Richard Baker v. Big Star Div. of the Grand Union Co., Connecticut Gen. Life Ins. Co., Great-West Life Assurance Co., 893 F.2d 288 (11th Cir. 1990). · Go Syfert
Richard Baker v. Big Star Div. of the Grand Union Co., Connecticut Gen. Life Ins. Co., Great-West Life Assurance Co., 893 F.2d 288 (11th Cir. 1990). Cases Citing This Book View Copy Cite
“erisa does not regulate the duties of non-fiduciary plan administrators. as such, non-fiduciaries cannot be held liable under erisa.”
166 citation events (96 in the last 25 years) across 36 distinct courts.
Strongest positive: McKinney v. Principal Financial Services Inc (alnd, 2025-01-23) · Strongest negative: Gary Kirwan v. Marriott Corporation, a Delaware Corporation (ca11, 1994-01-04)
Treatment trajectory · 1989 → 2026 · click a year to view as-of
1989 2007 2026
Top citers, strongest first. 50 distinct citers. How cited ↗
discussed Cited "but see" Gary Kirwan v. Marriott Corporation, a Delaware Corporation
11th Cir. · 1994 · signal: but cf. · confidence high
But cf. Baker v. Big Star Division of the Grand Union Co., 893 F.2d 288, 292 (11th Cir.1989) (citing Moon , court noted "that a panel of this court may have determined that express language of discretionary authority is necessary before the arbitrary and capricious standard is applicable”). 20 .
examined Cited as authority (verbatim quote) McKinney v. Principal Financial Services Inc (3×) also: Cited "see"
N.D. Ala. · 2025 · quote attribution · 1 verbatim quote · confidence high
plan administrator who merely performs claims processing, investigatory, and record keeping duties is not a fiduciary
discussed Cited as authority (verbatim quote) E. G. v. Companion Benefit Alternatives, Inc.
S.D. Ala. · 2018 · quote attribution · 1 verbatim quote · confidence high
erisa does not regulate the duties of non-fiduciary plan administrators. as such, non-fiduciaries cannot be held liable under erisa.
cited Cited as authority (rule) Secretary of Labor v. Gleason Research Associates, Inc., et al.
N.D. Ala. · 2026 · confidence medium
Co. of Am., 421 F.3d 459, 465 (7th Cir. 2005). “[N]on-fiduciaries cannot be held liable under ERISA.” Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 289 (11th Cir. 1989).
discussed Cited as authority (rule) The Southern Company Employee Savings Plan v. Costa
S.D. Ala. · 2024 · confidence medium
The Eleventh Circuit has found “a plan administrator who merely performs claims processing, investigatory, and record keeping duties is not a fiduciary.” Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir. 1989).
discussed Cited as authority (rule) Humphries v. Mitsubishi Chemical America, Inc.
S.D.N.Y. · 2024 · confidence medium
While the “formal title of ‘Plan Administrator’ has special significance under ERISA[,] . . . [o]ther courts have found that the title ‘Plan Administrator’ does not automatically make a third-party administrator a fiduciary if it has no discretionary authority.” Bouboulis, 442 F.3d at 65 (citing Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir. 1989)).
cited Cited as authority (rule) TOMCZAK v. STRIPES, LLC
D.N.J. · 2021 · confidence medium
Servs., Inc., 990 F.2d 513 , 516 (9th Cir.1993); Baker v. Big Star Div. of The Grand Union Co., 893 F.2d 288, 289-90 (11th Cir. 1989); Me.
discussed Cited as authority (rule) Smith v. Blue Cross Blue Shield of South Carolina
M.D. Fla. · 2020 · confidence medium
A third-party administrative services provider “does not become an ERISA ‘fiduciary’ simply by performing administrative functions and claims processing within a framework of rules established by an employer . . . .” Baker, 893 F.2d at 290 (citation omitted).
discussed Cited as authority (rule) Carolinas Electrical Workers Retirement Plan v. Zenith American Solutions, Inc.
11th Cir. · 2016 · confidence medium
A third-party administrator that performs purely ministerial functions, such as calculating benefits, maintaining participant records, and communicating with participants, is not a fiduciary within the meaning of 29 U.S.C. § 1002 (21)(A). 29 C.F.R. § 2509.75-8 (D-2); Cotton, 402 F.3d at 1279 (holding insurer’s allocation of premium payments, analysis of policy performance, and communications with participants constituted “ministerial policy-related services” that did not “render [the insurer] a fiduciary”); Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.…
cited Cited as authority (rule) Griffin v. Lockheed Martin Corp.
N.D. Ga. · 2015 · confidence medium
Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989) (citations omitted).
cited Cited as authority (rule) Griffin v. SunTrust Bank, Inc.
N.D. Ga. · 2015 · confidence medium
Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989) (citations omitted).
discussed Cited as authority (rule) Gill v. Bausch & Lomb Supplemental Retirement Income Plan I
W.D.N.Y. · 2014 · confidence medium
See, e.g., Sharkey, 70 F.3d at 229 (holding that the de novo standard is “the standard of review applicable to a decision to revoke benefits when that decision is made by a body other than the one authorized by the procedures set forth in the benefits plan”); accord Sanford v. Harvard Indus., Inc., 262 F.3d 590 , 597 (6th Cir.2001); Rodriguez-Abreu v. Chase Manhattan Bank, 986 F.2d 580, 584 (1st Cir.1993) (“Because the relevant plan documents did not grant discretionary authority to the Plan Administrator and the Named Fiduciaries did not expressly delegate their discretionary authority …
discussed Cited as authority (rule) Boster v. Reliance Standard Life Insurance Company
D.D.C. · 2013 · confidence medium
See Rodriguez-Abreu v. Chase Manhattan Bank, N.A., 986 F.2d 580, 583-84 (1st Cir.1993); Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 291 (11th Cir.1989); Crider v. Highmark Life Ins., 458 F.Supp.2d 487, 501-03 (W.D.Mich.2006); cf. Sharkey v. Ultramar Energy Ltd., 70 F.3d 226, 229 (2d Cir.1995) (remanding to the district court to make the factual determination as to who actually made the benefits determination).
discussed Cited as authority (rule) Cultrona v. Nationwide Life Insurance
N.D. Ohio · 2013 · confidence medium
Citing an analogous Eleventh Circuit case, -the court found that the entity in question processed claims and disbursed benefits, but that “the employer reserved the right to review the denial of claims.” Id. at 455 (citing Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989)).
discussed Cited as authority (rule) LifeCare Management Services LLC v. Insurance Management Administrators Inc. (2×)
5th Cir. · 2013 · confidence medium
In Baker v. Big Star Division of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989), the administrator did not have the authority to deny benefits.
discussed Cited as authority (rule) America's Health Insurance Plans v. Hudgens (2×) also: Cited "see"
N.D. Ga. · 2012 · confidence medium
In most cases, the employer offering the plan acts as the “fiduciary.” See Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989).
cited Cited as authority (rule) Rohan v. UnitedHealthcare Insurance
N.D. Fla. · 2012 · confidence medium
See Oliver, 497 F.3d at 1193-94 ; Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989); see also Castro v. Hartford Life Ins. and Acc. Ins.
discussed Cited as authority (rule) Quintana v. Lightner
N.D. Tex. · 2011 · confidence medium
See, e.g., Reich v. Lancaster, 55 F.3d at 1049 (holding that persons carrying out perfunctory or ministerial duties are not fiduciaries unless they “exercise discretionary authority and control that amounts to actual decision making power”); Kyle Railways, Inc. v. Pacific Administration Services, Inc., 990 F.2d 513, 516 (9th Cir.1993) (finding that the administrator of an ERISA plan was not a fiduciary where, according to the agreement between the employer and the administrator, the employer retained ultimate responsibility for all claims made under the plan); Baker v. Big Star Division of…
discussed Cited as authority (rule) WE Aubuchon Co., Inc. v. BENEFIRST, LLC
D. Mass. · 2009 · confidence medium
Without more, mechanical administrative responsibilities ... are insufficient to ground a claim of fiduciary status.''); Baker v. Big Star Div. of Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989) ("[The employer-plan sponsor] does no more than 'rent' [a] claims processing department ... to review claims and determine the amount payable 'in accordance with the terms and conditions of the Plan.’ ”) (quoting the applicable ASA in the case); Baxter v. C.A.
discussed Cited as authority (rule) Moeckel Ex Rel. Morrell v. Caremark, Inc. (2×)
M.D. Tenn. · 2007 · confidence medium
See Mulder, 432 F.Supp.2d at 459 (“[t]he Court ... finds no justification to impose upon PCS ERISA’s fiduciary duties where none could be extended to Oxford”); Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.l990)(finding that claims administrator was not an ERISA fiduciary where it is simply performing its functions within a framework of rules established by employer, especially if the claims processor has not been granted the authority to review benefit denials and make the ultimate decisions regarding eligibility); Klosterman v. Western Gen.
discussed Cited as authority (rule) Scarpulla v. Bayer Corp. Disability Plan
N.D. Ala. · 2007 · confidence medium
Oliver v. Coca Cola Co., 497 F.3d 1181, 1194-95 (11th Cir.2007) (holding that the plan administrator is the fiduciary subject to suit—not an administrative services provider such' as Broadspire) (citing Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989)).
cited Cited as authority (rule) Jones v. LMR International, Inc.
M.D. Ala. · 2007 · confidence medium
Baker v. Big Star Div. of the Grand Union Co. 893 F.2d 288, 290 (11th Cir.1989).
examined Cited as authority (rule) Geddes v. United Staffing Alliance Employee Medical Plan (4×) also: Cited "see, e.g."
10th Cir. · 2006 · confidence medium
See Rodriguez-Abreu v. Chase Manhattan Bank, 986 F.2d 580, 584 (1st Cir.1993) ("To be an effective delegation of discretionary authority so that the deferential standard of review will apply, therefore, the fiduciary must properly designate a delegate for the fiduciary's discretionary authority."); Madden v. ITT Long Term Disability Plan, 914 F.2d 1279, 1283-85 (9th Cir.1990) ("[W]e hold that where ... a named fiduciary properly designates another fiduciary, delegating its discretionary authority, the `arbitrary and capricious' standard of review ... applies ...."); and Baker v. Big Star Div. …
discussed Cited as authority (rule) Mulder v. PCS HEALTH SYSTEMS. INC.
D.N.J. · 2006 · confidence medium
As the Third Circuit held in Confer v. Custom Engineering Co., 952 F.2d 34, 39 (3d Cir.1991), a plan supervisor holds no discretionary authority where its “obligation [is] to follow the written plan instrument and follow .the instructions of the plan administrator.” See also Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989) (“An insurance company does not become an ERISA ‘fiduciary’ simply by performing administrative functions and claims processing within a framework of rules established by an employer ... especially if, as in this case, the claims pro…
discussed Cited as authority (rule) Anderson v. Unum Life Ins. Co. of America
M.D. Ala. · 2006 · confidence medium
Co., 322 F.Supp.2d 1376, 1381 (M.D.Fla.2004) (“Eleventh Circuit precedent is clear that where an unauthorized party denies plan benefits, that denial is reviewed under the de novo standard.”) (citing Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 291 (11th Cir. 1989)).
cited Cited as authority (rule) James P. Cotton, Jr. v. Massachusetts Mutual Life
11th Cir. · 2005 · confidence medium
Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 289 (11th Cir.1989) (“non-fiduciaries cannot be held liable under ERISA”).
discussed Cited as authority (rule) Via Christi Regional Medical Center, Inc. v. Blue Cross & Blue Shield of Kansas, Inc.
D. Kan. · 2005 · confidence medium
Gelardi v. Pertec Computer Corp., 761 F.2d 1323, 1325 (9th Cir.1985) (No fiduciary status when employer performs only administrative functions); Baker v. Big Star Div. of Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989) (a plan administrator who merely performs claims processing, investigatory, and record keeping duties is not a fiduciary) (citations and quotations omitted); Confer v. Custom Engineering Co., 952 F.2d 34, 39 (3d Cir.1991); see also 29 C.F.R. § 2509.75-8 .
discussed Cited as authority (rule) Mortgage Lenders Network USA, Inc. v. CoreSource, Inc.
D. Conn. · 2004 · confidence medium
Mgmt., 32 F.3d 1119, 1122-25 (7th Cir.1994) (concluding that third party administrator was not an ERISA fiduciary where it did not have authority to make the ultimate decisions in doubtful or contested claims, and where the eligibility determinations were based upon a framework established by the employer, despite the fact that the third party administrator created the computer program that formed the main method of determining eligibility); Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989) (“An insurance company does not become an ERISA “fiduciary” simply …
discussed Cited as authority (rule) Mazzacoli v. Continental Casualty Co.
M.D. Fla. · 2004 · confidence medium
Eleventh Circuit precedent is clear that where an unauthorized party denies plan benefits, that denial is reviewed under the de novo standard.” Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 291 (11th Cir.1989).
discussed Cited as authority (rule) Erlandson v. Liberty Life Assur. Co. of Boston
N.D. Tex. · 2004 · confidence medium
See, e.g., Reich v. Lancaster, 55 F.3d 1034, 1049 (5th Cir.1995) (holding that persons carrying out perfunctory or ministerial duties are not fiduciaries unless they “exercise discretionary authority and control that amounts to actual. decision making power”); Kyle Railways, Inc. v. Pacific Administration Services, Inc., 990 F.2d 513, 516 (9th Cir.1993) (finding that the administrator of an ERISA plan was not a fiduciary where, *510 according to the agreement between the employer and the administrator, the employer retained ultimate responsibility for all claims made under the plan); Baker…
discussed Cited as authority (rule) Sentara Virginia Beach General Hospital v. LeBeau
E.D. Va. · 2002 · confidence medium
Muer Corp., 941 F.2d 451 (6th Cir.1991) (a claims processor that only had the power to pay out benefits according to the terms of the established plan was not an ERISA fiduciary); Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989) ("An insurance company does not become an ERISA ‘fiduciary’ simply by performing administrative functions and claims processing within a framework of rules established by an employer.”). 7 .
discussed Cited as authority (rule) Skilstaf, Inc. v. Adminitron, Inc. (2×) also: Cited "see"
M.D. Ala. · 1999 · confidence medium
It is undisputed in this circuit that “a plan administrator who merely performs claims processing, investigatory, and record keeping duties is not a fiduciary.” Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989) (quoting Howard v. Parisian, Inc., 807 F.2d 1560, 1564 (11th Cir.1987)).
discussed Cited as authority (rule) Saravolatz v. Aetna US Healthcare
E.D. Mich. · 1999 · confidence medium
See Howard, 807 F.2d at 1564 ; Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 289-90 (11th Cir.1989) (holding that “[a]n insurance company does not become an ERISA ‘fiduciary’ simply by performing administrative functions and claims processing within a framework of rules established by an employer”); accord Zepke, slip op. at p. 6 (“There is no provision in ERISA authorizing suits against claims processing agents who perform only routine administrative and record keeping functions.
discussed Cited as authority (rule) Cerasoli v. Xomed, Inc.
W.D.N.Y. · 1999 · confidence medium
Servs., Inc., 990 F.2d 513 , 516 (9th Cir.1993) (“third-party administrators ... are not fiduciaries under ERISA when they merely perform ministerial duties or process claims”); Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989) (“a plan administrator who merely performs claims processing, investigatory, and record keeping duties is not a fiduciary”); accord Howard v. Parisian, Inc., 807 F.2d 1560, 1564 (11th Cir.1987); Munoz v. Prudential Ins.
discussed Cited as authority (rule) McNutt v. J.A. Jones Construction Co.
S.D. Ga. · 1998 · confidence medium
In Baker v. Big Star Division of the Grand Union Co., the court rejected defendant’s argument that the power to make initial eligibility determinations in accordance with the terms and conditions of the plan was *1381 inherently discretionary. 893 F.2d 288, 291 (11th Cir.1989).
cited Cited as authority (rule) Terry v. Bayer Corporation
1st Cir. · 1998 · confidence medium
Servs., Inc., 990 F.2d 513 , 516 (9th Cir. 1993); Baker v. Big Star Div. of The Grand Union Co., 893 F.2d 288, 289-90 (11th Cir. 1989).
cited Cited as authority (rule) Terry v. Bayer Corporation
1st Cir. · 1998 · confidence medium
Servs., Inc., 990 F.2d 513 , 516 (9th Cir. 1993); Baker v. Big Star Div. of The Grand Union Co., 893 F.2d 288, 289-90 (11th Cir. 1989).
cited Cited as authority (rule) Michael F. Terry v. Bayer Corporation and Bayer Corporation Disability Plan
1st Cir. · 1998 · confidence medium
Servs., Inc., 990 F.2d 513 , 516 (9th Cir.1993); Baker v. Big Star Div. of The Grand Union Co., 893 F.2d 288, 289-90 (11th Cir.1989).
examined Cited as authority (rule) Response Oncology, Inc. v. MetraHealth Insurance (3×) also: Cited "see"
S.D. Fla. · 1997 · confidence medium
Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1990).
cited Cited as authority (rule) Alacare Home Health Services, Inc. v. Prudential Insurance
M.D. Ala. · 1997 · confidence medium
Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989).
discussed Cited as authority (rule) HealthSouth Rehabilitation Hospital v. American National Red Cross
4th Cir. · 1996 · confidence medium
Muer Corp., 941 F.2d 451 (6th Cir.1991) (a claims processor that only had the power to pay out benefits according to the terms of the established plan was not an ERISA fiduciary); Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989) (“An insurance company does not become an ERISA ‘fiduciary' simply by performing administrative functions and claims processing within a framework of rules established by an employer.”); Haidle, 855 F.Supp. at 131-32 (Processing and paying claims are administrative, not discretionary functions, and an entity seized of the obligatio…
discussed Cited as authority (rule) Healthsouth Rehabilitation Hospital v. American National Red Cross
4th Cir. · 1996 · confidence medium
Muer Corp., 941 F.2d 451 (6th Cir.1991) (a claims processor that only had the power to pay out benefits according to the terms of the established plan was not an ERISA fiduciary); Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989) ("An insurance company does not become an ERISA 'fiduciary' simply by performing administrative functions and claims processing within a framework of rules established by an employer."); Haidle, 855 F.Supp. at 131-32 (Processing and paying claims are administrative, not discretionary functions, and an entity seized of the obligation to s…
cited Cited as authority (rule) Variety Children's Hospital, Inc. v. Blue Cross/Blue Shield of Florida
S.D. Fla. · 1996 · confidence medium
In support of this argument, CobraServ relies on Baker v. Big Star Division of the Grand Union Co., 893 F.2d 288, 289 (11th Cir.1989) and Howard v. Parisian, Inc., 807 F.2d 1560 (11th Cir.1987).
discussed Cited as authority (rule) Santana v. Deluxe Corp. (2×)
D. Mass. · 1996 · confidence medium
Servs., 990 F.2d 513 , 516 (9th Cir.1993) (holding that relief for nonfiduciary liability only available where nonfiduciary is engaged in prohibited transaction under section 1106(a)(1)); Baker v. Big Star Div. of the Grand Union Co., 893 F.2d 288, 289-90 (11th Cir.1990) (stating that duties of nonfiduciaries not regulated by ERISA); see also Mertens v. Hewitt Assocs., 508 U.S. 248 , 113 S.Ct. 2063 , 124 L.Ed.2d 161 (1993) (reserving question of whether nonfiduciaries are subject to suit under ERISA while observing that nonfiduciaries are not specified in ERISA statute as potential defendants)…
discussed Cited as authority (rule) 19 Employee Benefits Cas. 2590, Pens. Plan Guide P 23914y Daniel J. Sharkey v. Ultramar Energy Limited, Lasmo Plc, Lasmo (Aul Ltd), AKA American Ultramar Limited, and Pension Committee of the Ultramar U.S. Employees Retirement Plan
2d Cir. · 1995 · confidence medium
Rodriguez-Abreu, 986 F.2d at 584 ; Baker v. Big Star Div. of The Grand Union Co., 893 F.2d 288, 291 (11th Cir.1989) (as amended Jan. 29, 1990). 16 The factual issue of who actually made the benefit determination must be resolved before a court can properly decide whether or not to uphold the pension determination.
cited Cited as authority (rule) Sharkey v. Ultramar Energy Ltd.
2d Cir. · 1995 · confidence medium
Rodriguez-Abreu, 986 F.2d at 584 ; Baker v. Big Star Div. of The Grand Union Co., 893 F.2d 288, 291 (11th Cir.1989) (as amended Jan. 29, 1990).
discussed Cited as authority (rule) Brooks v. Protective Life Insurance
M.D. Ala. · 1995 · confidence medium
See also, Moon v. American Home Assurance Company, 888 F.2d 86, 88 (11th Cir.1989) ("the circuit courts which have found that particular ERISA plans granted discretion to plan administrators or fiduciaries, in cases after Firestone, have uniformly rested this finding upon express language of the ERISA plan before them"); Baker v. Big Star Division of the Grand Union Company, 893 F.2d 288, 292 (11th Cir.1989) (noting that a panel of the Eleventh Circuit may have determined that express language of discretionary authority is necessary before the arbitrary and capricious standard is evoked); Guy …
cited Cited as authority (rule) McMorgan & Co. v. First California Mortgage Co.
N.D. Cal. · 1995 · confidence medium
Id. at 290 (citations omitted).
discussed Cited as authority (rule) Haidle v. Chippenham Hospital, Inc.
E.D. Va. · 1994 · confidence medium
Muer Corp., 941 F.2d 451 (6th Cir.1991) (holding that administrator of plan was merely a claims processor that paid claims in accordance with the terms of the plan, and as such, was not a fiduciary); Baker v. Big Star Division of the Grand Union Co., 893 F.2d 288, 290 (11th Cir.1989) (“[The employer] did no more than ‘rent’ the claims processing department of [the plan administrator] to review claims and determine the amount payable ‘in accordance with the terms and conditions of the Plan.’ ... [The employer] reserved the right to review any and all claim denials---- An insurance com…
discussed Cited as authority (rule) Maushardt v. Harris Corp.
M.D. Fla. · 1994 · confidence medium
This circuit has interpreted Bruch to mandate de novo review unless the plan expressly provides the administrator discretionary authority to make eligibility determinations or to construe the plan’s terms. [Moon v. American Home Assurance Co., 888 F.2d 86, 88 (11th Cir.1989).] Thus, this court has applied the arbitrary and capricious standard when the plan provides that the administrators ‘“determinations *1243 shall be final and conclusive’ ” so long as they are “ ‘reasonable determinations which are not arbitrary and capricious.’ ” [Brown v. Blue Cross and Blue Shield of Al…
Retrieving the full opinion text from the archive…
Richard BAKER, Plaintiff-Appellant,
v.
BIG STAR DIVISION OF THE GRAND UNION COMPANY, Connecticut General Life Insurance Company, Defendants-Appellees. Great-West Life Assurance Company, Defendant
88-8787.
Court of Appeals for the Eleventh Circuit.
Jan 29, 1990.
893 F.2d 288
William R. Johnson, David P. Oliver, Moore & Rogers, Marietta, Ga., for plaintiff-appellant., William Henry Boice, Stephen Earl Hudson, Kilpatrick & Cody, Atlanta, Ga., for Big Star., H. Sanders Carter, Jr., Elizabeth Johnson Bondurant, Carter & Ansley, Atlanta, Ga., for Connecticut General Life Ins. Co.
Hill, Kravitch, Pointer.
Cited by 91 opinions  |  Published
[*289] HILL, Senior Circuit Judge:

This is an appeal from a decision by the District Court for the Northern District of Georgia granting summary judgment to ap-pellees the Grand Union Company (“Grand Union”) and Connecticut General Life Insurance Company (“Connecticut General”), in a dispute over the denial of a claim for disability benefits governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001-1381. We affirm in part, reverse in part, and remand for further proceedings.

FACTS

Appellant Richard Baker was an employee of the Big Star [supermarket] Division of the Grand Union Company for 13 years. Baker ceased working for Grand Union as an assistant store manager in October 1983 because of lower back pain. Baker received disability payments under an employee welfare benefits plan (hereinafter “Plan”) administered, for the purposes of this appeal, [1] by Connecticut General Life Insurance (hereinafter “Connecticut General”). Under the terms of the Plan, Baker received monthly benefits for two years because his lower back pain prevented him from performing the duties of his “regular occupation.”

After receiving disability benefits for two years, a covered employee will remain eligible for monthly benefits under the Plan only if he or she is “totally disabled” or “unable to perform any occupation for which [he or she] is qualified based on his or her education, training or experience.” Shortly after his initial 24 month benefits period expired in April of 1986, Baker submitted a medical report from his doctor and applied for the “total disability” benefits available under the Plan. Acting as the Plan’s administrator, Connecticut General required Baker to submit himself to an examination by a doctor of its choosing because it deemed the report submitted by Baker’s physician to be ambiguous and incomplete. On July 28,1986, on the basis of the second physician’s report, Connecticut General found that Baker was ineligible for the long-term, “total disability” benefits.

Connecticut General claims that Baker was informed of his right under ERISA to appeal the initial eligibility decision. Baker, on the other hand, alleges that he was told that if he chose to pursue the review procedure established by Grand Union, the same people who made his initial eligibility determination would review their own decision, and that the outcome — the denial of his claim — would be the same.

Baker filed an action in state court and the case was removed to federal court because the claim was governed by ERISA. The district court did not make a factual finding as to whether Baker’s failure to exhaust his administrative remedies was' excusable. The district court correctly applied the very limited “arbitrary and capricious” standard of judicial review for decisions by plan administrators under ERISA, see Chilton v. Savannah Foods & Indus., Inc., 814 F.2d 620, 624 (11th Cir.1987), and upheld the determination made by Connecticut General that Baker was not eligible for “total disability” benefits under Grand Union’s benefits plan. In addition, the district court held that Connecticut General was not a “fiduciary,” as defined under 29 U.S.C. § 1002(21)(A), and therefore could not be held liable under ERISA even if the determination of ineligibility had been wrong. We shall consider this latter issue first.

DISCUSSION

I. Fiduciary Status Under ERISA

ERISA does not regulate the duties of non-fiduciary plan administrators. As such, non-fiduciaries cannot be held liable under ERISA. Howard v. Parisian, Inc., 807 F.2d 1560, 1564-65 (11th Cir.1987). As the Supreme Court has recently explained,

[*290] ERISA defines a fiduciary as one who “exercises any discretionary authority or discretionary control respecting management of [a] plan or exercises any authority or control respecting management or disposition of its assets.” 29 U.S.C. § 1002(21)(A)(i). A fiduciary has “authority to control and manage the operation and administration of the plan," 29 U.S.C. § 1102(a)(1), and must provide a “full and fair review” of claim denials, 29 U.S.C. § 1133(2).

Firestone Tire & Rubber Co. v. Bruch, - U.S. -, -, 109 S.Ct. 948, 955, 103 L.Ed.2d 80 (1989). As Judge Freeman stated in ruling on this issue in the district court, “a plan administrator who merely performs claims processing, investigatory, and record keeping duties is not a fiduciary. See Howard, 807 F.2d at 1564.” [2] Connecticut General processed claims and disbursed benefit payments pursuant to Plan terms under an administrative services agreement with Grand Union. Connecticut General did not contract to provide Grand Union with benefits insurance for Grand Union employees.

Grand Union did no more than “rent” the claims processing department of Connecticut General to review claims and determine the amount payable “in accordance with the terms and conditions of the Plan.” Administrative Services Agreement § 2(a)(i). Grand Union reserved the right to review any and all claim denials. Id. at § 2(b). An insurance company does not become an ERISA “fiduciary” simply by performing administrative functions and claims processing within a framework of rules established by an employer, Gelardi v. Pertec Computer Corp., 761 F.2d 1323, 1325 (9th Cir.1985), especially if, as in this case, the claims processor has not been granted the authority to review benefits denials and make the ultimate decisions regarding eligibility. Howard, 807 F.2d at 1564; [3] DeGeare v. Alpha Portland Indus., Inc., 652 F.Supp. 946, 962 (E.D.Mo.1986) (payment of claims pursuant to provisions of benefits plan does not clothe administrator with discretionary authority to such an extent as to make administrator’s role that of a fiduciary); Munoz v. Prudential Insur. Co. of America, 633 F.Supp. 564 (D.C.Colo.1986) (“ability to make policy decisions outside of a pre-existing or separate framework of policies, practices and procedures” determines ERISA fiduciary status).

We affirm the decision of the district court that Connecticut General is not an ERISA fiduciary under the terms of the Plan and therefore is not subject to suit for its part in denying Baker “total disability” benefits under the Plan.

II. The Appropriate Standard of Judicial Review For The Denial of ERISA Benefits

As discussed supra, the district court reviewed the denial of “total disability” benefits for Baker under the arbitrary and capricious standard that then governed ERISA cases in this circuit. Subsequent to the district court’s decision in this case, the Supreme Court, on February 21, 1989, decided Firestone Tire and Rubber Co. v. Bruch, - U.S. -, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989), and held that “a denial[*291] of benefits challenged under [29 U.S.C.] § 1132(a)(1)(B) is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan,” [4] — U.S. at-, 109 S.Ct. at 956. In other words, a court must exercise de novo review unless (1) the plan fiduciary has “discretionary authority to determine eligibility for benefits or to construe the terms of the plan”; or (2) the plan administrator has “discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” Id.

Appellee Grand Union argues that, “[rjegardless of whether Connecticut General may be classified as a “fiduciary” under ERISA ... there is no dispute whatsoever that Grand Union had delegated to Connecticut General the authority ‘to determine eligibility for benefits.’ ” Appellee Grand Union would have us ignore the trust law principles upon which the Bruch decision is based and import greater significance to Justice O’Connor’s use of the word “or” than is warranted. True, the Supreme Court held that a de novo standard applies unless “the benefit plan gives the administrator or fiduciary discretionary authority,” Id. (emphasis added), yet it is clear that an administrator with discretionary authority is a fiduciary. See — U.S. at --, 109 S.Ct. at 955, discussed supra at section I.

Conversely, one who is not a fiduciary is also not “an administrator with discretionary authority” under 29 U.S.C. § 1002(16)(A) and (21)(A). “Administrators” are distinguished from “fiduciaries” by the former’s lack of discretionary authority or discretionary control”; therefore, any entity or person found not to be an ERISA “fiduciary” cannot be an “administrator with discretionary authority” subject to the arbitrary and capricious standard.

Grand Union makes essentially the same argument that was rejected by the Supreme Court in Bruch. In Bruch, Firestone “argue[d] that as a matter of trust law the interpretation of the terms of a plan is an inherently discretionary function.” — U.S. at-, 109 S.Ct. at 954. Similarly, Grand Union argues that since Connecticut General has the power to make initial eligibility determinations “ ‘in accordance with the terms and conditions of the Plan,’ ” Connecticut General’s role is “inherently discretionary.” As discussed above, Grand Union urges a far too facile reading of Bruch than can be sanctioned by this court. Just as Firestone’s “inherently discretionary” task of construing its benefits plan terms was insufficient to support a more deferential standard of judicial review under trust law principles, Connecticut General’s “inherently discretionary” task of making initial eligibility determinations “according to the terms of the Plan” does not trigger the application of an arbitrary and capricious standard of review under Bruch. See Moon v. American Home Assur. Co., 888 F.2d 86 (11th Cir. 1989) (rejecting a similar argument and finding that de novo standard of review applies). Grand Union, not Connecticut[*292] General, was given the authority to review claim denials; nor was Connecticut General given the power to formulate policy or terms of eligibility under the Plan.

While we note that the indicia of discretionary authority granted to administrators' or fiduciaries will differ with each ERISA plan reviewed by a given court — and we do not determine today which indicia of discretionary authority are sine qua non to trigger the arbitrary and capricious standard of review under Bruch —we hold that the benefits plan at issue in this case does not provide such discretion to its plan administrator. We note that a panel of this court may have determined that express language of discretionary authority is necessary before the arbitrary and capricious standard is applicable. See Moon, 888 F.2d at 88-89 (construing several post-Bruch cases to rest on the presence or absence of “express language” of discretionary authority) (emphasis in original). Thus, under Bruch we must remand this case to the district court for its de novo determination of whether appellant Baker is eligible for “total disability” benefits under the Plan. [5]

Next, appellee Grand Union argues that since no competent evidence existed upon which the district court could have determined that Mr. Baker was eligible for Plan benefits, this court should affirm the district court’s decision even if under Bruch the district court should have applied a de novo standard. We disagree. It will be the district court’s task to assess the conflicting medical evidence which exists in this case and make an independent determination of whether Mr. Baker is entitled to “total disability” benefits under the terms of the Plan. In this regard, the district court is free to make a factual finding as to whether Mr. Baker’s failure to pursue administrative review is excusable as futile.

CONCLUSION

The decision of the district court is AFFIRMED in part; REVERSED in part; and REMANDED for further proceedings consistent with this opinion.

1

. Appellant Baker’s original complaint named Great West Assurance Company as a defendant because Great West had administered the Plan for part of the time period in which Baker received disability benefits. Baker voluntarily dismissed his claims against Great West on July 13, 1987.

2

. In 1975 the Department of Labor issued questions and answers relating to certain aspects of fiduciary responsibility under ERISA. In those questions and answers the Department stated "a plan administrator ... must, b[y] the very nature of his position, have ‘discretionary authority or discretionary responsibility in the administration’ of the plan within the meaning of section 3(21)(A)(iii) of the Act. Persons who hold such positions will therefore be fiduciaries." 29 C.F.R. § 2509.75-8 D-3 (1988). As the Department recognized, these questions and answers are merely advisory and may be affected by subsequent legislation, regulations, court decisions, and interpretive bulletins. 29 C.F.R. § 2509.75-8.

3

. The following discussion by the court in Howard suffices to dispose of the claim that Connecticut General was acting as an ERISA fiduciary in this case.

As indicated above, Protective is the plan administrator, performing claims processing, investigatory, and record keeping duties. Protective performs these duties under an independent contract with Parisian. Thus, Protective is not a fiduciary under the plan, and it has no obligation governed by ERISA.

Howard, 807 F.2d at 1564.

4

. Appellant’s Reply Brief purportedly quotes the holding in Firestone as follows:

Under Firestone, supra "... a denial of benefits challenged under § 1132(a)(1)(B) must be reviewed under a de novo standard unless the benefit plan expressly gives the plan administrator or fiduciary discretionary authority to determine eligibility for benefits ...” (Emphasis added.)

The Reply Brief thereafter makes much of the absence of “express” discretionary authority in the terms under which Connecticut General administered the Plan. This may indeed be significant under an expansive reading of Bruch. See Moon v. American Home Assur. Co., 888 F.2d 86, 88-89 (11th Cir. 1989).

Nevertheless, counsel for appellant provides no specific citation to the "quoted” sentence in Bruch in which Justice O’Connor purportedly used the term "expressly.” Not only did the Supreme Court’s opinion in Firestone not turn on the word "expressly,” Justice O’Connor’s opinion nowhere made use of the term “expressly." Our reading of Firestone makes it appear that appellant Baker has quoted the publisher's syllabus of the case. A publisher’s syllabus or headnote is published for the convenience of the reader and constitutes no part of the opinion of the court. United States v. Detroit Lumber Co., 200 U.S. 321, 337, 26 S.Ct. 282, 287, 50 L.Ed. 499 (1906). It was not helpful to have this portion of the syllabus quoted to us as the Court’s opinion.

5

. In the relatively short period of time since the Supreme court decided Bruch on February 21, 1989, several other courts of appeals, including two panels of this court, have applied the Bruch analysis to determine the appropriate standard of review to a claim arising from the denial of ERISA benefits. These early decisions — although construing benefits plans that range from very similar to totally dissimilar to the plan at issue in this case — are completely consistent with the result we reach today in finding that the district court should apply a de novo standard of review. See Moon, 888 F.2d at 88-89, discussed in the text accompanying this footnote; Brown v. Ampco-Pittsburgh Corp., 876 F.2d 546, 551 (6th Cir.1989) (interpreting Bruch to require remand to district court for de novo review since "clear giant of discretion to plan administrator" absent); Dzinglski v. Weirton Sled Corp., 875 F.2d 1075, 1079 (4th Cir.1989) (de novo review appropriate under Bruch when plan trustee “not vested with discretionary authority" but could "only determine whether [the employee] met the eligibility standards of the plan").

Cf. Guy v. Southeastern Iron Workers' Welfare Fund, 877 F.2d 37, 39 (11th Cir.1989) (under Bruch, arbitrary and capricious standard applies when benefits plan trustee has " 'full and exclusive authority to determine all questions of coverage and eligibility’ and ‘full power to construe the provisions of [the] Trust ...’ ”); Boyd v. Trustees of United Mine Workers Health and Ret. Fund, 873 F.2d 57, 59 (4th Cir.1989) (arbitrary and capricious standard appropriate under Bruch when plan trustee given power to make "full and final" benefits eligibility determinations and to "promulgate rules and regulations to implement the plan"); Bali v. Blue Cross and Blue Shield Ass'n., 873 F.2d 1043, 1047 (7th Cir.1989) (arbitrary and capricious standard applies under Bruch to reasonableness of plan administrator's request for information when plan "clearly gives the administrator discretion as to the amount and kind of information required to prove disability”); Lowry v. Bankers Life & Cas. Ret. Plan, 871 F.2d 522, 524-25 (5th Cir.1989) (arbitrary and capricious standard applicable under Bruch when "Plan Committee” given the power to interpret and construe uncertain terms, determine rights or eligibility, and decide appeals from claim denials).