Engleson v. Unum Life Ins. Co. of Am.

• Decision Date: 03 July 2013
• Docket Number: No. 12–4049.,12–4049.
• Citation: 723 F.3d 611
• Parties: Jerry ENGLESON, Plaintiff–Appellant, v. UNUM LIFE INSURANCE COMPANY OF AMERICA; Seibert Keck Long Term Disability Income Plan, Defendants–Appellees.
• Court: U.S. Court of Appeals — Sixth Circuit

723 F.3d 611

Jerry ENGLESON, Plaintiff–Appellant,

v.UNUM LIFE INSURANCE COMPANY OF AMERICA; Seibert Keck Long Term Disability Income Plan, Defendants–Appellees.

No. 12–4049.

United States Court of Appeals, Sixth Circuit.

Argued: May 1, 2013.

Decided and Filed: July 3, 2013.

ARGUED:Kenneth L. Gibson, Gibson & Lowry, Cuyahoga Falls, Ohio, for Appellant. Brett K. Bacon, Frantz Ward LLP, Cleveland, Ohio, for Appellees. ON BRIEF:Kenneth L. Gibson, Gibson & Lowry, Cuyahoga Falls, Ohio, for Appellant. Brett K. Bacon, Olivia Lin Southam, Frantz Ward LLP, Cleveland, Ohio, for Appellees.

Before: MERRITT, CLAY, and DONALD, Circuit Judges.

OPINION

BERNICE BOUIE DONALD, Circuit Judge.

Jerry Engleson waited over eight years before seeking judicial review of his denied claim for long-term disability benefits. The terms of his disability plan, however, gave him a little more than three years to file such a suit. Despite Engleson's best efforts to convince us otherwise, neither the law nor principles of equity allow us to excuse the tardiness of his suit. As a result, we AFFIRM the decision of the district court.

I.

Jerry Engleson was a Vice President at the Seibert–Keck Insurance Agency in Akron, Ohio. His responsibilities included managing the company's casualty and property insurance lines. He suffered from a number of medical conditions, including Crohn's disease and depression. Eventually, the maladies proved to be too much; he stepped down from his position on June 16, 2001, citing his impaired state.

Seibert–Keck had a group plan for long-term disability benefits, managed by the Unum Life Insurance Company of America(Unum). Upon his departure from Seibert–Keck, Engleson filed a claim for long-term disability benefits under this plan. He then moved to Sarasota, Florida.

Unum denied his claim on August 22, 2001, reasoning that Engleson's clinical documentation did not support his assertion that his symptoms were so debilitating that he was precluded from working. From Unum's perspective, nothing in the file suggested that Engleson had been “continuously disabled.”

But Unum also offered an internal appeal, which Engleson took advantage of on August 28, 2001. In doing so, he asked for his claim file, stating: “I would appreciate it very much if you would provide me with the documents contained in your claim file which were pertinent to your denial decision.” Unum sent the file.

Engleson had no luck with the appeal; Unum denied it on October 10, 2001. Unum offered another opportunity for further review, which Engleson decided to take up. This time, he asked his treating physician in Ohio to submit additional supporting information on his behalf. When Unum received this information, Engleson lodged another internal appeal.

Engleson's second appeal met a similar fate as his first—Unum denied the subsequent appeal on November 29, 2001. After an on-site physician reviewed the new information, Unum concluded that the additional medical information “[did] not provide a sufficient basis to reverse the denial of benefits.”

Over the next few years, Engleson fell silent with respect to his unsuccessful claim. By 2007, he had returned to Ohio and to Seibert–Keck. But by August 1, 2008, his medical condition became too much to bear once more—Engleson filed another claim for disability benefits on that day, claiming that he was unable to work as of the day before. This time, Unum granted his request, awarding benefits in a letter dated December 23, 2008, with the date of disability denoted as August 5, 2008. Unum acknowledged the 2001 claim, but cautioned that it was “unable to overturn a disability claim decision where 2 appeals [had] been clearly made and upheld.” Its letter further provided that: “If you or your physician(s) have additional information to support your request for disability benefits based upon an earlier date of disability, we will be happy to reconsider your claim.”

Engleson wrote back that he was “somewhat disappointed that UNUM [had] chosen to use August 5, 2008 as the date of disability.” He asked what additional information the company might need to reconsider his 2001 claim. Unum responded by noting that it “already afforded [Engleson] two appeal reviews relevant to an earlier period of loss dating back to 2001” and that it would “not be completing an additional appeal review” as a result.

Engleson, undeterred, filed suit in district court on December 22, 2009, seeking the recovery of wrongfully denied benefits pursuant to 29 U.S.C. § 1132(a)(1)(B) and section 502(a) of the Employee Retirement Income Security Act (ERISA). He also sought equitable relief, alleging that he was not afforded a full and fair review of his claim under 29 U.S.C. § 1133 and that Unum breached its fiduciary duties under the terms of the plan.

On July 13, 2010, the magistrate judge ordered the parties to brief the issue of whether Engleson's suit was timely. After the briefs were filed, the district court held an evidentiary hearing. Determining that the three-year contractual limitations period barred the suit, the district court dismissed the case on June 29, 2012. It explained that, under the plan's provisions, Engleson had until March 12, 2005 to file a legal action with respect to his 2001 claim.¹ As the suit was filed in 2009, it was deemed untimely. Engleson appealed.

II.

We begin with a somewhat technical point that was not raised by either party, but one that has a bearing on how we view this case. The district court dismissed the case pursuant to Rule 12(b)(6), positing that its decision was premised on Engleson's pleadings and attachments thereto. That rule, however, “is generally an inappropriate vehicle for dismissing a claim based upon a statute of limitations.” Cataldo v. U.S. Steel Corp., 676 F.3d 542, 547 (6th Cir.2012).

When a district court “considers matters outside the pleadings in a Rule 12(b)(6) motion” and issues “the functional equivalent of a Rule 56 ruling,” we may treat the Rule 12 dismissal as a grant of summary judgment in the movant's favor. See Tackett v. M & G Polymers, USA, LLC, 561 F.3d 478, 487–88 (6th Cir.2009); see also Brigolin v. Blue Cross Blue Shield of Mich., 516 Fed.Appx. 532, 536, No. 11–1525, 2013 WL 781639, at *2 (6th Cir. Mar. 4, 2013) (explaining that, when district courts fail to convert a Rule 12(b)(6) motion to a motion for summary judgment when the circumstances warrant it, this court may “ignore the label attached to the proceeding and properly treat it as one for summary judgment”). Here, the proceedings leading up to the district court's decision give the impression that the decision was the “functional equivalent” of summary judgment in the guise of a Rule 12(b)(6) decision.

Take, for example, the fact that the parties filed briefs on the limitations issue and attached extrinsic evidence to such briefs. Add to that the district court's evidentiary hearing on the limitations issue. Both suggest that the district court “considered” extrinsic evidence in dismissing the claim on limitations grounds. While it may be true that the district court's opinion did not refer to any extrinsic evidence, the court's analysis of the contractual limitations clause was rather threadbare. Given the extensive appendices filed by both parties on appeal and our reliance on the evidence contained therein in our consideration of Engleson's arguments, we find it difficult to believe that the district court's decision could be sustained on the pleadings alone.

Accordingly, as the district court's decision was the “functional equivalent” of a Rule 56 ruling, we will treat it as such. See Tackett, 561 F.3d at 488. We review a district court's grant of summary judgment de novo. Price v. Bd. of Trs. of Ind. Laborer's Pension Fund, 707 F.3d 647, 650 (6th Cir.2013). “Summary judgment is appropriate if the pleadings, the discovery and disclosure materials on file, and any affidavits show that there is no genuine issue as to any material fact and that the movant is entitled to judgment as a matter of law.” Id. (quoting Price v. Bd. of Trs. of Ind. Laborer's Pension Fund, 632 F.3d 288, 291–92 (6th Cir.2011)).

Engleson raises three arguments in his attempt to stave off enforcement of the contractual limitations period. First, he asserts that Unum violated three ERISA regulations. Second, he claims Unum waived its contractual limitations defense in its 2008 correspondence. Finally, Englesoncontends he is entitled to equitable tolling of the limitations period. We discuss these arguments in turn.

III.

Engleson first points to three alleged violations of ERISA regulations: two arising from the content of Unum's adverse benefit determinations, the other from Unum's summary plan description. We discern no violation arising from any of these rules.

A.

The 2000 edition of the Code of Federal Regulations provides, in pertinent part:

(f) Content of notice. A plan administrator ... shall provide to every claimant who is denied a claim for benefits written notice setting forth in a manner calculated to be understood by the claimant:

...

(4) Appropriate information as to the steps to be taken if the participant or beneficiary wishes to submit his or her claim for review.

29 C.F.R. § 2560.503–1(f) (2000). Engleson contends that, under this provision, Unum was required to disclose his right to seek review in federal court and the contractual time limitation attached to that right in its claim denial letters. To support his argument, Engleson points to persuasive authority provided by two of our sister circuits in Chappel v. Laboratory Corp. of America, 232 F.3d 719 (9th Cir.2000) and White v. Sun Life Assurance Co. of Canada, 488 F.3d 240 (4th Cir.2007).

We construe the phrase “appropriate information” as requiring only the disclosure of information pertaining to internal processes, not judicial review. In doing so, we first look to the statutory origins of the rule: 29 U.S.C. § 1133. See VanderKlok v. Provident...