United States District Court, S.D. Mississippi, Southern Division
MEMORANDUM OPINION AND ORDER CONCERNING THE
PARTIES' CROSS-MOTIONS FOR SUMMARY JUDGMENT
GUIROLA, JR.UNITED STATES DISTRICT JUDGE.
THE COURT are the  Motion for Summary Judgment
filed by the defendant, Aetna Life Insurance Company, and the
 Motion for Summary Judgment filed by the plaintiff,
Jason Ward, in this lawsuit concerning the denial of
long-term disability benefits under a plan governed by ERISA.
The parties fully briefed Aetna's Motion, but Ward did
not file a reply in support of his Motion. After reviewing
the submissions of the parties, the record in this matter,
and the applicable law, the Court finds that Aetna's
Motion should be granted, and Ward's Motion should be
issued a group plan (policy number GP-737331-GID) that
provided long-term disability insurance to eligible employees
of Pacific Architects and Engineers Incorporated (hereafter
“PAE”) effective January 1, 2015. (Admin. R. 91,
ECF No. 14-1.) The plan's
booklet-certificate notifies employees that they must enroll
in the long-term disability plan within thirty-one days of
their eligibility date. (Id. at 95.) Employees who
do not enroll within thirty-one days of eligibility are
required to submit evidence of good health satisfactory to
Aetna at their own expense to obtain coverage. (Id.)
The plan grants Aetna discretion to determine whether an
employee's claim for benefits should be granted, and
Aetna is responsible for paying any valid claims.
Ward was diagnosed with renal cell carcinoma in November 2012
and underwent a right robotic nephrectomy on December 26,
2012. (Administrative R. 786, ECF No. 14.) On December 15,
2014, PAE hired Ward to work as an electrical engineer.
(Id. at 1841.) Ward became eligible for long-term
disability coverage when he was hired, but he did not enroll
in the long-term disability plan within thirty-one days of
eligibility. (Id. at 449.) An August 18, 2015
CT-scan revealed a nodule on Ward's right lung.
(Id. at 786.) Ward's physicians recommended a
six-month follow-up CT-scan. (Id.) Ward attempted to
enroll in the long-term disability plan for the plan period
beginning January 1, 2016. (Id. at 449.) On February
19, 2016, Ward's follow-up CT-scan revealed that Ward had
an additional nodule on his right lung, so Ward traveled to
M.D. Anderson for treatment recommendations. (Id. at
786.) At M.D. Anderson, physicians diagnosed Ward with
metastatic renal cell carcinoma; thus, his physicians had
determined that the cancer had spread from his kidney to his
lung. (Id. at 803-04.)
March 17, 2016, Ward filed a claim with Aetna for short-term
disability, which was ultimately granted. (Id. at
121, 211.) Ward then sought long-term disability benefits,
but Aetna denied Ward's claim because he did not submit
an evidence of insurability form demonstrating good health
when he enrolled in the long-term disability insurance plan.
(Id. at 291.) Ward appealed the denial of his claim,
asserting that he was told in writing that he had coverage.
He also noted that long-term disability insurance premiums
had been deducted from his paychecks. (Id. at 1759.)
Aetna denied Ward's appeal, and he filed this lawsuit
asserting claims for equitable relief pursuant to 29 U.S.C.
§ 1132(a)(3) and long-term disability benefits pursuant
to 29 U.S.C. § 1132(a)(1)(B). The parties have filed
cross-motions for summary judgment.
STANDARD OF REVIEW
an administrator has discretionary authority with respect to
the decision at issue, the standard of review should be one
of abuse of discretion.” White v. Life Ins. Co. of
N. Am., 892 F.3d 762, 767 (5th Cir. 2018) (quoting
Conn. Gen. Life Ins. Co. v. Humble Surgical Hosp.,
LLC, 878 F.3d 478, 483 (5th Cir. 2017)). “If the
plan administrator's interpretation is legally correct,
then no abuse of discretion has occurred, and the analysis
ends.” Owens v. W. & S. Life Ins. Co., 717
Fed.Appx. 412, 416 (5th Cir. 2018). However, if the plan
interpretation is “not legally sound, we then move on
to step two and determine whether the interpretation itself
constitutes an abuse of discretion.” Id.
“Only upon reaching this second step must the court
weigh as a factor whether the administrator operated under a
conflict of interest.” Stone v. UNOCAL Termination
Allowance Plan, 570 F.3d 252, 257 (5th Cir. 2009);
see also Gomez v. Ericsson, Inc., 828 F.3d 367, 374
n.5 (5th Cir. 2016). A court must “give deference to
the decision of the plan administrator and may not substitute
its judgment for the decision of the fiduciary.”
Killen v. Reliance Standard Life Ins. Co., 776 F.3d
303, 307 (5th Cir. 2015) (citing 1A Couch on Ins. § 7:59
(3d ed. 2014)).
WHETHER AETNA'S PLAN INTERPRETATION IS LEGALLY
determining whether an ERISA determination is legally
correct, we consider: ‘(1) whether the administrator
has given the plan a uniform construction, (2) whether the
interpretation is consistent with a fair reading of the plan,
and (3) any unanticipated costs resulting from different
interpretations of the plan.'” Gomez, 828
F.3d at 373-74 (quoting Stone, 570 F.3d at 258).
Ward has not argued that Aetna failed to give the plan a
uniform construction or that there are any unanticipated
costs resulting from the differing plan interpretations, so
it is not necessary to discuss the first and third factors.
Therefore, the Court must only address whether Aetna's
interpretation of the plan is consistent with a fair reading
of the plan.
for benefits under any ERISA plan is governed in the first
instance by the plain meaning of the plan language.”
Acosta v. Bank of La., 88 Fed.Appx. 688, 690 (5th
Cir. 2004) (citing Threadgill v. Prudential Secs. Grp.,
Inc., 145 F.3d 286, 292 (5th Cir. 1998)). Thus,
“[w]hen interpreting plan provisions, we interpret the
contract language in an ordinary and popular sense as would a
person of average intelligence and experience, such that the
language is given its generally accepted meaning if there is
one.” White v. St. Luke's Episcopal Health
Sys., 317 Fed.Appx. 390, 393 (5th Cir. 2009).
the heading “How and When to Enroll, ” the
plan's booklet-certificate provides:
You will be provided with plan benefit and enrollment
information when you first become eligible to enroll. You
will need to enroll in a manner determined by Aetna and your
employer. To complete the enrollment process, you will need
to provide all requested information including any evidence
of good health. You will also need to agree to make required
contributions for any contributory coverage. Your employer
will determine the amount of your plan contributions, and
will advise you of ...