Moorman v. Unumprovident Corp.

• Decision Date: 18 September 2006
• Docket Number: No. 05-15383.,05-15383.
• Citation: 464 F.3d 1260
• Parties: Ross Glenn MOORMAN, Jr., Plaintiff-Appellant, v. UNUMPROVIDENT CORPORATION, a Delaware Corporation, in its individual capacity and as controlling parent of its wholly owned subsidiary, Unum Life Insurance Company of America, a Maine Corporation, Unum Life Insurance Company of America, a Maine Corporation, in its individual capacity and as a wholly owned and controlled subsidiary of UnumProvident Corporation, Unum Corporation, a Maine Corporation merged to form UnumProvident Corporation, in its individual capacity and as controlling parent company of its wholly owned subsidiary, Unum Life Insurance Company of America, a Maine Corporation, Defendants-Appellees.
• Court: U.S. Court of Appeals — Eleventh Circuit

464 F.3d 1260

Ross Glenn MOORMAN, Jr., Plaintiff-Appellant, v. UNUMPROVIDENT CORPORATION, a Delaware Corporation, in its individual capacity and as controlling parent of its wholly owned subsidiary, Unum Life Insurance Company of America, a Maine Corporation, Unum Life Insurance Company of America, a Maine Corporation, in its individual capacity and as a wholly owned and controlled subsidiary of UnumProvident Corporation, Unum Corporation, a Maine Corporation merged to form UnumProvident Corporation, in its individual capacity and as controlling parent company of its wholly owned subsidiary, Unum Life Insurance Company of America, a Maine Corporation, Defendants-Appellees.

No. 05-15383.

United States Court of Appeals, Eleventh Circuit.

September 18, 2006.

COPYRIGHT MATERIAL OMITTED

Rhonda Michele Moorman, Moorman Med. Legal Consulting, Inc., Douglas, GA, for Moorman.

Elizabeth J. Bondurant, Kenton Jones Coppage, Nikole Marie Crow, Carter & Ansley, LLP, Atlanta, GA, for Defendants-Appellees.

Appeal from the United States District Court for the Northern District of Georgia.

Before EDMONDSON, Chief Judge, and BIRCH and ALARCON,^* Circuit Judges.

BIRCH, Circuit Judge:

The central issue in this interlocutory appeal is the proper reach of the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq. Ross Glenn Moorman, Jr., argues that the district court erred in ruling that ERISA governed the disability insurance plan provided by UnumProvident Corporation, Unum Life Insurance Company of America ("Unum Life"), and Unum Corporation (collectively "Appellees"). After careful review of the facts in this case, the relevant case law, and the underlying purposes of ERISA, we AFFIRM the district court's ruling that ERISA governs the plan in this case. As an additional matter, Appellees ask us to review Moorman's claims brought under the Racketeer Influenced and Corrupt Organizations Act ("RICO"), 18 U.S.C. 1961 et seq. We decline to review Moorman's RICO claims, which were not certified for appeal by the district court, because the district court has not had an adequate opportunity to address the defenses raised on appeal by the Appellees.

I. BACKGROUND

Quoting liberally and making additions as necessary, we largely adopt the district court's statement of the facts in this case: In a letter dated 17 October 1996, Brian Glenn, an agent for Unum Life, contacted Anne Rivers Carter, the office manager of Southeastern Steam, Inc., ("Southeastern Steam") to request the opportunity to present the disability insurance plan to the company's employees and to solicit enrollment. Carter later met with Glenn and applied to Unum Life for group coverages on behalf of Southeastern Steam. R.Exh. at 19-20; id. Exh. 3. She signed a "Client Information" form, through which she selected various eligibility requirements for the disability plan, including a 90-day waiting period and a 35-hour minimum workweek requirement. Id. Exh. 3.

On 24 April 1997, Glenn "met with company employees individually" to discuss coverage under the plan. R4-30 Exh. 1 at 6. Carter stated that publicity was conducted by "word of mouth, like, ... there's a guy coming, if you want disability insurance, you can meet with him ... he'll explain it to you." R.Exh. at 23. No representative from Southeastern Steam was present during these meetings. The decision on whether to sign up for disability insurance was left to the individual employee. Those who wished to enroll completed Disability Program Enrollment Forms, which Glenn drafted and provided. The forms stated, "Southeastern Steam Inc. is offering a comprehensive Disability program to protect you and your family in the event a non-occupational accident or sickness causes you to miss work." R4-30 Exh. 2B. Carter, who signed up for the plan, later stated that she never read this statement and that she believed Unum Life, rather than Southeastern Steam, was providing the plan. At the meetings, Glenn also discussed the benefits and premium amounts with each employee.

Carter testified that Southeastern Steam revised its employee handbook to include a reference to the plan in question, which was the only disability plan offered to the employees during that time. R.Exh. at 46. Under the heading "Benefits," Southeastern Steam's employee handbook stated: "The company makes available to employees access to benefits designed to meet the needs of employees and provide protection from financial hardship. These benefits will be reviewed periodically to assure that they keep pace with area practice and employee needs." Id. Exh. 5 at 22. In the same section, under the subheading "Disability Insurance," the handbook stated, "Disability insurance is available to all full-time employees. The premium for this coverage is the sole responsibility of the employee." Id. Exh. 5 at 23.

At the time of their enrollment, the participating employees were not provided copies of the plan nor any other written documents, apart from the enrollment forms themselves. The plan booklets and included certificates were later mailed to Carter, who filed them in a closet at Southeastern Steam. Carter testified that, while she did not widely distribute the booklets, she gave a booklet to Moorman and kept one for herself. Id. at 76. The plan certificate provides, inter alia, that: "[t]his policy is delivered in and is governed by the laws of the governing jurisdiction and to the extent applicable by the Employee Retirement Income Security Act of 1974 (ERISA) and any amendments." Id. Exh. 6 at 1. The Summary Plan Description designated Southeastern Steam as the plan administrator and as the agent for service of legal process on the plan. Id. Exh. 6 at 60-61.

Enrolled employees were required to pay their entire premium amounts on a post-tax basis. Carter collected employee premiums from employees by way of payroll deductions and remitted them to Unum Life by writing a check from Southeastern Steam's account. Id. at 33-34. While she provided Unum Life's 1-800 number to certain employees who asked questions regarding their claims and benefits, Carter also admitted that she personally "may have tried to help" employees who had such questions. Id. at 42, 52. Carter further stated that she had on file some blank forms that Unum Life had given her. Id. at 44. When one employee made a claim under the plan, Carter provided a form to that employee, and she completed and submitted the employer verification form to Unum Life. Id. at 44, 102-03; R4-30 Exh. 1 at 15-16. She also submitted an employer verification form for Moorman, when he filed his claim. R4-30 Exh. 1 at 15-16

Moorman, formerly employed by Southeastern Steam signed up for the plan during the 24 April 1997 meeting with Glenn. In February 1999, Moorman was diagnosed with rectal cancer. After he initially qualified as disabled under the plan, the Appellees determined that he no longer satisfied the definition of disability. Moorman disputed the denial of his disability benefits to the Appellees but he was unsuccessful. On 16 July 2004, Moorman filed the complaint in this case, in which he alleged the wrongful denial of disability benefits and various other state and federal law claims. On 26 August 2004, Appellees filed their motion to dismiss. On 22 October 2004, the district court converted the Appellees' motion to dismiss to a motion for summary judgment on the issue of whether the plan is governed by ERISA, which would preempt Moorman's state law claims.

In a subsequent order on 17 February 2005, from which this appeal is taken, the district court: (1) granted Appellees' converted motion for summary judgment in ruling that the plan was governed by ERISA; (2) granted Appellees' motion to dismiss Moorman's state law claims on grounds of ERISA preemption; and (3) denied Appellees' motion to dismiss Moorman's federal RICO claim. On 4 March 2005, Moorman filed (1) a motion for reconsideration; (2) an alternative motion seeking certification for interlocutory appeal; and (3) a motion to stay proceedings.

On 25 July 2005, the district court (1) denied Moorman's motion for reconsideration; (2) granted Moorman's alternative motion for certification for interlocutory appeal; (3) denied Appellees' request for certification for interlocutory appeal of the district court's refusal to dismiss Moorman's federal RICO claims; (4) granted Moorman's motion to stay proceedings; (5) denied without prejudice certain discovery motions filed by Moorman; and (6) ordered that the district court case be administratively terminated until remanded per the instructions of our court. We later granted Moorman's interlocutory appeal pursuant to 28 U.S.C. § 1292(b).

II. DISCUSSION

On appeal, Moorman alleges that the district court committed various errors in determining that ERISA governs the plan in this case. Specifically, he claims that the district court (1) improperly limited discovery; (2) improperly determined that ERISA governance was a question of fact for the district court, and not the jury, to decide; and (3) made an impermissible credibility determination with regard to a witness, and improperly construed and disregarded other evidence favorable to Moorman. With regard to Moorman's federal RICO claims, Appellees ask us to review whether this claim should be dismissed. After a brief examination of the relevant background law, we address these issues in turn.

A. Relevant Background Law

1. Standards of Review:

We review de novo the grant of a motion for summary judgment. Anderson v. UNUM Provident Corp., 369 F.3d 1257, 1262 (11th Cir.2004). Federal Rule of Civil Procedure 56(c) requires summary judgment when "there is no genuine issue as to any material fact and . . . the moving party is entitled to judgment as a matter of law." In deciding a summary judgment motion, the court must view all the evidence in the light most favorable to the nonmoving party, and resolve all disputes and...