1 IN THE UNITED STATES COURT OF APPEALS 2 FOR THE FIFTH CIRCUIT
3 _______________
4 No. 92-1147 5 _______________
6 CRYSTAL CAMMACK MEDINA, 7 Plaintiff-Appellant,
8 VERSUS
9 ANTHEM LIFE INSURANCE COMPANY, 10 f/k/a American General Group Insurance Co.,
11 Defendant-Appellee.
12 _________________________
13 Appeal from the United States District Court 14 for the Northern District of Texas 15 _________________________
16 (January 28, 1993) 17 Before GOLDBERG, SMITH, and EMILIO M. GARZA, Circuit Judges. 18 JERRY E. SMITH, Circuit Judge: 19 Crystal Cammack Medina sought to amend her complaint to add 20 claims for recovery of extracontractual and punitive damages from 21 her insurance carrier, Anthem Life Insurance Company ("Anthem"), 22 under section 502(a)(1)(B) of the Employee Retirement Income 23 Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132(a)(1)(B). She 24 also sought recovery from Anthem of certain payments she had made 25 to one of her doctors. The district court refused to find that 26 section 502(a)(1)(B) allows extracontractual and punitive relief 27 and also refused to grant Medina recovery of other payments because
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28 she failed to exhaust administrative remedies. We affirm.
29 I. 30 Medina works for Credit Finance Corporation, which is insured 31 by Anthem, which presently insures Medina. In January 1988, Medina 32 began a course of dental treatments during which her doctor 33 submitted a request to Anthem for predetermination of a dental 34 procedure. Anthem's claim committee reviewed the request, 35 concluded that sufficient evidence did not exist to prove the 36 medical necessity of the procedure, and refused to pay any benefit. 37 Medina's doctor submitted the request again in 1990; Anthem's claim 38 committee further reviewed the request and once again reached the 39 same conclusion. 40 In April 1990, Medina sought a second opinion from another 41 doctor, who recommended a different procedure. Anthem's claim 42 committee still determined that it would not cover the procedure. 43 In June, Medina's attorney wrote to Anthem seeking to convince 44 Anthem to approve the new procedure. Anthem sent Medina's records 45 to the Medical Review Institute of America for an independent 46 evaluation. When the institute recommended going forward with the 47 procedure, Anthem approved the procedure on August 16, 1990. 48 The next day, Medina brought suit against Anthem in state 49 court, seeking $10,035 as the cost of treatment, $50,000 for pain 50 and suffering and mental anguish, and $500,000 in punitive damages. 51 Anthem removed the case to federal court. 52 Medina then filed an amended complaint that acknowledged that
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53 ERISA preempts her state law remedies. She requested that the 54 court clarify her rights to future benefits, enjoin Anthem's "acts 55 and practices," and award her costs and attorneys' fees. 56 On October 16, 1991, Medina sought leave to file a second 57 amended complaint to add a claim for extracontractual and punitive 58 damages based upon Anthem's handling of her claims. The magistrate 59 judge refused to allow Medina to amend her complaint, finding that 60 ERISA precludes the award of extracontractual and punitive relief. 61 On November 18, 1991, Anthem moved to dismiss the complaint 62 for failure to exhaust administrative remedies. Anthem argued that 63 it had paid all claims that Medina had submitted in accordance with 64 its policy. All that remained was a disputed $1,363.20 that Medina 65 averred to have paid her doctor for the latest procedure she had 66 undergone. Anthem asserted that Medina never submitted proper 67 documentation to Anthem's claims department, so Anthem had no 68 obligation to reimburse Medina. The magistrate judge agreed and 69 dismissed Medina's complaint for failure to exhaust administrative 70 remedies.
71 II. 72 We turn first to Medina's contention that the magistrate judge 73 erred in refusing to allow Medina to amend her complaint to add a 74 claim for extracontractual and punitive damages. Medina urges us 75 to develop a body of federal common law to supplement the express 76 provisions of ERISA, which include no mechanism for awarding 77 extracontractual or punitive damages. Joining the Seventh and
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78 Eleventh Circuits, we decline this invitation. 79 ERISA section 502(a) is the civil enforcement provision of the 80 statute. It provides that 81 [a] civil action may be brought )) 82 (1) by a participant or beneficiary )) 83 . . .
84 (B) to recover benefits due to him under the terms 85 of his plan, to enforce his rights under the 86 terms of the plan, or to clarify his rights to 87 future benefits to under the terms of the plan 88 . . . .
89 The plain language of this statute does not mention recovery of 90 extracontractual or punitive damages. Nothing in the statute 91 instructs us to fashion a federal common law remedy to grant 92 plaintiffs the right to recover punitive or extracontractual 93 damages. Nevertheless, Medina asks us to do just that. 94 Medina points to legislative history that indicates a 95 willingness on the part of Congress to allow federal courts to mold 96 a federal common law of ERISA. The Conference Report describing 97 ERISA section 502(a) states that a plan beneficiary may bring a 98 civil action
99 to recover benefits under the plan which do not involve 100 application of the title I provisions . . . [and suits] 101 may be brought not only in U.S. district courts but also 102 in State courts of competent jurisdiction. All such 103 actions in Federal or State courts are to be regarded as 104 arising under the laws of the United States in similar 105 fashion to those brought under section 301 of the Labor- 106 Management Relations Act of 1947.
107 H.R. Conf. Rep. No. 1280, 93d Cong., 2d Sess. 327, reprinted in 108 1974 U.S.C.C.A.N. 4639, 5107. As late as 1989, the House Budget 109 Committee "reaffirmed the authority of the federal courts to shape
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110 legal remedies to fit the facts and circumstances of the cases 111 before them, even though those remedies may not be specifically 112 mentioned in ERISA itself." Report of the Comm. on the Budget, 113 House of Rep., 101st Cong., 1st Sess. 55-56 (1989). 114 Unfortunately for Medina, Congress has had almost two decades 115 to enact its putative intent into law and has not done so. Had 116 Congress intended to develop ERISA remedies additional to the ones 117 it specifically crafted, it has had ample opportunity to enact such 118 legislation. Since Congress has not translated its intent into 119 law, we are loathe to take this initiative on our own. 120 In Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 52 (1987), the 121 Court considered whether Congress meant for the civil enforcement 122 provisions of section 502(a) to be the exclusive remedy for 123 beneficiaries. While the Court directed its opinion to the 124 question of whether ERISA preempts a state law claim for improper 125 processing of disability benefits, and decided that ERISA did 126 preempt, it also noted that the text of the statute argues 127 "strongly for the conclusion that ERISA's civil enforcement 128 remedies were intended to be exclusive." Id. at 54. The Court 129 concluded that the "`carefully integrated civil enforcement 130 provisions found in § 502(a) of the statute as finally 131 enacted . . . provide strong evidence that Congress did not intend 132 to authorize other remedies that it simply forgot to incorporate 133 expressly.'" Id. (quoting Massachusetts Mut. Life Ins. Co. v. 134 Russell, 473 U.S. 134, 146 (1983)). 135 In Russell, 473 U.S. at 144, the Court also addressed section
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136 502(a)(1)(B). Although the issue at bar in that case was whether 137 a fiduciary to a plan may be held liable for extracontractual or 138 punitive damages under ERISA section 409(a), the Court turned to 139 section 502(a)(1)(B) for insight by analogy. Id. It noted that 140 since that section "says nothing about the recovery of 141 extracontractual damages . . . there really is nothing at all in 142 the statutory text to support the conclusion" that the statute 143 intended to give "rise to a private right of action for 144 compensatory or punitive relief." Id. The Court held that 145 Congress did not intend for section 409(a) to include any relief 146 outside of that expressly authorized by the statute. Id. 147 Medina points out that the Court more recently has addressed 148 this issue in Ingersoll-Rand Co. v. McClendon, 498 U.S. 133, 111 149 S. Ct. 478, 486 (1990). In a case once more holding that ERISA 150 preempts state law claims for damages for wrongful discharge, the 151 Court mentioned in dicta that "there is no basis in § 502(a)'s 152 language for limiting ERISA actions to those which seek `pension 153 benefits.' It is clear that the relief requested here 154 [compensatory and punitive damages] is well within the power of 155 federal courts to provide." Id. 156 Both the Seventh and Eleventh Circuits have considered 157 Ingersoll-Rand and nevertheless have refused to fashion an 158 extracontractual or punitive remedy under section 502(a). In McRae 159 v. Seafarers' Welfare Plan, 920 F.2d 819, 821 n.7 (11th Cir. 1991), 160 Judge Wisdom, sitting by designation, explained the Ingersoll-Rand 161 dicta as follows:
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162 We do not interpret these statements to mean that the 163 remedies which the plaintiff in Ingersoll-Rand was 164 seeking )) future lost wages, mental anguish and punitive 165 damages )) are necessarily available under ERISA 166 § 502(a). The Supreme Court was stating that federal law 167 provides relief for ERISA actions other than those that 168 seek to recover pension benefits, such as the plaintiff's 169 cause of action for wrongful termination. The Supreme 170 Court is not holding that the specific remedies this 171 plaintiff had sought under state law are necessarily the 172 remedies that will be afforded him should he be granted 173 relief under ERISA § 502.
174 The court then went on to rely upon the reasoning in Russell to 175 hold that section 502(a)(3) precludes extracontractual remedies. 176 Id. at 822. It refused to "create a federal common law of remedies 177 for the benefit of the plaintiff on the sole authority of the House 178 Committee Report." Id. at 823. 179 Similarly, in Harsch v. Eisenberg, 956 F.2d 651, 660 (7th 180 Cir.), cert. denied, 113 S. Ct. 61 (1992), the court dealt with the 181 Ingersoll-Rand dicta by declaring,
182 We are not rash enough to believe that the Court intended 183 to overrule settled law in most of the circuits, as well 184 as narrowly limit )) if not overrule )) its own decision 185 in Russell in such an off-hand manner . . . . We will 186 continue to doubt the availability of extracontractual 187 damages under ERISA until a more plausible signal reaches 188 us from above.
189 The court held that neither extracontractual nor punitive damages 190 were available under section 502(a)(1)(B). Id. at 660-61.1 191 We join the other circuits that have held that section 192 502(a)(1)(B) does not allow the recovery of extracontractual or 193 punitive damages. Like the court in Harsch, we are reluctant to
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See also Reinking v. Philadelphia Life Ins. Co., 910 F.2d 1210, 1219 (4th Cir. 1990) (denying claim for extracontractual damages for emotional distress).
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194 believe that the Supreme Court intended us to create a body of 195 federal common law based upon an off-hand statement in Ingersoll- 196 Rand. The more direct language in Pilot Life, 481 U.S. at 54, and 197 Russell, 473 U.S. at 144, shows that the Court felt that the 198 statutory enforcement scheme Congress crafted for ERISA in section 199 502(a) did not include a private remedy for extracontractual and 200 punitive damages. Without explicit instructions from Congress, we 201 are bound to the plain language of the statute that limits suits to 202 the terms of the plan at issue, rather than arbitrarily extending 203 its scope to include suits for extracontractual and punitive 204 damages. The magistrate judge correctly refused to allow Medina to 205 amend her complaint to include a claim for extracontractual and 206 punitive damages under section 502(a)(1)(B).
207 III. 208 We turn next to the issue of whether the magistrate judge 209 properly dismissed Medina's claim for failure to exhaust 210 administrative remedies. We first note that Medina's brief admits 211 that Anthem has paid all benefits due her in full. The only 212 possible claim that might remain is the disputed bill for 213 $1,363.20. 214 On July 11, 1991, Medina answered interrogatories put to her 215 by Anthem. In answer to Interrogatory No. 11, Medina claimed that 216 Anthem owed her $1,363.20 for a medical bill that Medina had paid 217 and for which Anthem had not reimbursed her. 218 In its motion to dismiss for failure to exhaust administrative
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219 remedies, Anthem responds that it refused to reimburse Medina 220 because she never filed any documentation with Anthem's claims 221 department showing that she had paid the bill. Anthem asserts that 222 it cannot process a claim unless it has received that claim and 223 that it maintains a reasonable claim submission policy that Medina 224 has ignored. Anthem assures us that if Medina takes the initial 225 step of submitting a claim, it will calculate her benefits 226 accordingly. 227 As the magistrate judge noted, we have fully endorsed the 228 prerequisite of exhaustion of administrative remedies in the ERISA 229 context.2 One of the policies underlying the exhaustion 230 requirement was Congress's desire that ERISA trustees, not federal 231 courts, be responsible for their actions so that not every ERISA 232 action becomes a federal case. Denton, 765 F.2d at 1300. 233 We find that Medina has not exhausted her administrative 234 remedies regarding the unpaid $1,363.20 bill. Medina has never 235 filed a claim for the disputed sum. She obviously knows how 236 Anthem's claims procedure operates, as she previously has filed 237 claims for which Anthem reimbursed her. Medina may not make her 238 first claim for the unpaid $1,363.20 in this lawsuit but must 239 follow proper procedures in filing a claim with Anthem. Since she 240 has not exhausted her administrative remedies, the magistrate judge
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See Simmons v. Willcox, 911 F.2d 1077, 1081 (5th Cir. 1990) (ERISA claimant who failed to file claim with insurance company failed to exhaust administrative remedies, so no cause of action existed); Meza v. General Battery Corp., 908 F.2d 1262, 1279 (5th Cir. 1990) (plaintiff may not make initial claim for benefits in a lawsuit); Denton v. First Nat'l Bank, 765 F.2d 1295, 1303 (5th Cir. 1985) (Congress intended ERISA claimants to exhaust administrative remedies before resorting to federal courts).
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241 correctly dismissed her complaint.
242 IV. 243 In summary, we refuse to fashion federal common law that would 244 allow recovery of extracontractual and punitive damages under ERISA 245 section 502(a)(1)(B). We also find that Medina failed to exhaust 246 her administrative remedies by failing to file a claim with Anthem 247 for the disputed $1,363.20. Consequently, we AFFIRM the judgment 248 of dismissal.