Connie Thacker v. Schneider Electric USA, Inc.

NOT RECOMMENDED FOR FULL-TEXT PUBLICATION
File Name: 13a0933n.06
No. 13-5306 FILED
Oct 30, 2013
UNITED STATES COURT OF APPEALS DEBORAH S. HUNT, Clerk
FOR THE SIXTH CIRCUIT
CONNIE THACKER, )
)
Plaintiff-Appellant, )
)
v. ) ON APPEAL FROM THE UNITED
) STATES DISTRICT COURT FOR THE
SCHNEIDER ELECTRIC USA, INC. ) EASTERN DISTRICT OF KENTUCKY
)
Defendant-Appellee. )
/
BEFORE: MERRITT and CLAY, Circuit Judges; and STAFFORD, District Judge.*
STAFFORD, District Judge.
The plaintiff-appellant, Connie Thacker ("Thacker"), filed this ERISA action after her
former employer, Schneider Electric USA, Inc. ("Schneider"), denied her applications for
disability retirement and disability life insurance benefits. The district court entered summary
judgment for Schneider. On Thacker's appeal from that judgment, we AFFIRM.
I. BACKGROUND
Schneider (f/k/a Square D Company) hired Thacker on June 22, 1994, to work at a plant
in Lexington, Kentucky. As a union employee, Thacker was eligible to participate in employee-
sponsored benefit plans governed by the Employee Retirement Income Security Act of 1974
("ERISA"), 29 U.S.C. §§ 1001–1461, including the Square D Company Coordinated Bargaining
*
The Honorable William H. Stafford, Jr., Senior United States District Judge for the
Northern District of Florida, sitting by designation.
Employees' Pension Plan (the "Pension Plan") and the Group Life and Health Plan for
Coordinated Bargaining Employees (the "Life and Health Plan"). The Pension Plan is an
"employee pension benefit plan" as defined in 29 U.S.C. § 1002(2). The Life and Health Plan is
an "employee welfare benefit plan" as defined in 29 U.S.C. § 1002(1). At all relevant times,
Schneider (or its predecessor, Square D Company) has been the plan sponsor for both the
Pension Plan and the Life and Health Plan. The plan administrator for both plans is an
administrative committee appointed by Schneider. Both plans grant broad discretion to the plan
administrator to determine eligibility for benefits and to construe and interpret the terms of the
respective plan documents.
Thacker began a disability leave of absence on June 3, 2008. After that date, she did not
return to work or perform any of her job functions. On June 15, 2009, Thacker stopped paying
the required premiums under the Life and Health Plan. She was advised in November 2009 that,
in fact, her medical and life insurance coverage was cancelled retroactive to June 15, 2009, for
non-payment of premiums.
On September 23, 2010, more than a year after she ceased being covered under the Life
and Health Plan, Thacker applied to Schneider for both disability retirement benefits and
disability life insurance benefits. Included with her applications was a copy of a letter from the
Social Security Administration ("SSA") dated September 16, 2010, advising Thacker that she
was entitled to monthly disability benefits retroactive to June 1, 2009.1 Her application for
disability life insurance benefits was soon after denied based on her failure to submit proof—as
required by the Life and Health Plan—of "Total and Permanent Disability" within one year after
1
The SSA determined that Thacker became disabled on December 31, 2008, entitling
her to benefits beginning five months later.
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ceasing to be a covered individual. Her application for disability retirement benefits was
similarly denied for untimeliness.
After she unsuccessfully appealed the two decisions administratively, Thacker filed this
action, seeking reversal of the plan administrator's denial of her applications for benefits. The
district court entered summary judgment for Schneider, finding—among other things—that the
denial of Thacker's applications for benefits was not arbitrary and capricious. This appeal
followed.
II. STANDARD OF REVIEW
We review de novo a district court's grant of summary judgment in an ERISA action,
"applying the same standard of review to the administrator's action as required by the district
court." Bidwell v. Univ. Med. Ctr., Inc., 685 F.3d 613, 616 (6th Cir. 2012) (quoting Moore v.
Lafayette Life Ins. Co., 458 F.3d 416, 427 (6th Cir. 2006)). Summary judgment is appropriate
where the pleadings and affidavits show that there is no genuine issue of material fact and one
party is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(a). In an ERISA case, the
relevant genuine issue of material fact is whether the administrator's decision was appropriate in
light of the applicable standard of review. Farhner v. United Transp. Union Discipline Income
Prot. Program, 645 F.3d 338, 342 (6th Cir. 2011).
ERISA does not specify the judicial standard of review applicable to actions challenging
a plan administrator's benefits determination. In Firestone Tire & Rubber Co. v. Bruch, 489 U.S.
101 (1989), however, the Supreme Court established that a denial of benefits "is to be reviewed
under a de novo standard unless the benefit plan gives the administrator . . . discretionary
authority to determine eligibility for benefits or to construe the terms of the plan." Id. at 115.
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When discretionary authority to determine eligibility for benefits or to construe the terms of a
plan is granted to an ERISA plan administrator, the highly deferential arbitrary-and-capricious
standard of review is appropriate. Judge v. Metro. Life Ins. Co., 710 F.3d 651, 657 (6th Cir.
2013).
Here, the district court found—and Thacker does not dispute—that both the Pension Plan
and the Life and Health Plan give the plan administrator discretionary authority to not only
interpret the terms of the respective plans but also to determine eligibility for benefits under the
plans. The district court accordingly determined—and we agree—that the arbitrary-and-
capricious standard of review governs the issues in this case. The district court correctly rejected
Thacker's arguments for a less deferential standard of review based on the plan administrator's
purported bias. See id. at 664.
III. ANALYSIS
We review de novo a district court's decision regarding the denial of benefits under an
ERISA plan. Smith v. Cont'l Cas. Co., 450 F.3d 253, 258 (6th Cir. 2006). Like the district court,
we will not overturn an administrator's discretionary decision to deny benefits unless that
decision was arbitrary or capricious. An administrator's decision is not arbitrary or capricious "if
it is the result of a deliberate, principled reasoning process and if it is supported by substantial
evidence." Glenn v. MetLife, 461 F.3d 660, 666 (6th Cir. 2006) (internal quotation marks
omitted).
A. Disability Life Insurance Benefits
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Thacker's application for disability life insurance benefits was denied because she failed
to submit proof of total and permanent disability within a year after she ceased to be a covered
individual under the Life and Health Plan. The Life and Health Plan expressly provides that "[i]f
you become totally and permanently disabled, your Term Life Insurance will be paid to you . . .
[provided] you furnish proof of Total and Permanent Disability within a year after ceasing to be
a covered individual." The Life and Health Plan also provides that, if—as here—an employee
becomes totally disabled prior to age 60, "life insurance will be continued during the period of
total disability, as long as premiums are paid." The plan administrator determined that Thacker
ceased to be a covered individual on June 15, 2009, based on her failure to pay the required
premiums after that date. Thacker does not dispute that she failed to pay the required premiums
after June 15, 2009. She also does not dispute that she submitted her SSDI award, which
qualified as proof of total and permanent disability, more than a year after she stopped paying
the required life insurance premiums. Because Thacker failed to comply with the clear terms of
the Life and Health Plan, the plan administrator's denial of Thacker's application for disability
life insurance benefits was not arbitrary or capricious. Thacker's arguments to the contrary are
without merit.
B. Disability Retirement Benefits
Under the terms of the Pension Plan, "an application for disability retirement benefits
must be filed with the Administrator within two years after the date the Participant is last
actively at work at the Company as a condition to receiving disability retirement benefits." Also
under the terms of the Pension Plan, a social security disability award may be used to support a
claim for total and permanent disability "provided that the Social Security Disability is incurred
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while the participant is in the Company's active employ; and further provided that the effective
date of the Social Security disability benefits must be a date within six (6) months after the date
the Participant stops actively working at the Company." The Pension Plan does not define the
phrases "active employ," "actively at work," or "actively working."2
The plan administrator denied Thacker's claim for disability retirement benefits for two
reasons: (1) Thacker failed to submit her application for benefits within two years after the date
she was last "actively at work at the Company;" and (2) the social security disability award that
she submitted as evidence of a total and permanent disability did not become effective within six
months after the date she stopped "actively working at the Company." The plan administrator
determined that Thacker stopped "actively working at the Company" on June 3, 2008, the day
her medical leave of absence began. Her application for benefits was submitted on September
24, 2010, more than two years later; and her SSDI award became effective on June 1, 2009, more
than six months after she began her leave of absence. The plan administrator thus determined
that Thacker failed to meet the Pension Plan's timing requirements.
The district court concluded that the plan administrator's interpretation of the phrases
"actively at work" and "actively working" was reasonable and, accordingly, found nothing
arbitrary or capricious about the administrator's decision to deny Thacker's claim for retirement
benefits based on the untimeliness of Thacker's application and SSDI award. We agree with the
district court's assessment. ERISA plan provisions are interpreted "according to their plain
meaning, in an ordinary and popular sense." Perez v. Aetna Life Ins. Co., 150 F.3d 550, 556 (6th
Cir. 1998) (en banc). Used in the ordinary sense, the words "actively working" and "actively at
2
In contrast, the Life and Health Plan defines "actively at work" to mean "working your
regularly scheduled hours per week."
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work" denote a functioning employee who is performing her job duties. It was thus reasonable
for the plan administrator to find that, when Thacker took leave of absence on June 3, 2008,
neither coming to her place of work nor performing any of her job duties thereafter, she stopped
"actively working at the Company." It follows that the plan administrator's decision to deny
Thacker's application for retirement benefits based on her failure to comply with the Pension
Plan's timing requirements was neither arbitrary nor capricious.3
IV. CONCLUSION
For the reasons stated above and for the reasons stated by the district court, we
AFFIRM.
3
Like the district court, we find that Thacker's estoppel claim is foreclosed by Bloemker
v. Laborers' Local 265 Pension Fund, 605 F.3d 436 (6th Cir. 2010), which sets forth the
elements of an estoppel claim where, as here, a pension plan's terms are unambiguous. See id. at
442–43. That being the case, the district court did not err in denying Thacker's request to
supplement the administrative record or to conduct limited discovery regarding her estoppel
claim.
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