Allinder v. Inter-City Products Corp. (USA)

• Decision Date: 10 August 1998
• Docket Number: INTER-CITY,No. 97-5909,97-5909
• Citation: 152 F.3d 544
• Parties: 22 Employee Benefits Cas. 2735 Linda ALLINDER, Plaintiff-Appellant, v.PRODUCTS CORPORATION (USA), Robert Henningsen, Defendants-Appellees.
• Court: U.S. Court of Appeals — Sixth Circuit

Page 544

152 F.3d 544

22 Employee Benefits Cas. 2735

Linda ALLINDER, Plaintiff-Appellant, v. INTER-CITY PRODUCTS CORPORATION (USA), Robert Henningsen Defendants-Appellees.

No. 97-5909.

United States Court of Appeals, Sixth Circuit.

Argued June 18, 1998.

Decided Aug. 10, 1998.

James L. Harris (argued and briefed), Nashville, Tennessee, for Plaintiff-Appellant.

Mark H. Floyd, Bynum E. Tudor, III (argued and briefed), Floyd & Tudor, Nashville, Tennessee, for Defendants-Appellees.

Before: MOORE, CLAY, and GILMAN, Circuit Judges.

GILMAN, Circuit Judge.

Linda Allinder sued her former employer, Inter-City Products Corporation, and its Vice President of Human Resources, Robert Henningsen (collectively "ICP"), for alleged violations of the Employee Retirement Income Security Act of 1974 ("ERISA"). She specifically claimed that ICP violated 29 U.S.C. § 1132(c) (refusal to supply requested information) and §§ 1104(a)(1) and 1106(b)(2) (breach of fiduciary duty). The essence of Allinder's suit concerned ICP's refusal to complete a form necessary for her to file a long-term disability insurance claim after she suffered a debilitating toxic reaction to pesticides sprayed in her work area. Although she was eventually paid in full the amount of benefits due under the policy, Allinder sought compensatory and punitive damages based on the allegedly intentional misrepresentations made by ICP in order to delay such payment.

While sympathetic to Allinder's plight, the district court nonetheless granted summary judgment in favor of ICP. The court's reasoning was twofold. First, the court concluded that ERISA's document-disclosure provisions do not cover claim forms. Second, relying upon this court's decision in Tassinare v. American Nat. Ins. Co., 32 F.3d 220 (6th Cir.1994), the district court held that Allinder could not make out a claim for breach of fiduciary duty because "fiduciary liability under ERISA arises in favor of the plan itself, and ... plan participants may not seek to recover in an individual capacity." For the reasons set forth below, we AFFIRM the judgment of the district court.

I. BACKGROUND

A. ICP's Long-Term Disability Insurance Policy

Allinder began work as a computer systems analyst at ICP's Lovergne, Tennessee facility in May of 1986. As is standard in the employment setting, ICP offered its employees a package of benefits, including a company-sponsored long-term disability insurance policy ("the policy"). Allinder elected to enroll in the policy when she assumed her position at ICP. The terms and conditions of the policy were contained in an insurance contract signed by ICP and Life Insurance Company of North America ("insurance company").

Under the terms of the policy, an eligible employee was considered insured at the conclusion of an initial twelve-month waiting period. In order to fall within the class of eligible employees, the employee had to be in active service and regularly work a minimum of thirty hours a week. An employee was considered to be in active service if he or she performed "all of the regular duties of his work" during scheduled work days. The policy did provide one exception: employees did not have to meet the eligibility requirements if they were unable to work due to a "total disability."

The term "total disability" was defined by the policy as one where, "because of injury or sickness, [an employee] is unable to perform all the essential duties of his occupation." The policy further provided that insured employees were entitled to receive payment of long-term disability benefits after they had suffered from a "total disability" for more than six months. According to the section of the policy titled "Long Term Disability Benefits," the insurance company was obligated to make monthly payments of disability benefits once it received proof that "the employee became Totally Disabled while insured." (emphasis added). Insured employees were thus entitled to disability benefits once they became disabled, regardless of when they filed a claim for benefits. The policy concluded by stating that the insurance company would deal solely with ICP, which was deemed the representative for the employee, and that any action ICP took in regard to the administration of the plan was binding on the employee.

B. The Disability Claim

ICP hired a local pest-control company in March of 1990 to spray for termites in the work area used by Allinder. Shortly after the spraying, Allinder began to experience a number of adverse symptoms, including itching, severe shortness of breath, extreme fatigue, pain, fever, and difficulty walking. After reporting these symptoms to her supervisor, Allinder left work and remained at home for several days. When she returned to work, Allinder requested that she be moved to another area in the building that had not been sprayed with pesticides. ICP accommodated Allinder's request and moved her to an alternate work area in its facility. Allinder's symptoms apparently subsided once she was transferred to the new work area. On April 10, 1990, however, Allinder's immediate supervisor, Rick Zorn, ordered Allinder to return to her original work area. Her symptoms reappeared upon her return. Allinder again requested and was allowed to go back to the alternate work area to carry out her job duties.

In early June of 1990, Zorn again forced Allinder to return to her original work area. Upon her return, Allinder began to suffer even more severe symptoms than she had earlier experienced. On June 19, 1990, Allinder's condition worsened to the point that she experienced uncontrollable tremors in her hands and legs, including one episode where her legs involuntarily jerked for four hours. Allinder was rushed to nearby Baptist Hospital's emergency room, where she was diagnosed as suffering from a toxic reaction to the pesticide sprayed by the pest-control company. Allinder's treating physician later diagnosed her as having suffered nerve damage from her exposure to the pesticide. Allinder remained away from work for the remainder of June because of her illness.

Allinder met with members of ICP's management in July to discuss her medical condition. At this meeting, Allinder presented a letter from her physician stating that she should not work in an area where pesticides have been applied or, alternatively, that she should be allowed to work at home. At the conclusion of this meeting, Allinder was asked whether she was resigning her job. Allinder responded that she intended to continue to work for ICP after she recovered from her illness. ICP nonetheless terminated Allinder's employment on August 24, 1990 due to her failure to report to work while she was seeking treatment for her illness. At the time she was fired, Allinder was less than a month away from being entitled to receive payment of long-term disability benefits.

On November 14, 1991, Allinder requested that ICP fill out its portion of the long-term disability claim form and submit it to the insurance company so that she could begin receiving payments of disability benefits. This claim form is a two-sided document. The front of the document provides questions for the employee to answer, while the back is to be completed by ICP. In a letter dated January 17, 1992, ICP's in-house counsel informed Allinder that the company would not fill out its portion of the form because she failed to "me[e]t the threshold requirement of active employee status at the time she made a claim for LTD (Long Term Disability) benefits."

This representation, as conceded by ICP at oral argument, was incorrect. According to the policy, the relevant date for determining whether insured employees were entitled to disability benefits was when they first became disabled, not when they made a claim for benefits. Because Allinder was insured at the time she first became disabled, she was entitled to disability benefits. The letter continued by informing Allinder that "the determination of active employee status is within the exclusive province of the Company. Thus, the submission of a LTD application form and setting in motion the decision-making process as to the merits of her claim is inappropriate." Allinder believed ICP's statements and decided not to pursue her request any further at that time.

Prompted by information she later learned while attending a public health law course, Allinder reconsidered her earlier decision and submitted another request to ICP to fill out its portion of the long-term disability claim form. This request was dated December 30, 1993. ICP again denied Allinder's request for the same reasons it had given earlier. Allinder then contacted the insurance company to seek its aid in resolving the matter. In a letter dated January 20, 1994, an insurance-company representative responded to Allinder's request by noting that "in order to file a claim for Long Term Disability benefits, we require that you provide proof of loss by submitting the appropriate form, i.e., ... the Group Long Term Disability form to be completed by both you and your employer."

Allinder then retained the services of an attorney. In a letter dated March 27, 1995, Allinder's attorney requested that ICP provide copies of the portions of the insurance policy which indicated that Allinder was not entitled to long-term disability benefits. The defendant Henningsen responded by sending Allinder a copy of the section of the insurance policy titled "Eligibility for Employee Insurance." This section of the policy, however, only delineates the requirements for disability-insurance coverage. It does not address under what conditions benefits are payable.

Faced with ICP's recalcitrance, Allinder's attorney negotiated a side agreement with the insurance company. According to the agreement, Allinder would fill out ICP's portion of the claim form and submit the "completed" form to the insurance company to process her claim. After Allinder actually submitted...