Rice v. Jefferson Pilot Financial Insurance Company

Filing 35

CORRECTED pages of Opinion 32 of USCA as to 31 Notice of Appeal filed by Jerry Rice (lvw1) Modified on 11/5/2009 to publish document(lvw1).

No. 08-4180

Rice v. Jefferson Pilot Financial Ins. Co.

Page 2

Ohio challenging the denial of his application for long-term disability benefits. The district court granted Jefferson Pilot's motion for judgment as a mattet of law, finding th4t Rice's owtrae,'uaI I;m,1-ci#;ons ,beriod. complaint was barred by the applicable tatutc -of limitatiol?. On appeal, Rice challenges the district court's determination of the date on which his claim accrued. For the following reasons, we employ a different analysis than the district court but ultimately affirm the dismissal of Rice's ERISA claim.
I.

Rice was employed by Rite Rug Company ("Rite Rug") in Columbus, Ohio as a floor covering installer from October of 1997 through May of 2002. According to Rice, he stopped working because he became disabled on May 22, 2002. He applied for disability benefits from the Social Security Administration ("SSA"), and the SSA determined that Rice was disabled. Jefferson Pilot's records show that Rice stopped working on June 1, "due to fatigue, headaches, aches/pains and an inability to stay focused secondary to depression and chronic fatigue syndrome." Rite Rug established a long-term disability plan insured by Jefferson Pilot for its employees. An employee became eligible under the plan for long-term disability benefits if he had been disabled for 180 days. The plan also gave Jefferson Pilot the "sole authority to administer claims, to interpret [plan] provisions, and to resolve questions arising under this [plan]
. . .

includ[ing]

.

.

.

determin[ing] Employees' eligibility for insurance and

entitlement to benefits." Significantly for this case, the plan included a period: .4i44a4.i@: "No legal action may be brought more than three years after written proof of claim is required to be given." After he ceased working, Rice applied for long-term disability benefits under the plan in October of 2002. Jefferson Pilot denied Rice's claim on December 23,2002, finding that his medical records did not support a finding that he was "disabled" for purposes of disability benefits under the plan. Rice appealed this decision, and Jefferson Pilot denied his appeal on February 3, 2003. Rice then filed a second appeal, but he declined to submit any additional information to support his application. Jefferson Pilot obtained an opinion from an outside physician, who determined, based on the record, that Rice was not disabled.

limit

No. 08-4180

Rice v. Jefferson Pilot Financial Ins. Co.

Page 3

Based on this physician's opinion, Jefferson Pilot denied Rice's second appeal on September 24, 2003. Rice filed suit against Jefferson Pilot pursuant to ERISA in the United States District Court for the Southern District of Ohio in November of 2003. While the litigation was pending, the partiesfiled ajoint motion to stay in order that Rice's claim could be remanded to the claims administrator for re-adjudication. The district court granted the motion. The district court further ruled that if the dispute had not been settled by April 22, 2005, either party could file a notice re-opening the case before April 30, 2005. Jefferson Pilot

conducted surveillance of Rice and submitted the surveillance report, which noted that "[d]uring the time of our surveillance we did not observe Mr. Rice engaged in any physical activity." However, Jefferson Pilot received anonymous telephone calls and affidavits from Rice's brother-in-law and cousin supporting a finding that Rice was not disabled and including statements that Rice had engaged in such physical activities as scuba diving and water skiing. Rice declined to submit any additional information, and Jefferson Pilot once again denied Rice's claim on April 20, 2005. Neither party filed a notice to re-open the federal lawsuit. On June 8, 2007, Rice filed a second complaint in the district court against Jefferson Pilot. Jefferson Pilot filed a motion for judgment as a matter of law, and Rice filed a motion for judgment as a matter of law on the administrative record. Applying the clear repudiation rule, the district court gr