United States Court of Appeals, District of Columbia Circuit
May 5, 2017
from the United States District Court for the District of
Columbia (No. 1:13-cv-01308)
Bachrach argued the cause and filed the briefs for
B. Elkin argued the cause and filed the brief for appellee.
Before: Tatel, Pillard and WILKINS, Circuit Judges.
Wilkins, Circuit Judge
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.
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.
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.
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.
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.
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
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
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, ...