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Marcin v. Reliance Standard Life Insurance Co.

United States Court of Appeals, District of Columbia Circuit

June 30, 2017

Jill Marcin, Appellee
v.
Reliance Standard Life Insurance Company and Mitre Corporation Long Term Disability Insurance Program, Appellants

          Argued May 5, 2017

         Appeal from the United States District Court for the District of Columbia (No. 1:13-cv-01308)

          Joshua Bachrach argued the cause and filed the briefs for appellants.

          Scott B. Elkin argued the cause and filed the brief for appellee.

          Before: Tatel, Pillard and WILKINS, Circuit Judges.

          OPINION

          Wilkins, Circuit Judge

         This appeal concerns Jill Marcin's recovery of long-term disability benefits under an ERISA-governed plan. In 2008, Ms. Marcin filed for disability benefits under the Mitre Long Term Disability Plan, Group Policy Number 111701 (the "Plan" or "Policy"), citing numerous ailments that affected her cognitive abilities and motor functioning. Reliance Standard Life Insurance Company ("Reliance"), the Plan administrator, denied Ms. Marcin's request for benefits, explaining that she did not meet the definition of "Total Disability." In particular, Reliance concluded that Ms. Marcin was capable of performing all material duties of her employment on a full-time basis. Following an unsuccessful administrative appeal, Ms. Marcin filed suit against Reliance and the Plan in District Court in 2010. See Marcin v. Reliance Standard Life Ins. Co. (Marcin I), 895 F.Supp.2d 105 (D.D.C. 2012). The District Court remanded the case to Reliance, requesting additional explanation as to how the record supported Reliance's conclusion that Ms. Marcin was not disabled.

         In early 2013, Reliance again denied Ms. Marcin's claim for disability benefits. Ms. Marcin filed a second lawsuit in District Court, which serves as the basis for this appeal. See Marcin v. Reliance Standard Life Ins. Co. (Marcin II), 138 F.Supp.3d 14 (D.D.C. 2015). Following an additional remand, the District Court entered judgment in favor of Ms. Marcin on October 14, 2015. Specifically, the District Court found that there was not substantial evidence in the record to support Reliance's denial of disability benefits, though it cautioned that it was not making a finding that Ms. Marcin was Totally Disabled. Id. at 30. In subsequent orders, the District Court determined that Ms. Marcin was entitled to disability benefits in the amount of $2, 409.74 per month, along with post-judgment interest at the rate of 0.27 percent per annum from October 14, 2015, and attorney's fees in the amount of $72, 240.

         Reliance timely appealed, arguing that the District Court erred by awarding Ms. Marcin disability benefits and miscalculating the amount of benefits owed. Reliance's strongest argument on appeal is that benefits under the Plan cannot be awarded without a factual finding of Total Disability. Given that the District Court explicitly disavowed making this determination, Reliance contends that an award of benefits was legally precluded. While we agree with Reliance that a finding of Total Disability was a prerequisite to the receipt of benefits, we are mindful of our de novo standard of review for summary judgment. Pursuant to this standard, we may affirm the District Court on any ground, and elect to do so on the basis that Ms. Marcin proved Partial Disability. According to the express terms of the Plan, Partial Disability is equivalent to Total Disability, and we find that Ms. Marcin was Totally Disabled within the relevant period. We also affirm the District Court's calculation of disability benefits owed to Ms. Marcin.

         I.

         For almost seven years, Ms. Marcin has been engaged in litigation under the Employee Retirement Income Security Act ("ERISA") to recover disability benefits owed under the Plan. To date, the litigation has spanned two lawsuits, at least three remands, and now an appeal. While the procedural posture of this case is tortuous, the issue we must decide is relatively straightforward: did Ms. Marcin prove Total Disability in accordance with the terms of the Plan? The factual evidence in this case shows that she did.

         A.

         Prior to developing her disability, Ms. Marcin "worked as a multi-discipline systems engineer at Mitre, a non-profit organization that supports federally funded research and development centers with systems engineering and information technology assistance." Marcin I, 895 F.Supp.2d at 107. Beginning January 1, 2005, Reliance issued Group Long-Term Disability Insurance Policy No. LTD 111701 to Mitre, and Ms. Marcin subsequently received coverage pursuant to the terms of this Plan. See id. As the claims review fiduciary, Reliance is responsible for determining eligibility for benefits under the Policy. Id.

         To be eligible for disability benefits, the Plan explicitly requires an insured to satisfy four elements. First, the individual must be "Totally Disabled as the result of a Sickness or injury covered by this Policy." J.A. 2131. The term "Totally Disabled" (or, alternatively, "Total Disability") means:

(1) during the Elimination Period and for the first 24 months for which a Monthly Benefit is payable, an Insured cannot perform the material duties of his/her regular occupation;
(a) "Partially Disabled" and "Partial Disability" mean that as a result of an Injury or Sickness an Insured is capable of performing the material duties of his/her regular occupation on a part-time basis or some of the material duties on a full-time basis. An Insured who is Partially Disabled will be considered Totally Disabled, except during the Elimination Period;
(b) "Residual Disability" means being Partially Disabled during the Elimination Period. Residual Disability will be considered Total Disability; and
(2) after a Monthly Benefit has been paid for 24 months, an Insured cannot perform the material duties of any occupation. Any occupation is one that the Insured's education, training or experience will reasonably allow. We consider the Insured Totally Disabled if due to an Injury or Sickness he or she is capable of only performing the material duties on a part-time basis or part of the material duties on a Fulltime basis.

J.A. 2123. In other words, an insured is entitled to disability benefits under this first prong of the Policy if, due to her ailments, she was incapable of performing all of the material duties of her occupation on a full-time basis. A Partial Disability under the Policy is equivalent to Total Disability.

         Further, the Policy provides that the insured's coverage will terminate on "the first of the Policy month coinciding with or next following the date the Insured ceases to meet the Eligibility Requirements." J.A. 2129, 2156. To meet the Eligibility Requirements, an insured must be an "Eligible Person, " meaning that she is a full-time or part-time employee actively at work. The term "Actively at Work" means that the insured is performing the material duties of her job on a fulltime or part-time basis in the place and manner in which the job is normally performed. This encompasses approved time off, including vacation and jury duty, but does not include time off as a result of injury or sickness. Thus, ...


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