WEITZENKAMP v. UNUM LIFE INSURANCE COMPANY OF AMERICA (July 11, 2011)

As a Time Warner Cable employee, Susie Weitzenkamp participated in its disability plan. Under the plan, a participant is entitled to 24 months of benefits if she can no longer perform her job duties. After 24 months, a participant must be unable to perform any occupation in order to continue receiving benefits. The plan also provides that benefits cease after 24 months in any event if the disability is primarily based on self-reported symptoms that are not verifiable by standard medical examinations. The plan administrator provided participants with a summary plan description ("SPD"). The SPD did not mention the self-reported symptoms exception. In December of 2005, Weitzenkamp became unable to work and was diagnosed with fibromyalgia, chronic pain, anxiety, and depression. Weitzenkamp applied for and received benefits. Weitzenkamp also applied for and received Social Security benefits. In August 2008, the plan administrator discontinued Weitzenkamp's benefits. It concluded both that she was not disabled and that she was ineligible for benefits based on the self-reported symptoms exception. Weitzenkamp brought suit against the administrator. The administrator counterclaimed to recover an overpayment created by the retroactive award of Social Security benefits. Judge Griesbach (E.D. Wis.) granted summary judgment to the administrator on both the complaint and counterclaim. Although the court concluded that the finding of no disability was arbitrary and capricious, it agreed that she was ineligible for benefits because of the self-reported symptoms exception. Weitzenkamp appeals. The administrator cross-appeals the arbitrary and capricious ruling.

In their opinion, Circuit Judges Rovner and Hamilton and District Judge Lefkow affirmed in part, reversed in part, and dismissed in part. The Court stated that ERISA requires an SPD to describe the plan’s requirements for benefits eligibility and note any circumstances that would result in a denial or loss of benefits. The SPD here did not mention the self-reported symptoms exception. It therefore failed to communicate to the plan participants the true scope of the plan and, therefore, violated ERISA. The plan administrator is estopped from relying on the exception. Summary judgment in its favor was error. With respect to the overpayments, the Court agreed with the district court. The Social Security Act does provide that benefits are not subject to levy, attachment, or garnishment. But that is not what the administrator has done. It only seeks a lien on the funds it has already paid to Weitzenkamp, not her Social Security benefits. It is entitled to recover the overpayments in this manner. In its cross-appeal, the administrator sought to challenge the district court's finding that the no disability conclusion was arbitrary and capricious. The Court noted that the cross-appeal was improper. A cross-appeal should be taken only one the party seeks a judgment different from that already rendered. When a party seeks merely to affirm a judgment on alternate grounds, as is the case here, it should raise it in the main appeal. The plan administrator therefore forfeited that argument. Finally, the Court considered whether it was proper to reinstate benefits or merely remand for further proceedings. Given that the plan administrator originally found her eligible for benefits and then withdrew those benefits improperly, the proper remedy is to return to the status quo and reinstate benefits retroactively. The Court noted, however, that the administrator is free to review her present eligibility.