Raniero Gimeno v. NCHMD, Inc. ( 2022 )


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  • USCA11 Case: 21-11833     Date Filed: 06/28/2022    Page: 1 of 12
    [PUBLISH]
    In the
    United States Court of Appeals
    For the Eleventh Circuit
    ____________________
    No. 21-11833
    ____________________
    RANIERO GIMENO,
    Plaintiff-Appellant,
    versus
    NCHMD, INC.,
    NCH HEALTHCARE SYSTEM, INC.,
    Defendants-Appellees.
    ____________________
    Appeal from the United States District Court
    for the Southern District of Florida
    D.C. Docket No. 1:20-cv-24870-BB
    ____________________
    USCA11 Case: 21-11833        Date Filed: 06/28/2022      Page: 2 of 12
    2                       Opinion of the Court                 21-11833
    Before WILLIAM PRYOR, Chief Judge, ROSENBAUM, and BRASHER,
    Circuit Judges.
    BRASHER, Circuit Judge:
    This appeal presents a question of first impression about the
    Employee Retirement Income Security Act, 
    29 U.S.C. § 1001
     et seq.
    Section 1132(a)(3) of ERISA authorizes a beneficiary of an ERISA
    plan to sue for “appropriate equitable relief” to redress violations
    of the plan or statute. 
    29 U.S.C. § 1132
    (a)(3). The question for us is:
    Does Section 1132(a)(3) create a cause of action for an ERISA ben-
    eficiary to recover monetary benefits lost due to a fiduciary’s
    breach of fiduciary duty in the plan enrollment process?
    Our answer is “yes.” Under our precedents, a court may or-
    der typical forms of equitable relief under Section 1132(a)(3). As the
    Supreme Court and many of our sister circuits have recognized,
    courts in equity could traditionally order “equitable surcharge”—
    that a fiduciary pay a beneficiary for losses caused by the fiduciary’s
    breach of a fiduciary duty. Accordingly, we hold that a beneficiary
    of an ERISA plan can bring a lawsuit under Section 1132(a)(3)
    against a fiduciary to recover benefits that were lost due to the fi-
    duciary’s breach of its duties. Because the district court held that
    such a claim would be futile and because there is no other basis to
    affirm, we reverse the district court.
    USCA11 Case: 21-11833       Date Filed: 06/28/2022     Page: 3 of 12
    21-11833               Opinion of the Court                        3
    I. Background
    Raniero Gimeno’s spouse, Justin Polga, was a medical doc-
    tor employed by NCHMD, Inc., which is a subsidiary of NCH
    Healthcare System, Inc. As part of the initial hiring process,
    NCHMD’s human resources staff helped Polga complete enroll-
    ment paperwork for life insurance benefits through an ERISA plan.
    Gimeno was the primary beneficiary under the plan, and NCH
    Healthcare was the named plan administrator.
    Polga elected to pay for $350,000 in supplemental life insur-
    ance coverage on top of $150,000 in employer-paid coverage. To
    receive supplemental coverage, Polga needed to submit an evi-
    dence of insurability form. But Polga did not receive the form with
    his enrollment paperwork, and the human resources staff did not
    notify him that the form was necessary or missing. As a result,
    Polga never submitted the form to the insurance company. None-
    theless, for three years, NCHMD deducted premiums correspond-
    ing to $500,000 in life insurance coverage from Polga’s paychecks.
    It also provided him with a benefits summary stating that he had
    $500,000 in coverage.
    Polga died, and Gimeno filed a claim for benefits with the
    plan’s insurance company. The insurance company partially de-
    nied the claim. It refused to pay any supplemental benefits because
    it had never received the form.
    Gimeno sued NCHMD and NCH Healthcare, asserting a
    claim under ERISA, 
    29 U.S.C. § 1132
    (a)(1)(B), which empowers a
    USCA11 Case: 21-11833        Date Filed: 06/28/2022     Page: 4 of 12
    4                      Opinion of the Court                 21-11833
    beneficiary to bring a civil action “to recover benefits due to him
    under the terms of his plan.” Gimeno argued that, by failing to no-
    tify Polga of the need for the form and misleading him about the
    nature of his coverage, the defendants breached their fiduciary du-
    ties to administer the plan fairly and properly, to inform Polga of
    his rights and benefits, and to ensure that all application forms were
    correctly completed and submitted. He sought an order requiring
    that NCHMD and NCH Healthcare pay him the plan benefits that
    he would have received but for their alleged breach—the unpaid
    $350,000.
    NCHMD and NCH Healthcare moved to dismiss for failure
    to state a claim. They argued that they were improper defendants
    for the Section 1132(a)(1)(B) claim because, unlike the insurer, they
    had no obligation to award the benefits at issue. In response,
    Gimeno conceded that Section 1132(a)(1)(B) provided no remedy.
    But he argued that he had a cause of action under 
    29 U.S.C. § 1132
    (a)(3) for “appropriate equitable relief.” He asked the district
    court to allow him to amend his complaint to “assert his claims
    under [Section 1132(a)(3)] and delete reference to [Section
    1132(a)(1)(B)].”
    The district court granted the motion to dismiss and denied
    Gimeno leave to amend. It concluded that amending the complaint
    would be futile because compensatory relief, such as an award of
    lost insurance benefits, is not equitable and is thus unavailable un-
    der Section 1132(a)(3). Gimeno appealed.
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    21-11833                Opinion of the Court                          5
    II. Standard of Review
    “We review de novo the dismissal of a complaint for failure
    to state a claim.” Rosenberg v. Gould, 
    554 F.3d 962
    , 965 (11th Cir.
    2009). We also “review de novo an order denying leave to amend
    on the grounds of futility, because it is a conclusion of law that an
    amended complaint would necessarily fail.” Boyd v. Warden, Hol-
    man Corr. Facility, 
    856 F.3d 853
    , 864 (11th Cir. 2017).
    III. Discussion
    Gimeno argues the district court erred in concluding that his
    proposed amendment would be futile because Section 1132(a)(3)
    allows the relief he seeks. The defendants dispute that argument,
    and they also contend that the district court’s order should be af-
    firmed because Gimeno improperly raised alternative claims under
    Section 1132(a)(1)(B) and Section 1132(a)(3). We address each of
    these issues in turn.
    A.
    Gimeno first argues that Section 1132(a)(3) permits him to
    file a cause of action to recover money equal to the insurance ben-
    efits lost due to the defendants’ alleged breach of fiduciary duty.
    We agree.
    Section 1132(a)(3) authorizes a beneficiary of an employ-
    ment benefit plan to sue for “appropriate equitable relief” for vio-
    lations of the statute or the terms of the plan. 
    29 U.S.C. § 1132
    (a)(3).
    “Equitable relief” refers to “those categories of relief that
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    6                      Opinion of the Court                 21-11833
    were typically available in equity” before the fusion of courts of eq-
    uity and courts of law. Mertens v. Hewitt Assocs., 
    508 U.S. 248
    , 256
    (1993). Compensatory damages were not typically available in eq-
    uity. 
    Id.
     at 255–59. Accordingly, the Supreme Court has held that
    Section 1132(a)(3) does not usually permit a plaintiff to recover
    money damages. Id.; see also Great-West Life & Annuity Ins. Co.
    v. Knudson, 
    534 U.S. 204
    , 214 (2002); Sereboff v. Mid Atl. Med.
    Servs., Inc., 
    547 U.S. 356
    , 362–63 (2006).
    That said, certain kinds of monetary relief were typically
    available in equity, and this history must inform our interpretation
    of ERISA. See LaRue v. DeWolff, Boberg & Assocs., Inc., 
    552 U.S. 248
    , 253 n.4 (2008). Courts in equity could order restitution of “par-
    ticular funds or property in the defendant’s possession.” Knudson,
    
    534 U.S. at 214
    . They could also impose equitable surcharge—an
    order that a trustee compensate a trust beneficiary for a loss due to
    a breach of fiduciary duty. See Samuel L. Bray, Fiduciary Remedies,
    in The Oxford Handbook of Fiduciary Law 449, 456–58 (Evan J.
    Criddle et al. eds., 2019); Restatement (Third) of Trusts § 95 cmt.
    b. “The trustee’s personal liability to make compensation for the
    loss occasioned by a breach of trust is a simple contract equitable
    debt” and “may be enforced by a suit in equity against the trustee
    himself.” 4 John N. Pomeroy, Equity Jurisprudence § 1080, p. 229
    (5th ed. 1941). This remedy—as between a trust beneficiary and a
    trust fiduciary—is “equitable in character and enforceable against
    [a] trustee[] in a court exercising equity powers.” Restatement
    (Third) of Trusts § 95 (Am. L. Inst. 2012).
    USCA11 Case: 21-11833        Date Filed: 06/28/2022      Page: 7 of 12
    21-11833                Opinion of the Court                         7
    Because equitable surcharge is a typical equitable remedy as
    between beneficiaries and fiduciaries, the Supreme Court has rec-
    ognized that Section 1132(a)(3) allows an ERISA beneficiary to sue
    an ERISA fiduciary for this kind of relief. See CIGNA Corp. v.
    Amara, 
    563 U.S. 421
    , 441–42 (2011). In Amara, a district court had
    ordered a plan administrator to pay higher benefits to beneficiaries
    because it had given them an incomplete and misleading notice of
    a change to their pension plan. 
    Id.
     at 426–34. The Supreme Court
    vacated that decision, concluding that the remedy was not availa-
    ble under Section 1132(a)(1)(B). 
    Id.
     at 435–438, 445. But, to guide
    the lower courts on remand, it explained that the district court’s
    remedy closely resembled equitable surcharge and thus fell within
    the scope of the term “appropriate equitable relief” in Section
    1132(a)(3). 
    Id.
     at 440–42. The Court reasoned that surcharge histor-
    ically took “the form of monetary ‘compensation’ for a loss result-
    ing from a trustee’s breach of duty.” 
    Id.
     at 441–42. And it explained
    that the defendant’s status as a fiduciary made a “critical difference”
    in differentiating a surcharge from the kind of compensatory dam-
    ages that were not typically available in courts of equity. 
    Id. at 442
    .
    Since Amara, every circuit court to address the issue has rec-
    ognized that Section 1132(a)(3) creates a cause of action for mone-
    tary relief for breaches of fiduciary duty. See Sullivan-Mestecky v.
    Verizon Commc’ns Inc., 
    961 F.3d 91
    , 102–03 (2d Cir. 2020); Moyle
    v. Liberty Mut. Ret. Benefit Plan, 
    823 F.3d 948
    , 960 (9th Cir. 2016);
    Silva v. Metro. Life Ins. Co., 
    762 F.3d 711
    , 720–22, 724–25 (8th Cir.
    2014); Gearlds v. Entergy Servs., Inc., 
    709 F.3d 448
    , 450–52 (5th Cir.
    USCA11 Case: 21-11833        Date Filed: 06/28/2022      Page: 8 of 12
    8                       Opinion of the Court                 21-11833
    2013); Kenseth v. Dean Health Plan, Inc., 
    722 F.3d 869
    , 880–82 (7th
    Cir. 2013); McCravy v. Metro. Life Ins. Co., 
    690 F.3d 176
    , 180–83
    (4th Cir. 2012). We reach the same conclusion here. To be sure, the
    Supreme Court’s discussion of equitable surcharge in Amara is
    likely dicta. But unlike our own dicta, the “thoroughly reasoned”
    dicta of the Supreme Court “is of considerable persuasive value”
    and “is not something to be lightly cast aside.” Schwab v. Crosby,
    
    451 F.3d 1308
    , 1325–26 (11th Cir. 2006) (quotation marks omitted).
    Moreover, the Supreme Court’s discussion in Amara is correct: eq-
    uitable surcharge is a typical equitable remedy that may be im-
    posed on a fiduciary for a breach of fiduciary duty.
    In light of Amara and the established law of equitable sur-
    charge, we are unpersuaded by the defendants’ arguments that Sec-
    tion 1132(a)(3) provides no comparable remedy here. They cite the
    Supreme Court’s decisions in Knudson and Mertens to assert that
    the recovery of money is not an equitable remedy. But neither de-
    cision concerned claims against a fiduciary. E.g., Mertens, 
    508 U.S. at 251
     (stating the question as “whether ERISA authorizes suits for
    money damages against nonfiduciaries”). And the Supreme Court
    in Amara explained that a defendant’s status as a fiduciary makes a
    “critical difference” in the availability of monetary equitable relief.
    
    563 U.S. at 442
    .
    For his part, Gimeno has adequately alleged that both
    NCHMD and NCH Healthcare are fiduciaries. An entity is a fidu-
    ciary under ERISA if it “exercises any discretionary authority or dis-
    cretionary control respecting management” or “administration” of
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    21-11833                Opinion of the Court                          9
    the plan. 
    29 U.S.C. § 1002
    (21)(A). Proof of fiduciary status “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.” Hamilton v. Allen-Bradley Co., 
    244 F.3d 819
    , 824 (11th
    Cir. 2001). For example, in Hamilton, an employer fulfilled a fidu-
    ciary function as plan administrator by requiring employees to go
    through its human resources department to apply for insurance
    benefits, holding itself out as providing administrative services re-
    lated to the plan, distributing claim forms, and fielding questions
    about the plan. 
    Id.
    NCHMD disputes that it is a fiduciary. It points out that only
    NCH Healthcare was named as the plan administrator in plan doc-
    uments. But Gimeno alleges that NCHMD’s human resources staff
    provided Polga with plan enrollment paperwork, guided him
    through completing it, and notified him when important compo-
    nents—such as proof of dependent eligibility—were missing. It also
    provided him with a benefits summary stating that he had $500,000
    in life insurance coverage, and it deducted corresponding premi-
    ums from his paycheck. These functions are analogous to the em-
    ployer’s actions in Hamilton, which we found sufficient to render
    the employer a fiduciary under ERISA. See 
    244 F.3d at 824, 826
    .
    In short, the district court erred in concluding that it was fu-
    tile for Gimeno to amend the complaint to include a claim under
    Section 1132(a)(3). Gimeno asserts that the defendants breached
    their fiduciary duties by failing to adequately notify his spouse
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    10                      Opinion of the Court                 21-11833
    about the form and providing misinformation about his benefits.
    See 
    29 U.S.C. § 1104
    (a)(1)(B) (enumerating fiduciary duties of care,
    skill, prudence, and diligence); Jones v. Am. Gen. Life & Acc. Ins.
    Co., 
    370 F.3d 1065
    , 1072 (11th Cir. 2004) (citing Ervast v. Flexible
    Prods. Co., 
    346 F.3d 1007
    , 1016 n.10 (11th Cir. 2003)) (“[A]n ERISA
    participant has a right to accurate information, and . . . an ERISA
    plan administrator’s withholding of information may give rise to a
    cause of action for breach of fiduciary duty.”). Gimeno argues that
    he lost life insurance benefits because of those breaches and seeks
    monetary relief equivalent to those lost benefits. Because he has
    sufficiently alleged that the defendants are fiduciaries, Gimeno can
    sue for lost benefits under Section 1132(a)(3).
    B.
    As an additional ground for affirmance, the defendants argue
    that Gimeno improperly pleaded alternative claims under Section
    1132(a)(1)(B) and (a)(3). We have held that “an ERISA plaintiff who
    has an adequate remedy under [Section 1132(a)(1)(B)] cannot alter-
    natively plead and proceed under [Section 1132(a)(3)]” because Sec-
    tion 1132(a)(3) is an equitable “‘catchall’ provision that provides re-
    lief only for injuries that are not otherwise adequately provided for
    by ERISA.” Ogden v. Blue Bell Creameries U.S.A., Inc., 
    348 F.3d 1284
    , 1287–88 (11th Cir. 2003) (quoting Varity Corp. v. Howe, 
    516 U.S. 489
    , 512 (1996)). The defendants point out that Gimeno’s op-
    erative complaint relied on Section 1132(a)(1)(B) and that his pro-
    posed amendment relied on Section 1132(a)(3). They argue that,
    by asking the district court to both deny the motion to dismiss and
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    21-11833                Opinion of the Court                        11
    grant him leave to amend, Gimeno was improperly attempting to
    plead claims under both subsections.
    The defendants misunderstand our holding in Ogden. A
    plaintiff can plead as many alternative claims as he wants, “regard-
    less of consistency.” Fed. R. Civ. P. 8(d)(3). But, as with any equita-
    ble claim, a plaintiff cannot succeed on a Section 1132(a)(3) claim if
    he “has an adequate remedy” at law, such as a remedy under Sec-
    tion 1132(a)(1)(B). Ogden, 
    348 F.3d at 1287
    . Section 1132(a)(1)(B)
    allows a beneficiary “to recover benefits due to him under the
    terms of his plan.” 
    29 U.S.C. § 1132
    (a)(1)(B). Accordingly, a plaintiff
    like Gimeno has “an adequate remedy” at law if the “allegations
    supporting the [Section 1132(a)(3)] claim [a]re also sufficient to
    state a cause of action” for benefits under Section 1132(a)(1)(B).
    Jones, 
    370 F.3d at 1073
    . In such a case, the plaintiff must proceed
    under Section 1132(a)(1)(B) instead of Section 1132(a)(3).
    Here, however, Gimeno does not have an adequate remedy
    at law because he cannot sue for benefits under Section
    1132(a)(1)(B). In fact, Gimeno “concede[s] . . . that [he is] not enti-
    tled to the . . . benefit[s] under the terms of [his] plan.” Jones, 
    370 F.3d at 1074
    . In his request to amend his complaint, Gimeno ex-
    plained that he is not entitled to recover the remaining $350,000 in
    supplemental benefits under the terms of the plan because, despite
    paying the higher premiums, his spouse never filed the required
    form. He argues instead that he is due compensation because the
    defendants’ breach of fiduciary duty prevented his spouse from be-
    coming eligible for the supplemental benefits. These allegations do
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    12                      Opinion of the Court                 21-11833
    not state a claim for plan benefits under Section 1132(a)(1)(B); they
    state a claim for equitable relief under Section 1132(a)(3). See Jones,
    
    370 F.3d at 1074
    . Because Gimeno “must rely on” Section
    1132(a)(3) or he would “have no remedy at all,” 
    id.
     (quoting Varity,
    
    516 U.S. at 515
    ), his claim may proceed under Section 1132(a)(3).
    IV. Conclusion
    We REVERSE and REMAND to allow Gimeno to bring a
    claim for breach of fiduciary duty under Section 1132(a)(3).