Bailey v. CIGNA Insurance , 87 F. App'x 347 ( 2004 )

United States Court of Appeals
Fifth Circuit
F I L E D
IN THE UNITED STATES COURT OF APPEALS February 3, 2004
FOR THE FIFTH CIRCUIT
Charles R. Fulbruge III
Clerk
No. 03-30661
Summary Calendar
JOHN J. BAILEY; LINDA BAILEY,
Plaintiffs-Appellants,
versus
CIGNA INSURANCE CO.; ET AL.,
Defendants,
CONNECTICUT GENERAL LIFE INSURANCE CO.; CASENEWHOLLAND, INC.;
CNH HEALTH AND WELFARE PLAN,
Defendants-Appellees.
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Appeal from the United States District Court
for the Western District of Louisiana
USDC No. 01-CV-1115
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Before HIGGINBOTHAM, DAVIS and PRADO, Circuit Judges.
PER CURIAM:*
John and Linda Bailey have appealed the district court’s
order dismissing their complaint asserting claims under the
Employment Retirement Income Security Act (“ERISA”) against
Connecticut General Life Insurance Company, CaseNewHolland, Inc.,
and CNH Health and Welfare Plan for reimbursement of physical
therapy expenses. The appellees have moved to dismiss the
*
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this opinion should not be published and is not precedent except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.
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appeal, arguing that the district court abused its discretion in
extending the appeal period under FED. R. APP. P. 4(a)(5).
Because the district court did not abuse its discretion, the
Court DENIES the motion. See Lackey v. Atlantic Richfield Co.,
990 F.2d 202, 206 (5th Cir. 1993).
The Baileys contend that the district court erred in
granting the motion to dismiss. This Court reviews this question
de novo. Brown v. NationsBank Corp., 188 F.3d 579, 585 (5th Cir.
1999). “[I]n deciding a motion to dismiss for failure to state a
claim, courts must limit their inquiry to the facts stated in the
complaint and the documents either attached to or incorporated in
the complaint.” Lovelace v. Software Spectrum Inc., 78 F.3d
1015, 1017 (5th Cir. 1996). The district court considered two
documents which were not attached to or incorporated in the
complaint: an Enrollment Guide and a Summary Plan Description.
Because the Enrollment Guide and the Summary Plan Description
were attached to the defendants’ motion to dismiss, were referred
to by the Baileys in their complaint, and were central to the
Baileys’s claim, the district court did not err in considering
the documents in ruling on the motion to dismiss. Collins v.
Morgan Stanley Dean Witter, 224 F.3d 496, 498–99 (5th Cir. 2000).
The Baileys contend that the Enrollment Guide and the
Summary Plan Description, which are not consistent with respect
to limitations on the number of physical-therapy visits permitted
under the plan, both constitute summary plan descriptions. The
No. 03-30661
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Baileys contend that they relied on the Enrollment Guide to their
detriment and that the ambiguity between the documents should be
resolved in their favor. See Hansen v. Continental Ins. Co., 940
F.2d 971, 982 (5th Cir. 1991).
“The summary plan description is one of the central ERISA
disclosure requirements.” Martinez v. Schlumberger, Ltd., 338
F.3d 407, 411 (5th Cir. 2003). “[C]lear and unambiguous
statements in the summary plan description are binding” on the
plan administrator. McCall v. Burlington Northern/Santa Fe Co.,
237 F.3d 506, 511 (5th Cir. 2000). In Hicks v. Fleming
Companies, Inc., 961 F.2d 537, 542 (5th Cir. 1992), this Court
adopted a bright-line rule for determining whether a document is
a summary plan description. Citing Hicks, the district court
held that the Enrollment Guide was not a summary plan description
because it did not conform to ERISA and Department of Labor
regulations. The district court noted that the Enrollment Guide
contained none of the information required of a summary plan
description by 29 U.S.C. § 1022(b) and 29 C.F.R. § 2520.102-3.
The Enrollment Guide did not provide information regarding plan
administration, eligibility requirements, circumstances resulting
in disqualification or loss of benefits, or procedures for
presenting claims.
The Baileys do not explain in their brief why the district
court erred in concluding that the Enrollment Guide was not a
summary plan description. Instead, their argument focuses on the
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discrepancy between the two documents regarding the number of
physical therapy visits permitted under the plan. No error has
been shown.
The Baileys contend that they were never provided with a
copy of the Summary Plan Description and that they detrimentally
relied on the statements in the Enrollment Guide. They contend
that plan administrator should be estopped from asserting that
number of physical therapy visits is limited. The appellees
contend that this issue is not properly before the Court because
it is based upon a state-law theory which the district court
determined is preempted by ERISA. They contend that the Baileys
failed to appeal a prior order disposing of the state law claims.
The Baileys do not discuss this argument in their reply brief and
do not address the question of preemption. Although they cite
Godwin v. Sunlife Assurance Co. of Canada, 980 F.2d 323 (5th Cir.
1992), for the proposition that they were prejudiced by a lack of
notice of the coverage limits for physical therapy treatment,
Godwin involved the validity of an ERISA plan amendment and there
was no plan amendment in this case. See Godwin, 980 F.2d at 328.
No error has been shown.
The district court held also that the plan administrator had
complied with the Summary Plan Description in refusing to pay for
the extended physical therapy visits. The Baileys do not
challenge this conclusion on appeal. The Court AFFIRMS the
judgment.
No. 03-30661
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AFFIRMED; MOTION DENIED.