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Wilkins v. Baptist Healthcare Sys.

Wilkins v. Baptist Healthcare Sys.

United States Court of Appeals for the Sixth Circuit

March 12, 1998, Argued ; August 4, 1998, Decided ; August 4, 1998, Filed

No. 97-5074

Opinion

 [**2]   [***2]   [*611]  OPINION

R. GUY COLE, JR., Circuit Judge. Plaintiff, Bob Wilkins, appeals the district court's grant of summary judgment in favor of defendants, Life Insurance of North America ("LINA" or "the Plan Administrator") and Baptist Healthcare System, Inc. ("Baptist Healthcare"), and the district court's denial of Wilkins's motion to alter or amend the judgment, pursuant to Fed R. Civ. P. 59(e), in this ERISA action for disability benefits under the Baptist Healthcare Long Term Disability Plan ("the Plan").

Wilkins raises the following issues on appeal: (1) whether the district court erred in affirming LINA's denial of Wilkins's claim for long-term disability benefits; (2) whether  [***3]  the district court erred in refusing to consider evidence not included in the administrative record; (3) whether Wilkins is entitled to compensatory damages, pursuant to 29 U.S.C. § 1132(a)(3); (4) whether a claimant for benefits under 29 U.S.C. § 1132 is entitled to a jury trial; and (5) whether the district court erred in disposing of Wilkins's claim by granting the defendants' motion for summary judgment.

For the following reasons,  [**3]  we AFFIRM the judgment of the district court.

A. BACKGROUND

Wilkins, a former housekeeper and janitor for Baptist Healthcare, claims that as a result of a rotator cuff injury in his shoulder he became totally disabled in February of 1993. Wilkins last worked for Baptist Healthcare on February 19, 1993. On June 15, 1993, Wilkins applied for long-term disability benefits with LINA, Baptist Healthcare's ERISA insurer and plan administrator. On November 23, 1993, based on "the accumulated occupational and medical evidence" as well as an independent medical examination of Wilkins by Dr. James E. Russell, LINA notified Wilkins that he did not qualify for disability benefits under the Plan because he was not totally disabled. LINA also advised Wilkins of his right to appeal the denial of his claim by submitting a written request for review, along with any supporting documents, within sixty days of receipt of the denial letter.

After LINA denied Wilkins's claim, and shortly before his time to appeal expired, LINA received a letter from Wilkins's physician, Dr. Phillip Corbett, stating that Wilkins could not lift more than forty pounds and that his shoulder had been "giving [**4]  way." Wilkins never filed a written appeal of LINA's denial of benefits. Apparently believing that Wilkins's submission of Dr. Corbett's letter was an attempt to contest its denial of benefits, LINA sent Wilkins a letter, advising him of the procedure for perfecting an appeal.

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150 F.3d 609 *; 1998 U.S. App. LEXIS 17699 **; 1998 FED App. 0236P (6th Cir.) ***; 28 Employee Benefits Cas. (BNA) 1218

BOB G. WILKINS, Plaintiff-Appellant, v. BAPTIST HEALTHCARE SYSTEM, INC.; LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendants-Appellees.

Subsequent History:  [**1]  Rehearing Denied August 27, 1998, Reported at: 1998 U.S. App. LEXIS 24427.

Prior History: Appeal from the United States District Court for the Eastern District of Kentucky at Lexington. No. 94-00305. Karl S. Forester, District Judge.

Disposition: AFFIRMED the judgments of the district court.

CORE TERMS

district court, summary judgment, benefits, denial of benefits, administrative record, disabled, plan administrator, de novo, jury trial, breach of fiduciary duty, de novo review, bench trial, summary judgment motion, standard of review, medical evidence, genuine, cases, terms of the plan, fiduciary duty, rotator cuff, defendants', guidelines, amend, pain, compensatory damages, disability benefits, amended complaint, cause of action, right shoulder, colleagues'

Civil Procedure, Appeals, Standards of Review, De Novo Review, Pleadings, Amendment of Pleadings, General Overview, Summary Judgment, Appellate Review, Standards of Review, Motions for Summary Judgment, Entitlement as Matter of Law, Pensions & Benefits Law, Judicial Review, De Novo Standard of Review, ERISA, Civil Litigation, Handling of Claims, Environmental Law, Administrative Proceedings & Litigation, Judicial Review, Governments, Fiduciaries, Torts, Intentional Torts, Breach of Fiduciary Duty, Remedies, Damages, Monetary Damages, Jury Trial Prohibition, Administrative Law, Administrative Record, Scope of Review