Godwin v. Sun Life Assur. Co. of Canada, 91-1368

• Decision Date: 31 December 1992
• Docket Number: No. 91-1368,91-1368
• Citation: 980 F.2d 323
• Parties: 16 Employee Benefits Cas. 1341 Murphy R. GODWIN, Plaintiff-Appellant, v. SUN LIFE ASSURANCE COMPANY OF CANADA, Defendant-Appellee.
• Court: U.S. Court of Appeals — Fifth Circuit

Page 323

980 F.2d 323

16 Employee Benefits Cas. 1341

Murphy R. GODWIN, Plaintiff-Appellant, v. SUN LIFE ASSURANCE COMPANY OF CANADA, Defendant-Appellee.

No. 91-1368.

United States Court of Appeals Fifth Circuit.

Dec. 31, 1992.

Bill Waller, Jr., Waller & Waller, Jackson, Miss., for plaintiff-appellant.

William V. Westbrook, III, White & Morse, Gulfport, Miss., for defendant-appellee.

Appeal from the United States District Court for the Southern District of Mississippi.

Before JOLLY and EMILIO M. GARZA, Circuit Judges, and SHAW, District Judge. ^*

EMILIO M. GARZA, Circuit Judge:

Murphy R. Godwin alleges that Sun Life Assurance Company of Canada ("Sun Life") violated the Employee Retirement Income Security Act of 1974 ("ERISA") ¹ by (a) failing to provide plan information that Godwin had requested; (b) illegally offsetting his award under the plan with Social Security old age benefits; and (c) erroneously calculating an offset for workers' compensation benefits. The district court granted Sun Life's motion for summary judgment. Godwin appeals, and, finding no error, we affirm.

I

Godwin began work for School Pictures, Inc., in 1966. In the mid-1970s, Godwin became a participant in a group long-term disability plan issued to School Pictures by Sun Life. Subsequent to his participation, the plan was amended five times, the last amendment taking effect in December 1983. On December 19, 1984, Godwin sustained an injury in the course of his employment. He continued to work, however, until November 4, 1986, when a second employment-related injury left him disabled. On November 18, 1986, School Pictures terminated Godwin--then sixty-seven years old--for health reasons. After he was terminated, Godwin applied to Sun Life for benefits under the plan.

Sun Life determined that Godwin was entitled to fifteen months of benefits (eighteen months less a three-month waiting period), and it issued Godwin two checks for a total of $1,773.11. Those checks represented three months of benefits at $591.04 a month. ² However, Sun Life later recalculated the benefits to which Godwin was entitled, included an offset of $725 a month for social security benefits, and determined that the offsets exceeded benefits. ³ Subsequently, the Mississippi Workers' Compensation Commission approved Godwin's workers' compensation claims with regard to his two on-the-job injuries. After deducting attorneys fees and expenses, Godwin received $9,941.62. ⁴

In July 1989, Godwin brought suit in district court against Sun Life, claiming that Sun Life's actions violated ERISA. The parties filed cross-motions for summary judgment, and the district court granted Sun Life's motion. Godwin appeals.

II

Godwin contends (a) that he is entitled to statutory penalties under ERISA because Sun Life failed to provide plan information that Godwin requested; (b) that Sun Life's offset of social security old age benefits was illegal because the offset was not set forth in the original policy and Godwin never received notice that the plan was amended to include the offset; and (c) that Sun Life erroneously calculated an offset for workers' compensation benefits.

A

Godwin contends that he is entitled to penalties due to Sun Life's failure to supply certain requested information. Godwin alleges that, in July 1985--prior to his application for disability benefits--he requested from Sun Life information relating to the benefit plan and that, over the course of the next four years, Sun Life and School Pictures refused his requests. Godwin argues that Sun Life's failure to provide the information violates ERISA.

Section 502(c)(1) of ERISA provides, in relevant part, that:

Any administrator who ... fails or refuses to comply with a request for any information which such administrator is required by this subchapter to furnish to a participant or beneficiary (unless such failure or refusal results from matters reasonably beyond the control of the administrator) by mailing the material requested to the last known address of the requesting participant or beneficiary within 30 days after such request may in the court's discretion be personally liable to such participant or beneficiary in the amount of up to $100 a day from the date of such failure or refusal and the court may in its discretion order such relief as it deems proper.

29 U.S.C. § 1132(c). The term administrator is defined as:

(i) the person specifically so designated by the terms of the instrument under which the plan is operated;

(ii) if an administrator is not so designated, the plan sponsor....

29 U.S.C. § 1002(16)(A).

The district court's summary judgment against Godwin was based, in part, on its conclusion that, because no administrator was named in the policy, School Pictures was the sponsor and, therefore, the administrator, pursuant to 29 U.S.C. § 1002(16)(A). The district court thus found that an action under 29 U.S.C. § 1132 did not exist against Sun Life. See Record on Appeal, vol. 2, at 444-45. The district court also discounted Godwin's argument that Sun Life was a de facto administrator of the plan. The district court concluded that Godwin was not prejudiced by the alleged failure to disclose information, and that the question whether Sun Life was a de facto administrator thus was irrelevant. ⁵

Godwin asks us to recognize Sun Life as a de facto administrator and argues that ERISA does not require a claimant to show prejudice in order to be entitled to penalties. ⁶ In support of this argument, Godwin reminds us of our decision in Fisher v. Metropolitan Life Ins. Co., 895 F.2d 1073, 1077 (5th Cir.1990).

In Fisher, the plaintiff suggested that the plan insurer, Metropolitan, should be regarded as a de facto plan administrator because Metropolitan had been delegated responsibility for evaluating and administering claims. Noting that "Fisher's argument that Metropolitan should be regarded as a de facto administrator has intuitive appeal[,]" ⁷ we nevertheless declined to recognize Metropolitan as the de facto administrator because, in any event, we found no abuse of discretion on the part of the district court in refusing to award the plaintiff penalties under section 1132(c).

As in Fisher, we need not here resolve the question whether Sun Life should be regarded as a de facto administrator, thus entitling Godwin to penalties under 29 U.S.C. § 1132. See Paris v. Profit Sharing Plan For Employees of Howard B. Wolf, Inc., 637 F.2d 357, 362 (5th Cir.), cert. denied, 454 U.S. 836, 102 S.Ct. 140, 70 L.Ed.2d 117 (1981) ("The decision to grant relief under 29 U.S.C. § 1132(c) is committed to the discretion of the trial judge."). Although section 1132 does not require the claimant to show he was prejudiced to be entitled to penalties, ⁸ we suggested in Paris that prejudice is one factor a district court may consider in exercising its discretion. See Paris, 637 F.2d at 362 ("The plaintiffs have not attempted to demonstrate that they were prejudiced by the alleged failure to respond, and we cannot say the district court abused its discretion."); accord Curry v. Contract Fabricators Inc. Profit Sharing Plan, 891 F.2d 842, 847 (11th Cir.1990) (citations omitted). The district court's consideration of a lack of prejudice in denying an award of penalties was, therefore, not an abuse of discretion.

B

Godwin next contends that the 1981 amendment to the Sun Life plan which mandates an offset for "any amount of Old Age Income provided to the employee under the Social Security Act" ⁹ does not apply to him because he had no notice of the amendment when he applied for benefits.

We begin with the premise that, as a general rule, Social Security old age income may be offset against monthly disability payments. See Alessi v. Raybestos-Manhattan, Inc., 451 U.S. 504, 514-15, 101 S.Ct. 1895, 1901-02, 68 L.Ed.2d 402 (1981) (integration of employee benefits with other sources of income available to employees is permissible); see also Fisher, 895 F.2d at 1076 n. 1 (noting that the Supreme Court has upheld the validity of integration provisions, which Congress had specifically approved in enacting ERISA). We then determine whether the 1981 amendment to the Sun Life plan is valid and applicable to Godwin. That is, did Sun Life comply with the ERISA requisites for plan modifications with respect to Godwin? ¹⁰

ERISA requires that participants and beneficiaries be furnished with a summary plan description. See 29 U.S.C. § 1022. This summary plan description must contain certain information, including "circumstances which may result in disqualification, ineligibility, or denial or loss of benefits" 29 U.S.C. § 1022(b). Sections 102(a)(1) and 104(b)(1) of ERISA require that a copy of the summary plan description and all modifications and changes be furnished to participants and beneficiaries not later than 210 days after the plan year in which the change is adopted. See 29 U.S.C. §§ 1022(a)(1) and 1024(b)(1), amendment noted in 29 U.S.C.A. § 1024(b)(1) (Supp.1991).

In support of its assertion that Sun Life gave proper notice of the amendment, Sun Life presented to the district court the affidavit of its Director of Group Services and Administration--Dale L. Kurtz. ¹¹ In his affidavit, Kurtz testified that Sun Life prepared and sent to School Pictures for distribution updated summary plan description booklets following each amendment to the School Pictures plan. ¹² Godwin, however, maintains that he never received notice of the amendment, and he argues that such personal notice was required under ERISA.

The district court, in rejecting Godwin's argument that the 1981 amendment was invalid as to him for lack of notice, relied principally on two cases interpreting the ERISA notification provisions: Moore v. Metropolitan Life Ins. Co., 856 F.2d 488 (2d Cir.1988) and Henne Corp. v. Allis-Chalmers Corp., 660 F.Supp. 1464 (E.D.Wis.1987). The district court found:

Wherever fault might lie for the alleged nonreceipt by Godwin of...