermott v. GMAC Mortgage Group, LLC Comprehensive Welfare Benefits Plan) 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
McDermott v. GMAC Mortgage Group, LLC Comprehensive Welfare Benefits Plan, 389 F. App'x 153 (3d Cir. 2010).

Opinion

OPINION

HILLMAN, District Judge:

GMAC Mortgage Group, LLC Comprehensive Welfare Benefits Plan (“the Plan”) appeals the granting of David McDer-mott’s (“McDermott”) motion for summary judgment. The District Court determined that McDermott was entitled to supplemental long-term disability benefits under the Plan, and denied the Plan’s cross-motion for summary judgment. The District *155 Court had jurisdiction to consider the parties’ motions under 29 U.S.C. §§ 1132(e)(1) and (f), as well as 28 U.S.C. § 1331, and we have jurisdiction under 28 U.S.C. § 1291. We will affirm.

I. Background

On January 15, 2007, McDermott applied for supplemental long-term disability coverage (“the Policy”), which was one component of the Plan offered by his employer, GMAC Residential Capital Corporation, LLC (“GMAC”), and administered by Metropolitan Life Insurance Company (“MetLife”). The effective date of the Policy was April 1, 2007. Shortly after applying for the Policy, McDermott took a medical leave of absence from January 19, 2007 until April 16, 2007. He then returned to work on April 17, 2007 for three months, until going out indefinitely as a result of illness again on July 17, 2007. After complying with the requisite waiting period and paying his premiums, McDermott applied for benefits under the Policy. His application was denied by MetLife in December 2007, on the grounds that he was not “actively at work” as of the effective date of the Policy. McDermott’s appeals of this decision were also denied and the instant litigation followed.

The District Court found that the Plan did not contain language sufficient to confer discretionary authority on MetLife and, accordingly, that a deferential standard of review of its denial of benefits was not appropriate. Applying a de novo standard of review, the District Court considered two different provisions cited by the parties.

First, the District Court considered the Short-Form Application for Individual Disability Income Insurance (“the Application”), cited by the Plan, which provides:

MetLife will have no liability unless the Proposed Insured is working 30 hours per week at the regular place of business of the employer named in this application as of the effective date of the policy, or is in school on a full-time basis if a student.

(App. at 44 (emphasis added).) If this provision controlled, McDermott would have been properly denied benefits since he was on leave on April 1, 2007, the effective date of the Policy.

Second, the District Court considered the Summary Plan Description (“SPD”), cited by McDermott, which provides:

When Does Coverage Begin?
If you are a new hire, your coverage for a particular benefit begins on the date specified in Schedule A for that benefit and remains in effect through December 31 of the calendar year in which you first become eligible. Please note that you must be Actively-at-Work as an eligible associate (see “Eligibility” section page 6) in order for your benefit to become effective. If you are not actively at work as an eligible associate when your benefits would otherwise become effective, these benefits will become effective on the date of your return to “Active Work” as an eligible associate. “Actively-at-Work” or “Active Work” means that you are performing all the material duties of your job with the Employer where these duties are normally carried out. If you were Actively-at-Work on your last scheduled working day, you will be deemed Actively-at-Work while on a paid vacation or on a scheduled non-working day, provided you are not disabled.

(Id. at 21 (emphasis added).) In contrast to the Application, if this provision applied to McDermott, by its terms the Policy became effective on April 17, 2007, the date he returned from his leave.

*156 The District Court concluded that the SPD was susceptible to two possible meanings, as it could be read to apply to all employees (McDermott’s position) or to new hires only (the Plan’s position). Applying the doctrine of contra proferen-tem, 1 the District Court held that it must interpret the SPD in the manner most favorable to McDermott, that when so interpreted the SPD conflicts with the Application, and that the SPD must control when such a conflict exists. The District Court thus held that the effective date of the Policy was April 17, 2007, the date McDermott returned to active work, and MetLife erred in finding McDermott ineligible for benefits because he was not at work on April 1, 2007.

The Plan argues that the District Court erred in applying a de novo standard of review, and that MetLife’s determination should have been reviewed under an arbitrary and capricious standard because it was granted discretionary authority under the Plan. Further, the Plan argues that the District Court erred in finding that a conflict existed between the SPD and the Application. Instead, it argues, the SPD clearly and unambiguously related to new hires, MetLife’s interpretation of the SPD was correct and at the very least reasonable, and even if a conflict existed the Application should have governed.

II. Discussion

This Court exercises plenary review over an appeal from a grant of summary judgment. Jacobs Constructors, Inc. v. NPS Energy Servs., Inc., 264 F.3d 365, 369 (3d Cir.2001). Summary judgment is appropriate if there is no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. Id. (citing Fed.R.Civ.P. 56(c)). “In making this determination, we must consider the evidence in the record in the light most favorable to the nonmoving party.” Id.

It is well established that a court must apply a de novo standard of review to adverse benefits determinations “unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan,” in which case an arbitrary and capricious standard of review is applied. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). In determining the appropriate standard of review, a court must accordingly start with the terms of the plan. Id. at 111, 109 S.Ct. 948.

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Cite This Page — Counsel Stack

Bluebook (online)
389 F. App'x 153, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcdermott-v-gmac-mortgage-group-llc-comprehensive-welfare-benefits-plan-ca3-2010.