GREGGORY B. OWINGS, Plaintiff - Appellant,
UNITED OF OMAHA LIFE INSURANCE COMPANY, Defendant-Appellee.
FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF
KANSAS (D.C. No. 6:15-CV-01108-EFM)
N. Peterson, II (Sean M. McGivern, with him on the briefs),
Graybill & Hazlewood, LLC, Wichita, Kansas, appearing for
William E. Hanna (Christopher J. Leopold, with him on the
brief), Stinson Leonard Street, LLP, Kansas City, Missouri,
appearing for Appellee.
BRISCOE, MATHESON, and PHILLIPS, Circuit Judges.
BRISCOE, Circuit Judge.
Greggory Owings sustained a disabling injury on the job and
was afforded long-term disability benefits by defendant
United of Omaha Life Insurance Company (United), under the
terms of a group insurance policy issued by United to
Owings' employer. Owings disagreed with, and attempted
without success to administratively challenge, the amount of
his disability benefits. He then filed suit against United in
Kansas state court, but United removed the action to federal
district court, asserting that the federal courts had
original jurisdiction over the action because the policy was
governed by the Employee Retirement Income Security Act of
1974 (ERISA). The district court ultimately granted summary
judgment in favor of United. Owings now appeals. Exercising
jurisdiction pursuant to 28 U.S.C. § 1291, we conclude
that United was arbitrary and capricious in determining the
date that Owings became disabled and, in turn, in calculating
the amount of his disability benefits. Consequently, we
reverse the district court's grant of summary judgment in
favor of United and remand with directions to enter summary
judgment in favor of Owings.
Policy and Plan
worked for Grene Vision Group in Wichita, Kansas, from 2001
until October 8, 2013. At all times relevant to this case,
Grene was covered by a group insurance policy (Policy) issued
by United. Aplt. App., Vol. I at 80. The Policy funded a
welfare benefit plan (the Plan) that provided long-term
disability benefits to qualifying employees of Grene.
Policy incorporates by reference the terms of the
Certificates and the Summary of Coverage that were
provided to Plan participants, such as Owings. Together,
these documents serve as the summary plan description and
plan document for the Plan. The Plan is governed by the
Employee Retirement Income Security Act of 1974 (ERISA), 29
U.S.C. § 1001, et seq.
Policy defines the terms "Disability" and
"Disabled" in the following manner:
Disability and Disabled mean that because
of an Injury or Sickness, a significant change in Your mental
or physical functional capacity has occurred, as a result of
a)during the Elimination Period, You are prevented from
performing at least one of the Material Duties of Your
Regular Occupation on a part-time or full-time basis; and
b) after the Elimination Period, You are:
1. prevented from performing at least one of the Material
Duties of Your Regular Occupation on a part-time or full-time
2. unable to generate Current Earnings which exceed 99% of
Your Basic Monthly Earnings due to that same Injury or
After a Monthly Benefit has been paid for 3 years,
Disability and Disabled mean You are unable
to perform all of the Material Duties of any Gainful
Id., Vol. II at 359.
Policy defines the terms "Material Duties, "
"Regular Occupation, " and "Basic Monthly
Earnings, " in the following manner:
Material Duties means the essential tasks,
functions, and operations relating to an occupation that
cannot be reasonably omitted or modified. In no event will We
consider working an average of more than the required
Full-Time hours per week in itself to be a part of material
duties. One of the material duties of Your Regular Occupation
is the ability to work for an employer on a full-time basis.
Id. at 360.
Regular Occupation means the occupation You are
routinely performing when Your Disability begins. Your
regular occupation is not limited to Your specific position
held with the Policyholder, but will instead be considered to
be a similar position or activity based on job descriptions
included in the most current edition of the U.S. Department
of Labor Dictionary of Occupational Titles (DOT). We have the
right to substitute or replace the DOT with another service
or other information that We determine to be of comparable
purpose, with or without notice. To determine Your regular
occupation, We will look at Your occupation as it is normally
performed in the national economy, instead of how work tasks
are performed for a specific employer, at a specific
location, or in a specific area or region.
Id. at 361.
Basic Monthly Earnings for salaried Employees means
Your gross annual salary from the Policyholder in effect on
the day immediately prior to the date on which Your