Moran v. Aetna Life Ins. Co.

• Decision Date: 04 April 1989
• Docket Number: No. 87-6733,87-6733
• Citation: 872 F.2d 296
• Parties: , 10 Employee Benefits Ca 2329 Yvonne MORAN, Plaintiff-Appellant, v. AETNA LIFE INSURANCE COMPANY, Defendant-Appellee.
• Court: U.S. Court of Appeals — Ninth Circuit

Page 296

872 F.2d 296

57 USLW 2619, 10 Employee Benefits Ca 2329

Yvonne MORAN, Plaintiff-Appellant, v. AETNA LIFE INSURANCE COMPANY, Defendant-Appellee.

No. 87-6733.

United States Court of Appeals Ninth Circuit.

Argued and Submitted Nov. 4, 1988.

Decided April 4, 1989.

Richard S. MacNaughton, Beverly Hills, Cal., for plaintiff-appellant.

Michael P. McNamara, Gibson, Dunn & Crutcher, Los Angeles, Cal., for defendant-appellee.

Appeal from the United States District Court for the Central District of California.

Before FLETCHER, ALARCON and KOZINSKI, Circuit Judges.

ALARCON, Circuit Judge:

The Plaintiff/Appellant Yvonne Moran, (Moran) appeals from the district court's grant of summary judgment in favor of Defendant/Appellee Aetna Life Insurance Company (Aetna) and the denial of Moran's motion for summary judgment. Moran sued Aetna as a "Plan Administrator" under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. Sec. 1001 et seq. (1982 & Supp. IV 1986) for failure to provide Plan Documents at Moran's request. The district court concluded that since Aetna was not the plan administrator as defined by 29 U.S.C. Sec. 1002(16)(A) (1982), it is not liable for damages under 29 U.S.C. Sec. 1132(c) (Supp. IV 1986).

Moran contends that Aetna is liable under section 1132(c) because its claims supervisor advised her attorney that Aetna was the plan administrator. Because Aetna was not the plan administrator under the applicable statutory language, we disagree and affirm.

I

Moran was an employee of the law firm of Meserve, Mumper & Hughes (employer) and was insured under an Aetna policy. Aetna provided the employer with a booklet describing the plan for distribution to the employees. The booklet does not identify a plan administrator. Aetna also provided Moran with a health insurance identification card which states that "[t]his group Health Benefits Program is administered by Aetna Life Insurance Company."

Moran received chiropractic treatments from Dr. Jim Takeda in July 1986. Dr. Takeda submitted a claim for his services to Aetna in the amount of $364.00. On September 16, 1986, Aetna sent a check for $104.00 in payment of the claim. Aetna also informed Dr. Takeda and Moran of the benefits provided under the plan and denied a portion of the claim.

Moran's attorney, Richard MacNaughton, wrote to Aetna on September 29, 1987, requesting a copy of the Plan Documents and the insurance policy. Mr. MacNaughton also inquired whether Aetna was the "Plan Administrator" of the plan.

Ruthie McNatt, Aetna's claims supervisor, replied to MacNaughton's letter on November 10, 1986. She explained why Aetna denied a portion of the claim. McNatt also stated that "[y]our [plaintiff's counsel's] assumption that Aetna is the plan administrator is correct."

MacNaughton claims to have sent letters to Aetna on December 5, 1986, January 10 1987, February 12, 1987, and March 6, 1987, reiterating the request for Plan Documents and stating that he relied on McNatt's statement in the November 10, 1986, letter that Aetna was the plan administrator. MacNaughton obtained proof of service by mail for the March 6, 1987 letter. Aetna denies receiving these letters. Aetna's employees allege that they never read any of these letters, and that they are not in the relevant files.

On April 3, 1987, Moran filed this action in the district court against Aetna under 29 U.S.C. Sec. 1132(c) to obtain copies of ERISA Plan Documents. On April 29, 1987, subsequent to the filing of this lawsuit, a senior attorney with Aetna, Linda Newton, wrote MacNaughton to deny that Aetna was the "Plan Administrator" under ERISA. Newton also provided MacNaughton with a copy of the group policy and the certificate/booklet prepared for Meserve, Mumper & Hughes to distribute to its employees participating in the plan.

The district court entered summary judgment in Aetna's favor on November 30, 1987. Moran has filed a timely appeal from that order. She also seeks review of the September 14, 1987 order denying her motion for summary judgment.

II

The district court had jurisdiction over this matter pursuant to ERISA, Section 502(e)(1), 29 U.S.C. Sec. 1132(e)(1) (1982). The district court's order of November 30, 1987, granting summary judgment in favor of Aetna constitutes a final order, reviewable by this court under 28 U.S.C. Sec. 1291 (1982).

We review a grant of summary judgment independently and without deference to the district court's conclusion "and will affirm if the pleadings and supporting materials show the absence of a genuine issue of material fact and that the moving party is entitled to judgment as a matter of law." Medallion Television Enterprises, Inc. v. SelecTV of Calif., Inc., 833 F.2d 1360, 1362 (9th Cir.1987) (Citation omitted).

Aetna argued in support of its motion for summary judgment that it cannot be sued under section 1132(c) because it is not the plan administrator under section 1002(16)(A). Moran responded that Aetna should be estopped from denying that it is the plan administrator because of the representation of its claims supervisor.

Section 1132(c) provides:

Any administrator ... (2) 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 ... 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 other relief as it deems proper.

"In any action under this subchapter ... by a participant, beneficiary, or fiduciary, the court in its discretion may allow a reasonable attorney's fee and costs of action to either party." 29 U.S.C. Sec. 1132(g) (1982).

An administrator has a duty of disclosure and reporting:

The administrator of each employee benefit plan shall cause to be furnished in accordance with Section 1024(b) of this title to each participant covered under the plan and to each beneficiary who is receiving benefits under the plan--

(1) a summary plan description described in Section 1022(a)(1) of this title: and

(2) the information described in Section 1024(b)(3) and 1025(a) and (c) of this title.

29 U.S.C. Sec. 1021(a) (1982).

ERISA further requires that "[t]he administrator shall, upon written request of any participant or beneficiary, furnish a copy of ... instruments under which the plan is established or operated." 29 U.S.C. Sec. 1024(b)(4) (1982).

An administrator of an ERISA plan has a duty to provide a plan summary and other documents to each participant upon request under sections 1021(a) and 1024(b)(4). Failure or refusal to provide such documents may result in fines of up to $100 a day, costs and attorney's fees under sections 1132(c) and (g).

Section 1002(16)(A) defines a plan "administrator" as follows:

The term "administrator" means--

(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; or

(iii) in the case of a plan for which an administrator is not designated and a plan sponsor cannot be identified, such other person as the Secretary may by regulation prescribe.

The group policy in the instant matter does not designate an administrator under section 1002(16)(A)(i). Therefore, the "plan sponsor" is the administrator under section 1002(16)(A)(ii). The term "plan sponsor" refers to "the employer in the case of an employee benefit plan established or maintained by a single employer." 29 U.S.C. Sec. 1002(16)(B)(i) (1982). Under these facts, Moran's employer, Meserve, Mumper & Hughes, is the plan administrator under section 1132(c).

III

The United States Supreme Court has stated: "We are reluctant to tamper with an enforcement scheme crafted with such evident care as the one in ERISA." Mass. Mutual Life Ins. Co. v. Russell, 473 U.S. 134, 147, 105 S.Ct. 3085, 3093, 87 L.Ed.2d 96 (1985). The Supreme Court further stated that when "a statute expressly provides a particular remedy or remedies, a court must be chary of reading others into it." Id. (quoting Transamerica Mortgage Advisors, Inc. v. Lewis, 444 U.S. 11, 19, 100 S.Ct. 242, 247, 62 L.Ed.2d 146 (1979)). ¹ The precise question presented in Russell concerned the types of remedies available under ERISA. The Supreme Court held that ERISA does not provide a cause of action for extracontractual damages to a beneficiary caused by improper processing of benefit claims. Id. Section 409(a) could not extend relief because other sections of ERISA benefit individuals. Id. at 142-43, 105 S.Ct. at 3090-91. ²

We believe that the rationale and policies articulated by the court in Russell require us to limit liability under 1132(c) to the targets expressly identified by Congress in section 1002(16). Congress has provided for three classes of persons who may be sued as the plan administrator under section 1132(c). Because Aetna was not designated as plan administrator in the policy and is not the plan sponsor, it is not liable under the statute. ³

Both parties agree that Aetna is not the plan administrator as defined by section 1002(16). Moran states in Plaintiff's Reply Memorandum in Support of her Motion for Partial Summary Judgment that "[d]efendant contends that it is not the Plan Administrator. Plaintiff obviously agrees. That is the very reason that plaintiff has brought this motion on the Estoppel Theory." We have recently refused to apply estoppel to a claim governed by ERISA. In Davidian v. S. Cal. Meat Cutters Union, 859 F.2d 134, 136-37 (9th Cir.1988), we held that ERISA forbids recovery against a benefit fund based upon estoppel. Davidian sought recovery of benefits from a benefit fund based on estoppel, claiming a fund employee misled him as to the limitations of a health insurance plan. We rejected Davidian's estoppel theory...