Andrews v. Reliance Standard Life Insurance Company

IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF ALABAMA
MOBILE DIVISION
TANYA ANDREWS, 	)
Plaintiff, 	)
)
v. 	) CIVIL ACTION NO. 1:23-00415-TFM-N
)
RELIANCE STANDARD LIFE 	)
INSURANCE COMPANY, 	)
Defendant. 	)
REPORT AND RECOMMENDATIONS
This action is before the Court1 on the following items:
(1) Plaintiff 	Tanya 	Andrews’s 	“Motion 	for 	Partial 	Summary 	Judgment
Establishing the Applicability of a De Novo Standard of Review,” with brief
in support and evidentiary materials (Docs. 16, 17, 18);
(2) Defendant 	Reliance 	Insurance 	Company’s 	(“Reliance”) 	“Brief 	on 	the
Applicable ERISA Standard of Review” (Doc. 19);2
(3) Plaintiff’s 	“Response 	to 	Defendant 	Reliance 	Standard’s 	Brief 	Arguing
Against a De Novo Review Standard” (Doc. 21); and,
(4) Reliance’s “Response to Plaintiff’s Motion for Partial Summary Judgment
on the Applicability of a De Novo Review Standard” (Doc. 20).
Upon 	consideration 	and 	for 	the 	reasons 	stated 	herein, 	the 	undersigned
1 The District Judge assigned this to case has referred the operative filings to the undersigned
Magistrate Judge for appropriate action under 28 U.S.C. § 636(a)-(b), Federal Rule of Civil Procedure
72 and S.D. Ala. GenLR 72(a); See S.D. Ala. GenLR 72(b) (3/1/2024, 3/4/2024, 3/22/2024 elec. refs.).
2 Facially, only Plaintiff has “moved” for partial summary judgment on the standard of review issue,
which can fairly be considered “part of a claim or defense” under Fed. R. Civ. P. 56(a). (Compare Doc.
16 with Doc. 19; see Docs. 1, 5). In substance, while Reliance’s filing is styled merely as a “Brief”
addressing this part of a claim or defense, it also seeks a definitive resolution of this disputed issue.
(Id.). Accordingly, the undersigned construes Reliance’s filing dated March 1, 2024 (Doc. 19) as a cross-
motion for partial summary judgment under Rule 56(a). See McConnell v. Am. Gen. Life Ins. Co., 434
F. Supp. 3d 1285, 1285 n.1 (S.D. Ala. Jan. 21, 2020) (construing mislabeled “brief” as cross-motion for
summary judgment in the context of an ERISA standard of review dispute).
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RECOMMENDS both motions be DENIED without prejudice as premature.
I. 	Introduction
This action was initiated November 6, 2023, upon the filing of Plaintiff’s
complaint seeking legal and equitable relief under the Employment Retirement
Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. (Doc. 1). It is brought
pursuant to ERISA’s civil enforcement provision, 29 U.S.C. § 1132(a) “to secure
disability benefits due to Plaintiff through an ERISA welfare benefits plan,” and
“seeks any and all benefits to which she may be entitled[.]” (Id.). See 29 U.S.C. §
1132(a)(1)(B) (providing for civil actions “to recover benefits due to him under the
terms of his plan, to enforce his rights under the terms of the plan, or to clarify his
rights to future benefits under the terms of the plan”). The complaint challenges not
only Reliance’s ultimate decision to deny benefits, but also the manner in which it
handled Plaintiff’s claim for those benefits – asserting a myriad of procedural
irregularities and “fiduciary breaches and errors” mired the administrative process.
(See generally Doc. 1). Reliance filed its answer with affirmative defenses November
29, 2023, generally maintaining Plaintiff is not entitled to benefits as alleged and
that it both properly and sufficiently handled her claim for benefits. (Doc. 5).
An introductory statement in the parties’ Fed. R. Civ. P. 26(f) planning report
provides:
Because the standard of review is a threshold issue that impacts the
scope of discovery and trial, Defendants propose that the parties submit
briefs on the issue of the appropriate standard of review, with the
parties filing principal briefs by March 1, 2024 and response briefs by
March 22, 2024. Although Plaintiff disagrees with Defendant about the
impact resolution of this question will have on discovery generally
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moving forward, Plaintiff does not oppose early briefing of this issue,
and agrees it is capable of resolution though cross-motions for partial
summary judgment on the question because the facts relevant to it
appear undisputed.
(Doc. 12, PageID.52-53) (emphasis in original). During a Fed. R. Civ. P. 16 scheduling
conference held January 25, 2024, the parties echoed their position(s) on early
resolution 	of 	this 	standard 	of 	review 	question. 	(See 	Doc. 	14). 	Following 	that
conference, the undersigned entered a directive stating in relevant part:
As noted on the record and in the Fed. R. Civ. P. 26(f) planning report
(see Doc. 53), the parties have differing views as to the applicable
standard of review in this ERISA case. However, they agree an early
determination on this question will be beneficial to all, as the relevant
standard will impact the scope of discovery and trial. (Id.). Accordingly,
the parties have agreed and are ORDERED to brief this issue from the
outset. Principal briefs shall be filed and served by no later than March
1, 2024, and response briefs shall be filed and served by no later than
March 22, 2024. Once the applicable standard of review is determined,
a formal scheduling order will be entered.
(Doc. 15).
The parties timely filed briefs as directed, but they are a comparison of apples
to oranges. For example, Plaintiff’s principal filings are styled as a motion seeking
partial summary judgment under Fed. R. Civ. P. 56 with a brief and evidentiary
materials 	in 	support 	(Docs. 	16, 	17, 	18), 	while 	Reliance’s 	principal 	filing 	and
supporting materials make no reference to Rule 56. (Doc. 19). See n. 2. Additionally,
Reliance’s principal filing address this case within the context of the standard(s) of
review typically applied in ERISA benefits-denial cases, while Plaintiff’s principal
filings make no mention of the same. (See Docs. 16, 17, 18, 19). Moreover, both parties
submit only selected excerpts of the administrative record (“AR”), with some pages of
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the AR appearing in both parties’ materials, while others appear in one or the other.
Additionally, their characterizations of excerpts from the administrative record and
interpretations of the regulations applicable to Plaintiff’s claim for benefits differ
drastically.
The undersigned concludes both parties seek a ruling that would be premature
at this stage. These briefs have been submitted at a preliminary stage with an eye on
potential discovery, but both parties all but ask for a decision on the ultimate issue –
or at least ask the Court to bind them to a standard of review that will be applied
when deciding that ultimate issue. (Docs. 16, 17, 19). As explained herein, the parties
fail to grasp the nuance of this case within the larger context of ERISA’s framework
by focusing on the ultimate issue, i.e., a merits review of Reliance’s benefits-denial
decision, in a vacuum.
II. 	Legal Standard
Under Federal Rule of Civil Procedure 56(a):
A party may move for summary judgment, identifying each claim or
defense – or the part of each claim or defense – on which summary
judgment is sought. The court shall grant summary judgment if the
movant shows that there is no genuine dispute as to any material fact
and the movant is entitled to judgment as a matter of law.
Fed. R. Civ. P. 56(a). An issue of fact is material “if it might affect the outcome of the
suit under governing law” and genuine “if the evidence is such that a reasonable jury
could return a verdict for the nonmoving party.” Ave. CLO Fund, Ltd. v. Bank of Am.,
N.A., 723 F.3d 1287, 1294 (11th Cir. 2013) (cleaned up). See Anderson v. Liberty
Lobby, Inc., 477 U.S. 242, 247-52 (1986) (“The mere existence of some alleged factual
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dispute between the parties will not defeat an otherwise properly supported motion
for summary judgment.”). In evaluating a motion for summary judgment, “[t]he
evidence of the nonmovant is to be believed, and all justifiable inferences are to be
drawn in his favor.” Anderson, 477 U.S. at 255 (citation omitted). If “reasonable
minds” might differ on inferences arising from facts not in dispute, summary
judgment should be denied. Allen v. Tyson Foods, Inc., 121 F.3d 642, 646 (11th Cir.
1997) (citation omitted).
The movant “always bears the initial responsibility of informing the district
court of the basis for its motion” by pointing to pertinent materials which it believes
demonstrate the lack of any genuine issue of material fact. Celotex Corp. v. Catrett,
477 U.S. 317, 323 (1986). This can be established by evidence showing there is no
dispute of material fact or by pointing to the non-movant’s failure to present evidence
in support of some element of its case on which it bears the ultimate burden of proof.
Id. at 322-24. If the movant meets this initial burden, the burden shifts to the non-
movant “to show that specific facts exist that raise a genuine issue for trial.” Dietz v.
Smithkline Beecham Corp., 598 F.3d 812, 815 (11th Cir. 2010) (citation omitted).
Cross-motions for summary judgment implicate the same standard under Rule
56(a). See United States v. Oakley, 744 F.2d 1553, 1555 (11th Cir. 1984) (per curiam)
(“Cross-motions for summary judgment will not, in themselves, warrant the court in
granting summary judgment unless one of the parties is entitled to judgment as a
matter of law on facts that are not genuinely disputed”) (citation omitted)). In
practice, cross-motions “may be probative of the nonexistence of a factual dispute, but
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this procedural posture does not automatically empower the court to dispense with
the determination whether questions of material fact exist…” Ga. State Conf. of
NAACP v. Fayette Cty. Bd. of Comm'rs, 775 F.3d 1336, 1345 (11th Cir. 2015) (citation
and quotations omitted). See Shook v. United States, 713 F.2d 662, 665 (11th Cir.
1983) (“Where… the parties disagree as to the facts and take inconsistent legal
theories the mere filing of cross motions for summary judgment does not warrant the
entry of such judgment”) (citations omitted)). Ultimately, the Court “must consider
each motion on its own merits, resolving all reasonable inferences against the party
whose motion is under consideration.” Torres v. Rock & River Food Inc., 244 F. Supp.
3d 1320, 1327-28 (S.D. Fla. Apr. 28, 2016) (citation omitted).
III. 	Discussion
ERISA itself does not provide a standard for courts to apply when reviewing
decisions of plan administrators or fiduciaries. Capone v. Aetna Life Ins. Co., 592 F.3d
1189, 1195 (11th Cir. 2010) (citing Firestone Tire & Rubber Co. v. Bruch, 489 U.S.
101, 	109 	(1989)). 	In 	Firestone, 	the 	Supreme 	Court 	articulated 	“three 	distinct
standards for reviewing an ERISA plan administrator’s decision,”3 and the Eleventh
Circuit has expanded on guidance from Firestone and Metro. Life Ins. Co. v. Glenn,
554 U.S. 105 (2008) to develop a progressive “[six]-step framework to guide courts in
3 The Supreme Court’s articulated standards are:
(1) de novo if the plan does not grant the administrator discretion;
(2) arbitrary and capricious where the plan grants the administrator discretion; and
(3) heightened arbitrary and capricious where the plan grants the administrator discretion and
the administrator has a conflict of interest.
Capone v. Aetna Life Ins. Co., 592 F.3d 1189, 1195 (11th Cir. 2010) (citations omitted).
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reviewing an ERISA plan administrator’s benefits decisions.” Blankenship v. Metro.
Life Ins. Co., 644 F.3d 1350, 1354 (11th Cir. 2011) (citing Williams v. BellSouth
Telecomms., Inc., 373 F.3d 1132 (11th Cir. 2004)).4 Under these authorities, the
“baseline standard” is de novo review, which should be applied “unless the benefit
plan gives the administrator or fiduciary discretionary authority to determine
eligibility for benefits or to construe the terms of the plan.” Brewer v. UNUM Grp.
Corp., & UNUM Life Ins. Co. of Am., 622 F. Supp. 3d 1113, 1127 (N.D. Ala. Aug. 22,
2022) (citing Firestone, 489 U.S. at 115). Simply put, when a Court reviews an
administrator’s benefits-denial decision in the face of a 29 U.S.C. § 1132(a) challenge,
review is limited to the administrative record if the arbitrary and capricious standard
applies, while review beyond the administrative record is permissible if review is
conducted de novo.
Despite an assertion to the contrary by Plaintiff’s complaint (see Doc. 1), there
does not appear to be a genuine dispute that Reliance was vested with discretionary
4 The Eleventh Circuit’s test, referred to herein as the “Williams framework,” goes like this:
(1) Apply the de novo standard to determine whether the claim administrator’s benefits-denial
decision is “wrong” (i.e., the court disagrees with the administrator’s decision); if it is not, then
end the inquiry and affirm the decision.
(2) If the administrator’s decision in fact is “de novo wrong,” then determine whether he was
vested with discretion in reviewing claims; if not, end the judicial inquiry and reverse the
decision.
(3) If the administrator’s decision is “de novo wrong” and he was vested with discretion in
reviewing claims, then determine whether “reasonable” grounds supported it (hence, review
his decision under the more deferential arbitrary and capricious standard).
(4) If no reasonable grounds exist, then end the inquiry and reverse the administrator’s decision;
if reasonable grounds do exist, then determine if he operated under a conflict of interest.
(5) If there is no conflict, then end the inquiry and affirm the decision.
(6) If there is a conflict of interest, then apply heightened arbitrary and capricious review to the
decision to affirm or deny it.
Blankenship, 644 F.3d at 1355 (citation omitted).
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authority to apply and interpret the Plan at issue here. The relevant Policy provides:
[Reliance] shall serve as the claims review fiduciary with respect to the
insurance policy and the Plan. The claims review fiduciary has the
discretionary authority to interpret the Plan and insurance policy to
determine 	eligibility 	for 	benefits. 	Decisions 	by 	the 	claims 	review
fiduciary shall be complete final and binding on all parties.
(Doc. 19-1, PageID.363; AR 18).
Under Firestone, this vesting would typically take de novo review of the
benefits decision off the table and trigger inquiry into whether Reliance operated
under a conflict of interest. Blankenship, 644 F.3d at 1355. Reliance’s brief makes
this point exactly before arguing that any conflict of interest under which it operated
did not influence its decision to deny Plaintiff the benefits which she seeks to recover
by way of this action. (See Doc. 19, PageID.334-337).
However, Reliance’s dependence on Firestone and the Williams framework is
misplaced here. Both are used when “reviewing the benefits decision of plan
administrators or fiduciaries.” Blankenship, 644 F.3d at 1354-55 (emphasis supplied).
See Firestone, 489 U.S. at 112-116 (discussing standards of review in the context of
“a denial of benefits challenged under § 1132(a)”). Rephrased, they are designed to
aid a court’s inquiry into the correctness of the ultimate issue, i.e., “whether the plan
administrator erred in interpreting or applying the plan.” Boysen v. Ill. Tool Works,
Inc., 767 F. App’x 799, 806 (11th Cir. 2019) (per curiam) (unpublished). But briefing
reveals that more initial questions persist – namely, “whether the plan administrator
adequately complied with the procedural aspects of the applicable statutes and
regulations.” 	See 	id. 	(rephrasing 	the 	operative 	inquiry 	as 	“whether 	the 	plan
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administrator satisfied his obligations in compiling the record”). Indeed, Plaintiff’s
primary argument is that she was not afforded a “full and fair” review within the
meaning of 29 C.F.R. § 2560.503-1 because she was denied the opportunity to appeal
a June 14, 2023 decision to deny Plaintiff’s claim for benefits.5 (Docs. 16, 17, 21). See
29 C.F.R. § 2560.503-1(h) (“Every employee benefit plan shall establish and maintain
a procedure by which a claimant shall have a reasonable opportunity to appeal an
adverse benefit determination to an appropriate named fiduciary of the plan, and
under which there will be a full and fair review of the claim and the adverse benefit
determination.”).
Evaluating whether a “reasonable opportunity” for a “full and fair review” was
provided is a precursor to any application of the Williams framework. Boysen, 767 F.
App’x at 806 (citing Melech v. Life Ins. Co. of N. Am., 739, F.3d 663, 672 (11th Cir.
2014)). See Martinez v. Mia. Child.’s Health Sys., 674 F. Supp. 3d 1256, 1262 (S.D.
Fla. May 25, 2023) (concluding the same). The Melech Court explains:
As 	a 	matter 	of 	common 	sense, 	we 	cannot 	evaluate 	[a 	plan
administrator’s] ultimate decision to deny [a benefits] claim without
first considering whether the record [the plan administrator] had before
it was complete. This inquiry is not as much a Williams “step zero” as it
is a predicate to our ability to review the substantive decision…
739 F.3d at 673 (citations omitted).
While 	the 	Eleventh 	Circuit 	has 	stated 	that 	it 	“limit[s] 	review 	to 	the
administrative record ‘[w]hen conducting a review of an ERISA benefits denial under
5 Plaintiff also maintains Reliance failed to render a timely decision under the regulations, but that
position is naturally subsumed by her primary argument that Reliance offered no appeal right at all.
(See Doc. 17).
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an arbitrary and capricious standard,’” it does so “because ‘the function of the court
[in such a case] is to determine whether there was a reasonable basis for the decision,
based upon the facts as known to the administrator at the time the decision was
made.’” Harris v. Lincoln Nat’l Life Ins. Co., 42 F.4th 1292, 1296 (11th Cir. 2022)
(citations omitted). Comparatively, no deference is owed to a plan administrator
when 	evaluating 	whether 	its 	adjudication 	procedure 	met 	the 	“minimum
requirements” for reasonable claims procedures set out in 29 C.F.R. § 2560.503-1
because “adherence to statutes and regulations involves no discretionary call by the
plan administrator.” Boysen, 767 F. App’x at 806 (citation omitted). See Martinez, 674
F. Supp. 3d at 1262 (“[W]hen conducting the ‘full and fair’ inquiry, a court affords no
deference to the administrator”) (citations omitted)); Stewart v. Hartford Life &
Accident Ins. Co., 2021 U.S. Dist. LEXIS 87002, *46 (N.D. Ala. May 6, 2021) (stating
the same). Put differently, the Court serves a different function in conducting a “full
and fair” review inquiry than it does when evaluating a benefits-denial.
At the current stage of this action, issues of material fact exist as to whether
Reliance complied with 29 C.F.R. § 2560.503.1. Plaintiff has also raised claims
relating to potential conflict(s) of interest and alleges numerous “fiduciary breaches
and errors.” (See generally Doc. 1). The record in its current form, which notably lacks
a complete copy of the underlying AR, cannot support a conclusive determination on
any of these matters, nor does caselaw suggest Plaintiff’s hands should be tied with
respect to potential discovery as it relates to them. One district court explains:
Pursuant to the body of law developed under ERISA, the court, at the
very least, must examine the “facts known to the administrator at the
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time the decision [to deny benefits] was made” to determine whether the
administrator’s 	decision 	was 	reasonable. 	See 	Gla[z]er 	v. 	Reliance
Standard Life Insurance Co., 524 F.3d 1341, 1246 (11th Cir. 2008). “To
the extent those ‘facts known’ are not reflected in the papers in the
claims file, nothing prohibits Plaintiff from conducting discovery as it
pertains to [(1) examining whether an administrator fulfilled his or her
fiduciary duties, (2) whether the proper procedures were followed in
compiling the record; (3) whether the record is complete; and (4) whether
the administrator had a conflict of interest].” Lake v. Hartford Life &
Accident Insurance Co., 218 F.R.D. 260, 261 (M.D. Fla. 2003) (citing
Cerrito v. Liberty Life Assurance Co. of Boston, 209 F.R.D. 663, 664 (M.D.
Fla. 2002)). In addition, if the administrator was acting under a conflict
of interest when if made the plaintiff’s benefit decision, the plaintiff has
a right to conduct discovery into the surrounding circumstances to
determine whether such a conflict affected the benefits decision. See
[Glenn, 554 U.S. at 116] (noting the significance of an administrator’s
conflict of interest depends on the degree to which the circumstances
suggest that the conflict affected the benefits decision).
Adams v. Hartford Life & Accident Ins. Co., 589 F. Supp. 2d 1366, 1367 (N.D. Ga.
Dec. 16, 2008). Other courts within this circuit have reached similar findings. See e.g.,
Bloom v. Hartford Life & Accident Ins. Co., 917 F. Supp. 2d 1269, 1277-78 (S.D. Fla.
Jan. 	22, 	2013) 	(permitting 	“extra-record 	materials 	pertaining 	to 	[plaintiff’s]
accusations that [the administrator] deviated from its own claim practices, and thus,
failed to provide a full and fair review” and collecting cases to show how courts have
“carved out exceptions for claims alleging procedural irregularities and conflicts of
interest affecting a claimant’s full and fair review”), aff’d 558 F. App’x 854 (11th Cir.
2014) (per curiam) (unpublished); Rzepkoski v. Nova Se. Univ., Inc., 2023 U.S. Dist.
LEXIS 235648 (S.D. Fla. Sep. 25, 2023) (denying Rule 56 motion as premature after
evaluating 	similar 	caselaw 	and 	concluding 	limited 	discovery 	beyond 	the
administrative record to be appropriate). See also, Harvey v. Std. Ins. Co., 787 F.
Supp. 2d 1287 (N.D. Ala. May 25, 2011) (granting motion to compel with respect to
---
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claims relating to allegations of conflict of interest).
In light of the foregoing, the undersigned reasons that the parties’ request for
the Court to enter a ruling on the applicable standard of review to be applied in this
action is both premature and needless. Though the undersigned does not purport to
“delineate the parameters” of any discovery which could conceivably be conducted in
this action, discovery relating to potential conflict(s) of interest, fulfillment of
fiduciary duties (or lack thereof), compilation of a record, and procedural/regulatory
compliance appears permissible without the Court’s blessing. See Adams, 589 F.
Supp. 2d at 1368. Of course, any discovery would remain subject to the Federal Rules
of Civil Procedure, this Court’s Local Rules, and provisions of any forthcoming
scheduling order, and inappropriate discovery would remain subject to potential
protection if pursued by appropriate motion.
IV. 	Conclusion
Upon 	consideration 	and 	for 	the 	reasons 	stated 	above, 	the 	undersigned
RECOMMENDS 	both 	Plaintiff’s 	“Motion 	for 	Partial 	Summary 	Judgment
Establishing the Applicability of a De Novo Standard of Review” (Doc. 16) and
Defendant’s “Brief on the Applicable ERISA Standard of Review” (Doc. 19), construed
as a cross-motion for partial summary judgment, be DENIED without prejudice
as premature.
NOTICE OF RIGHT TO FILE OBJECTIONS
A copy of this report and recommendation shall be served on all parties in the manner
provided by law. Any party who objects to this recommendation or anything in it
must, within 14 days of the date of service of this document, file specific written
objections with the Clerk of this Court. See 28 U.S.C. § 636(b)(1); Fed. R. Civ. P. 72(b);
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S.D. Ala. GenLR 72(c). The parties should note that under Eleventh Circuit Rule 3-
1, “[a] party failing to object to a magistrate judge's findings or recommendations
contained in a report and recommendation in accordance with the provisions of 28
U.S.C. § 636(b)(1) waives the right to challenge on appeal the district court's order
based on unobjected-to factual and legal conclusions if the party was informed of the
time period for objecting and the consequences on appeal for failing to object. In the
absence of a proper objection, however, the court may review on appeal for plain error
if necessary in the interests of justice.” In order to be specific, an objection must
identify the specific finding or recommendation to which objection is made, state the
basis for the objection, and specify the place in the Magistrate Judge’s report and
recommendation where the disputed determination is found. An objection that merely
incorporates by reference or refers to the briefing before the Magistrate Judge is not
specific.
DONE this the 23rd day of July 2024.
/s/ Katherine P. Nelson
KATHERINE P. NELSON
UNITED STATES MAGISTRATE JUDGE
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