A court in Florida has declined to expand the remedies available under a claim for benefits due under 29 U.S.C. § 1132(a)(1)(B) of ERISA. Keys v. Bell, 2019 U.S. Dist. LEXIS 195505 (M.D. Fla. 2019). The court dismissed the plaintiff’s claim for “equitable estoppel by silence” under that provision of ERISA’s civil remedies.
This supports the trend in other courts following the U.S. Supreme Court’s 2011 decision in CIGNA Corp. v. Amara, which marked firm boundaries for litigation of claims under § 1132(a)(1)(B) versus under § 1132(a)(3) of ERISA. Amara strongly signaled that claims under § 1132(a)(1)(B) rise and fall on the terms of the plan and are to be litigated under principles of the law of contracts. Equitable principles (such as estoppel, reformation, and surcharge) are available to provide relief under § 1132(a)(3), but only where the plaintiff can demonstrate a claim under § 1132(a)(1)(B) would provide inadequate relief because of the inequitable conduct of the defendant.
Plaintiff Tyrone Keys was an NFL defensive lineman from 1983 until 1989, when he retired because of football-related injuries. Keys participated in the Bert Bell/Pete Rozelle NFL Player Retirement Plan, which originally offered three types of disability benefits: (1) Line of Duty (LOD) Benefits available to NFL players demonstrating “substantial disablement” because of injuries incurred while playing for the NFL but who are not otherwise totally disabled; (2) Football Degenerative Total and Permanent (Football T&P) benefits, available to former players demonstrating total disability because of injuries incurred while playing for the NFL; (3) Inactive T&P benefits, available to former NFL players demonstrating total and permanent disability because of circumstances unconnected to playing for the NFL. The Plan’s Retirement Board is the ultimate decisionmaker for disputed claims.
Keys submitted, and was approved for, a claim for LOD benefits in 1991. Keys received LOD benefits for the full five-year period available under the Plan. His request that his claim be converted to one for Football T&P benefits was denied in 1997. A car accident in 2002 aggravated Keys’ football injuries. In 2003, Keys again applied for Football T&P Benefits. The Board at first approved Keys for Inactive T&P benefits, but, after an appeal, the Board granted Keys’ claim for Football T&P benefits retroactively to January 2004. Keys continued to receive benefits over the next 13 years, although there were several denials and appeals during that period.
In 2011, the Plan’s benefit structure was reorganized. Football Degenerative T&P benefits were thereafter designated as “Inactive A T&P benefits.” Inactive T&P benefits were re-designated as “Inactive B T&P benefits.” Keys received benefits under both the A and B classifications for a time.
In August 2017, the Board determined Keys was never entitled to Inactive A T&P benefits, because it had concluded the 2002 accident, which the Board said it did not know of until its recent review of Keys’ records for his Social Security Disability benefits, was the proximate cause of disability after the accident. The Board concluded Keys had been overpaid by $831,488.28 and that all of Keys’ Inactive B T&P benefits would be retained until the overpayment was recovered, leaving Keys with no benefit payment at all. The plaintiff’s appeal was denied and Keys filed suit.
Keys asserted under 29 U.S.C. § 1132(a)(1)(B) of ERISA: (1) a claim for a declaration of rights under the Plan; (2) a claim for benefits due under the plan; and (3) a claim for equitable estoppel based on silence. The latter was on the theory the Board knew, or should have known, about the accident long before bringing it up to deny Keys’ claims in 2017, and so the Board should be estopped from ending Keys’ Inactive A T&P benefits and from recouping the alleged overpayment against his Inactive B T&P benefits.
In considering the Plan’s motion to dismiss the estoppel claim, the court noted the Eleventh Circuit’s adoption, in 1994, of “a very narrow common law doctrine” of equitable estoppel under §1132(a)(1)(B) claims, “where the plaintiff can show that (1) the relevant provisions of the plan at issue are ambiguous, and (2) the plan provider or administrator has made representations to the plaintiff that constitute an informal interpretation of the ambiguity.” (The Eleventh Circuit’s limited estoppel remedy appears to be a holdover from pre-Amara days and may well be overruled on that basis soon.) Keys agreed his theory of “estoppel by silence” did not fit within that narrow exception but insisted such a claim should be adopted because it was needed to ensure participants can obtain relief for plan administrators’ unfair, bad faith conduct.
The court, however, was not persuaded that Keys would be barred from relief if he could not assert a claim for estoppel by silence under § 1132(a)(1)(B). It observed that Keys’ estoppel by silence claim “closely resembles a claim for breach of fiduciary duty, a sometimes-permissible alternative claim under § 1132(a)(3)(B).” Granting the motion to dismiss, the court concluded, “The fact that Keys, who is the master of his complaint, chose not to bring a claim that might have provided other ‘appropriate equitable relief’ under § 1132(a)(3)(B) does not require the Court to strain to adopt a new theory of law, particularly when that theory appears at odds with prior precedent.”