U.S. Fifth Circuit Affirms Denial under Active Serviceman Exclusion not in SPD

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Plaintiff purchased life insurance for herself and her husband through her employer, UPS. Her husband was an active-duty soldier in the United States Army. He was killed in a weekend motorcycle accident while off base and not on duty. Prudential denied his widow’s claim pursuant to an exclusion for active-duty servicemen. The district court granted summary judgment for Prudential and UPS, and the U.S. Fifth Circuit affirmed.

 

Although the SPD did not advise the participants of the exclusion, the Court refused to recognize a potential breach of fiduciary duty claim that had not be specifically pleaded in the complaint.

 

“Mrs. Singletary argues that Prudential abused its discretion by enforcing an exclusion of which she was not on notice. She claims that the only document she received was the Summary Plan Description. Prudential admitted in the administrative proceedings below that the SPD did not mention the exclusion. Even so, under ERISA, the claim Mrs. Singletary has brought requires us simply to interpret the Plan…. Mrs. Singletary is not seeking to enforce the Plan. She instead is seeking relief from the provisions of the Plan because of lack of notice of something that she does not dispute is actually in the Plan. She argues that the SPD’s failure to disclose this exclusion violated ERISA, and therefore, Prudential should be estopped from relying on the exclusion. ERISA requires that an insurer’s SPD list ‘circumstances which may result in disqualification, ineligibility, or denial or loss of benefits….’ An equitable claim such as this one can be brought, but ‘failure to comply with ERISA’s SPD requirements cannot be the basis for a [Section 1132] (a)(1)(B) benefit claim.’ Two other sections, though, are possible bases for the claim….” However, “we should not transform a Section 1132(a)(1)(B) suit into a Section 1132(a)(2) or (a)(3) suit. “ERISA … expressly authorizes several claims for relief. Several procedural, as well as substantive, aspects of the litigation vary according to the specific claim alleged in the complaint…. Following the lead of the Supreme Court … courts now look closely at the particular §502(a) claim for relief being alleged. Courts are extremely reluctant to improvise or alter these forms of action.’ We need not resolve whether subsection (a)(2) or (a)(3) is the better fit. The claim could have been brought by referring to both sections. The problem here is that the only source for the claim used by the plaintiff was the inapplicable Section 1132(a)(1)(B).”

 

Singletary v. Prudential Insurance Co., No.15-30762, 2016 WL 3629029 (5th Cir. July 6, 2016).

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