Miller v. Monumental Life Insurance , 376 F. App'x 871 ( 2010 )

FILED
United States Court of Appeals
Tenth Circuit
April 28, 2010
UNITED STATES COURT OF APPEALS
Elisabeth A. Shumaker
Clerk of Court
FOR THE TENTH CIRCUIT
RODNEY MILLER,
Plaintiff-Appellant,
v. No. 09-2110
(D.C. No. 1:04-CV-00970-JB-RHS)
MONUMENTAL LIFE INSURANCE (D. N.M.)
COMPANY,
Defendant-Appellee.
ORDER AND JUDGMENT *
Before McKAY, Circuit Judge, BRORBY, Senior Circuit Judge, and EBEL,
Circuit Judge.
Rodney Miller appeals from an order of the district court remanding this
ERISA benefits case to the Plan administrator for further proceedings. Because
we lack jurisdiction over the district court’s order remanding the case, we dismiss
the appeal.
*
After examining the briefs and appellate record, this panel has determined
unanimously to grant the parties’ request for a decision on the briefs without oral
argument. See Fed. R. App. P. 34(f); 10th Cir. R. 34.1(G). The case is therefore
ordered submitted without oral argument. This order and judgment is not binding
precedent, except under the doctrines of law of the case, res judicata, and
collateral estoppel. It may be cited, however, for its persuasive value consistent
with Fed. R. App. P. 32.1 and 10th Cir. R. 32.1.
BACKGROUND
This is the second time this case has come before us. See Miller v.
Monumental Life Ins. Co., 502 F.3d 1245 (10th Cir. 2007). As detailed in our
prior decision, Mr. Miller was injured in an automobile accident in September
1997 while working for Aycox Transportation. Following the accident, he
applied for and received Supplemental Security Income (SSI) benefits from the
Social Security Administration. He then applied for the Continuous Total
Disability Benefit (Continuous Benefit) under a master-group policy issued by
defendant Monumental Life Insurance Company (Monumental).
In order to receive the Continuous Benefit under Monumental’s policy, an
applicant must satisfy four criteria. First, he must be “totally disabled,” Aplt.
App. at 10, that is, “unable to perform every duty pertaining to any occupation for
which he is or may become qualified by education, training or experience[.]”
Id. at 5. Second, he must have “been granted a Social Security Disability
Award.” Id. Third, the disabling injury must have “occurred while the Insured
Person was at work performing the duties of his regular occupation.” Id. at 10.
Finally, the injury must have “resulted solely and directly from [the] Injury” and
satisfy certain other temporal requirements under the policy. Id.
On November 19, 2003, a claims representative for the Plan administrator
sent Mr. Miller a letter denying his claim. The letter explained the denial as
follows:
-2-
According to the terms of the policy in order to be eligible for
continuous total disability you must be unable to engage in any
gainful employment for which you can be reasonably trained for
[sic].
You must be awarded a social security disability award for injuries
sustained from this accident of 9-15-97. The information you have
provided to us from the social security office is for supplemental
security income and not a social security disability award. Therefore
no benefits are available.
Id. at 18.
Mr. Miller thereafter filed this suit under the Employee Retirement Income
Security Act (ERISA) challenging Monumental’s denial of his request for
long-term disability benefits. Monumental moved for summary judgment,
contending (1) Mr. Miller had not been granted a Social Security Disability
Award; (2) his disability commenced more than six months from the date of
injury; and (3) his disability had not occurred “solely and directly” from an
accidental, on-the-job injury. Id. at 27. The district court granted the motion for
summary judgment on the basis that the SSI benefit did not constitute a “Social
Security Disability Award.” It did not reach Monumental’s other arguments.
Mr. Miller appealed, and we reversed the district court. Miller, 502 F.3d
at 1255. We concluded that Mr. Miller’s “Title XVI [SSI] award coupled with a
finding of disability satisfied the Social Security Disability Award requirement.”
Id. We further concluded that the SSA’s finding also appeared to satisfy the
Plan’s disability requirement, “that a recipient of Continuous Benefit be ‘unable
-3-
to perform the physical and mental requirements of any past relevant work.’” Id.
at 1251. Noting that Monumental had moved for summary judgment on the
alternate ground that Mr. Miller’s accident was not the “sole cause” of his
disability, we remanded for the purpose of permitting the district court to address
this issue. Id.On remand, the district court entered the extensive order that forms the
basis of this appeal. It determined, first, that although Monumental had not relied
on the “solely and directly” clause in its policy to deny benefits, coverage cannot
be created by waiver or estoppel and Monumental could therefore raise the issue
for the first time in opposing Miller’s breach-of-contract claim. Second, the
record was insufficiently developed on the “solely and directly” issue and a
remand to the Plan administrator was necessary for further proceedings on that
issue. Third, although language in this court’s prior opinion suggested that Miller
had satisfied the “total disability” requirement, the district court concluded there
had been no definitive decision on that issue and it should also be addressed on
remand. Finally, the district court denied Monumental’s motion to strike Miller’s
motion for attorney’s fees, and also denied Miller’s motion for fees.
Miller appeals, arguing (1) the district court should not have permitted
Monumental to raise the “sole cause” issue for the first time in district court;
(2) the remand to the Plan administrator was unnecessary; (3) Miller should
prevail on the “sole cause” issue; (4) this court has already determined that Miller
-4-
met the “total disability” requirement and that issue should therefore not be
revisited; and (5) this court should award him attorney’s fees. For its part,
Monumental argues that we lack jurisdiction over the order remanding this case to
the Plan administrator; that estoppel and waiver did not forbid it from raising the
“sole cause” issue; that remand to the administrator was appropriate; and that
Miller was not entitled to attorney’s fees.
ANALYSIS
As we must, we examine first our jurisdiction to consider this appeal.
“Aside from a few well-settled exceptions, federal appellate courts have
jurisdiction solely over appeals from ‘final decisions of the district courts of the
United States.’” Rekstad v. First Bank Sys., Inc., 238 F.3d 1259, 1261 (10th Cir.
2001) (quoting 28 U.S.C. § 1291) (emphasis added). “A final decision is one that
ends the litigation on the merits and leaves nothing for the court to do but execute
the judgment.” Id. (quotation omitted).
In general, a court order remanding a claim to a plan administrator, like an
order remanding a claim to an administrative agency, is not a final decision. See
id. at 1262. Even so, “district court orders remanding an issue to an ERISA plan
administrator are not per se nonfinal. The [finality] decision should be made on a
case-by-case basis applying well-settled principles governing ‘final decisions.’”
Id. at 1263.
-5-
One concern in assessing finality is whether a remand order’s practical
effect makes an important legal question effectively unreviewable. Id. at 1262.
This concern originally arose in administrative agency cases. A district court
exercising judicial review sometimes resolved a legal question and then remanded
to the agency for further proceedings. Though the agency’s decision on remand
was often dictated by the district court’s legal analysis, the agency was barred
from seeking judicial review of what became its “own” decision after remand.
Since the agency could neither appeal the non-final remand order, nor appeal
from the ultimate disposition of the case, the district court’s legal analysis was
effectively insulated from appellate review. Id. To avoid this problem, courts
crafted a “practical finality” rule, which permits appeal of a remand order where
an important legal issue exists and the right to appeal would otherwise be lost.
Subsequent cases have extended this rule to the ERISA context.
Relying on our practical finality cases, Miller argues that he has presented
a legal issue that will, as a practical matter, be unreviewable if he is not permitted
an immediate appeal. This issue he wishes to preserve through immediate appeal
is whether Monumental could raise a “new defense” of “sole cause” at the district
court level. Aplt. Reply Br. at 2. Putting aside the fact that our prior decision
remanded precisely for a determination concerning this new defense, we find no
basis to conclude that a practical finality problem arises here. While it is
conceivable that Miller may ultimately convince either this court or the district
-6-
court that Monumental was barred from raising the “sole cause” defense, the fact
that he must wait to do so until proceedings on remand are complete does not
make the issue effectively unreviewable. The district court’s order clearly
contemplates further review in the event that Miller is dissatisfied with the
administrator’s resolution of this issue.
This case resembles Garner v. U.S. West Disability Plan, 506 F.3d 957(10th Cir. 2007). In Garner, we found no appellate jurisdiction where the district
court remanded to the plan administrator for further consideration of the
plaintiff’s claim for disability based on her alleged major depression. We stated:
To be sure, the inability to appeal at this stage will compel Ms.
Garner to participate in a remand that she contends was improperly
ordered, and that burden cannot be fully cured through a later appeal.
But courts do not ordinarily treat the burden of having to participate
in litigation as one that justifies appeal from a nonfinal order.
Id. at 961.
Moreover, we stated in Garner that even if the plaintiff’s assertion was
correct that the district court lacked jurisdiction to remand to the administrator,
there was “no reason to believe that a remand to the Plan at this juncture would
prevent us from considering her argument in a later appeal following a final
order.” Id. at 962. Thus, the case did not fall within the “practical finality” rule.
Id.The same is true here. Neither the cost or delay associated with additional
review of the “sole cause” defense, nor Miller’s unfounded fear about loss of his
-7-
argument that Monumental was not entitled to raise this defense, justifies
treatment of the remand order as a final order for purposes of review. Miller’s
contentions are not “effectively unreviewable.”
This appeal is therefore DISMISSED for lack of jurisdiction. We DENY
Miller’s request for appellate attorney’s fees and Monumental’s motion to file a
sur-reply brief.
Entered for the Court
Monroe G. McKay
Circuit Judge
-8-