Wilkins v. Baptist Healthcare System, Inc.

• Citation: 150 F.3d 609
• Decision Date: 04 August 1998
• Docket Number: No. 97-5074,97-5074
• Parties: Bob G. WILKINS, Plaintiff-Appellant, v. BAPTIST HEALTHCARE SYSTEM, INC.; Life Insurance Company of North America, Defendants-Appellees.
• Court: United States Courts of Appeals. United States Court of Appeals (6th Circuit)

Page 609

150 F.3d 609

Bob G. WILKINS, Plaintiff-Appellant, v. BAPTIST HEALTHCARE SYSTEM, INC.; Life Insurance Company of North America, Defendants-Appellees.

No. 97-5074.

United States Court of Appeals Sixth Circuit.

Argued March 12, 1998.

Decided Aug. 4, 1998.

Leslie Rosenbaum (argued and briefed), Rosenbaum & Rosenbaum, Lexington, Kentucky, for Plaintiff-Appellant.

Ronald L. Green (argued), W.T. Adkins, Michael J. Cox (briefed), Boehl, Stopher & Graves, Lexington, Kentucky, for Baptist Healthcare System, Inc.

Samuel G. Bridge, Jr. (argued and briefed), Michelle D. Wyrick (briefed), Wyatt, Tarrant & Combs, Louisville, Kentucky, for Life Ins. Co. of North America.

Before: RYAN, COLE, and GILMAN, Circuit Judges.

COLE, J., announced the judgment of the court and delivered an opinion, in which RYAN and GILMAN, JJ., concurred except as to Part II.F. GILMAN, J. (pp. 617-620), delivered a separate opinion, in which RYAN, J. concurred, which constitutes the opinion of the court on the issue addressed in Part II.F.

COLE, Circuit Judge.

Plaintiff, Bob Wilkins, appeals the district court's grant of summary judgment in favor of defendants, Life Insurance of North America ("LINA" or "the Plan Administrator") and Baptist Healthcare System, Inc. ("Baptist Healthcare"), and the district court's denial of Wilkins's motion to alter or amend the judgment, pursuant to Fed R. Civ. P. 59(e), in this ERISA action for disability benefits under the Baptist Healthcare Long Term Disability Plan ("the Plan").

Wilkins raises the following issues on appeal: (1) whether the district court erred in affirming LINA's denial of Wilkins's claim for long-term disability benefits; (2) whether the district court erred in refusing to consider evidence not included in the administrative record; (3) whether Wilkins is entitled to compensatory damages, pursuant to 29 U.S.C. § 1132(a)(3); (4) whether a claimant for benefits under 29 U.S.C. § 1132 is entitled to a jury trial; and (5) whether the district court erred in disposing of Wilkins's claim by granting the defendants' motion for summary judgment.

For the following reasons, we AFFIRM the judgment of the district court.

I.

A. Background

Wilkins, a former housekeeper and janitor for Baptist Healthcare, claims that as a result of a rotator cuff injury in his shoulder he became totally disabled in February of 1993. Wilkins last worked for Baptist Healthcare on February 19, 1993. On June 15, 1993, Wilkins applied for long-term disability benefits with LINA, Baptist Healthcare's ERISA insurer and plan administrator. On November 23, 1993, based on "the accumulated occupational and medical evidence" as well as an independent medical examination of Wilkins by Dr. James E. Russell, LINA notified Wilkins that he did not qualify for disability benefits under the Plan because he was not totally disabled. LINA also advised Wilkins of his right to appeal the denial of his claim by submitting a written request for review, along with any supporting documents, within sixty days of receipt of the denial letter.

After LINA denied Wilkins's claim, and shortly before his time to appeal expired, LINA received a letter from Wilkins's physician, Dr. Phillip Corbett, stating that Wilkins could not lift more than forty pounds and that his shoulder had been "giving way." Wilkins never filed a written appeal of LINA's denial of benefits. Apparently believing that Wilkins's submission of Dr. Corbett's letter was an attempt to contest its denial of benefits, LINA sent Wilkins a letter, advising him of the procedure for perfecting an appeal.

On August 9, 1994, Wilkins filed his complaint in district court, alleging that LINA's denial of benefits was "arbitrary, illegal, capricious, unreasonable, discriminatory, not made in good faith, and ... an abuse of discretion," in violation of 29 U.S.C. § 1001 et seq. Wilkins requested the following relief: (1) an order that LINA and Baptist Healthcare award Wilkins benefits under the Plan retroactive to May 1993; (2) a declaration that Wilkins was totally disabled and entitled to benefits under the Plan, or in the alternative, the award of a money judgment "for all sums due and owing"; (3) prejudgment interest accruing from May 31, 1993; (4) a jury trial; (5) attorneys' fees; (6) costs incurred in this action; and (7) any other relief that the court would "deem just and proper."

After Wilkins initiated this action, his attorney claimed that he had submitted additional medical information relating to Wilkins's condition to LINA on April 26, 1994. Although LINA was unable to locate the additional information in its files, it agreed to review its decision on Wilkins's claim, waiving any defense based on the late submission of information. The supplemental medical information included office notes from Dr. David Caborn from January and February of 1994, a letter from Dr. Charles Combs dated March 21, 1994, a January 19, 1995 report from Dr. Corbett, and a February 11, 1994 Magnetic Resonance Imaging film ("MRI") and the accompanying report by Dr. William J. Vanarthos ("Vanarthos MRI"). LINA sent all the medical information it had considered, including the supplemental information submitted in 1994 and 1995, to the Medical Assessment Clinic in Louisville, Kentucky for a final, independent review of its decision. Dr. James Harkness of the Medical Assessment Clinic reviewed Wilkins's records. Relying on the independent medical examination of Wilkins that Dr. Russell conducted in October 1993 and the independent records review of Dr. Harkness, LINA again denied Wilkins's claim for benefits on May 4, 1995. Meanwhile, Wilkins's lawsuit against LINA and Baptist Healthcare proceeded.

B. District Court Orders

On May 30, 1995, LINA, joined by Baptist Healthcare, filed a motion for summary judgment. The district court granted the motion in favor of the defendants, reasoning that "both the Supreme Court and the Sixth Circuit have made clear that money damages are not available under 29 U.S.C. § 1132(a)(3)." The district court likewise rejected Wilkins's request for a jury trial, reasoning that this court's precedent denying jury trials in actions for recovery of benefits, under 29 U.S.C. § 1132, was well settled. ¹

In his complaint, Wilkins had petitioned the district court to review LINA's denial of benefits and consider information that was not part of the administrative record at the time LINA denied Wilkins's claim. The district court declined to consider this additional information, relying on this court's holdings limiting the district court's scope of review to the administrative record. Reviewing the administrative record de novo, the district court affirmed LINA's November 23, 1993 denial of benefits, citing a "lack of objective medical evidence showing the basis for [Wilkins's] complaints of pain." The district court then affirmed LINA's May 4, 1995 denial decision, considering the medical information submitted after the November 1993 denial, including the Vanarthos MRI. In granting the defendants' motion for summary judgment, the district court acknowledged an "apparent conflict in some of the medical opinion[s]," but concluded that "the bulk of the accumulated evidence" supported a denial of Wilkins's claim.

Subsequently, Wilkins filed a motion to alter or amend judgment, pursuant to Fed.R.Civ.P. 59(e), conceding that the November 23, 1993 denial of his claim was correct, but insisting that the Vanarthos MRI provided objective evidence that Wilkins was entitled to benefits prior to the May 1995 denial. Wilkins also contended that the district court's grant of summary judgment in favor of the defendants failed to address all the issues he had raised in his complaint. First, Wilkins referred to the allegation raised in his third amended complaint that he did not receive a full and fair review of the denial. Second, Wilkins directed the district court's attention to the alleged violations of the defendants' fiduciary duties, raised in the first amended complaint and the tendered second amended complaint.

In support of his argument, Wilkins claimed that LINA's attorney questioned Dr. Harkness concerning the significance of Dr. Vanarthos's analysis of the MRI. Because Dr. Harkness did not specifically confirm that he had read the MRI and subsequent medical evidence, Wilkins claimed that LINA denied him a full and fair review, without the benefit of expert advice concerning the significance of the MRI, thereby breaching its fiduciary duty to Wilkins "not to deal with plan assets for its own interest and own account." Therefore, Wilkins requested that the district court require LINA to depose Dr. Harkness, to compel him to give an opinion of the MRI, or, in the alternative, that the district court grant Wilkins permission to depose Dr. Harkness to preserve Wilkins's right to a full and fair review. In addition, Wilkins requested permission to depose LINA's attorney to determine the reasons he considered Dr. Harkness's acknowledgment of the MRI to be important.

The district court rejected Wilkins's contention that LINA's second denial of benefits was incorrect, noting that it had considered the entire administrative record, including the Vanarthos MRI, in affirming LINA's denial of Wilkins's claim, and remained unconvinced that it should alter its previous decision. Responding to Wilkins's contention that the district court failed to address the issues he raised in his third amended complaint, the district court noted that it had denied Wilkins's motion to file a third amended complaint. Finally, the district court addressed Wilkins's claim that LINA breached its fiduciary duty, stating that "it is not appropriate to afford [Wilkins] additional, alternative relief for breach of fiduciary duty based on what the Court agrees is a correct benefit denial decision." ² The district court concluded, "Congress provided a remedy for [Wilkins's] injury in [29 U.S.C. § 1132(a)(1)(B...