Federal Circuits, 11th Cir. (April 29, 1997)
Docket number: 96-8795
Permanent Link:
http://vlex.com/vid/counts-counter-accident-claimants-gulf-36135113
Id. vLex: VLEX-36135113
Click here to download this article in graphic format (Acrobat Reader)

US Code - Title 29: Labor - 29 USC 1133 - Sec. 1133. Claims procedure
Code of Federal Regulations - Title 29: Labor - 29 CFR 2560.503-1 - Claims procedure.
U.S. Court of Appeals for the 11th Cir. - Roland H. Bickley v. Caremark RX, Inc. (11th Cir. 2006)
U.S. Court of Appeals for the 11th Cir. - Lisa Ann Byars v. The Coca-Cola Company (11th Cir. 2008)
U.S. Court of Appeals for the 8th Cir. - Kathleen Burds; Patricia Caramagno; Susan Carriere; Lynn Cuddihy; Kathy Darnell; Vicky Edmonds; Pamela Engelke; Helen Garcia; Delica Herndon; Yolanda Herron; Gerri Hohl; Gail Huss; Gilma Jones; Peggy Lavelle; Gwen Lippold; Mary Mclaughlin; Connie Peterson; Joan Quinton-Cox; Carol Anne Ruthloff; Marcie Sheehy; Deborah Walley; Jeannie Barkman-White, Appellants, v. Union Pacific Corporation; Southern Pacific Transportation Company; Southern Pacific Rail Corporation; St. Louis Southwestern Railway Company; Rio Grande Industries, Inc. Health and Welfare Plans; Southern Pacific Rail Corporation Thrift Plan; Southern Pacific Rail Corporation Medical Plan, as of 1/1/94; Rio Grande Industries, Inc., Medical, Dental, and Health Care Plan; Rio Grande Industries, Inc. Life, Personal Acc & Bus Trav. Plan; Rio Grande Industries, Inc. Benefit Choices Plan, Effective 1/1/90; Rio Grande Industries, Inc. Medical Benefits Plan, Effective 1/1/90; Rio Grande Industries, Inc. Dental Benefits Plan, Effective 1/1/90; Rio Gra..., 223 F.3d 814 (8th Cir. 2000) Appellants, v. Union Pacific Corporation; Southern Pacific Transportation Company; Southern Pacific Rail Corporation; St. Louis Southwestern Railway Company; Rio Grande Industries, Inc. Health and Welfare Plans; Southern Pacific Rail Corporation Thrift Plan; Southern Pacific Rail Corporation Medical Plan, as of 1/1/94; Rio Grande Industries, Inc., Medical, Dental, and Health Care Plan; Rio Grande Industries, Inc. Life, Personal Acc & Bus Trav. Plan; Rio Grande Industries, Inc. Benefit Choices Plan, Effective 1/1/90; Rio Grande Industries, Inc. Medical Benefits Plan, Effective 1/1/90; Rio Grande Industries, Inc. Dental Benefits Plan, Effective 1/1/90; Rio Gra...
Susan Warren Cox, Gerald M. Edenfield, Edenfield & Cox, P.C., Statesboro, GA, for Plaintiff-Counter Defendant-Appellant.
Wade W. Herring, II, Hunter, Maclean, Exley & Dunn, Savannah, GA, for Defendants-Counter Claimants-Appellees.Appeal from the United States District Court for the Southern District of Georgia.Before DUBINA and BLACK, Circuit Judges, and COHILL*, Senior District Judge.DUBINA, Circuit Judge:Appellant J.W. Counts ("Counts") appeals the district court's grant of summary judgment in this ERISA1 action in favor of Appellees American General Life and Accident Insurance Company and American General Corporation Plan Administrator (collectively, "AGLA"). The district court ruled that Counts failed to exhaust his administrative remedies. For the reasons that follow, we affirm.I. BACKGROUNDCounts worked as an insurance agent and sales manager for AGLA and its predecessors from 1965 to 1990. Counts was a participant in the Gulf Life Field Representative's Long-Term Disability Plan ("the Plan"),2 an employee benefit plan governed by ERISA and administered by AGLA. A participant must be totally disabled to receive long term disability ("LTD") benefits under the Plan. The Plan defines total disability as a sickness or injury which prevents a participant from performing the main duties of his or her regular occupation. After 12 months, however, the definition changes: the participant must be unable to perform "each and every of the main duties of any occupation. Any occupation is one that the Participant's training, education, or experience will reasonably allow." R3-61, District Court Order at 3 (emphasis added).Counts injured his back in 1986. Four years later, he became totally disabled and stopped working. In November 1990, AGLA began paying Counts LTD benefits under the Plan. Counts received LTD benefits for 12 months. AGLA then suspended his benefits pending receipt of an opinion from his physician, Dr. Cannon, as to whether Counts was totally disabled under the "any occupation" definition. In March 1992, Dr. Cannon sent AGLA a letter stating that he felt Counts was capable of light clerical work and was not totally disabled. Two other doctors who evaluated Counts reached similar conclusions.By letter dated April 30, 1992, AGLA's Disability Committee terminated both Counts' LTD benefits and his employment with AGLA. The termination letter stated that the committee had determined that Counts no longer met the requirements for total disability under the Plan. The letter also provided as follows:The Disability Committee decision is final unless overturned by an appeal; therefore, your employment and benefit status will remain terminated during the appeal process.If you disagree with this determination, you may appeal the decision by sending your written request within 60 days following your receipt of this notice stating the reason for your appeal along with any additional information for review to [address omitted].If you wish to examine any pertinent documents, we will need a written authorization from your physician before medical information can be released to you.District Court Order at 4-5.Counts did not appeal the decision. Four months after the 60-day appeals period expired, Counts' attorney wrote AGLA a letter discussing Counts' medical situation and stating, "We would appreciate hearing from you regarding this matter at your earliest convenience." Id. at 5. Counts' attorney did not request any specific information from AGLA. AGLA wrote back reiterating its basis for discontinuing Counts' benefits and offering further assistance upon request. Ten months later, Counts' attorney wrote AGLA a second letter stating that AGLA's letter terminating Counts' LTD benefits failed to comply with the notice requirements set forth in 29 U.S.C. 1133 and 29 C.F.R. § 2560.503-1(f). AGLA responded that it felt its denial letter was in substantial compliance with the regulatory requirements, but that it welcomed further inquiries. Counts made none. Five months later, Counts filed this action.Counts' complaint alleged (1) that AGLA wrongfully discontinued his LTD benefits under the Plan and (2) that AGLA terminated his employment for the purpose of interfering with his rights under other AGLA employee benefit plans in which Counts was a participant. Counts sought an order reinstating his LTD benefits and requiring AGLA to continue contributing to his other employee benefit plans. Counts also sought attorney's fees and an award of civil penalties for AGLA's alleged failure to supply him with requested information. AGLA counterclaimed for overpayment of LTD benefits. The district court granted AGLA's motion for summary judgment on the ground that Counts failed to exhaust his administrative remedies. Counts appealed.3II. DISCUSSIONWe review the district court's grant of summary judgment de novo, applying the same standards as the district court. Harris v. Board of Educ. of the City of Atlanta,Try vLex for FREE for 3 days
Access legal information from United States including:
Try vLex without any commitment for 3 days and see why you need it.
3
days of Free Access