Valeck v. Watson Wyatt & Co.

92 F. App'x 270
CourtCourt of Appeals for the Sixth Circuit
DecidedMarch 11, 2004
DocketNo. 03-1854
StatusPublished
Cited by4 cases

This text of 92 F. App'x 270 (Valeck v. Watson Wyatt & Co.) 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
Valeck v. Watson Wyatt & Co., 92 F. App'x 270 (6th Cir. 2004).

Opinion

ORDER

Karen Valeck, a pro se Michigan resident, appeals a district court judgment dismissing her complaint regarding a denial of long term disability benefits by the plan administrator for Watson Wyatt and Company. This case has been referred to a panel of the court pursuant to Rule 34(j)(l). Rules of the Sixth Circuit. Upon examination, this panel unanimously agrees that oral argument is not needed. Fed. R.App. P. 34(a).

In September 1999, Valeck applied for disability retirement benefits. After evaluating Valeck’s medical condition, the plan administrator notified Valeck on April 17, 2000, that her request for benefits was denied. A subsequent appeal was also denied on June 19, 2000. After being denied benefits, Valeck entered into a general release of claims and settlement agreement with Watson Wyatt. The agreement was executed in August 2000 and released Watson Wyatt from all claims against the company with the exception of her claim to pursue her application for long term disability benefits. After the execution of the release, Valeck filed a second application for benefits in October 2000. Valeck made it clear that her 2000 application was a new claim based on her current condition. That application was denied in March 2001.

Valeck then sought judicial review of her request for benefits under the Employment Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1132. The district court, in a published opinion, affirmed the decision of the plan administrator. Valeck v. Watson Wyatt & Co., 266 F.Supp.2d 610 (E.D.Mich.2003).

On appeal, Valeck’s brief is construed as raising the same arguments that she presented to the district court.

The standard of review in ERISA cases is de novo unless the benefit plan gives the plan administrator discretion to determine eligibility for benefits or to construe the terms of the plan. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989); see also Wilkins v. Baptist Healthcare Sys., Inc., 150 F.3d 609, 616 (6th Cir.1998).

[272]*272Watson Wyatt’s pension plan document expressly provides that the company’s retirement committee is responsible for administration of the plan and that the committee has “discretionary authority to construe the terms of the Plan ... and ... to determine all questions arising in the administration of the Plan, including those relating to the eligibility of persons to participate; [and] the rights of Employees, former Employees and Beneficiaries ----”

Because the plan grants Watson Wyatt’s retirement committee complete discretion to determine eligibility for benefits under the plan, Watson Wyatt is entitled to an “arbitrary and capricious” standard of review. Under the arbitrary and capricious standard, the court determines whether Watson Wyatt’s decision to deny Yaleck benefits was rational and consistent with the terms of the policy. Miller v. Metro. Life Ins. Co., 925 F.2d 979, 984 (6th Cir. 1991).

The district court properly dismissed the case. Valeck challenges the district court’s factual and legal determinations as to both her applications for benefits. Valeck’s brief is construed as reiterating the arguments she presented to the district court. Regarding her September 1999 application, the district court summarized the argument as follows:

At issue with respect to Plaintiffs September 1999 application for Disability Retirement benefits is whether the language of the [Summary Plan Description] SPD — “regular job” — or of the language in the plan itself — “regular occupation” — used by Watson Wyatt in defining “total disability” are in conflict. Ms. Valeck argues that the term “regular job” is narrower than “regular occupation” and means the specific job in the specific office and with the specific supervisor and co-workers with whom she worked, not just the kind of work she did, which she contends would define her “occupation.” She does not claim that anyone at Watson Wyatt ever told her that the two words “job” and “occupation” should be interpreted this way; rather this is merely her own subjective interpretation of the two words. And, because the SPD uses the word “job” while the Plan document itself uses the word “occupation,” based upon the distinction between the two words that she herself has drawn. Plaintiff argues that the SPD and Plan document are inconsistent. Therefore, she argues that the Court is required to use the “regular job” language of the SPD and construe that phrase as she does. In support, Plaintiff relies on Edwards v. State Farm Mutual Automobile Insurance Company, 851 F.2d 134 (6th Cir.1988).

Valeck, 266 F.Supp.2d at 620-21.

The district court’s analysis in rejecting Valeck’s argument was correct. In Edwards, the court held that when the summary plan description and the plan document contain conflicting language, the SPD controls. Edwards, 851 F.2d at 136. The Edwards court enforced the terms of the summary description where the terms directly contradicted those in the plan and where the plaintiff had received only a summary description and not the plan document. The court found that “[i]t is of no effect to publish and distribute a plan summary booklet designed to simplify and explain [the plan] ... and then proclaim that any inconsistencies will be governed by the plan. Unfairness will flow to the employee for reasonably relying on the summary booklet.” Id. (citations omitted). However, Edwards requires more than an inconsistency of terms. The SPD and the plan must directly conflict. Id. In this case, the SPD and the plan do not conflict. At most, the alleged inconsistency in terms is that the word “job” as used by the SPD is [273]*273ambiguous. “[L]anguage in a plan summary that is merely ambiguous should not be permitted to trump unambiguous language in the plan itself.” Foltice v. Guardsman Prods., Inc., 98 F.3d 933, 938 (6th Cir.1996). Even if the plan language did not control, under the arbitrary or capricious standard, the court must defer to the plan administrator’s interpretation that is rational in light of the plan's provisions. Miller, 925 F.2d at 986. Watson Wyatt’s plan administrator determined that Valeck was not disabled because Miller, 925 F.2d at 986. Watson Wyatt’s plan administrator determined that Valeck was not disabled because the undisputed medical evidence showed that while she could not work with two specific individuals, she could continue her same job as an employee benefit professional under different circumstances. Contrary to her assertions, Valeck was not prevented from generally working, nor was she prevented from continuing to work as an employee benefit consultant. The prohibition was her continued work under the specific management within her department at Watson Wyatt.

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Bluebook (online)
92 F. App'x 270, Counsel Stack Legal Research, https://law.counselstack.com/opinion/valeck-v-watson-wyatt-co-ca6-2004.