Phelan v. Wyoming Associated Builders

574 F.3d 1250, 47 Employee Benefits Cas. (BNA) 1900, 2009 U.S. App. LEXIS 17197, 2009 WL 2343739
CourtCourt of Appeals for the Tenth Circuit
DecidedJuly 31, 2009
Docket08-8055
StatusPublished
Cited by11 cases

This text of 574 F.3d 1250 (Phelan v. Wyoming Associated Builders) 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
Phelan v. Wyoming Associated Builders, 574 F.3d 1250, 47 Employee Benefits Cas. (BNA) 1900, 2009 U.S. App. LEXIS 17197, 2009 WL 2343739 (10th Cir. 2009).

Opinions

McCONNELL, Circuit Judge.

Scott Phelan, recently diagnosed with bone cancer at age twenty-six, was covered by the healthcare plan of his former employer, which in turn was a member of Wyoming Associated Builders, Inc. (“WAB”), a trade organization that maintained a trust to provide health insurance benefits for its members’ employees. Just as Mr. Phelan was about to submit an unusually large claim relating to his cancer treatment, WAB terminated his employer’s membership in the insurance trust, purportedly because that employer had submitted a payment that was both late and in the wrong form. Mr. Phelan was denied health benefits as a result. He brought a number of claims against both WAB and his employer, one of which alleged that WAB had breached its fiduciary duty, thus entitling him to equitable relief under 29 U.S.C. § 1132(a)(3) of the Employee Retirement Income Security Act (ERISA). The district court found that WAB’s stated reasons for terminating Mr. Phelan’s employer were a pretext for avoiding payment on Mr. Phelan’s pending claim and that the termination was arbitrary and capricious. It ordered retroactive reinstatement of his employer’s health care coverage as a remedy. WAB now appeals, arguing that retroactive reinstatement is a legal remedy (and thus impermissible under § 1132(a)(3)), and also that the termination was not arbitrary and capricious. We disagree on both grounds and affirm the district court.

I. BACKGROUND

The Lock Shop of Cheyenne operates a locksmith business in Cheyenne, Wyoming. It provides health insurance for its employees through Wyoming Associated [1252]*1252Builders, Inc., a non-profit trade organization that provides more than fifty other businesses with health insurance for their employees. WAB, in turn, provides this coverage through the Wyoming Associated Builders Insurance Trust (“WABIT”). WABIT is administered by a board of trustees who are authorized to construe the provisions of the trust agreement, promulgate rules, and delegate ministerial powers and duties. The WABIT board hired Josh Carnahan to serve as plan administrator; Mr. Carnahan then delegated the day-to-day management of the trust to Benefit Administrators, Inc., a company owned and operated by Lynn Johnson.

Plan participants were required to pay premiums on the first day of each month. In June 2006, WABIT promulgated a late payment policy for the first time. The policy provided for both late payment penalties and eventual termination. While premiums were still due on the first of each month, “Premiums not received (postmarked) by the 10th of each month will have a 25% of premium due, up to a maximum of $500 penalty applied. The Trust Board also recommends the use of ACH [Automated Clearing House] transfers for premium payment, which is available from Benefit Administrators.” Dist. Op. 8-9 (formatting omitted). As for termination, “If premiums are not paid by the 15th of the month, the Plan Administrator is notified and if premiums are still not received by the 20th of the month, the group is recommended by the Plan Administrator for termination by the Trust Board, with the termination effective retroactive back to the 1st of the month.” Id. at 9 (formatting omitted).

The Lock Shop ran into financial difficulties in 2006 and struggled to make its payments on time. In June 2006, its premium check bounced. So did its October payment. On October 30, Lynn Johnson mailed the Lock Shop a letter informing it that its October payment had been returned for insufficient funds and requesting repayment by either money order or cashier’s check. The Lock Shop made its October payment on November 6.

The Lock Shop was not the only one in bad financial shape that year. In the summer of 2006 a consultant had informed the WAB participants that use of the plan was higher than expected. In the past year, WABIT had spent almost $4.5 million paying out claims, but it had collected only a bit over $3.3 million in premiums. Two claims alone totaled over $1.2 million. Although the Trust carried stop-loss insurance that would pay claims over $75,000, the existence of such claims would have ramifications for renewal of the stop-loss policy. Terminating the Lock Shop’s coverage would therefore eliminate Mr. Phelan’s very expensive claim at a time when the Trust badly needed it.

In December, the Lock Shop was again behind in its payments. Ms. Johnson called the Lock Shop on December 13 and notified it that if its premium payment was not posted to the account by December 20, the Lock Shop would be terminated. Ms. Johnson also told the Lock Shop that the payment should be made by cashier’s check or ACH. After scrambling to raise funds, Tami Austin of the Lock Shop mailed a personal check to WAB’s bank, Hilltop National Bank, on the afternoon of December 19. She sent the check by Federal Express, which assured her that the check would be delivered by the next morning. Unfortunately for the Lock Shop and its employees, Mother Nature intervened: a severe snowstorm hit Cheyenne that night and delayed all deliveries. The check arrived at Hilltop National Bank at 3:15 p.m. on December 20, but the snowstorm had forced the Cheyenne banks to close at noon. Thus, while Hilltop National Bank had physically received the [1253]*1253check, it was unable to post the payment into WABIT’s account until the next day.

When Ms. Johnson and Mr. Carnahan had spoken about Lock Shop the night before payment was due, Mr. Carnahan told Ms. Johnson to terminate Lock Shop if the payment was not received the next day. Benefit Administrators checked the WABIT bank account on the afternoon of December 20 and saw that no payment had posted, so it contacted Mr. Carnahan. He immediately took action to terminate Lock Shop from the plan. As soon as the Lock Shop learned of its termination it appealed to the WABIT board, explaining that the payment did indeed make it to the bank by the deadline, but that the snowstorm had unexpectedly prevented it from making it in time to be posted on that day. The trustees nevertheless denied the appeal on the grounds that the Lock Shop’s payment was late and, even if it had been timely, was made by personal check rather than cashier’s check or ACH.

As noted above, the Lock Shop’s termination did not occur in a vacuum. WABIT was facing some serious financial liabilities, and the elimination of Mr. Phelan’s claim would provide much-needed financial relief. Both Ms. Johnson and Mr. Carnahan claimed not to have been aware of Mr. Phelan’s pending claim, but the district court found that this strained credulity. Ms. Johnson had spoken to Mr. Phelan’s father on November 30, and on December 8 — -just days before the decision was made to terminate Lock Shop — Mr. Phelan’s father had sent Benefit Administrators notification by certified mail that his son had been undergoing chemotherapy and radiation therapy since October and would soon have to undergo surgery to remove a cancerous tumor.

After a bench trial, the court found that it was this desire to avoid paying Mr. Phelan’s expensive claim that truly motivated the Lock Shop’s termination. While WAB contended that the termination was a reasonable application of its administrative policies and was necessary to ensure prompt and timely payments to the Trust, the district court found that, in truth, “the termination was prompted by a desire to avoid further financial risk to the Trust by the payment of [Mr. Phelan’s] cancer expenses,” Dist. Op.

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

Related

Arapahoe Surgery Center, LLC v. Cigna Healthcare, Inc.
171 F. Supp. 3d 1092 (D. Colorado, 2016)
Foster v. PPG Industries, Inc.
693 F.3d 1226 (Tenth Circuit, 2012)
Gautier-Figueroa v. Bristol-Myers Squibb Puerto Rico, Inc.
845 F. Supp. 2d 444 (D. Puerto Rico, 2012)
EUGENE S. v. Horizon Blue Cross Blue Shield
663 F.3d 1124 (Tenth Circuit, 2011)
Coriale v. Xerox Corp.
775 F. Supp. 2d 583 (W.D. New York, 2011)
Dove v. Prudential Insurance Co. of America
364 F. App'x 461 (Tenth Circuit, 2010)
Phelan v. Wyoming Associated Builders
574 F.3d 1250 (Tenth Circuit, 2009)

Cite This Page — Counsel Stack

Bluebook (online)
574 F.3d 1250, 47 Employee Benefits Cas. (BNA) 1900, 2009 U.S. App. LEXIS 17197, 2009 WL 2343739, Counsel Stack Legal Research, https://law.counselstack.com/opinion/phelan-v-wyoming-associated-builders-ca10-2009.