Russell v. Catholic Healthcare Partners Employee Long Term Disability Plan

614 F. App'x 271
CourtCourt of Appeals for the Sixth Circuit
DecidedJune 8, 2015
Docket13-4084
StatusUnpublished

This text of 614 F. App'x 271 (Russell v. Catholic Healthcare Partners Employee Long Term Disability Plan) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Russell v. Catholic Healthcare Partners Employee Long Term Disability Plan, 614 F. App'x 271 (6th Cir. 2015).

Opinions

AMENDED OPINION

ARTHUR J. TARNOW, Senior District Judge.

Plaintiff-Appellant appeals the dismissal of her claim for long-term disability (“LTD”) benefits under her employee compensation package. Plaintiff had worked as a registered nurse for about thirty years when she applied for disability benefits in 2007. Defendant-Appellee Unum granted Plaintiff twenty-four months of [273]*273LTD benefits starting in 2007, and then terminated her benefits in 2009. Plaintiff filed her ERISA claim in 2011, wherein the district court upheld the administrative determination of Plaintiffs claim. The district court found that Plaintiffs claim was time-barred and, that even if her claim had been timely, her claim failed on its merits because the administrative decision was not arbitrary and capricious. In this appeal, we hold that Plaintiffs ERISA action was timely and that the administrative decision was not arbitrary and capricious. Accordingly, we AFFIRM the judgment of the district court.

Jurisdiction is not forfeitable or waivable; therefore, we must first address Plaintiffs jurisdictional arguments. In re Lindsey, 726 F.3d 857, 858 (6th Cir.2013). For the reasons stated below, we hold that we have subject-matter jurisdiction to decide this appeal. Next, we hold that Plaintiffs claims are not time-barred pursuant to the intervening precedent in Moyer v. Metro. Life Ins. Co., 762 F.3d 503 (6th Cir.2014). Finally, we reach the merits of Plaintiffs claim and hold that Defendants’ termination of her LTD benefits was not arbitrary and capricious.

On May 12, 2007, Plaintiff became unable to perform her occupational duties due to bilateral knee osteoarthritis, right ankle post-traumatic osteoarthritis, anxiety, and depression. Plaintiff remained disabled until November 12, 2007, satisfying Unum’s six-month elimination period and becoming eligible to receive disability benefits. In a letter dated November 15, 2007, Unum informed Plaintiff that they had approved her claim for disability benefits effective November 12, 2007. A.R. 347-48. Unum informed Plaintiff that they found her eligible for twelve months of benefits at that time because she was “limited from performing the material and substantial duties of [her] regular occupation due to [her] sickness or injury ...” A.R. 348. In that same November 2007 letter, Unum informed Plaintiff “[a]fter 24 months of payments, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.” Id. The November 2007 letter also informed Plaintiff of Unum’s contractually reserved right to request proof of continuing disability. In the fall of 2008, Unum approved Plaintiffs eligibility for disability benefits for an additional twelve months. Throughout the twenty-four month period, Unum sent Plaintiff several written requests for proof of continuing disability.

■ After twenty-four months of benefits, Unum terminated Plaintiffs LTD benefits, finding that Plaintiffs medical records indicated that she could work as a Triage Nurse or Nurse Case Manager. Plaintiff exhausted Unum’s internal administrative appeal process on July 20, 2010, when Unum issued its final decision denying Plaintiffs LTD benefits. A.R. 1466472.

Oh March 30, 2011, Plaintiff filed an action in the district court seeking a reversal of the plan administrator’s decision denying her benefits. The parties filed dueling motions in the -district court — Plaintiff filed a Motion for Judgment Reversing Administrator’s Decision and Defendant filed a Motion to Uphold the Administrative Decision. Each party responded and replied to both motions. The district court decided both motions in a single Order, denying Plaintiffs motion and granting Defendants’ motion. R. at [39]. Plaintiff now appeals.

On appeal, Plaintiff disputes whether United States Courts have jurisdiction over this case because the plan may not be an ERISA plan. Defendants argue that whether the plan is an ERISA plan is a [274]*274substantive element of Plaintiffs ERISA claim, not a jurisdictional issue. Defendants argue .that Plaintiff forfeited the substantive element by filing this action and prosecuting it to judgment. Questions about subject-matter jurisdiction present legal issues, which we review de novo. Musson Theatrical, Inc. v. Federal Express Corp., 89 F.3d 1244, 1248 (6th Cir.1996).

In Daft v. Advest, Inc., 658 F.3d 583 (6th Cir.2011), the Sixth Circuit analyzed whether the presence of an ERISA plan is jurisdictional under the rubric in Arbaugh v. Y & H Corp., 546 U.S. 500; 126 S.Ct. 1235, 163 L.Ed.2d 1097 (2006).. We held that “the existence of' an ERISA plan is a nonjurisdictional element of Plaintiffs’ ERISA claim.” Advest, 658 F.3d at 587. “[T]he existence of an ERISA plan must be considered an element of a plaintiffs claim under [29 U.S.C. § 1132](a)(l)(B), not a prerequisite for federal jurisdiction.” Id. at 590-91. There is no basis to find that the plan here is different from the plan in Advest, and thus we consider the existence of an ERISA plan to be a substantive element of the claim rather than jurisdictional in this case.

Plaintiff argues the underlying plan might be a “church plan” that is not an ERISA plan. “[Wjhen Congress does not rank a statutory limitation on coverage as jurisdictional, courts should treat the restriction as nonjurisdictional in character.’ ” Id. at 590 (quoting Arbaugh, 546 U.S. at 516, 126 S.Ct. 1235). ERISA’s jurisdictional provision does not predicate jurisdiction upon whether a plan meets the definition of a “church plan.” 29 U.S.C. § 1132(e)(1). Both the provision defining what qualifies as a “church plan” — 29 U.S.C. § 1002(33) — and the provision stating whether such a plan is covered by ERISA — 29 U.S.C. § 1003(b)(2) — are separate from ERISA’s jurisdictional provision.

In Advest, this Court' reasoned that fairness also weighed against treating the existence of a plan as jurisdictional because the party arguing against jurisdiction on appeal was the party that originally invoked federal jurisdiction. 658 F.3d at 593. The interests of fairness also compel a nonjurisdictional conclusion here. It was Plaintiff who initially invoked federal jurisdiction in 2011 and then, over two years into the litigation, after Defendants prevailed in trial court, raised the issue of jurisdiction. Whether Defendants’ plan is an ERISA plan is a substantive element that Plaintiff forfeited, not a jurisdictional prerequisite.

The parties briefed the issue of whether Plaintiffs claim is time-barred before the Court published Moyer. In Moyer,

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614 F. App'x 271, Counsel Stack Legal Research, https://law.counselstack.com/opinion/russell-v-catholic-healthcare-partners-employee-long-term-disability-plan-ca6-2015.