The
plaintiff in today's case had been in a
serious bicycle accident and suffered
cognitive impairments as a result.
Gammell
v. Prudential Ins.Co. of America,
2007 U.S.Dist.LEXIS 36604 (D.Mass. May
17).
On account
of his injuries, Thomas Gammell received
benefits through his employer's group
disability insurer, Prudential, from 1989
through 2002; however, benefits were
terminated after Prudential's nonexamining
doctors concluded that Gammell was not
significantly impaired. The plaintiff
appealed, but Prudential upheld its
determination. A second appeal, submitted
in 2004, remained undetermined when suit
was filed on October 2006.
That suit,
in addition to seeking recovery of
benefits in accordance with section
502(a)(1)(B) of the ERISA law, also pled a
claim for breach of fiduciary duty under
section 502(a)(3). Section 502(a)(1)(B)
allows a participant in an employee
benefit plan ''to recover benefits due to
him under the terms of his plan.'' The
claim for breach of fiduciary duty invoked
section 502(a)(3), which permits a suit
''by a participant, beneficiary, or
fiduciary (A) to enjoin any act or
practice which violates any provision of
this subchapter or the terms of the plan,
or (B) to obtain other appropriate
equitable relief (I) to redress such
violations or (II) to enforce any
provisions of this subchapter or the terms
of the plan.''
The leading
case under section 502(a)(3) is
Varity
Corp. v. Howe, 516 U.S. 489,
512, 116 S. Ct. 1065, 134 L. Ed. 2d 130
(1996), where the Supreme Court found that
section 502(a)(3)'s '' 'catchall'
provisions act as a safety net, offering
appropriate equitable relief for injuries
caused by violations that section [1132]
does not elsewhere adequately remedy.''
However, the court also made it clear that
where a claim brought under section
502(a)(1)(B) would provide adequate
relief, a second claim asserted under
section 502(a)(3) would be duplicative and
may not be permitted. Thus, the court
struck the plaintiff's claim under section
502(a)(3).
The court
also struck a Gammell's jury demand.
Although the ERISA law is silent as to
whether a claim brought under that statute
provides for a jury trial, the majority of
courts have denied jury trials ''because
claims for pension benefits were formerly
brought under the law of trusts and are
thus equitable in nature. See, e.g.,
Wardle v.
Central States, Se. & Sw. Areas Pension
Fund, 627 F.2d 820, 829 (7th
Cir. 1980) ('We conclude that Congress'
silence on the jury right issue reflects
an intention that suits for pension
benefits by disappointed applicants are
equitable. Such suits under the law of
trusts have existed for quite a while.…
These suits have been considered equitable
in nature.').''
Thus, the
court found no right to trial by jury.
The court's
dismissal of the jury trial claim relied
on precedent that appears significantly
outdated in light of the Supreme Court's
most recent discussions both as to the
jury trial right and the distinction
between legal and equitable relief under
the ERISA statute. See, generally, Donald
T. Bogan, ''ERISA: Rethinking
Firestone
In Light Of
Great-West — Implications For
Standard Of Review And The Right To A Jury
Trial In Welfare Benefit Claims,'' 37
J.Marshall L.Rev. 629 (2004). In
Wardle v.
Central States, supra., the
court rejected the conclusion reached in
Stamps
v. Michigan Teamsters Joint Council,
No. 43, 431 F. Supp. 745 (E.D. Mich.
1977), that the ERISA law does provide for
jury trials. Stamps concluded that the
specification of equitable relief in
section 502(a)(3) meant that claims
brought under section 502(a)(1)(B) were
legal in nature.
Wardle
disagreed and ruled that claims
brought against the trustees of a pension
plan invoked a trust remedy, which was
equitable. However, the claim in
Gammell
involved a suit against an
insurer that would unquestionably
constitute a claim for breach of contract
if the ERISA law did not apply. See, e.g.,
Cox v.
Washington Natl. Insur.Co., 520
S.W.2d 76 (Ct.App.Mo. 1974) (employer
sponsored disability benefit claim
accorded plenary civil procedure);
Antram v.
Stuyvesant Life Insur.Co., 287
So.2d 837 (Ala. 1973) (same). Although
ERISA abounds with trust law references
according to
Firestone
Tire & Rubber Co. v. Bruch, 489
U.S. 101 (1989), no one can doubt, as
pointed out in
Van Boxel
v. Journal Employees' Pension Trust,
836 F.2d 1048, 1050 (7th Cir.
1987), that even with pension funds,
employee benefit claims arise out of
''contractual entitlements'' and
Firestone
described ERISA's intent to
''protect contractually defined
benefits.''
Firestone
also held the ERISA law should
not afford ''less protection to employees
and their beneficiaries than they enjoyed
before ERISA was enacted.'' As the cases
cited above point out, prior to ERISA's
1974 enactment, claimants enjoyed the
right to a jury trial in benefit claims.
Two parallel
developments suggest these concepts need
to be revisited. Subsequent to
Wardle,
the Supreme Court issued two
rulings clarifying when the right to a
jury trial exists. In both
Granfinanciera, S.A. v. Nordberg,
492 U.S. 33, 42, 109 S.Ct. 2782, 2790,
106 L.Ed.2d 26 (1989) and in
Chauffeurs, Teamsters & Helpers, Local No.
391 v. Terry, 494 U.S. 558
(1990), the Supreme Court held that two
factors dictate when the Seventh Amendment
guarantees a right to trial by jury. A
court first looks to see whether the cause
of action resembles an action known to the
common law that provided for a trial by
jury. Second, the court examines the
nature of the relief requested. As to the
first point, the issue is easily resolved
— claims for breach of contract have
traditionally been subject to jury trials.
As to the
nature of the remedy, the Supreme Court
itself has drawn a distinction between
claims for benefits and other equitable
claims under ERISA.
Great-West Life & Annuity Ins. Co. v.
Knudson, 534 U.S. 204, 122 S.Ct.
708, 151 L.Ed. 2d 635 (2002) represents
the watershed in that regard. There, in
making it clear that claims brought
pursuant to section 502(a)(3) allow only
equitable relief, the court suggested that
claims brought under section 502(a)(1)(B)
were legal in nature. Indeed, the court
explained, ''[a] claim for money due and
owing under a contract is quintessentially
an action at law.'' At least three
district courts have since ruled that the
distinction made by
Great-West supports allowing
ERISA benefit claimants jury trials on
their section 502(a)(1)(B) claims. See,
Lamberty
v. Premier Mill Work and Lumber Co. Inc.,
329 F.Supp.2d 737 (E.D.Va.
2004),
Bona v.
Barasch, 2003 U.S. Dist. LEXIS
4186 (S.D.N.Y. 2003), and
Kirse v.
McCullough, 2005 U.S.Dist.
LEXIS 17032 (W.D. Mo. 2005).
A recent 2d
U.S. Circuit Court of Appeals ruling
authored by Judge Richard D. Cudahy from
the 7th Circuit, sitting by designation,
carries on the analysis.
In Nechis
v. Oxford Health Plan Inc., 421
F.3d 96, 103-04 (2d Cir. 2005), which
dismissed an ERISA claim for breach of
fiduciary duty involving the denial or
mishandling of claims involving
chiropractic services on several grounds,
including a claim seeking monetary
damages, the court remarked:
''A claim
for money due and owing under a contract
is quintessentially an action at law. The
Supreme Court has delineated what forms of
equitable restitution are available under
section 502(a)(3), distinguishing
permissible forms of equitable restitution
such as employment of a constructive trust
or of an equitable lien from forms of
legal restitution. Thus, a constructive
trust or equitable lien is imposed when,
in the eyes of equity, a plaintiff is the
true owner of funds or property, and the
money or property identified as belonging
in good conscience to the plaintiff [can]
clearly be traced back to particular funds
or property in the defendant's possession.
For the reasons aptly articulated by the
district court, neither form of equitable
restitution is involved here; the monies
upon which [Alexina] Nechis seeks to
impose a trust are premiums paid for
health care coverage, which Oxford is
under no obligation to segregate and which
Nechis does not allege to be segregated in
a separate account. Moreover, the language
of Nechis's request for relief involves
words of contract rather than those of
equity, a circumstance that undermines her
claim that the district court misconstrued
the nature of the relief that she has
sought. Since early on, Nechis has
complained that she did not receive the
benefit of the bargain and has requested
disgorgement of ill-gotten gains and
restitution of premiums paid. And she
persists in seeking money damages under a
theory of unjust enrichment, alleging that
ERISA's remedies must be supplemented by
the federal common law since the statute
does not provide adequate relief in the
present circumstances. We decline this
invitation to perceive equitable clothing
where the requested relief is nakedly
contractual.''
Therefore,
as the result of
Great-West v. Knudson and
developments clarifying the right to jury
trial since
Wardle
was issued more than 25 years
ago, there is ample reason to reexamine
the question of whether claimants seeking
benefits under the ERISA law are entitled
to jury trials. Even in those cases that
are decided under an arbitrary and
capricious standard of review, there is no
reason to deny a right to trial by jury.
Courts frequently call upon juries to
answer special interrogatories, and, as
Head v.
Lutheran General Hospital, 516
N.E.2d 921 (Ill.App. 1987), represents,
upon being instructed as to the meaning of
the term ''arbitrary and capricious,'' a
jury was able to determine whether a
physician was improperly denied hospital
staff privileges under that standard.
There is no reason why jurors could not
make the same determination in ERISA
claims.
Nor is the
treatment of ERISA cases as
quasi-administrative law claims a basis
for denying jury trials. Many courts view
ERISA cases as review proceedings where
the court conducts an ''appellate review''
of the evidence initially presented to the
insurer or plan administrator. Not only is
Professor Bogan critical of that approach
in the article cited above, but I have
also authored two articles critical of the
application of administrative law concepts
in ERISA cases: ''The Paradox of the
Misuse of Administrative Law in ERISA
Benefit Claims,'' 37 John Marshall Law
Review 727 (2004), and ''Disability
Insurance Under the ERISA Law: Economic
Security or Litigation Nightmare,'' 25
J.Insur.Reg. 33 (Spring 2007). Both
articles cite Supreme Court and federal
appellate precedent for the conclusion
that ERISA cases should not be treated as
review proceedings and should be treated
as plenary proceedings in the same manner
as any other civil action.