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Edwards v. Briggs & Stratton Ret. Plan

United States Court of Appeals for the Seventh Circuit

January 18, 2011, Argued; April 29, 2011, Decided

No. 09-2326

Opinion

 [*358]  Murphy, District Judge 1.

I. Introduction

The issue presented by this appeal, which arises out of a suit brought by Plaintiff-Appellant Augusta Edwards against Defendant-Appellee Briggs & Stratton Retirement Plan ("the Plan") for benefits due under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1001 et seq., is straightforward: whether the Plan should have excused the fact that Edwards's administrative appeal from a denial of her claim for disability benefits by the Plan was approximately eleven days late. The issue concerns, of course, whether Edwards exhausted her administrative remedies as a predicate to filing  [**2] suit under ERISA in federal court. Finding that Edwards failed to exhaust, the district court dismissed the case on summary judgment. Because we find no error in the district court's decision, the decision is affirmed.

II. Background and Procedural History

It is undisputed that the Plan is an employee welfare benefit plan and that Edwards is a participant in the Plan, all within the meaning of ERISA. See 29 U.S.C. § 1002(1), (7). Edwards, an employee of the Wisconsin-based Briggs & Stratton Company ("Briggs & Stratton"), ceased working in November 2005 due to a variety of ailments, including cervical radiculopathy, bilateral carpal tunnel syndrome, and ulnar nerve compression. Edwards was treated by, inter alia, Dr. James Stoll, an orthopedic surgeon. On August 9, 2007, Edwards made a claim for disability retirement benefits under the Plan, basing the claim upon Stoll's opinion that Edwards is totally and permanently disabled, cannot return to Briggs & Stratton, and cannot perform any work at all. The Plan retained its own medical consultant, Dr. Richard Fritz, a specialist in internal medicine, to evaluate Edwards's claim. Fritz opined that Edwards is not totally and permanently disabled.  [**3] On September 26, 2007, the Plan denied Edwards's  [*359]  claim for disability retirement benefits and on September 29, 2007, Edwards was notified of the denial of her claim. The letter informing Edwards of the denial of her claim advised Edwards that she had 180 days from receipt of the letter to appeal the denial of benefits to the Plan's Retirement Committee. The requirement that an appeal from a denial of Plan benefits must be made within 180 days from receipt of a denial letter is contained in the Plan document.

On October 9, 2007, Edwards wrote to the Plan to request copies of the records relied upon by the Plan in denying her claim for benefits and advised the Plan that "[a]fter I get these things [the records], I'll decide whether or not to appeal." Upon receipt of the records as requested, Edwards retained counsel to bring an appeal to the Plan from the denial of her claim for benefits. On February 4, 2008, the Plan received a letter from Edwards's counsel requesting a copy of the Plan document and advising the Plan that Edwards's counsel would be filing an administrative appeal on Edwards's behalf "soon." On February 8, 2008, Elizabeth Mlekush, the Plan administrator, answered the  [**4] letter, sending a copy of the Plan document as requested and advising Edwards's counsel that Edwards's appeal letter must be received by the Plan by March 31, 2008. 2

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639 F.3d 355 *; 2011 U.S. App. LEXIS 8895 **; 51 Employee Benefits Cas. (BNA) 1626

AUGUSTA EDWARDS, Plaintiff-Appellant, v. BRIGGS & STRATTON RETIREMENT PLAN, Defendant-Appellee.

Prior History:  [**1] Appeal from the United States District Court for the Eastern District of Wisconsin. No. 2:08-cv-0496-AEG. Aaron E. Goodstein, Magistrate Judge.

Edwards v. Briggs & Stratton Ret. Plan, 2009 U.S. Dist. LEXIS 37950 (E.D. Wis., May 4, 2009)

CORE TERMS

benefits, administrative appeal, plan administrator, notice, conflicting interest, denial of benefits, summary judgment, deadline, insurer, arbitrary and capricious, administrative remedy, claim for benefits, claimant's, untimely, exhaust, cases, required to exhaust, district court, notice-prejudice, disability, excused, exhaustion of administrative remedies, doctrine of substantial compliance, benefit plan, appeals

Civil Procedure, Summary Judgment, Entitlement as Matter of Law, Appropriateness, Appeals, Summary Judgment Review, Standards of Review, Motions for Summary Judgment, Cross Motions, Pensions & Benefits Law, Judicial Review, Standards of Review, Arbitrary & Capricious Review, De Novo Standard of Review, Civil Litigation, Causes of Action, Suits to Recover Plan Benefits, Remedies, Exhaustion of Administrative Remedies, ERISA, Fiduciaries, General Overview, Claim Procedures, Handling of Claims, Abuse of Discretion, Insurance Law, Liability & Performance Standards, Notice to Insurers, Prejudice to Insurers, Disclosure, Notice & Reporting, Fiduciary Responsibilities, Conflict of Interest Analysis