Chauvin v. Unum Life Insurance Co. of America , 109 F. App'x 680 ( 2004 )

United States Court of Appeals
Fifth Circuit
F I L E D
UNITED STATES COURT OF APPEALS
FIFTH CIRCUIT September 22, 2004
Charles R. Fulbruge III
Clerk
No. 04-30229
Summary Calendar
KEVIN CHAUVIN,
Plaintiff-Appellant,
versus
UNUM LIFE INSURANCE COMPANY OF AMERICA,
Defendant-Appellee.
Appeal from the United States District Court
for the Eastern District of Louisiana
(01-CV-157-C)
Before HIGGINBOTHAM, JONES, and BARKSDALE, Circuit Judges.
PER CURIAM:*
Kevin Chauvin appeals the summary judgment awarded UNUM Life
Insurance Company against his claim that UNUM, as plan
administrator, abused its discretion in denying his claim for
partial disability benefits. Chauvin contends UNUM failed in its
duty to disclose steps necessary to preserve his right to obtain
those benefits under the Employee Retirement Income Security Act
(“ERISA”), 29 U.S.C. § 1001, et seq.
*
Pursuant to 5TH CIR. R. 47.5, the court has determined that
this opinion should not be published and is not precedent except
under the limited circumstances set forth in 5TH CIR. R. 47.5.4.
UNUM issued a group long term disability policy pursuant to a
group insurance trust in which Venture Transport, Inc. (Venture),
was a participating employer. As a Venture employee, Chauvin was
provided a booklet describing plan benefits available to him.
Chauvin alleged he became disabled on the job on 14 October
1996. UNUM approved his claim for long term disability benefits on
3 June 1997. Chauvin’s policy’s definition of total disability
required that Chauvin be unable to perform each of the material
duties of any gainful occupation for which he is reasonably fitted
by training, education, or experience.
After providing benefits to Chauvin for 24 months, UNUM
conducted several evaluations, including a medical examination, on
Chauvin. As a result of these evaluations, it was determined that
Chauvin could perform a number of jobs. Therefore, on 17 December
1999, UNUM notified Chauvin that his benefits were being
terminated. The notification letter explained why benefits were
being terminated; identified seven occupations UNUM concluded
Chauvin could perform, as well as work skills Chauvin possessed;
and advised Chauvin that, within 90 days, he could submit a written
request to UNUM’s appeal department to have the decision reviewed.
Following the appeal process, the benefits-termination was upheld.
Chauvin filed this action in state court; UNUM removed it to
the district court. The district court granted in part and denied
in part UNUM’s summary judgment motion, and denied Chauvin’s
summary judgment motion. The court concluded that, although the
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plan administrator did not abuse his discretion in denying
Chauvin’s claim for disability benefits, he failed to consider
whether Chauvin qualified for partial disability benefits.
Therefore, the district court retained jurisdiction pending the
plan administrator’s decision.
The plan administrator denied Chauvin’s claim for partial
disability benefits. After permitting Chauvin to amend his
complaint, the district court considered UNUM’s motion for
reconsideration of the district court’s earlier denial of the
summary judgment motion.
In so doing, the district court concluded the plan
administrator did not abuse its discretion in determining Chauvin
did not meet the plan definition of “partially disabled”, and was
therefore not entitled to benefits. No authority need be cited for
our reviewing de novo a summary judgment and for its being proper
if there are no material fact issues and the movant is entitled to
judgment as a matter of law.
Chauvin contends: the summary plan description (SPD) did not
adequately inform him of his obligations in order to obtain partial
disability benefits; the plan administrator did not adequately
respond to his request for information concerning his eligibility
for them; and the administrator failed in its duty to fully
disclose the steps necessary for him to preserve his right to
obtain them.
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Pursuant to ERISA, a SPD must be furnished to plan
beneficiaries; it must “be written in a manner calculated to be
understood by the average plan participant, and shall be
sufficiently accurate and comprehensive to reasonably apprise such
participants and beneficiaries of their rights and obligations
under the plan”. 29 U.S.C. § 1022. Clear and unambiguous
statements in the SPD for an ERISA plan are binding. McCall v.
Burlington Northern/Santa Fe. Co., 237 F.3d 506, 512 (5th Cir.
2000).
The SPD, which Chauvin received, includes the following
definition of partial disability:
“Partial disability” and “partially disabled”
mean that because of injury or sickness you,
while unable to perform all the material
duties of his regular occupation on a full-
time basis, are:
1. performing at least one of the material
duties of your regular occupation or another
occupation on a part-time or full-time basis;
and
2. currently earning at least 20% less per
month than your indexed pre-disability
earnings due to that same injury or sickness.
The SPD also provides that, to be eligible for partial disability
benefits, an employee must submit proof of partial disability
within 31 days of the end of a period during which he received
disability benefits. Chauvin does not dispute having received the
SPD; instead, he contends he did not understand he would be
required to work to receive current earnings. The pertinent
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language of the SPD is clear; as quoted above, it states that, to
be partially disabled, a beneficiary must be currently earning
money performing at least one of his regular occupation material
duties. UNUM fulfilled its obligation to inform Chauvin of his
obligations under the plan regarding entitlement to partial
disability benefits.
It is undisputed that Chauvin was not working and was
receiving disability benefits until being notified on 17 December
1999 that those benefits were being terminated; it is also
undisputed that he was not employed within 31 days of 17 December,
as required by the plan for eligibility for partial disability
benefits. Even so, Chauvin contends UNUM failed to adequately
respond to his request for information concerning eligibility for
disability benefits. Despite this contention, the administrative
record includes no evidence that Chauvin made any inquiry after his
total disability benefits were terminated and prior to the
expiration of the 31 days thereafter. In short, the administrative
record does not show that a timely request was made.
Finally, Chauvin contends UNUM breached its fiduciary duty
under 29 U.S.C. § 1104 to provide complete and correct material
information about the plan to Chauvin. This contention is raised
for the first time on appeal. It is well-established that we will
not review issues raised in that fashion. See, e.g., Priester v.
Lowndes County, 354 F.3d 414, 424 (5th Cir. 2004).
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AFFIRMED
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