Federal Circuits, 9th Cir. (August 16, 1993)
Docket number: 92-15471
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Appeal from the United States District Court for the Eastern District of California; Edward J. Garcia, District Judge, Presiding.
E.D.Cal.AFFIRMED.Before: SNEED, POOLE and TROTT, Circuit Judges.MEMORANDUM*Appellants Roger and Stephanie Perkins appeal the district court's grant of summary judgment in favor of the Valley Clerks Health and Welfare Trust Fund ("Trust Fund"). The Perkinses had filed a suit under the Employee Retirement and Income Security Act (ERISA), 29 U.S.C. Sec . 1001 et seq., disputing the Trust Fund's determination their son Joey was not entitled to death benefits at the time of his death in September 1986. At that time Joey was employed by Safeway Stores, Inc. in Truckee, California. The Trust Fund determined Joey had not worked sixty-four hours during his first month of employment in June 1986, and thus did not become eligible for the Trust Fund's medical and death benefits until October 1, 1986, three weeks after his death.We affirm the district court's grant of summary judgment.* EXHAUSTION OF REMEDIESAs an initial matter, we must address appellee's argument that we should affirm the district court's grant of summary judgment on the grounds the Perkinses failed to exhaust their administrative remedies before filing this suit. The benefit plan provisions require a notice of death claim be filed within ninety days of the covered death. The plan also requires proof of death, e.g., a death certificate, be provided to the Trustees. Once a claim is finally denied, the plan provisions require that a request for review of a claim be filed within sixty days of receipt of the denial notice. Appellees maintain the Perkinses failed to fulfill these requirements and thus their ERISA claim is barred by a failure to exhaust administrative requirements. Amato v. Bernard, 618 F.2d 559, 566-68 (9th Cir.1980).We decline to apply the exhaustion requirement for several reasons. Although this matter was argued by appellees before the district court, the court did not specifically rule on this matter. However, the court did examine the merits of the Perkins' claims and ruled against them in summary judgment. Although the court did not formally decide the exhaustion issue, its examination of the merits of this case leads us to conclude the court, for whatever reason, chose not to apply the exhaustion requirement to bar appellants' claims. The court may have tacitly decided this issue in the Perkins' favor or the court may have been merely exercising its discretionary authority to waive the exhaustion requirement. Horan v. Kaiser Steel Retirement Plan, 947 F.2d 1412, 1416 (9th Cir.1991). In any event, this issue is not properly before this court, as appellees did not appeal from this aspect of the district court's decision, nor is there enough information in the record for this court to decide that issue sua sponte. Because we affirm the district court's grant of summary judgment on the other grounds articulated by the district court, we need not grapple with this issue.IISUMMARY JUDGMENTAppellants first contend the district court erred in granting the Trust Fund's motion for summary judgment. We review de novo the district court's grant of summary judgment. Schneider v. TRW, Inc., 938 F.2d 986, 989 (9th Cir.1991). We must determine, viewing the evidence in the light most favorable to the nonmoving party, whether there are any genuine issues of material fact and whether the district court correctly applied the substantive law. Id. "A party opposing a summary judgment motion must produce specific facts showing that there remains a genuine factual issue for trial and evidence 'significantly probative' as to any [material] fact claimed to be disputed." Steckl v. Motorola, Inc., 703 F.2d 392, 393 (9th Cir.1983) (quotations omitted).We generally review de novo a challenge to a denial of benefits under an ERISA plan. Jones v. Laborers Health & Welfare Trust Fund, 906 F.2d 480, 481 (9th Cir.1990). However, we review such a denial for an abuse of discretion where " 'the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.' " Id. (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)). We have reviewed the provisions of the Trust Agreement in this case and find that its provisions are nearly identical to the provisions of the plan reviewed by this court in Jones, in which the court found the language of the trust indicated discretionary authority and thus mandated discretionary review. Also, because the Board of Trustees of the Trust Fund consists of both management and union employees, there is no conflict of interest to justify less deferential review. Jones, 906 F.2d at 481. Therefore, we agree with the district court's application of the abuse of discretion standard.The issue in this case is not, as appellants argue, whether there is any disputed issue of material fact that Joey Perkins worked the requisite sixty-four hours in June to become eligible for life insurance benefits on September 1, 1986. The issue instead is whether the Trust Fund abused its discretion in denying the appellants' death benefits in this case. " '[T]rustees abuse their discretion if they render decisions without any explanation, or construe provisions of the plan in a way that clearly conflicts with the plain language of the plan.' " Eley v. Boeing Co., 945 F.2d 276, 279 (9th Cir.1991) (quoting Johnson v. Trustees of the Western Conf. of Teamsters Pension Trust Fund, 879 F.2d 651, 654 (9th Cir.1989)). In order to constitute an abuse of discretion, the factual findings made by the Trust Fund in support of its decision must be clearly erroneous. Jones, 906 F.2d at 482.Because Joey had been employed by Safeway for less than twelve months, he was covered by the eligibility provisions applicable to "new employees." These eligibility requirements for medical and death benefits under the Trust Fund read in relevant part:After a new employee has been employed for one (1) month (of sixty-four (64) or more hours) the employee thereafter becomes eligible for benefits on the first day of the second month following any month in which the employee has worked sixty-four (64) or more hours. New employees are defined as employees who have not been eligible under this Plan in any of the last twelve (12) consecutive months.EXAMPLE: If an employee works 64 hours in January and 64 hours in February, eligibility will commence on April 1, UNLESS the employee has left the industry.Under the terms of the benefits provision, a new employee must work an initial sixty-four hour month. The employee must then work an additional sixty-four hour month, and thereafter becomes eligible on the first day of the second month following this additional month. It is undisputed Joey worked sixty-four hour months in July and August 1986. At issue is whether he worked the requisite sixty-four hours in June 1986, which would have made him eligible for benefits at the time of his death in September 1986.The Trust Fund concluded Joey had not worked sixty-four hours in June, and thus was not eligible for benefits until October 1986. The evidence supports the district court's conclusion the Trust Fund did not abuse its discretion in reaching this determination. The Trust Fund determined Joey worked only thirty-nine hours in June 1986. This factual determination was not clearly erroneous. The Trust Fund examined payroll documents, time cards, and payroll stubs provided by Safeway, Joey's employer, which indicated he had not worked a sufficient number of hours in June. An employment form signed by Joey Perkins indicated an employment starting date with Safeway of June 23. Both Safeway and the Trust Fund checked and rechecked these documents at the Perkins' request several times over a three year period.The Perkinses contest the Trust Fund's interpretation of the payroll documents and offer an alternative reading, which includes unsubstantiated allegations that Safeway intentionally maintained inaccurate employment records to conceal its allegedly illegal employment of Joey under the California Labor Code. Appellants also offered affidavits from individuals who recollected three years later that Joey had in fact been employed by Safeway prior to June 23. We cannot say the Trust Fund's rejection of these contentions and its determination, based on the employment and payroll records supplied by Safeway, that Joey Perkins did not work the necessary sixty-four hours during the month of June, was clearly erroneous.Appellants also maintain the Trust Fund abused its discretion because it did not consider the affidavits and other extrinsic evidence offered by the Perkinses. These allegations are unsupported by any evidence. The case appellants rely on, Fogarty v. UMWA Health & Retirement Funds, 673 F.Supp. 1410, 1411 (W.D.Va.1987), is inapposite. The Fund in that case specifically ruled it would accept only documentary proof and not sworn testimony. In contrast, the Valley Clerk's Trust Fund has no such policy of excluding sworn testimony and has stated it considered the statements appellants provided. The Perkinses have offered no evidence which indicates the Fund did otherwise. We likewise reject appellants' unsubstantiated allegations the district court refused to consider this evidence.The Trust Fund did not clearly err in determining Joey Perkins worked less than sixty-four hours in June 1986. The Trust Fund thus did not abuse its discretion in determining that, under the terms of the insurance coverage, Joey Perkins was not eligible for medical or death benefits at the time of his death in September 1986. Accordingly, the district court properly granted summary judgment in favor of the Trust Fund.IIICONTRA PROFERENTEMThe Perkins argue that even if we uphold the Trust Fund's determination that Joey did not work the required hours in June, the language of the eligibility rules is ambiguous as to the date coverage starts and thus should be interpreted in the Perkins' favor. They urge us to apply the rule of "contra proferentem," which dictates that an ambiguous contract term should be interpreted against the party who drafted the ambiguous provision. Timms v. United States, 678 F.2d 831, 834 (9th Cir.), cert. denied,Try vLex for FREE for 3 days
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