Hamilton v. Allen-Bradley Company, ALLEN-BRADLEY

• Decision Date: 10 July 2000
• Docket Number: ALLEN-BRADLEY,No. 99-11766
• Citation: 217 F.3d 1321
• Parties: (11th Cir. 2000) Dorothy HAMILTON, Plaintiff-Appellant, v.COMPANY, INCORPORATED, Defendant-Appellee.
• Court: U.S. Court of Appeals — Eleventh Circuit

Page 1321

217 F.3d 1321 (11th Cir. 2000)

Dorothy HAMILTON, Plaintiff-Appellant, v. ALLEN-BRADLEY COMPANY, INCORPORATED, Defendant-Appellee.

No. 99-11766.

United States Court of Appeals Eleventh Circuit.

July 10, 2000.

[Copyrighted Material Omitted]

[Copyrighted Material Omitted] Appeal from the United States District Court for the Southern District of Georgia.(No. 98-00041-CV-3), Dudley H. Bowen, Jr., Chief Judge.

Before ANDERSON, Chief Judge, and BLACK and HALL^*, Circuit Judges.

HALL, Circuit Judge:

Dorothy Hamilton ("Hamilton") appeals the grant of summary judgment entered in favor of Allen-Bradley Company, Inc. ("Allen"). Hamilton had sued Allen for breach of fiduciary duty under the Employee Retirement Income Security Act ("ERISA"). We have jurisdiction pursuant to 28 U.S.C. 1291.

I

Hamilton was employed by Allen as a "repair service operator," a job that required her to repeatedly manipulate heavy objects. Sometime in 1993 she developed carpal tunnel syndrome, and by October 1994, she was completely unable to perform her job as a result of her carpal tunnel syndrome and diabetes. She had surgery for her carpal tunnel syndrome, but with poor results. In February 1995, she returned to work briefly, but had to quit after a couple of days, and never returned to work after that. Hamilton applied and was granted social security disability benefits.

After Hamilton realized that she could no longer work, she inquired of Melba Lee ("Lee"), Allen's human resources director, about whether she could qualify for long-term disability. Hamilton asserts that on this occasion and on several more occasions from 1994 until 1996, Lee stated that Hamilton did not qualify. According to Hamilton, Lee also refused to give Hamilton a claim form, and did not inform Hamilton of the identity of the insurer for the disability plan. At Allen, employees are required to go through the human resources department when they seek to apply for disability benefits. Lee does not remember ever having turned Hamilton away, but admits that she fields about 50 calls every week and therefore, Hamilton may have asked her for an application without her remembering the event. Allen claims that pursuant to company policy, on March 12, 1995, a letter was mailed to Hamilton containing the disability application. Lee stated in her deposition that she did not know if that letter was ever sent and Hamilton states that she never received it.

In 1996, after another request by Hamilton for a disability application, Lee forwarded to her a health insurance claim instead. Hamilton contacted the health insurer, CIGNA, which told her that all requests for benefits had to go through Lee. (CIGNA was not the insurer for the disability plan). Therefore Hamilton contacted Lee again, who allegedly did not respond to Hamilton's further solicitations.

In 1997, Hamilton encountered several former Allen employees who were all receiving disability benefits under Allen's disability plan. At this point, Hamilton contacted Lee again and this time received the correct application form for her disability insurer, UNUM insurance. Hamilton returned the form to Lee who sent it onto UNUM which denied Hamilton's claim on the basis that Hamilton had not properly complied with the notice and proof-of-claim requirements of the policy, i.e. Hamilton's claim was untimely.

In December 1997, Hamilton appealed the denial of her claim to UNUM. Her basis for the appeal was that Hamilton was required to go through Lee before she could file a claim, had done so in a timely fashion, but was prevented from sending UNUM her application by Lee. In fact, Hamilton asserted that Allen knew in September 1994, that Hamilton was having medical problems, and actually separated Hamilton from work in October 1995, for "being unable to return to work." UNUM rejected her appeal, and Hamilton filed suit against UNUM and Allen in Georgia state court. UNUM and Allen removed to federal court and moved for summary judgment which the district court granted. Hamilton only appeals the ruling as it pertains to Allen and argues that she should prevail because: (1) Allen is culpable for wrongfully denying Hamilton her benefits; and (2) Allen breached its fiduciary duty by failing to provide her with the necessary information needed to file her disability claim.

II

We review de novo an order granting summary judgment, applying the same legal standards as the district court. See Wolf v. Coca-Cola Co., 200 F.3d 1337, 1339 (11th Cir.2000). As such, the record has to be viewed in the light most favorable to the non-moving party. See Holbrook v. City of Alpharetta, 112 F.3d 1522, 1525- 26 (11th Cir.1997).

A. WRONGFUL DENIAL

1. Waiver

The Federal Rules of Civil Procedure provide that a complaint contain a short and plain statement of the claim showing that the pleader is entitled to relief, and a respective demand for that relief. See FRCP 8(a). Detail is not the bedrock on which a proper complaint stands; all that is required is that the defendant be put on notice of the claim being asserted against it and the ground on which it rests. See Sams v. United Food & Commercial Workers International Union, AFL-CIO, CLC, 866 F.2d 1380, 1384 (11th Cir.1989). Thus, the form of the complaint is insignificant, even if it fails to categorize correctly the legal theory giving rise to the claim, so long as the complaint alleges the facts on which relief can be granted. See Evans v. McClain of Georgia, Inc., 131 F.3d 957, 964 n. 2 (11th Cir.1997).

Allen's primary contention in the context of Hamilton's wrongful denial claim is that she has failed to raise it until now and therefore it should be deemed waived. The complaint which Hamilton filed in state court seeks a reinstatement of her disability benefits based on a wrongful denial, and names both UNUM and Allen as defendants. Allen is alleged as not having appropriately forwarded Hamilton's request for benefits to UNUM. See Complaint at 3, 9. Even though the complaint is not a model of clarity, the fact that the only relief sought was reinstatement of benefits based on a wrongful denial, and Allen was named as a party, should have put Allen on notice that this allegation was being leveled against it by Hamilton. See Itel Capital Corp. v. Cups Coal Co., Inc., 707 F.2d 1253, 1258 (11th Cir.1983). Moreover, the district court's opinion states that Hamilton is "alleging that Defendants [i.e. UNUM and Allen] wrongfully denied her claim for long-term disability benefits." See District Court Opinion at 1. Because the district court construed Hamilton's wrongful denial claim as being brought against both defendants, it is incorrect for Allen to argue at this late date that such a claim is being raised for the first time on appeal. Therefore, we will review Hamilton's appeal for wrongful denial of benefits on the merits.

2. Merits

ERISA provides that a "civil action may be brought by a participant or beneficiary ... to recover benefits due ... under the terms of [the] plan." See 29 U.S.C. 1132(a)(1)(B). In the Eleventh Circuit, this section confers a right to sue the plan administrator for recovery of benefits. See Rosen v. TRW, Inc., 979 F.2d 191, 193-94 (11th Cir.1992). Therefore, if the employer is administering the plan, then it can be held liable for ERISA violations. See id. at 193-94. Proof of who is the plan administrator may come from the plan document, but can also come from the factual circumstances surrounding the administration of the plan, even if these factual circumstances contradict the designation in the plan document. See id. at 193.

The key question on this issue is whether Allen had sufficient decisional control over the claim process that would qualify it as a plan administrator under Rosen. This requires an analysis of the facts surrounding the administration of the disability plan. The first fact is that the plan booklet states that any claim must be made to UNUM. This would seem to cut in Allen's favor.

However, Hamilton offers testimony by Lee to the effect that Allen requires its employees to go through its human resources department in order to obtain an application for disability benefits. This fact places Allen in sufficient control over the process to qualify as the plan administrator notwithstanding the language of the plan booklet. See Law v. Ernst & Young, 956 F.2d 364, 373-74 (1st Cir.1992). Moreover, Allen's benefit choice booklet states: "Plan Administrator-Manager, Employee Benefit Programs, Allen Bradley Company, .... The Plan Administrator has designed the identified insurance companies and the Allen Bradley Company as its agents to administer the Plan, to process all claims and appeals, and to provide other administrative services." (Emphasis added). Hamilton points out that Allen did carry out its administrative designation by handing out the claim forms itself without getting prior permission from UNUM, and by fielding questions about the plan from employees. Hamilton also includes an excerpt of Lee's deposition that identifies Milwaukee (Allen's headquarters) as the headquarters of the plan administration. Under the factual inquiry outlined in Rosen, there are sufficient indicators that point to Allen as a plan administrator.

Allen's arguments against the above conclusion are misplaced. First, Allen points to law in other circuits which does not allow for the employer to be designated as a co-plan administrator for the purposes of liability. See e.g. Crocco v. Xerox Corp., 137 F.3d 105, 107 (2d Cir.1998); Madden v. ITT Long Term Disability Plan for Salaried Employees, 914 F.2d 1279, 1287 (9th Cir.1990). Because there is law going in the opposite direction in this circuit, we are bound to follow the law of our circuit and Allen's argument is without merit.

The second argument that Allen raises is that because Hamilton's claim was untimely, she has no cause of action for wrongful denial. The essence of this second argument is...