Mary Eggiman Vs. Self-insured Services Co., And R.h. Hummer, Jr., Inc.

IN THE SUPREME COURT OF IOWA
No. 70 / 05-0246
Filed July 28, 2006
MARY EGGIMAN,
Appellant,
vs.
SELF-INSURED SERVICES CO., and
R.H. HUMMER, JR., INC.,
Appellees.
________________________________________________________________________
On review from the Iowa Court of Appeals.
Appeal from the Iowa District Court for Johnson County,
Douglas S. Russell, Judge.
Plaintiff seeks further review from court of appeals decision
affirming district court order that granted defendants’ summary
judgment motion and dismissed plaintiff’s claim for benefits under a
medical insurance policy. DECISION OF COURT OF APPEALS
VACATED; DISTRICT COURT ORDER REVERSED IN PART AND
REMANDED FOR FURTHER PROCEEDINGS.
Wallace L. Taylor, Cedar Rapids, for appellant.
Larry G. Gutz and Brian J. Fagan of Moyer & Bergman, P.L.C.,
Cedar Rapids, for appellees.
2
STREIT, Justice.
A woman suffering from clinical obesity alleges the company
processing claims on behalf of her health insurance plan made
misrepresentations that led her to obtain treatment not covered by the
plan. Mary Eggiman filed the present action against her husband’s
employer, R.H. Hummer, Jr., Inc., and Self-Insured Services Company
(SISCO), the claims processor for the health insurance plan. Hummer
and SISCO filed a motion for summary judgment. This motion argued
the denial of benefits was proper because Eggiman failed to obtain pre-
authorization for the surgery. The motion also argued the
misrepresentation claim against SISCO was improper because SISCO
was not a fiduciary under the Employment Retirement Income and
Security Act (ERISA). 29 U.S.C. §§ 1001, et seq. (2000). The district
court found as a matter of law it was proper to deny benefits based on
Eggiman’s failure to obtain pre-authorization. The court also concluded
SISCO was not an ERISA fiduciary and therefore could not be found
liable for any allegedly misleading statements made to Eggiman. The
court of appeals affirmed the district court ruling. On further review, we
vacate the decision of the court of appeals and reverse the portion of the
district court order which found SISCO was not an ERISA fiduciary and
therefore could not be liable for any misleading statements made to
Eggiman.
I. Background Facts and Proceedings
Eggiman suffers from clinical obesity. In 2001, her physician
recommended she consider gastric bypass surgery. Eggiman is insured
through her husband’s employer, R.H. Hummer, Jr., Inc., a trucking
firm. Hummer utilized a self-insured health and medical plan
(hereinafter “Hummer Health Plan”) as a benefit for its employees. The
3
Hummer Health Plan is governed by a “plan document” detailing the
benefits, rights, and privileges of covered individuals. In essence, the
plan document explains when the plan will pay or reimburse all or a
portion of covered expenses. SISCO marketed and sold this plan to
Hummer. SISCO is also the “claims processor” for the plan. Through a
service agreement between SISCO and Hummer, SISCO contractually
agreed to perform various functions related to the administration of the
plan. Healthcorp, Inc., SISCO’s sister company underneath the same
corporate umbrella, is listed in the plan document as the “review
organization.”
The Hummer Health Plan provides the following conditions for the
coverage of a gastric bypass procedure:
26. Charges for services in connection with surgical
treatment of morbid obesity will be considered Eligible
Expenses, subject to the following conditions:
a. A second concurring opinion is required prior to the
surgical procedure; and
b. Pre-authorization is required.
Coverage is subject to the following guidelines:
a. Body weight must be at least 200% of the optimal
weight.
b. The covered individual must have been considered
morbidly obese by a Physician for at least five (5) years
prior to the date surgical treatment is sought.
c. Non-surgical methods of weight reduction must
have been attempted under a Physician’s supervision
for at least a three (3) year period immediately prior to
the date surgical treatment is sought.
On April 23, 2001, a health insurance review specialist hired by
Eggiman’s physician sent a letter to SISCO requesting a review and
authorization for the gastric bypass surgery. Among other things, the
4
physician’s health insurance review specialist informed SISCO that
Eggiman weighed 283.8 pounds and was 132.8 pounds overweight.
On May 14, 2001, the physician’s health insurance review
specialist received a letter from Cottingham & Butler (hereinafter “C&B”) 1
denying “eligibility” because the following criteria had not been met: (1)
Eggiman’s weight was less than 200% of her optimal weight, (2) there
was no documentation from a physician indicating she had been
morbidly obese for at least five years, (3) there was no documentation of
at least three years of unsuccessful physician supervised weight-loss
plans, and (4) there was no second surgical opinion.
On June 5, 2001, Eggiman received a letter from C&B, signed
HealthCorp, Inc., informing her that “hospitalization cannot be certified
due to” insufficient information. Eggiman called SISCO and spoke with a
representative about what information was still needed for certification.
On June 15, 2001, the physician’s health insurance review
specialist received another letter from C&B. This letter stated the
following criteria had been met: (1) Eggiman was considered morbidly
obese by a physician for at least the previous five years, and (2) non-
surgical methods of weight reduction had been attempted under a
physician’s supervision for at least a three year period prior to the date of
the proposed surgery. However, the letter denied “eligibility” because a
second surgical opinion had not been obtained and Eggiman’s weight
was only 188% of her ideal weight. There is no indication this letter was
sent to Eggiman.
1
C&B is the parent company of SISCO and HealthCorp. All correspondence
pertinent to this claim was sent on C&B stationery. This stationery listed the names
SISCO and HealthCorp under the name C&B.
5
On the same day, Eggiman received a letter from C&B, signed
HealthCorp. Inc., that stated:
[Mary Eggiman] has been pre-certified for a GASTRIC
BYPASS FOR OBESITY by HealthCorp, the managed care
company selected by your employer. At this time a date has
not been established for the procedure. HealthCorp should
be notified . . . when a date is confirmed.
The physician, SISCO, and the hospital have been
notified of your certification. IT DOES NOT GUARANTEE
PAYMENT.
Healthcorp’s certification process evaluates the
appropriate length of hospital stay and/or the
appropriateness of services provided. Please be advised that
the determination of your benefits will be decided by the
rules within your company’s health plan document. Any
reimbursement is based on the services that were provided,
the participant’s eligibility and the plan limitations.
(Emphasis in original.)
On July 24, 2001, Eggiman received another letter from C&B,
signed by HealthCorp. Inc. The letter stated the following:
This letter is to notify you that your upcoming
hospitalization, listed above, has been precertified. The
length of stay precertified is an anticipated length of stay. If
additional days are medically appropriate, the length of stay
will be increased.
You will receive a “final certification” letter after your
discharge from the hospital. The final letter will include all
days certified for this hospitalization.
Healthcorp’s certification process determines the
medical appropriateness of hospitalization and/or services
provided. The final determination of continued
hospitalization is the decision of the attending physician.
The final determination of benefits will be made by SISCO.
Any reimbursement is based on the medical appropriateness
of services provided, participant’s eligibility, and plan
limitations.
The admitting physician, SISCO, and the hospital have
been notified of your precertification. This precertification
provided by Healthcorp satisfies the requirements of your
employer’s admission review process.
6
(Emphasis added.) This letter contained language indicating the
final determination of benefits would be made by SISCO. Eggiman had
received similar letters from SISCO and the bills were always paid.
The surgery was performed on July 30, 2001. Eggiman had a
second surgery on August 14, 2001 to repair a leak in the surgical
incision from the first surgery. She was also “precertified” by HealthCorp
for this second surgery.
On September 11, 2001, Eggiman received a letter from C&B
indicating both surgeries were not covered under the plan because “all
items” were not satisfied. Specifically, the letter stated her body weight
was not 200% of her optimal weight and a concurring secondary surgical
opinion had not been obtained. In addition, in direct conflict with the
letter sent on June 15, the letter stated a physician had not considered
her morbidly obese for at least five years prior to the date of surgery, and
there was no record of non-surgical weight reduction attempted under a
physician’s supervision for the three year period immediately prior to the
surgery.
Eggiman filed the present action on October 12, 2003 against both
Hummer and SISCO claiming she was denied medical and health care
benefits to which she was entitled under the Hummer Health Plan.
Hummer and SISCO filed a motion for summary judgment. The motion
pointed out that “pre-certification” and “pre-authorization” were two
separate concepts under the Hummer Health Plan. While Eggiman was
“pre-certified,” she was never “pre-authorized” and therefore failed to
meet the criteria set forth in the plan. 2 The motion also argued SISCO
2
“Pre-certification” is described in the plan as a “mandatory utilization review
requirement . . . required for all scheduled Hospital admissions and Outpatient
services. . . . Pre-certification determines that services received are Medically
Necessary.” On the other hand, the term “pre-authorization” was listed as a
7
should be dismissed from the lawsuit because it did not qualify as
an ERISA fiduciary and therefore was not liable to Eggiman.
Eggiman resisted the motion, claiming she had complied with all of
the requirements demanded of her prior to the surgery. She also
indicated she was never told she was not pre-authorized for the surgery
until after the surgery was complete. She also argued SISCO’s
representations and actions led her to believe the procedure was covered.
The district court concluded no genuine issue of material fact remained
as to her coverage under the terms of the plan. The court found as a
matter of law it was proper to deny benefits for the surgery because
Eggiman failed to obtain pre-authorization. The court further found
SISCO held no fiduciary responsibility to Eggiman, as contemplated
under ERISA, and SISCO therefore could not be found liable for any
allegedly misleading statements it made to Eggiman. The district court
made no ruling on whether the statements were, or were not, misleading.
Eggiman appealed and the court of appeals affirmed the district
court’s ruling. The court of appeals noted Eggiman did not “specifically
contest” the district court’s conclusion that it was proper to deny benefits
based on Eggiman’s failure to obtain pre-authorization. Eggiman
conceded her appeal was based on the position she had a valid ERISA
claim because of the misleading statements made by SISCO. The court
of appeals found this misrepresentation issue was not properly preserved
for appellate review. We granted Eggiman’s application for further
review.
________________________
requirement for gastric bypass surgery, but it was not defined or otherwise described in
the plan.
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II. Scope of Review
Summary judgment is proper only when the record shows no
genuine issue of material fact and the moving party is entitled to
judgment as a matter of law. Iowa R. Civ. P. 1.981(3). The court must
view the record in the light most favorable to the nonmoving party. Lloyd
v. Drake Univ., 686 N.W.2d 225, 228 (Iowa 2004). In deciding whether
there is a genuine issue of material fact, the court should also afford the
nonmoving party every legitimate inference the record will bear. Smidt v.
Porter, 695 N.W.2d 9, 14 (Iowa 2005). Our review of a summary
judgment ruling is for correction of errors at law. Hlubek v. Pelecky, 701
N.W.2d 93, 95 (Iowa 2005).
III. Merits
The district court made an adverse ruling on Eggiman’s coverage
claim. It concluded there was no factual dispute with regard to the
approval Eggiman was required to obtain before the surgery and it was
therefore proper to deny benefits based on her failure to obtain pre-
authorization. Eggiman does not contest this finding on appeal. Instead,
she argues she has a valid ERISA claim because SISCO’s misleading
statements erroneously caused her to believe she would be covered
under the plan. We therefore proceed to analyze her misrepresentation
claim.
A. Misrepresentation
1. Error Preservation
Although not argued by either party, the court of appeals
determined Eggiman’s misrepresentation claim was not preserved for
appellate review. It is a fundamental doctrine of appellate review that
issues must ordinarily be raised and decided by the district court before
we will decide them on appeal. Metz v. Amoco Oil Co., 581 N.W.2d 597,
9
600 (Iowa 1998). In order to preserve error for appeal, the party
who raised an issue that was not ruled upon must file a motion
requesting a ruling.
The court of appeals concluded there was no ruling on the
misrepresentation issue and Eggiman failed to file a motion requesting
such a ruling. We disagree. The district court expressly addressed
Eggiman’s misrepresentation argument in its ruling. The district court
said:
Plaintiff argued at hearing that the representations
and actions of SISCO led both plaintiff and the health care
provider to believe that the procedure was covered. Plaintiff
asserted she was “encouraged” by [a SISCO claims
representative] to go ahead with the surgery, leading plaintiff
to believe the surgery was covered. . . . Finally, Plaintiff
argued that SISCO is a fiduciary in this matter.
Later, the district court stated:
The Court turns to the issue of whether SISCO is a
fiduciary and, therefore, is liable to [plaintiff]. ERISA
provides a cause of action for a fiduciary’s misrepresentation
of health plan coverage. To establish a breach of fiduciary
duty, Plaintiff must prove SISCO is an ERISA fiduciary.
(Emphasis added.) The district court then determined, based on the
terms in the service agreement between Hummer and SISCO, SISCO was
not an ERISA fiduciary. Because SISCO was not an ERISA fiduciary, the
court determined SISCO did not have a fiduciary responsibility to
Eggiman.
Although the court did not address whether SISCO’s letters were
actually misleading, it did rule on Eggiman’s misrepresentation claim by
concluding SISCO had no fiduciary duty to Eggiman. As discussed
below, fiduciary status was a preliminary requirement for Eggiman’s
misrepresentation claim. Eggiman was not required to file a motion
asking the court to hypothecate whether it would have found the
10
statements misleading had it determined SISCO was an ERISA
fiduciary. Indeed, it would have been improper for the court to do so.
See Wickey v. Muscatine County, 242 Iowa 272, 287, 46 N.W.2d 32, 40
(1951) (holding Iowa courts decline to issue opinions on nonjusticiable
issues). Therefore the misrepresentation issue was adequately preserved
for our review.
2. Cause of Action
Eggiman argues SISCO’s allegedly misleading statements caused
her to have the surgery because she erroneously believed she would be
covered under the Hummer Health Plan.
Our analysis begins with the cause of action as established under
ERISA. ERISA was enacted to
protect . . . the interests of participants in employee benefit
plans and their beneficiaries, by requiring the disclosure and
reporting to participants and beneficiaries of financial and
other information with respect thereto, by establishing
standards of conduct, responsibility, and obligation for
fiduciaries of employee benefit plans, and by providing for
appropriate remedies, sanctions, and ready access to the
Federal courts.
29 U.S.C. § 1001(b). In keeping with this design, ERISA imposes several
fiduciary duties on certain entities. Specifically, 29 U.S.C. § 1104(a)(1),
which governs fiduciary duties, provides in relevant part:
a fiduciary shall discharge his duties with respect to a plan
solely in the interest of the participants and beneficiaries
and—
(A) for the exclusive purpose of:
(i) providing benefits to participants and their
beneficiaries; and
(ii) defraying reasonable expenses of administering the
plan;
(B) with the care, skill, prudence, and diligence under the
circumstances then prevailing that a prudent man acting in
a like capacity and familiar with such matters would use in
the conduct of an enterprise of a like character and with like
aims . . . .
11
Several courts have held that misleading communications to
plan participants regarding plan administration (i.e. eligibility under a
plan or the extent of benefits under a plan) support a claim for breach of
fiduciary duty. Berlin v. Mich. Bell Tel. Co., 858 F.2d 1154, 1163 (6th Cir.
1988); see also Peoria Union Stock Yards Co. Ret. Plan v. Penn Mut. Life
Ins. Co., 698 F.2d 320, 326 (7th Cir. 1983) (“Lying is inconsistent with
the duty of loyalty owed by all fiduciaries and codified in [29 U.S.C.
§ 1104].”); Rosen v. Hotel & Rest. Employees & Bartenders Union, 637
F.2d 592, 600 n.11 (3d Cir. 1981) (holding a fiduciary is under a duty to
communicate material facts to a plan beneficiary); Muenchow v. Parker
Pen Co., 615 F. Supp. 1405, 1417 (W.D. Wis. 1985) (stating “ERISA
supplies plaintiffs a remedy for the wrong [of misrepresentation by
fiduciaries] alleged in their complaint”); Dist. 65, UAW v. Harper & Row
Publishers, Inc., 576 F. Supp. 1468, 1480 (S.D.N.Y. 1983) (precluding
summary judgment on claim fiduciary breached its fiduciary duties by
failing to provide the plan participants with information necessary to
make an informed decision). The first step in such a claim is proof the
person supplying the misleading information qualifies as an ERISA
fiduciary. Ince v. Aetna Health Mgmt., Inc., 173 F.3d 672, 674 (8th Cir.
1999); Greenblatt v. Prescription Plan Servs. Corp., 783 F. Supp. 814, 820
(S.D.N.Y. 1992).
3. ERISA Fiduciary
An entity is an ERISA fiduciary if it performs fiduciary functions.
Bd. of Trustees of the W. Lake Superior Piping Indus. Pension Fund v. Am.
Benefit Plan Adm’rs, Inc., 925 F. Supp. 1424, 1433 (D. Minn. 1996)
(recognizing the status of a person providing administrative services to
an ERISA plan is not determined by the person’s title, label, or
designation, but rather by whether the person performs or has been
12
assigned functions that fall within the scope of 29 U.S.C.
§ 1002(21)(A)). ERISA provides a person is an ERISA fiduciary if:
(i) he exercises any discretionary authority or discretionary
control respecting management of such plan or exercises any
authority or control respecting management or disposition of
its assets, (ii) he renders investment advice for a fee or other
compensation, direct or indirect, with respect to any moneys
or other property of such plan, or has any authority or
responsibility to do so, or (iii) he has any discretionary
authority or discretionary responsibility in the
administration of such plan.
29 U.S.C. § 1002(21)(A) (emphasis added).
Because ERISA was enacted to protect participants in employee
benefits plans, courts give the term “fiduciary” a liberal construction to
maintain the remedial purpose of ERISA. Am. Fed’n of Unions v.
Equitable Life Assurance Soc’y, 841 F.2d 658, 662 (5th Cir. 1988). In
essence, so long as SISCO exercised discretionary authority over the
management of the Hummer Health Plan or had discretionary authority
or responsibility in the plan’s administration, then SISCO qualifies as an
ERISA fiduciary for the purposes of Eggiman’s claim. See 29 U.S.C.
§ 1002(21)(A).
The district court concluded, as a matter of law, SISCO was not an
ERISA fiduciary because the duties set forth in the service agreement
between Hummer and SISCO did not give SISCO a fiduciary
responsibility with regards to Eggiman. The court also concluded SISCO
did not utilize any discretionary authority.
We find such a conclusion was, at best, premature. Eggiman has
produced evidence that could lead a fact finder to conclude SISCO’s
actions made it an ERISA fiduciary. Eggiman points out that SISCO or
its parent company drew up the terms of the benefits plan and made all
13
the decisions and exercised all of the authority and discretion in
determining whether her claim was approved or denied.
In Brock v. Self, 632 F. Supp. 1509, 1519-21 (W.D. La. 1986), a
Louisiana district court found a pension plan service company, its chief
executive officer, and an employee managing its pension and profit-
sharing plan servicing operations were all ERISA fiduciaries because they
had, among other things, helped to design the plan, provided all of the
documents and materials necessary to establish the plan, and had
admitted responsibility to amend the plan to conform to ERISA
requirements.
While the service agreement between Hummer and SISCO states
SISCO was to “provide assistance in the preparation of plan documents
and plan amendments” at Hummer’s request, testimony from Ronald
Hummer, Jr., the owner of R.H. Hummer, Jr., Inc. indicates SISCO did
much more than “provide assistance.” Mr. Hummer testified that SISCO
devised and prepared the entire plan with little or no input from him.
The only input Mr. Hummer had in the plan was the dollar amount of the
deductible paid by Hummer. There is an obvious conflict between the
plan’s rendition of who drafted the plan and Ronald Hummer’s testimony
about who drafted the plan; therefore, taking the facts in the light most
favorable to the nonmoving party, there is a reasonable inference that
SISCO designed the plan and provided all materials necessary to
establish the plan.
There is also enough evidence to support a reasonable inference
that SISCO had the authority to exercise its own discretion to determine
whether Eggiman’s claim was covered. According to the Department of
Labor, a person or entity is not considered an ERISA fiduciary even
though the person or entity processes claims and makes
14
recommendations to others for decisions with respect to plan
administration. 29 C.F.R. § 2509.75-8, D-2 (2005). However, in the
present case, there is enough evidence for a reasonable person to
conclude SISCO did much more than merely process claims and make
recommendations. While the plan document gave Hummer the authority
“to control and manage the operation and administration of the Plan,”
and the “sole authority and responsibility to review and make final
decisions on all claims,” it also stated “Hummer may delegate
responsibilities for the operation and administration of the plan.”
Hummer made such a delegation in the service agreement with SISCO.
The agreement held SISCO was to provide “claims administration” and
“shall . . . [m]ake claim payment decisions, except when specifically
directed by the Employer.” This delegation of power arguably gave
SISCO some discretionary authority over Eggiman’s claim.
Beyond the authority listed in the service agreement, the testimony
from Ronald Hummer, the correspondence from HealthCorp, and
SISCO’s actions in processing Eggiman’s claim also point towards
discretionary authority. In his deposition, Ronald Hummer repeatedly
stated that SISCO made the decision whether to approve or deny claims.
He stated, “I don’t make that judgment call. We hired SISCO to do that.”
It was Ronald Hummer’s understanding that he, as the employer, had
“no say-so in how [the plan] was administrated.” Likewise, in the July 24
letter to Eggiman, HealthCorp told Eggiman “[t]he final determination of
benefits will be made by SISCO.” (Emphasis added.) The present record
does not indicate SISCO ever asked Ronald Hummer whether Eggiman’s
claim should be pre-authorized, approved, or disapproved. These
decisions were apparently all made by SISCO itself.
15
SISCO’s argument that the court should find, as a matter of
law, SISCO did not have discretionary authority because Hummer held
the ultimate authority to approve or deny all claims is not persuasive. In
American Federation of Unions v. Equitable Life Assurance Society, an
administrator was held to be a fiduciary because he was empowered to
investigate, process, resolve, and pay claims to members of an ERISA
fund. 841 F.2d at 662-63. The court concluded those functions
qualified “as discretionary control respecting management of a plan or its
assets within the meaning of § 1002(21)(A).” Id. at 663. The court
stated, “[the administrator’s] fiduciary status was not diminished by the
trustees’ final authority to grant or deny claims and approve
investments. The term fiduciary includes those to whom some
discretionary authority has been delegated.” Id. (emphasis added). Even
though Hummer possessed the ultimate authority to approve or deny
Eggiman’s benefit claim, Eggiman has produced enough evidence to
suggest some discretionary authority had been delegated to SISCO and
SISCO acted for the purposes of Eggiman’s claim, as an ERISA
fiduciary. 3
3SISCO’s argument that it had no discretionary authority because it was bound
to follow the terms and criteria set forth in the Hummer Health Plan is not dispositive at
the summary judgment level. As stated in Protocare of Metropolitan N.Y., Inc. v. Mutual
Association Administrators, Inc., 866 F. Supp. 757, 762 (S.D.N.Y. 1994), “[a] person who
has no power to make any decisions on plan policy, interpretations, procedures or
practices, but who applies the rules determining eligibility for participation or benefits
in the plan is not a fiduciary.” (Internal quotations and citations omitted; emphasis
added.) While the plan document sets forth the criteria for benefits, Hummer’s
testimony was that SISCO wholly designed the plan and was hired to make all decisions
on whether to approve or deny benefit claims. Therefore, taking the facts in the light
most favorable to the nonmoving party, we cannot find that SISCO had “no power to
make any decisions.” See id.
16
IV. Conclusion
We do not disturb the district court’s conclusion that it was proper
to deny benefits based on Eggiman’s failure to obtain pre-authorization.
However, we reverse the decision which found, as a matter of law, SISCO
owed no fiduciary responsibility to Eggiman. As once stated by the
United States Court of Appeals for the Fourth Circuit:
Even in cases where the judge is of the opinion that he will
have to direct a verdict for one party or the other on the
issues that have been raised, he should ordinarily hear the
evidence and direct the verdict rather than attempt to try the
case in advance on a motion for summary judgment, which
was never intended to enable parties to evade jury trials or
have the judge weigh evidence in advance of it being
presented.
Pierce v. Ford Motor Co., 190 F.2d 910, 915 (4th Cir. 1951). Based on the
present record, a reasonable fact finder could conclude Hummer drafted
the health plan and, despite Ronald Hummer’s testimony to the contrary,
held all the authority and exercised all discretion to approve or deny
claims. On the other hand, a reasonable fact finder could conclude
SISCO’s actions went far beyond merely processing claims and making
recommendations. The fact finder might conclude SISCO sold the plan
to Hummer as a full service plan but then wrote the plan document so as
to shield itself from ERISA fiduciary status.
When two legitimate, conflicting inferences are present at the time
of ruling upon the summary judgment motion, the court should rule in
favor of the nonmoving party. See Daboll v. Hoden, 222 N.W.2d 727, 733
(Iowa 1974) (“If reasonable minds could draw different inferences and
reach different conclusions from the facts, even though undisputed, the
issue must be reserved for trial.”). In this case, the court balanced and
weighed the evidence to reach an ultimate decision on the merits of the
17
case. As noted above, the court’s role at the time of summary
judgment was to determine whether a rational trier of fact could conclude
SISCO was an ERISA fiduciary, not to make an ultimate decision on the
merits of the case. Because reasonable minds could draw different
inferences from the conflicting set of facts in this case, the district court’s
decision to find against Eggiman on this motion for summary judgment
was erroneous. 4 We therefore vacate the decision of the court of appeals
and reverse the district court’s decision in part and remand for further
proceedings.
DECISION OF COURT OF APPEALS VACATED; DISTRICT
COURT ORDER REVERSED IN PART AND REMANDED FOR
FURTHER PROCEEDINGS.
4
Although we do not conclude, as a matter of law, that SISCO was an ERISA
fiduciary, we do conclude there is enough evidence in the record for a rational trier of
fact to conclude that SISCO was a fiduciary with respect to the Plan.