Krishna v. Life Ins Company

Case: 22-20516 Document: 00516828965 Page: 1 Date Filed: 07/21/2023
United States Court of Appeals
for the Fifth Circuit United States Court of Appeals
Fifth Circuit
____________ FILED
July 21, 2023
No. 22-20516
Lyle W. Cayce
____________ Clerk
Deepa Krishna,
Plaintiff—Appellant,
versus
Life Insurance Company of North America; Honeywell
International, Incorporated Accidental Death and
Dismemberment Plan; Honeywell International,
Incorporated; Steven Jacobs; Honeywell
International, Incorporated Benefit Plan,
Defendants—Appellees.
______________________________
Appeal from the United States District Court
for the Southern District of Texas
USDC No. 4:21-CV-1813
______________________________
Before Wiener, Southwick, and Duncan, Circuit Judges.
Per Curiam: *
Plaintiff-Appellant Deepa Krishna brought this suit under the
Employees Retirement Security Act of 1974, 29 USC § 1001, et seq.
(“ERISA”) after her husband Karthik Balakrishnan died in the crash of a
_____________________
*
This opinion is not designated for publication. See 5th Cir. R. 47.5.
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relatively small private airplane on which he was a passenger. Recovery was
denied under ERISA because of an express exclusion of death or injury
incurred as a passenger in such an aircraft. Krishna appeals the denial of
summary judgment regarding her claim for benefits under ERISA §
502(a)(1)(B) against Defendants-Appellees Life Insurance Co. of North
America (“LINA”), Honeywell International Inc. Accidental Death and
Dismemberment Plan, Honeywell International, Inc., Steven Jacobs, Vice
President of Compensation and Benefits for Honeywell International Inc.,
and Honeywell International Inc. Benefit Plan (collectively “Honeywell”).
Krishna also appeals the district court’s grant of LINA and Honeywell’s
cross-motion for summary judgment. For the following reasons, we affirm
the district court’s judgment.
I. Factual and Procedural Background
Plaintiff Deepa Krishna is the widow of Karthik Balakrishnan and the
mother of their young daughter. Balakrishnan began working at Honeywell
International, Inc. in August 2019 and became a participant in the Honeywell
International, Inc. Benefit Plan (“the Plan”), which is governed by ERISA.
That plan provided Balakrishnan with accidental death and dismemberment
(“AD&D”) benefits totaling $1,881,000 under Group Accident Policy No.
OK 980358, which was underwritten by LINA (“the Policy”).
On October 25, 2020, Balakrishnan died when in the crash of a
privately-owned, single-engine airplane in which he was a passenger. Krishna
filed a claim under the Honeywell International, Inc. Benefit Plan, and LINA
approved her claim for life insurance benefits in the amounts of $297,000 and
$1.58 million on December 1, 2020. On December 31, 2020, however, LINA
denied her claim for accidental death benefits, citing the Policy’s Common
Exclusions that include “[a] loss caused by or resulting from flight in an
aircraft is specifically excluded from coverage . . . . except in the case where
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an insured is traveling as a fare-paying passenger on a regularly scheduled
commercial airline.” Krishna appealed, but LINA denied her appeal on
March 23, 2021 for the same initial reasons.
On June 4, 2021, Krishna sued LINA and Honeywell seeking
accidental death benefits under ERISA § 502(a)(1)(B) or, alternatively,
equitable relief under ERISA § 502(a)(3) for breach of fiduciary duty,
misinformation, equitable estoppel, and surcharge based on summary plan
description deficiencies. 29 U.S.C. § 1132(a)(1)(B), (a)(3). On February 10,
2022, Krishna moved for summary judgment on her § 502(a)(1)(B) claim
only. LINA filed an opposition and cross-motion for summary judgment
regarding the § 502(a)(1)(B) claim, in which Honeywell joined. After those
motions were filed, Krishna moved for voluntary dismissal of her § 502(a)(3)
claim in its entirety “to avoid the further stress and anxiety of reliving painful
events.”
On August 11, 2022, the magistrate judge issued a memorandum and
recommendation (“the Recommendations”) which recommended that
Krishna’s motion for partial summary judgment regarding § 502(a)(1)(B) be
denied and LINA and that Honeywell’s cross-motion for summary judgment
be granted. The district court reviewed the magistrate judge’s conclusions de
novo and adopted the Recommendations, dismissing Krishna’s § 502(1)(B)
claim with prejudice. The district court also granted Krishna’s motion for
partial voluntary dismissal, dismissing § 502(a)(3) claim without prejudice.
Krishna timely filed an appeal regarding the rulings on the motions for
summary judgment.
II. Standard of Review
We review a district court’s summary judgment rulings de novo. Tolson
v. Avondale Indus., Inc., 141 F.3d 604, 608 (5th Cir. 1998) (citing FDIC v.
Myers, 955 F.2d 348, 349 (5th Cir. 1992)). “Whether the district court
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employed the appropriate standard in reviewing an eligibility determination
made by an ERISA plan administrator is a question of law.” Lynd v. Reliance
Standard Life Ins. Co., 94 F.3d 979, 980–81 (5th Cir. 1996) (citing Chevron
Chem. Co. v. Oil, Chem. & Atomic Workers Local Union 4–447, 47 F.3d 139,
142 (5th Cir. 1995)). “When an ERISA plan lawfully delegates discretionary
authority to the plan administrator, a court reviewing the denial of a claim is
limited to assessing whether the administrator abused that discretion.”
Ariana M. v. Humana Health Plan of Tex., Inc., 884 F.3d 246, 247 (5th Cir.
2018) (en banc) (citing Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115
(1989)). When a plan lacks a valid delegation clause, “a denial of benefits
challenged under § 1132(a)(1)(B) must be reviewed under a de novo
standard.” Firestone, 489 U.S. at 102.
III. Law and Analysis
On appeal, Krishna asserts that (1) LINA was never vested with
discretionary authority over the Policy; (2) LINA considered a summary plan
document that was not operable at the time of Balakrishnan’s death; (3) as
plan administrator, LINA’s interpretation of the flight exclusion was an
abuse of discretion; (4) LINA’s interpretation of the flight exclusion was
legally incorrect under this circuit’s multifactor test; and (5) Honeywell and
LINA violated ERISA regulations during the claims process, depriving
Krishna of a full and fair review. We examine each contention in turn.
A. Whether the operative Plan documents vested LINA with
discretionary authority
Krishna asserts that LINA was never vested with discretionary
authority under ERISA to determine her accidental death benefits claim.
Central to this and her other contentions is a dispute regarding which
coverage-related documents were operative from the time of Balakrishnan’s
start of employment on August 19, 2019, through his death on October 25,
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2020. The parties agree that the AD&D components of his benefits plan were
insured through the Policy, but disagree as to whether a 2003-dated
document displaces the alleged 2019 version of that document. Krishna also
alleges that various documents were never produced to Balakrishnan during
his employment or to her during the claims process. We first determine
which documents were operative during the relevant time period and then
whether such documents vested LINA with discretionary authority.
i. Which documents were operative during the relevant
timeframe?
Krishna agrees that the Policy was operative at all relevant times but
contends that the Plan and the Summary Plan Description (“the 2019
SPD”), should be disregarded as nonoperative. Krishna alleges that she did
not gain possession of the Plan and the 2019 SPD until after this litigation was
initiated, so they cannot be determinative of her claim. Krishna asserts that a
document dated January 1, 2003 (“the 2003 Honeywell SPD”) was provided
to her in January 2021, during the claims process, and again in November
2021, through Honeywell’s administrative record production. Moreover,
Krishna claims that her husband was given the 2003 SPD shortly after he
began employment at Honeywell. Krishna therefore alleges that the 2019
SPD and the Plan should be disregarded as related to her claim.
On the other hand, LINA and Honeywell assert that the Plan and the
2019 SPD form one operative “Wrap Plan Document,” which, along with
the Policy, govern Krishna’s claim. LINA and Honeywell claim that the Plan
and the 2019 SPD are dated January 1, 2019, so that any previous versions of
those documents were no longer operative during the relevant timeframe.
LINA points to the declaration of Kristine Vandergriff, which was attached
to LINA and Honeywell’s cross-motion for summary judgment. Vandergriff,
who has served as the Senior Benefits Manager at Honeywell since 2021,
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identified the Plan, the 2019 SPD, and the Policy as the operative documents
related to Krishna’s AD&D claim. LINA further contends that Krishna has
not established the origin of the 2003 Honeywell SPD and that any failure to
produce Plan-related documents was Honeywell’s—not LINA’s—
responsibility. LINA asserts that, even if this had been its own responsibility,
Krishna has failed to show how missing the 2019 SPD would deny her a full
and fair review of her claim. LINA notes that Krishna “was admittedly in
possession of the Policy, the actual governing Plan document upon which
LINA’s determination was based.”
The magistrate judge considered all of the coverage-related
documents at issue, including the Policy, the Plan, the 2019 SPD, and the
2003 SPD, concluding that the Policy, the Plan, and the 2019 SPD were
effective during the relevant timeframe and validly delegated discretionary
authority to LINA. The magistrate judge did not engage in a specific analysis
of whether the 2003 SPD was operative during the relevant timeframe and
thus displaced the 2019 SPD. The magistrate judge only explained that the
2003 SPD “is silent regarding discretion to decide claims.”
We first resolve the dispute regarding which documents were
operative from August 19, 2019 to October 25, 2020. The Plan and the 2019
SPD speak for themselves. The Plan is titled “Honeywell International Inc.
Benefit Plan and Summary Plan Description (As Amended and Restated
Effective January 1, 2019).” The Plan clarifies that “it consists of this
document including any Appendices attached hereto and incorporated
herein by reference.” Included in these appendices are various Benefit
Booklet-Certificates, such as the Policy. Moreover, the Group Accident
Certificate, which is part of the 2019 SPD, specifically references the Policy
by number. We next note that Vandergriff’s declaration credibly identifies
the Policy, the Plan, and the 2019 SPD as the relevant, operative documents
and explains that “[a]ny earlier version of a SPD . . . was not the applicable
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SPD during August 2019 through October 2020.” Krishna has not shown
how the 2003 SPD—which is dated January 1, 2003, and does not even
reference the Policy—displaces the 2019 SPD. Although the 2003 SPD is
part of the administrative record that LINA produced, it appears to have been
produced as part of Krishna’s submission on appeal, rather than as a benefits-
related document. Therefore, the 2019 SPD should not be disregarded in
favor of the 2003 SPD. The Plan, the Policy, and the 2019 SPD were
operative documents during the relevant time frame.
ii. Did the operative documents vest LINA with discretionary
authority?
Krishna acknowledges that the 2019 SPD “has adequate language to
vest LINA with discretion,” but contends that the 2019 SPD “should not
even be consulted as the operative SPD, as it was never treated as such by
Honeywell.” Krishna asserts that, even if the 2019 SPD were consulted, the
Policy language alone governs and the 2019 SPD cannot waive or alter any of
its terms.
LINA and Honeywell, on the other hand, assert that the Plan, the 2019
SPD, and the Policy clearly delegate claim adjudication authority from
Honeywell, as Plan Administrator, to a named fiduciary, such as LINA.
LINA and Honeywell note that the Plan states that the “Plan Administrator
has the authority, in the Plan Administrator’s sole discretion, to interpret the
Plan and resolve ambiguities therein … and to make factual determinations.”
They further note that the 2019 SPD states “[t]he Plan Administrator
[Honeywell] has appointed the Insurance Company [LINA] as the named
fiduciary for adjudicating claims for benefits under the Plan, and for deciding
any appeals of denied claims.” Honeywell and LINA also observe that the
Policy contains nearly the same language: “[t]he Plan Administrator has
appointed the Insurance Company [LINA] as the named fiduciary for
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deciding claims for benefits under the Plan, and for deciding any appeals of
denied claims.” LINA and Honeywell also note that, under this circuit’s
precedent, the language in these documents is sufficient to delegate
discretionary authority under ERISA.
The district court, through the magistrate judge’s Recommendations,
held that the language of the Policy, the Plan, and the 2019 SPD validly
delegated discretion to LINA. Those Recommendations concluded that the
language used in the documents “is consistent with language the Fifth
Circuit has found sufficient to confer discretion.” 1 The district court
explained that the Policy’s language neither directly conflicts with nor
invalidates the delegation of discretion contained in the 2019 SPD. That
court acknowledged that “[w]hile the language in the Policy itself may not be
sufficient to confer on LINA full discretionary authority to interpret the
Policy. . . the language in the 2019 SPD and Insurance Certificate clearly is.”
The district court considered the 2003 SPD but noted that it “is silent
regarding discretion to decide claims.” Concluding that LINA was properly
vested with discretionary authority, the district court applied an abuse-of-
discretion standard of review to LINA’s denial of Krishna’s claim.
ERISA defines “fiduciary” as one who “exercises any discretionary
authority or discretionary control respecting management of [a] plan or
exercises any authority or control respecting management or disposition of
its assets.” 29 U.S.C. § 1002(21)(A)(i). A fiduciary also has “authority to
control and manage the operation and administration of the plan,” §
1102(a)(1), and must provide a “full and fair review” of claim denials, §
1133(2). The Fifth Circuit does not require the use of “discretion” or other
_____________________
1
See Batchelor v. Int’l Bhd. Of Elec. Workers Loc. 861 Pension & Ret. Fund, 877 F.2d
441, 443 (5th Cir. 1989); Dowden v. Blue Cross & Blue Shield of Tex., Inc., 126 F.3d 641, 644
(5th Cir. 1997).
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“magic words” to validly delegate discretionary authority to a fiduciary.
Wildbur v. ARCO Chem. Co., 974 F.2d 631, 637 (5th Cir. 1992) (quoting Block
v. Pitney Bowes Inc., 952 F.2d 1450, 1453 (D.C. Cir. 1992)). “Rather, the
Supreme Court directed lower courts to focus on the breadth of the
administrators’ power—their ‘authority to determine eligibility for benefits
or to construe the terms of the plan.’” Jimenez v. Sun Life Assur. Co. of
Canada, 486 F. App’x 398, 405 (5th Cir. 2012) (internal citation omitted in
original). In doing so, courts must “read the plan as a whole” to see whether
it satisfies the criteria promulgated by the Supreme Court in Firestone Tire &
Rubber Co. v. Bruch. Wildbur, 974 F.2d at 636–37. As this circuit has
recognized, “[a] different standard of review will sometimes lead to a
different outcome, but there will also be many cases in which the result would
be the same with deference or without it.” Ariana M., 884 F.3d at 257.
We conclude that the Policy, the Plan, and the 2019 SPD vested LINA
with discretionary authority to adjudicate Krishna’s AD&D claim. First, the
2019 SPD and the Plan’s key language cited by LINA and Honeywell clearly
permits the delegation of discretionary authority to a fiduciary such as LINA.
That language encompasses the authority to make both factual and legal
determinations under the Plan, as required by ERISA and by this circuit’s
precedent. See Jimenez, 486 F. App’x at 405. The Policy contains nearly
identical language to that found in the 2019 SPD regarding the delegation of
discretionary authority. When read “as a whole,” the language of the Policy,
the Plan, and the 2019 SPD demonstrate that LINA, as the named fiduciary,
was vested with discretionary authority. The district court thus correctly
applied the abuse-of-discretion standard of review to LINA’s denial of
AD&D benefits. We now determine whether LINA, in its authority as named
fiduciary, abused its discretion in denying Krishna’s claim.
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B. Whether LINA’s interpretation of Exclusion 6 was an abuse of
discretion
Exclusion 6 in the Policy’s “Common Exclusions” section is central
to this dispute because LINA relied on that exclusion when it denied
Krishna’s claim. The relevant section states:
In addition to any benefit-specific exclusions, benefits will not be paid
for any Covered Injury or Covered Loss which, directly or indirectly,
… is caused by or results from any of the following…:
* * *
6. flight in, boarding or alighting from an Aircraft or any craft
designed to fly above the Earth’s surface:
a. except as a passenger on a regularly scheduled
commercial airline;
b. being used for:
i. crop dusting, spraying or seeding, giving and
receiving flying instruction, firefighting, sky
writing, sky diving or hang-gliding, pipeline or
power line inspection, aerial photography or
exploration, racing, endurance tests, stunt or
acrobatic flying; or
ii. any operation that requires a special permit from
the FAA, even if it is granted (this does not apply
if the permit is required only because of the
territory flown over or landed on);
c. designed for flight above or beyond the earth’s
atmosphere;
d. an ultra-light or glider;
e. being used for the purpose of parachuting or skydiving;
f. being used by any military authority…
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As a preliminary matter, Krishna asserts that the 2003 SPD’s
“Common Exclusions” section displaces Exclusion 6 in the Policy. 2 As
explained above, we disagree because Krishna has not shown that the 2003
SPD was the operative document during the relevant time period. Krishna
alternatively contends that if Exclusion 6 governs, it should be strictly
construed in favor of the insured because it is ambiguous. Krishna asserts that
Exclusion 6’s poor construction leaves it open to more than one reasonable
interpretation, such as “6.b.-f. as explanation of what exactly is excluded if
one is not a commercial airline passenger excepted from exclusion by 6.a.”
Although Krishna contends that de novo review is appropriate here, she
asserts that LINA’s interpretation of the Policy was also an abuse of
discretion. Krishna contends that LINA abused its discretion because its
interpretation of Exclusion 6 was legally incorrect, as more fully explained
below.
According to LINA and Honeywell, Exclusion 6 excludes AD&D
benefits for a death caused by flight in, boarding, or alighting from an aircraft
_____________________
2
The 2003 Honeywell SPD excludes many of the same items that the Policy
excludes, but with relevant differences. The Honeywell SPD excludes:
• Travel in an aircraft (including getting on or off the aircraft) if the aircraft is
being used:
• For test or experimental purposes; or
• By or for any military authority, including aircraft flown by the U.S.
Military Airlift Command (MAC) or similar service of another
country); or
• For travel, or is designed for travel, beyond the earth’s atmosphere; or
• By or for the Employer, whether owned, leased, operated or controlled
by the Employer, including chartered aircraft; or
• Travel in an aircraft (including getting on or off the aircraft) if you or a
Dependent is:
• Serving as pilot or crew member (or student taking a flying lesson) and
is not riding as a passenger; or
• Hang-gliding; or
• Parachuting unless necessary for self-preservation ...
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in general unless the insured was a passenger on a regularly scheduled
commercial airline. LINA and Honeywell insist that the subparts listed under
Exclusion 6 are merely illustrative examples—not specific exclusions. In
other words, LINA reads the phrase preceding Exclusion 6 to be the
preamble, with each subpart—(a)-(f)—independently following to create a
complete sentence that states: “benefits will not be paid for any … Covered
Loss which, directly or indirectly, in whole or in part, is caused by or results
from … flight in, boarding or alighting from an Aircraft … except as a
passenger on a regularly scheduled commercial airline.” LINA insists that
Krishna cannot show that this interpretation was “legally incorrect” because
(1) “LINA has applied its interpretation uniformly for at least a dozen
years,” (2) “there would be unanticipated costs to the Plan from private-
flight losses like Krishna’s,” and (3) “LINA’s interpretation—confirmed as
unambiguously correct by multiple federal judges—was a fair reading of the
Plan’s text.”
The magistrate judge’s Recommendations concluded that LINA’s
interpretation of Exclusion 6 was legally correct and therefore was
“consistent with a fair reading of the Plan.” The magistrate judge endorsed
LINA’s view that the structure of the “Common Exclusions” section is a
“preamble, followed by numbered paragraphs 1-11, which in turn contain
indented subparts (such a 6(a) through 6(f)).” Referencing a text authored
by Justice Antonin Scalia and Bryan Garner, 3 the magistrate judge agreed that
Exclusion 6 may be read as one continuous sentence, starting with the
preamble and ending with subpart (f). The magistrate judge explained that
“[t]his reading is consistent with the ordinary meaning of the words in the
_____________________
3
ANTONIN SCALIA & BRYAN A. GARNER, READING LAW: THE
INTERPRETATION OF LEGAL TEXTS 156 (2012) (discussing the scope of
subparts canon).
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provisions as well as the ‘scope of subparts canon’ of contract construction,”
which provides that “[m]aterial within an indented subpart relates only to
that subpart; material contained in unindented text relates to all the following
or preceding indented subparts.” 4 The magistrate judge further explained
that the structure of this provision prevents the ambiguity that Krishna
claims to exist “by reading subparts (a)-(f) as a whole.” The
Recommendations ultimately conclude that LINA’s interpretation was not
an abuse of discretion under this circuit’s precedent.
“Interpretations of policy provisions in ERISA-regulated plans are
governed by federal common law.” Talamantes v. Metro. Life Ins. Co., 3 F.4th
166, 169 (5th Cir. 2021); see also Ramirez v. United of Omaha Life Ins. Co., 872
F.3d 721, 725 (5th Cir. 2017). Federal common law rules of contract
construction and interpretation incorporate ordinary rules of contract
construction. See Green v. Life Ins. Co. of N. Am., 754 F.3d 324, 331 (5th Cir.
2014). “When construing ERISA plan provisions, courts are to give the
language of an insurance contract its ordinary and generally accepted
meaning if such a meaning exists . . . [o]nly if the plan terms remain
ambiguous after applying ordinary principles of contract interpretation are
we compelled to apply the rule of contra proferentum and construe the terms
strictly in favor of the insured.” Talamantes, 3 F.4th at 169.
A plan administrator/fiduciary may abuse its discretion by denying
claims on either legal or factual grounds. Ariana M., 884 F.3d at 248. “Legal
grounds” refers to the interpretation of a plan’s terms, while “factual
grounds” refers to the application of a plan’s terms. Rittinger v. Healthy All.
Life Ins. Co., 914 F.3d 952, 956 (5th Cir. 2019) (per curiam). For legal
disputes—that is, disputes about a plan’s meaning—the abuse-of-discretion
_____________________
4
Id.; see also Matter of Pirani, 824 F.3d 483, 495 (5th Cir. 2016)).
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analysis has “two steps.” Encompass Off. Sols., Inc. v. La. Health Serv. &
Indem. Co., 919 F.3d 266, 282 (5th Cir. 2019). The first step asks whether the
administrator’s reading is “legally correct.” Id. To determine if a decision is
legally correct, a court considers “(1) whether the administrator has given
the plan a uniform construction, (2) whether the interpretation is consistent
with a fair reading of the plan, and (3) any unanticipated costs resulting from
different interpretations of the plan.” Porter v. Lowe’s Cos., Inc.’s Bus. Travel
Acc. Ins. Plan, 731 F.3d 360, 364 n.8 (5th Cir. 2013). The second consideration
is the more critical. Id. If the decision is deemed legally correct, “the inquiry
ends, and there was no abuse of discretion.” Id. But if not, we proceed to step
two, which employs several factors to decide whether the administrator’s
legally erroneous interpretation of the plan’s terms still falls within the
administrator’s discretion. See id. Under the abuse-of-discretion standard,
the court must uphold the plan administrator’s decision if it “fall[s]
somewhere on a continuum of reasonableness – even if on the low end.”
Conn. Gen. Life Ins. Co., 878 F.3d 478, 483; see also Gonzales v. ConocoPhillips
Co., 806 F. App’x 289, 291 (5th Cir. 2020).
Here, the district court, through its adoption of the magistrate judge’s
Recommendations, correctly determined that LINA did not abuse its
discretion in interpreting Exclusion 6 of the Policy. LINA denied Krishna’s
claim on legal rather than factual grounds, so we must engage in this circuit’s
two-step test to determine whether LINA’s interpretation was “legally
correct.” Porter, 731 F.3d at 364 n.8. The Recommendations noted that the
parties’ briefing did not fully address whether LINA applied a uniform
interpretation or whether Krishna’s interpretation would create
unanticipated costs. Instead it focused on whether LINA’s interpretation
was consistent with a fair reading of the Plan. We do the same.
First, applying “ordinary rules of contract construction,” we
conclude that LINA’s interpretation is consistent with a fair reading of the
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Plan. Reading Exclusion 6 and its preamble as one continuous sentence aligns
with the “scope of subparts canon of contract construction,” which we have
previously endorsed. 5 We also agree that the structure of the Common
Exclusions section prevents the ambiguity that Krishna insists is created by
reading subparts (a)-(f) as a whole. We have previously held that overlapping
or even redundant exclusions do not necessarily render a policy exclusion
ambiguous. See Const. State Ins. Co. v. Iso-Tex Inc., 61 F.3d 405, 409 (5th Cir.
1995). There, we pointed out that “[g]iven the strict rules of construction
against a drafter, an insurance provider would be motivated to draft
overlapping and redundant clauses which exclude coverage for the same
conduct.” Id.On at least two occasions, federal courts have upheld LINA’s
interpretation of substantially similar flight exclusions. 6 Weber v. Life Ins. Co.
_____________________
5
Pirani, 824 F.3d at 495.
6 The language of the flight exclusions at issue in those cases was nearly identical
to Exclusion 6 but with the addition of a subsection 6b. They read:
6. flight in, boarding or alighting from an Aircraft or any craft designed to fly
above the Earth's surface:
a. except as a passenger on a regularly scheduled commercial airline;
b. being flown by the Covered Person or in which the Covered Person is a
member of the crew;
c. being used for:
i. crop dusting, spraying or seeding, giving and receiving flying
instruction, fire fighting, sky writing, sky diving or hang-gliding,
pipeline or power line inspection, aerial photography or explora-
tion, racing, endurance tests, stunt or acrobatic flying; or
ii. any operation that requires a special permit from the FAA,
even if it is granted (this does not apply if the permit is required
only because of the territory flown over or landed on);
d. designed for flight above or beyond the earth's atmosphere;
e. an ultra-light or glider;
f. being used for the purposes of parachuting or skydiving;
g. being used by any military authority, except an Aircraft used by the Air
Mobility Command or its foreign equivalent.
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of N.A., 836 F. Supp. 2d 427 (W.D. Va. 2011), aff'd, 492 F. App’x 444 (4th
Cir. 2012); Toohey v. Wyndham Worldwide Corp. Health & Welfare Plan, 727
F. Supp. 2d 978 (D. Or. 2010). In Weber, the district court for the Western
District of Virginia held that the ordinary meaning of Exclusion 6’s language
was unambiguous. The Weber court explained that “subparagraphs (b)
through (g) stand as additional, independent grounds of exclusion that
address plausible factual scenarios not presented in this case.” 836 F. Supp.
2d at 435. As we see no reason to depart from this well-founded view, we hold
that this interpretation is legally correct and that LINA did not abuse its
discretion in denying Krishna’s claim.
C. Whether Honeywell violated ERISA regulations
Krishna contends on appeal that Honeywell and LINA violated
ERISA’s procedural regulations by supplying a deficient 2019 SPD and by
withholding various documents during the claims process. Both of these
contentions are unavailing because (1) Exclusion 6 in the Policy is
unambiguous; (2) Krishna waived her claims regarding any deficiencies in
the 2019 SPD; and (3) Krishna also waived her claims regarding LINA and
Honeywell’s failure to produce documents during the claims process.
Krishna first contends that because of Exclusion 6’s alleged
ambiguity, the 2019 SPD must be consulted for its AD&D exclusion
language. Krishna asserts that, when thus consulted, the 2019 SPD’s
applicable language violates ERISA’s requirement that an exclusion be
expressed with clarity. Krishna further asserts that 2019 SPD violates
ERISA’s requirement that the “[t]he description or summary of restrictive
plan provisions need not be disclosed in the summary plan description in
close conjunction with the description or summary of benefits, provided that
_____________________
Weber, 836 F. Supp. 2d at 433; Toohey, 727 F. Supp. 2d at 984–45.
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adjacent to the benefit description the page on which the restrictions are
described is noted.” 29 C.F.R. § 2520.102–2. Finally, Krishna alleges that
the 2019 SPD violates ERISA’s requirement that a “summary plan
description must not have the effect to misleading, misinforming or failing to
inform participants and beneficiaries.” 29 C.F.R. § 2520.102.
Krishna next asserts that LINA and Honeywell violated ERISA §
1024(b) and its corresponding regulation, 29 C.F.R. § 2560.503-1(b)(5), by
failing to furnish the 2019 SPD to Balakrishnan or to Krishna during the
claims process. Section 2560.503-1(b)(5) requires that “claims procedures
contain administrative processes and safeguards designed to ensure and to
verify that benefit claim determinations are made in accordance with
governing plan documents.” 29 C.F.R. § 2560.503-1(b)(5). ERISA § 1024(b)
requires that the plan administrator provide a copy of the summary plan
description within 90 days after an employee’s enrollment in a benefits plan
or on written request from any participant or beneficiary. 29 U.S.C. §
1024(b)(1)(A), (b)(4). In support of this contention, Krishna references
January 2021 emails between herself and Denise Cherney, Honeywell’s HRS
Benefits Analyst, in which Cherney represented that “full plan
documentation, summary plan description and policy have been provided.”
Krishna also cites to Cherney’s deposition testimony and a January 2021
email exchange between Cherney and LINA regarding Krishna’s claim.
Krishna asserts that these documents show that LINA and Honeywell were
both aware that the 2003 SPD was the operative SPD during the relevant
time frame and that they knowingly failed to produce Plan-related documents
when requested.
We have already determined that Exclusion 6 is unambiguous.
Therefore, it is unnecessary to examine the 2019 SPD for deficiencies as they
relate to the claims process. Even if Exclusion 6 were ambiguous, “claims for
injuries relating to SPD deficiencies are cognizable under ERISA § 502(a)(3)
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and not ERISA § 502(a)(1)(B).” Manuel v. Turner Indus. Grp., L.L.C., 905
F.3d 859, 866 (5th Cir. 2018). On the second page of her brief, Krishna clearly
states that her ERISA § 502(a)(3) cause of action “was voluntarily dismissed
and is not at issue here.” Krishna has thus waived any claims related to
regulatory deficiencies associated with the 2019 SPD.
Krishna has also waived her claims related to LINA and Honeywell’s
withholding of particular Plan-related documents, in violation of ERISA §
1024(b) and corresponding ERISA regulations. In her second amended
complaint, Krishna asserted these claims under ERISA § 502(a)(3), “as it
relates to deficiencies in Summary Plan Description duties, disclosures and
deficiencies.” Krishna clarified that her § 502(a)(3) cause of action was
pleaded “only in the alternative to, and completely independent of” her
cause of action under § 502(a)(1)(B).
As noted above, Krishna expressly stated in her brief that her §
502(a)(3) cause of action “was voluntarily dismissed and is not at issue
here.” Indeed, in her motion for summary judgment, which is now before
this court, Krishna clarified that the “motion only involves only Plaintiff’s
first cause of action” under § 502(a)(1)(B). Accordingly, any arguments
related to her § 502(a)(3) claim were not before the court when the
magistrate judge made the Recommendations. Although we review the
summary judgment record de novo, we will not consider evidence or
arguments that were not presented to the district court for its consideration
in ruling on the motion. See Skotak v. Tenneco Resins, Inc., 953 F.2d 909, 915–
16 (5th Cir. 1992); John v. Louisiana, 757 F.2d 698, 710 (5th Cir. 1985).
Krishna has therefore waived any claims that are cognizable under ERISA §
502(a)(3).
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IV. Conclusion
For the reasons set forth above, we AFFIRM the district court’s
denial of Krishna’s motion for summary judgment and its grant of Honeywell
and LINA’s cross-motion for summary judgment. This appeal is therefore
DISMISSED.
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