Beruflich Dokumente
Kultur Dokumente
Before
Bownes and Cyr, Senior Circuit Judges,
and Keeton,* District Judge.
_____________________
Lynn Thomas Johnson, with whom Blaine J. DeFreitas and
Saab
____________________
July 7, 1997
____________________
This
appeal presents
issues
to
regulation
(ERISA).
under the
Employee
In particular,
Retirement Income
Security
Act
to
judicial
review
of
the
of
the
SS 1132(a)(1)(B)
out-of-court
and 1132(c),
decisions,
for
under
at least
judicial
29
U.S.C.
one purpose:
to
determine
In
U.S.C. SS 636(c)(3)
28
plaintiff-appellant's
cases
involving
this
kind
of
judicial
review,
other
of
two kinds.
that
the
order is one
remanding to the
out-of-court
judgment
affirming
the
decisions
form of order is
of
the
out-of-court
decisionmaker.
In
this
-2-
capricious."
(Appellee's Br.
at 2.)
Though acknowledging as
for
that "the
Committee's reasonable
decision must
be
permitted
to
at 22.)
Appellant,
also,
seeks
a final decision in this court.
district
possibly as
court on
conclusion
an alternative request,
of this
not clearly
appeal),
except
argued in
the
questions from
the
contending that, if we
were for
court.
Instead,
the parties
and capricious,
join
in
decisions
then we
should
(1)
decide
this
these
circumstances,
fundamental question
about
the
Part
I, we
this
scope of
appeal
presents
jurisdiction
of
the
address this
fundamental
jurisdictional
question
in
Part
II,
III
we
turn
to
other issues,
over
which
we
do
In
have
jurisdiction,
-3-
against
approval
plaintiff-appellant is
of
all details
of
I.
to be
the
affirmed, though
district
Background
court's
without
reasoning.
The incident that forms the basis for this civil action
and
this
The
am on January
workstation on
the sixth
floor for
her
the
on
the
ground
floor.
the
elevator.
Action
result of
injuries sustained
in this
(Id.)
incident,
She was
granted
(Id. at 3-4.)
to
receive
payments
[Accident
on
account
of
of
accidental
injury ...arising out of and in
the course of employment by the Company.
-4-
Accidental
injuries shall be considered as
arising
out of
employment
only
and
in
where
the
the
course
of
injury
has
and
duties
to
which
the
employee
is
assigned...
(Id.)(emphasis added).
payment of Accident
on the duration
of
the
plan,
is
that
the
employee remains unable to work.
(Id. at 4 n.2.)
The
plan
does
not
(Id.
out of
at
and in the
course of
4)(emphasis added).
accidental
employment by
Sickness
does
the
Disability
the
terms
of
the
plan.
(Id.
at 4, n.2.)
(Id. at 3.)
determined that
Recupero was
not
(Id.)
Recupero
("EBC"
or "Committee"),
which denied
her appeal
by letter
on
December 15, 1993, stating that "it was determined that there
is
evidence that you were not eligible for Accident Benefits for the
incident report on January 18, 1990."
an identical
appeal
with
the Employee
stating
that
(Id.)
"after
Benefits
Claim
Review
of
all
her
available
-5-
information,
including
(Id. at 5.)
Recupero
Massachusetts.
The
district
(1) the
EBC
and
the
her
(Id. at 9.)
cross
of
review,
where the benefit plan vests the fiduciary with the discretionary
authority to determine benefits eligibility and to construe
provisions.
(Id.)
The
court
then
made
the
determination:
[T]he NET
plan enumerates in
sufficient
plan
following
of
for
application
of the deferential standard of
review.
Thus,
committees will
the rulings
of the
not be disturbed
NET
unless
the
denials
were arbitrary and capricious.
(Id. at 8.)
-6-
various
stated
as her
first
argument
that
the
to
Review
Committee
improperly
categorized
(Id. at 9.)
This
argument
concluded
with
the
court concluded
the EBC
and EBRC
(contrary to
had not
or
(Id.)
Recupero's
been arbitrary
and
capricious
in
plan
which
indicates
that
the
she
point
to
language
scope of the
Provision
should
be
which
Accident
given
be applied when
a
the
activity
motivated
On
the
by
which
a
is
job-related
contrary,
and
the
language
narrower
reading.
(Id. at 10-11.)
The
court
below
also
limitation, such as
connection."
(Id. at 11.)
"only," "solely,"
and "in
had
direct
are
-7-
plain and
be
eligible
for
(Id.)
It
is
an
undisputed fact that Recupero was
taking her break and going to get
at the time
Breaks fall
outside the
plain language
of the
coffee
injuries.
purview of
Accident
the
Benefit
Provisions.
Therefore,
given
that
break at
the time,
her
and
Recupero was on
(Id.)
Because, as
the
court below
viewed the
matter,
the
plaintiff
of
the plan,
and
that
the Committees
did
not
act
(Id. at
12.)
Recupero's
second
contention
below
was
that
the
Committees
EBC and the EBRC either never met to review her claim
or
failed
to
have a quorum present when they did meet.
(Id.)
The
court
below
whether
the
notices
the statutory
requirements
of
ERISA.
(Id.)
Recupero
specific
-8-
her claim, or to
plan
from
(Id. at 14.)
strictly to the
requirements
29 U.S.C. S 33,
as
a matter
of
a practical matter,
and
law.
the
to
been
denied.
(Id.)
Having so concluded,
the lower
court then
considered
(Id.)
The court
NET on all
(Id. at 15.)
claims.
Recupero
appealed.
summary
No
cross
II.
decisions
district
-9-
court.
29
U.S.C.
SS
1132(a)(1)(B)
and
1132(c);
28
U.S.C.
the
judicial
violated
the
"arbitrary
and
capricious"
standard.
v.
Bruch, 489 U.S. 101, 113 (1989); Pagan v. NYNEX, 52 F.3d 438, 442
(2d Cir.
1995)
(judicial review
of
decision by
pension
plan
administrator
gave
the
plan
administrator
broad
discretion
to
determine
of
the
of
NYNEX Committee
as
if we
were
considering the
issue
eligibility
anew,"
interpretation; court
and
as
if
reviews
free
to
only the
upset
reasonable
decision of
the
NYNEX
Committee
and,
even
if
an
entity
different from
the
NYNEX
Committee,
and
were
v.
(trustees'
decision
pursuant
to powers
that the
Plan
that
instrument
granted
to
the
Supp.
619,
622-23 (D.
Me.
to
overturn
Security
-10-
1987)
(declining
payments, by insurer
by
Plan)).
Though
the
the jurisdiction of the district court and this court differ, all
parties to this appeal
expansive
ERISA
benefit
determinations.
urges
jurisdiction not
us
only
standard of review to
decisions, but also
to hold
to
that
apply the
the
district
arbitrary
and
court
had
capricious
out-of-court
on material and
genuinely
disputed
factual
issues
or
factual
issue
as
to
are
challenged.
We
are
asked
to
exercise
plenary
acknowledge that
in some
statements
passages from
made about
"de
authoritative sources,
novo
standing
jurisdictional
contentions.
We
misunderstanding of that
Such a misreading
of
Firestone,
sequels.
Judge)
Breyer's
opinion
for
the
First Circuit in Diaz, 13 F.3d at 458.
-11-
In
that case
granting
that the
amendment "merely
made express
a power
...
plainly
implied
all
Id.
...
Consistent with established principles
of trust
law, we hold
that a denial
of
unless
the
benefit
plan
administrator or fiduciary
authority to
determine
gives
the
discretionary
eligibility
for
the
plan.
489 U.S. at 115 (emphasis added).
In several significant respects, the case before us
this appeal differs from Firestone.
Nevertheless, in this
in
case,
one
of
the
questions
we
case:
we address the
"First,
review
of
benefit
appropriate standard of
determinations
three
welfare
fiduciaries
judicial
plan
and
by
that
or
"pension
benefit
plans
-12-
for
its
employees:
termination pay
plan."
Id.
plan, a retirement
plan, and
a stock
purchase
different
ways)
by
ERISA."
governed
by
ERISA, but
provisions that
applied
Id.
in
to the
respects by
Firestone
the
plans and
same
ERISA
in
other
respects
by
different
ERISA provisions.
Firestone
plans were "welfare and pension plans," and the NET plan
is
not.
purposes
of
actions
under
of
the
plan at issue
and
is funded or unfunded
regardless
of whether the administrator or
fiduciary
is
operating under a possible or
actual conflict of interest.
489 U.S. at 115.
"de novo
standard" is
affected, however,
by the
applying the
terms of
the
gives
discretion
determining
whether
there
is
an
abuse
of
discretion.'
Id.
that
judicial
review,
to
the EBC and EBRC.
Committees
-13-
Also,
we
do
not
and
of
115.
or
fiduciary
construe plan
a deferential
review.
Id.
discretion
to
determine
terms, Firestone
"arbitrary
Thus,
and its
and capricious"
a
deferential
benefit
progeny
standard
"arbitrary
of
and
out-of-
to fill
the gap
left because
"ERISA does
determinations.").
not set
the
1132(a)(1)(B)
489 U.S.
at
109.
Because
differences
of
between
the
the
combination
circumstances
of
in
similarities
Firestone
and
and
the
-14-
the extent to which, instead, it requires deference to an out-ofcourt decision that is not "arbitrary and capricious."
An example of the kind of problems we must consider
the determination
plan
this
case, "Sickness
Benefits."
of the meaning of
is
Disability
Determining
Benefits" and
the
meaning of
"Accident
such
plan
Disability
provisions
ordinarily
meaning of
reviewing court,
at
least in
explicitly declaring
committee
the
is
that
arbitrary
of the
absence of
interpretation
manifested meaning
relevant provisions
varies
from
plan
plan.
provisions
to decide that
an
and capricious,
unambiguously
and
must
be
disregarded.
clarity
does
for decision by
findings of fact
in the district
court
(either
by
a
jury
or
by
the district judge).
Instead, interpretive
may
require
some
other allocation of decisionmaking functions.
We say
more
on
this
subject
in
conclude that in
view of the
Supreme
Court's
pronouncement
in
-15-
federal
courts
review
some ERISA claims de novo.
review is
appropriate,
limitations.
context of
however, it
is
often subject
to
some
the
ERISA-
on the merits of
benefits claim.
B.
the
1.
With
respect
specifically
to
an
issue
regarding
do not
have expansive
plenary jurisdiction
discretionary authority to
the
determine
plan."
to
Cir.
v.
Bissonette
,
1997
WL
determinations
bearing
upon
habeas
most conspicuous
adjudications").
... [being]
Thus,
if
an
judicial review
ERISA
of
out-of-court
decisionmaker
to
determine
whether
that
later
This
many
First Circuit
decisions that
recognize
the
Cir.
1995) ("In
ERISA
cases ...
court
F.3d
should
it
reflects
the
purposeful
relinquishment
of
an
employee's
of a
denial
ERISA-
of the
of benefits
insurance policy,
entails
no deference
267
the
judicial
to
the
at
456-58 (arbitrary
to
trustee
rules
promulgated
authority" granted
to
the
pursuant
trustee in
to
of review applied
"broad,
the
trust
discretionary
instrument);
Rodriguez-Abreu
v.
Chase
standard properly
applied where
"the
-17-
relevant
plan
document
Plan Administrator
expressly
delegate
their
Allen v. Adage, Inc., 967 F.2d 695, 697-98 (1st Cir. 1992) (where
nothing
in
Jurisdictional Limits
that
is in
essence jurisdictional
is
an
appropriate
regarding
involving
courts and
other federal
courts are
not
courts
of
general jurisdiction.
Co.
v.
Kroger
, 437 U.S. 365, 374 (1978).
subject-matter
jurisdiction appears
of
(by
reason
of
claim on
some federal
question), federal
courts are
not
automatically
of unconstitutionality of
legislation,
Court of the
United States)
are partly
statutory.
E.g.
,
Kokkone
-18-
A
central
it tends to be
rather
See
American Law
court
Institute,
Federal
Oakley, in an
introductory Memorandum to
identifies as an organizing
principle
court
specific'
operates
basis that
is
on
'claim-
concealed
and
confused
by
the 'action-specific' language
of the basic statutory grants of original
jurisdiction to the district courts.
Id. at xvii.
He adds:
.... Although the basic statutes
purport
the
the
to
confer
federal
particular
types
jurisdiction
of
'civil
over
actions,'
'cases,'
'proceedings,' and the like, they
have
been
administered on a claim-specific
rather than
the
law
action-specific basis,
of
functioning
supplemental
in
mechanism for
the
jurisdiction
background
determining
with
which
as
the
claims
kinds of issues
scope of Article
within federal
of their
III
judicial
relationship
or
to
parties
and
in
a
passage
of
the
F
-19-
jurisdiction,"
recognized
as
of
involving
constitutiona
l, statutory, and decisional "tiers" of authorization
and limitation.
Id. at 36-45.
We
conclude
that
a
theme
of claim-specific limitations on
decide
anew on
jurisdiction over
the
merits, and
a specific type
more confined
of claim
within the
type
of
court's
jurisdiction.
may be
solely for
judicial review
of an
out-of-court
is
primarily
statutory
in
origin.
a statutory authorization
substantive
decisions
(of
governmental agencies,
under
many
different
provisions of
out-of-court
types)
the
made
by
Administrative
Procedure
Act,
5
U.S.C.
S 706(2)(A).
may be implicit
in statutory provisions
of
special
kinds
of
U.S.C.
regime
characterized in
large part
by
limited
jurisdiction,
a
for a court
to
-20-
own
initiative
and
to
a
We
claims
distinctive nature
decision, one
of
a court's
must
role
take
account
in judicial
of
review,
an
the
in
contrast
with
the
role
judicial review of an
out-of-court
action
asserting tort,
contract, or
property claims,
or even
In cases of
alleged
judicial
review,
of this kind.
C.
-21-
properly a
part
of the
"record"
for judicial
review
is
is
issues
to
is
not
to
set
aside
a
Ordinarily the
deference to a
decision on the
merits
to
give
somewhat
less
see, e.g.,
Massachusetts
AIDS
but
application
Action Comm.
of a First
42 F.3d 1,
Inc.
7 (1st Cir.
letting
engages
of Mass.,
most
them
in de
of its
resolutions
stand unless
they
novo
of
review
Amendment standard to
v.
1994)
court's
of
mixed
are
clearly
trial
court's
the facts of
the
particular
Cir. 1993)
("The standard
of review
applicable to
mixed
questions
usually
-22-
deference
continuum;
the
to be clearly erroneous.")
accepted
-- so likewise a
court
engaged
in
appears
the particular
instance.
In applying
such a
less
deferential
to the
merits and
is
merits
decision of a
dispute
the record of an
out-of-court
non-
documentary
properly
considered (which one party or the other asks the trial court
"strike" or
otherwise treat as
irrelevant to judicial
to
review).
Obversely,
the
dispute
decision
should have
-23-
included, and
did
not,
additional materials (which one party or the other asks the trial
court to rule must be taken into account).
the
trial judge
determines
that, by
reason
of
departures
form
of
remedy
fits.
Concerning
court's
v.
Yamasaki
,
First,
the
framed to
fit within
the authorized
scope of
judicial
review.
Second,
the
of
-24-
plaintiff's
claim, plaintiff
failed to
use her
available opportunities
to
complete an
explanation
of the
contrast
between
deciding
2.
As to who is to
canvass three
apparent in
remand
Who Decides?
decide a dispute about the record,
possibilities (and
this case:
(1) the
variations on
each) that
are
out-of-court decisionmaker
court or courts
we
on
where
judicial
review
occurs;
a nonjury proceeding),
judge's rulings,
appeal.
those rulings
guided on the
law by the
trial
being subject
to correction
on
The
first
decisionmaker) may
possibility
(remand
sometimes be
to
the
appropriate, but
out-of-court
is likely
to
result
in
delay,
and
not resolved to
the satisfaction
of all
interested
parties,
and
This is
one of the
multiple
1993)
-25-
(citing Perry
1990)).
Cir.
ways that
may
reasonably
unresolved conflicts.
E.g.,
be understood
as
creating
some
Community
Health Plan, Inc., 953 F. Supp. 419 (D. Mass. 1997), with Padilla
De
for
the
reason
that
in
record
for
judicial
review
of
Jurisdiction for
be
expanded
to
function.
review of an
In a
case
out-of-court
is to
be affirmed,
or
is to
be set
aside
as
arbitrary
or
-26-
recent decision
of
the
Supreme Court
in
very
different
context
helps
trial
issue of interpretation of
which reasonable
patent law and
to
of
particular
a patent claim as
decide
kind
of
Court,
factual
issue.
Markman
v.
to
Westview
Instruments,
Inc.
,
116
at the time of
application of
Seventh Amendment's
the
entail
to
the
construction
of
the
it as
interpretive skills
of judges and
relative
allocating construction
policy
issues to
the
court.").
Much
of
the
reasoning
of
experience
-27-
governing
law.
And,
historically,
factual
dispute
of
a
instead to
judges, the
Westview opinion
cited other
Court
pristine
at times has
turned on a
determination that, as
better
question.").
positioned
than
Other decisions
another
to
decide
the
issue
in
added
we
reach
in
serving
Keohane, 116 S.
a sentence
under
state
(habeas
conviction
had
Alaska
federal
district
warnings; the Ninth Circuit affirmed on the ground that the state
court's ruling that the accused was not "in custody" for
Miranda
purposes
2254(d)
was
establishes
a
a
"fact" determination
presumption
of
as
to
correctness;
which
this
"Court
has
classified
as
'factual
-28-
"[t]his
juror
'basic,
primary,
or
the
judgment
of
'in custody'
as a
determination qualifying
for
United
States,
Inc.,
to
which the
reviewing
court
must
exercise its own independent judgment.").
also U.S. Term
(1995)
(Thomas,
O'Connor, J.,
J.,
dissenting,
See
joined
(citing Bose
by
1875
Rehnquist,
C.J.,
and declaring:
"In
little
its
own
independent
-29-
3.
We turn
go
about performing
the
function of
deciding disputes
about
the
record.
(a) Non-jury Trial
Precedents
for distinctive
and
limited purposes
associated
with
judicial
review.
J.) ("It
could happen
that a
1989)
particular instance
of
judicial
review
of
an
the EIS
ignored? ...
However
to
discretionary
with
the
reviewing court.") (citations omitted).
practice seems equally applicable
court decisions of
to judicial review of
The
out-of-
whose
and
from
evidence) as to
that
-30-
factual
finding
made
by
(b)
Evidence on Motion
a kind of
taking evidence at
evidentiary proceeding
that differs
Rule of Civil
43(a).
Evidence on Motions.
When
a motion
is
based
on
facts not appearing of record the
court may hear
the matter on
affidavits
but
be
from
Procedure
testimony
or deposition.
Fed. R.
Civ.
P. 43(d).
This procedural
authority,
however,
regarding
and decisional
law governing
the
court's jurisdiction.
Federal
Rules
of
Civil
the
-31-
on
fair
and
substantive law.
based
rather than
case-based
theme of
federal
claim-
subject-matter
the "record" as
considered by
restrict
the decisionmaker
See Mongeluzo v.
who
Baxter
Cir.
1995);
Quesinberry
v.
Lif
Pension
v.
Cir.
1992).
Rather,
we simply
emphasize for
clarity that
making
the
"record"
for judicial
review
is fundamentally
to decide the
different
merits of a
from
benefits
claim.
As stated above,
a trial court
on
motion"
or
convene
a
-32-
made
is
complete and,
if
not,
what
supplementation
is
appropriate.
For example,
a
Fourth
district
in our Berry
significant
opinion
restraints
on
the
district
court's ability to allow evidence
beyond
what
was
administrator.
In
presented
to
the
our view,
the
most
which
balances
these multiple purposes of ERISA.
Consequently, we adopt a scope of
that permits
the district
review
court in
its
the
district
plan
court
discretion,
should
however,
circumstances
additional
administrator.
clearly
evidence
is
exercise
The
its
only
when
establish
that
necessary
to
4.
and deciding
a motion
or
Summary
fair
-33-
Under
genuinely in
the
opportunity
and
burden
opportunity
and
burden
P.
56.
so
later
on
grounds
concerned with fair process.
Digital Equip. Corp., 637 F.2d 24, 29-30 (1st Cir. 1980).
and
confusion
about
when
and
If the trial
judge
needs
the dispute
for
judicial
review,
Rule
56
Thus, no formal or
disputed
be
that
the
judge
can
-34-
genuinely disputable
fact must be
assumption
reflects
a
delay.
the record
trial
judge
is
not
required
to
await trial.
exercise
discretion
advantage
of the
about
the
method
opportunity for
of
proceeding,
flexibility about
taking
scheduling
5.
issue
that
may
be
opportunity
to discover
and present
Ordinarily
relevant
evidence
it is a good practice to
do
is to be
of
misunderstanding.
Once
this
requirement
of
the
parties
that
factual
and in no
event by a
jury, be decided
sooner
rather
than
later.
may
make
solely
for
D.
For completeness,
we take
note of
another source
of
In some
instances,
an independent
claim over
which
for trial on
the
subject to judicial
review
court
the
judicial
review.
Some potential
illustrations are
identified
immediately below.
2.
in
If
and
proffers
appropriate
under the law governing trial of that claim, the trial judge
has
determine, "as
a matter
evidence is sufficient, if
of law,"
whether the
One
proffered
the
independent
charge
to
of
benefits plan.
above,
the claim
this responsibility
for
benefits under
continues
to be
the
performed
employee
II.C
without
3.
Violation of Obligation
as
an
Recupero
has
not
claimed
-37-
4.
factual
claim is
proved, will
closely coincide
with a
if
component
exist concerning
claim or issue
trial,
and
procedural
rules
preclusion, the
and
practices
right to
bearing
on
jury
case
of jurisdiction in a
judicial
E.
first instance,
the
EBRC in
to the EBC in
the second
instance,
the
the
function
of
construe
plan
constitutional and
provisions
as
statutory limits on
consensually
overriding
the jurisdiction of
the
courts,
or
plenary
consideration of
plaintiff-appellant's
the
merits.
Included
request that
court make
factual
is the
claims
the district
on
findings
on
any
on the merits.
When the
law
authorizes
parties to
make
their
own
consensual
arrangement
ordinarily the parties may prescribe their own set of rules about
how decisions are to be made,
prescribed legal
arrangements.
limits on the
E.g., Mitsubishi
nature of
transgress
consensual
Chrysler-
claims is enforceable
absent a showing
of
circumstances
to
that
F.
this
The
constitutionally
and
request of the
by a stipulation or
joint
privately-
to
them under
of
law.
Ordinarily, claims
benefit determinations
-39-
consensually
designated
private
decisionmakers
on
whom
plan
court's
jurisdiction,
judicial
review may present added complexities, but we need not and do not
fundamental
characteristics of
the
legal
system as background, one may locate the legal and factual issues
of
a
particular
civil
action in the larger legal landscape.
remainder of
this
opinion, we
consider
each of
the
In the
material
contentions
controversy has proceeded both before and after the filing of the
civil action in the United States District Court for the District
of Massachusetts.
III.
A.
Introduction
The
parties
to
this
-40-
Committees must
be judicially reviewed
capricious" standard.
less deferential
standard.
Also,
after the
filing of
under an "arbitrary
an "arbitrary
as proceedings have
the civil
decisions
than
and
capricious"
action, some
and
issues earlier
and
in
has
of
issues, beginning
with
asserted
violations
of
the
B.
respect
to typical
that
claims under
jurisdictionally limited
the role
of the
an employee
to review, if
courts
with
benefits plan
is
a plan administrator
or
fiduciary
Recupero argues:
was on-duty
company.
and being
paid by
an
while
the
was in the
and
was
under
the direction and control of her
employer.
the Plan
that Ms.
Recupero
sustained
an
"accident" and not "sickness"
and
it
was
arbitrary and capricious of the
Plan to
deny her
"accident"
disability
claim.
-41-
en route
building lobby
obtain coffee
at the
in
the
direction of
her
accident.
She
adjustment [from
her
made
...
usual time
[an]
for
(Id.
away
at
13).
while
on
(Appellees' Br.
an
elevator en
at 7.)
route
This fact,
to
coffee
NET contends,
shop."
shows
that
Recupero
was
not
Committees
to
of
NET
on
this
issue.
The
act
defense
not entitled
"accident benefits."
not
Thus, the
and
determining that
did
(Id.)
arbitrarily
capriciously in
the
injury.
Recupero was
(Id.)
she was
at the
request of
her
the
coffee
-42-
phone
Such
call
which
a fact is not
she
a
was
properly
First,
the
court,
when applying the arbitrary and
capricious standard
review the
of review, may
actions of
only
the fiduciary
in
the
time it made
does not
appear
Office,
the EBC
its decision.
that the
or
NET
the EBCRC
It
Benefits
had
the
(#20,
2,
Affidavit of Richard Waldron, q7).
Second,
this
is
"mere
allegation"
unsupported
"by affidavits or as otherwise
provided" under
Fed.
R. Civ.
P.
56(e)
Action
capricious.
The
court
below
correctly
determined
that
Recupero had not proffered evidence before the EBC or EBRC of any
irregularity in
the break
incident occurred.
(Id.)
she was
in the
on when
the
record before
the
record
this
court
suggests otherwise.
the
duties
at
a
later
time,
judicial
and
capricious.
Second.
Despite
the
into
either
the
category of
"accident"
or
the
category
of
"sickness,"
the
prescribe a definition
of
A plan
may
the
myriad
of
possible
ways
out-of-court
determination
application of
rather
bright-line
rules
than
rigorously
that leave
no
logical
choice,
even
reasoned
paradigm
tort
or
(1st
Cir.
1987)
(in tort law, not only ordinary fact questions but also
"evaluative applications
concept of
of legal standards
'foreseeability')
questions"), cited
to
the facts
with approval in
(such as the
are
legal
properly
Dedham Water v.
jury
Cumberland
-44-
In
the context
decisions, however, if
discretion
on
an
of
judicial
employee benefit
out-of-court
evaluative determinations
of that
review
of
out-of-court
plan provisions
decisionmaker,
confer
ordinarily
decisionmaker are
the
judicially
in
this case.
It provides:
Relationship
of
Injury
to
Employment.
Accidental
injuries shall be considered as
arising
out of
employment
and
only
in
where
the
the
course
of
injury
has
and
duties
to
which
the
employee
is
assigned
in
the service of the Company, or
was assigned by
Associated or
or
which
1984, or
perform
which
by
he
proper
voluntarily
is
directed
authority,
protecting
property or interests.
the
to
or
in
Company's
There must be
and
circumstances
accidentally
inflicted,
of
which
injury
must
be
must be satisfactory
such injury
renders
the
evidence
employee
at 59-60)
(emphasis
added).
In view
of
the
-45-
Third.
assumption
that because
she
was eligible
for
worker's
compensation,
that
standards
of
eligibility
for
workers'
an
ERISA-regulated
plan
be
the same.
court
did
not
err
C.
is not seeking
"Sickness
Disability
Benefits"
beyond those already paid to her.
is asking merely that we
order,
that
the
Rather, she
benefits already
as
"Sickness
"Accident
Disability Benefits."
paid
to
her
to
Recupero
which she could creditably do so, that she was entitled to such a
reclassificat
ion decision by the district court, or is entitled to
have
this
court
declare
such a reclassification.
-46-
this
court,
claim
for benefits,
even
proceedings
if we
were
to
determine
that we have jurisdiction to do so.
to
place
she
made
a
request
Nor has she called to our attention any good cause for
circumstances,
without
undertaking
to
resolve
In
very
substantial
supported by
precedent.
See, e.g.,
conclude
This conclusion
United
States
is
v.
Bongiorno, 106
arguments
not raised in
(constitutional
cannot be advanced
on
appeal);
Armstrong
v.
Jef
1994)
(argument that
in
made
-47-
D.
general
characteristics
of
rule
ERISA
(independently
claims
of
cases),
the
disputes
special
over
interpretation
of
a
Bank,
A.S.
v.
Firs
And,
determine
that
an
Cir. 1994)
("In
scrutinizing
administrative
actions,
is limited
to a
search for
arbitrary or
capricious
behavior.").
If a
regarding existence of
the
is
issue."
communications, in
exceptional circumstances
an issue
of
interpretatio
n on which reasonable persons may differ is submitted
to
a
"trier
of
fact."
Bo
-48-
a
party
who
controversy
to benefit from
to
proffer
ambiguity (for
extrinsic
evidence
example, by
being
supporting
its
interpretatio
n) [that party] must show ambiguity in the meaning of
the agreement with respect to
The
these
reasons,
we
conclude,
without
deciding
(see
NET
plan provisions
Benefits" claimed
bearing upon
by Recupero.
"Accident
Moreover, such an
Disability
interpretive
the jury
sits,
has
plenary
jurisdiction.
II.B
and
on an
court's role
interpretive question
is limited to
does not
judicial review
apply when
of an
the
out-of-court
decision.
-49-
E.
Futility of Remand
NET
argues
that
the
same
outcome
on
issues
of
another
ground.
The
this
court
from
to determine
that remand
would be
futile because,
undisputed
facts
that
the
merits.
perspective,
debatable,
the
We
conclude
decision of
this
though
matter
might
limited
have
seemed
with
this
supports this
from
defense position
case of
closer probing
that,
Disability
Benefits."
Recupero
has
be
plan
F.
Denial of Notice
As an independent basis for rejecting Recupero's
claim
-50-
the plan
that
Recupero
failed
to
to
support
any
finding
of
prejudice
to
her.
Recupero
had
not
in
any relevant
sense.
(Memorandum
and
Order,
effect,
Recupero
has
attempted
to
demonstrate
of the type
rather than by
of
proffering
to
were
unique
or
at
least exceptional.
for relief
because of inadequacy
of formal
notice without
any
inconsistent
benefit
plans.
In
that
the
show
prejudice in
these
circumstances,
relevant sense
we
conclude
is unassailable,
regardless
of
-51-
CONCLUSION
For the reasons stated in this opinion, it is ORDERED:
The
judgment
of
the
district court is AFFIRMED.
the appeal are awarded to Appellees.
Costs of
-52-