Tetreault v. Reliance Standard Life Ins., 1st Cir. (2014)

7/26/2019 Tetreault v. Reliance Standard Life Ins., 1st Cir. (2014)

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United States Court of AppealsFor the First Circuit

No. 13- 2353

MI CHELE C. TETREAULT,

Pl ai nt i f f , Appel l ant ,

v.

RELI ANCE STANDARD LI FE I NSURANCE COMPANY;THE LI MI TED LONG TERM DI SABI LI TY PROGRAM,

Def endant s, Appel l ees.

APPEAL FROM THE UNI TED STATES DI STRI CT COURT

FOR THE DI STRI CT OF MASSACHUSETTS

[ Hon. J oseph L. Taur o, U. S. Di st r i ct J udge]

Bef or e

Thompson, Kayat t a and Bar r on,Ci r cui t J udges.

J onat han M. Fei genbaum, f or appel l ant .J oshua M. Cachr ach, wi t h whom Wi l son, El ser , Moskowi t z,

Edel man & Di cker LLP was on br i ef , f or appel l ees.

Oct ober 6, 2014


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BARRON, Circuit Judge. The Empl oyee Ret i r ement I ncome

Secur i t y Act of 1974 ( ERI SA) gover ns empl oyee benef i t pl ans. 29

U. S. C. 1001 et seq. Among ot her t hi ngs, t he st at ut e per mi t s

benef i ci ar i es t o go t o cour t t o chal l enge t hei r pl an' s deci si on t o

deny or cut of f t hei r benef i t s. I d. 1132( a) ( 1) ( B) . Bef or e

f i l i ng sui t , however , benef i ci ar i es must f i r st use - - or , as i t i s

of t en put , "exhaust " - - t hei r pl an' s pr ocedur es f or maki ng cl ai ms.

Mader a v. Mar sh USA, I nc. , 426 F. 3d 56, 61 ( 1st Ci r . 2005) . The

mai n quest i on f or us concer ns whi ch document a benef i t pl an must

use to set f or t h t hose pr ocedur es.

The benef i ci ar y who br i ngs t hi s appeal , Mi chel e

Tet r eaul t , ar gues t hat ERI SA r equi r es a benef i t pl an t o use one

par t i cul ar t ype of document , whi ch t he st at ut e cal l s t he "wr i t t en

i nst r ument . " 29 U. S. C. 1102( a) ( 1) . And she f ur t her ar gues t hat

we shoul d excuse her f ai l ur e t o compl y wi t h what her benef i t pl an

cont ends was one of i t s cl ai ms procedur es - - a 180- day deadl i ne f or

f i l i ng an i nt er nal appeal of an adver se benef i t s deci si on - -

because t he benef i t pl an' s wr i t t en i nst r ument di d not ment i on i t .

But Tet r eaul t i s mi st aken on t hat poi nt . That i s because t he

wr i t t en i nst r ument i n thi s case expr essl y i ncor porat ed a document

t hat cl ear l y set s f or t h t he appeal s deadl i ne. For t hat r eason, we

af f i rm t he Di str i ct Court ' s deci s i on t o di smi ss Tet reaul t ' s

benef i t s chal l enge. We al so af f i r m t he Di st r i ct Cour t ' s di smi ssal

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of Tet r eaul t ' s t wo ot her ERI SA cl ai ms, whi ch, r espect i vel y, ar e f or

st at ut or y penal t i es and f or br each of f i duci ar y dut y.

I .

Mi chel e Tet r eaul t i nj ur ed her back i n 2000 whi l e wor ki ng

as a st or e manager at The Li mi t ed, a nat i onwi de cl ot hi ng r et ai l er .

She t hen f i l ed a cl ai m under The Li mi t ed' s l ong- t er m di sabi l i t y

benef i t pl an, whi ch i s cal l ed The Li mi t ed Long Ter m Di sabi l i t y

Pr ogr am. The benef i t pl an i ni t i al l y deni ed Tet r eaul t ' s cl ai m but

t hen, i n 2004, r ever sed cour se af t er Tet r eaul t successf ul l y

chal l enged t he deni al i n cour t .

The si t uat i on changed yet agai n i n 2008. By t hen,

Rel i ance St andard Li f e I nsurance Company had st art ed admi ni st er i ng

cl ai ms f or The Li mi t ed Long Ter mDi sabi l i t y Pr ogr am. I n t hat r ol e,

Rel i ance St andard i nf ormed Tet r eaul t on December 18 that , af t er

r evi ewi ng her medi cal r ecor ds, i t had det er mi ned she coul d per f or m

"sedent ar y" wor k and t hus was no l onger el i gi bl e f or t he benef i t s

she had been r ecei vi ng. Rel i ance St andar d al so i nf or med Tet r eaul t

at t hat t i me t hat she coul d appeal t he deci si on i n wr i t i ng t o

Rel i ance St andard, but t hat she woul d have to do so "wi t hi n 180

days of your r ecei pt of t hi s l et t er or t he l ast dat e t o whi ch we

have pai d, whi chever i s l at er . "

On J anuar y 14, 2009, Tet r eaul t ' s counsel wr ot e t o

Rel i ance St andar d and r equest ed " [ t ] he Summary Pl an Descr i pt i on and

t he Pl an document s f or t he LTD pl an. " Tet r eaul t ' s counsel al so

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r equest ed that Rel i ance St andard pr ovi de "[ a] compl et e copy of Ms.

Tet r eaul t ' s f i l e i n Rel i ance' s possess i on. "

Ni ne days l ater , Rel i ance St andar d r esponded. I t sent

Tet r eaul t ' s counsel t he r equest ed f i l e, whi ch cont ai ned cer t ai n of

her medi cal r ecords as wel l as ot her document s t hat r el at ed t o her

cl ai m f or benef i t s. Rel i ance St andar d al so sent t he document t hat

est abl i shed t he 1998 ver si on of t he benef i t pl an. That document

made no r ef erence t o an appeal s deadl i ne.

Rel i ance St andard di d not at t hat t i me send t he "Summary

Pl an Descr i pt i on" Tet r eaul t ' s counsel had r equest ed. Rel i ance

Standar d al so di d not send some ot her document s t hat , t hough not

t hen i n i t s possessi on, ar e r el evant t o t he mer i t s of Tet r eaul t ' s

argument s t o t hi s Cour t . These document s concer ned a 2005 ver si on

of The Li mi t ed Long Ter m Di sabi l i t y Pr ogr am. They i ncl uded bot h

t he document t hat est abl i shed t hat ver si on of t he benef i t pl an and

anot her document t hat descr i bed i t s ter ms. Thi s l ast document ,

whi ch i dent i f i ed i t sel f as t he "summar y pl an descr i pt i on, " set

f or t h t he 180- day deadl i ne f or maki ng an i nt er nal appeal of an

adver se benef i t deci si on.

On J une 15, 2009 - - f our days bef ore t he 180- day per i od

was set t o r un out - - Tet r eaul t ' s counsel sent a l et t er t o Rel i ance

St andar d st at i ng t hat Tet r eaul t "w[ oul d] be appeal i ng" t he

t er mi nat i on deci si on to Rel i ance St andar d and that she expect ed to

compl et e t hat appeal wi t hi n 30 days. Rel i ance St andard r esponded

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by l et t er f axed t o Tet r eaul t ' s counsel on J une 17. The l et t er

r emi nded Tet r eaul t ' s counsel t hat t he 180- day per i od was about t o

expi r e. The l et t er al so st at ed t hat Rel i ance St andar d woul d not

accept an appeal f i l ed af t er t hat per i od. Fi nal l y, t he l et t er

war ned Tet r eaul t ' s counsel t hat i f he f i l ed Tet r eaul t ' s appeal

l at e, t he "' f ai l ur e t o exhaust ' def ense" woul d bar her f r om

chal l engi ng t he deci si on t o t er mi nat e her benef i t s.

The appeal s deadl i ne expi r ed on J une 19, 2009. Tet r eaul t

di d not f i l e an appeal wi t h Rel i ance St andar d unt i l near l y a year

l at er , on May 27, 2010. Rel i ance St andard t hen deni ed t he appeal

as unt i mel y, at whi ch poi nt Tet r eaul t f i l ed sui t .

The Di st r i ct Cour t decl i ned t o excuse Tet r eaul t ' s f ai l ure

t o appeal t o Rel i ance St andar d wi t hi n t he 180- day per i od. I n doi ng

so, t he Di st r i ct Cour t f i r st r ej ect ed Tet r eaul t ' s ar gument t hat

ERI SA r equi r ed t he benef i t pl an t o i ncl ude t he deadl i ne i n t he

"wr i t t en pl an i nst r ument . " The Di st r i ct Cour t t hen hel d i n t he

al t er nat i ve t hat Tet r eaul t ' s sui t coul d not pr oceed because t he

"wr i t t en pl an i nst r ument " i n t hi s case act ual l y di d i ncl ude t he

deadl i ne thr ough i t s expr ess i ncor por at i on of t he "summar y pl an

descri pt i on. " The Di st r i ct Cour t al so r ej ect ed addi t i onal ERI SA

cl ai ms Tet r eaul t pr essed t hat st emmed f r om Rel i ance St andard not

havi ng produced the document s t hat est abl i shed and summar i zed the

2005 ver si on of t he benef i t pl an.

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I I .

We begi n wi t h Tet r eaul t ' s ar gument t hat we shoul d excuse

her f ai l ur e t o f i l e her appeal wi t h Rel i ance St andar d wi t hi n t he

180- day per i od. Tet r eaul t r eads ERI SA t o say t hat onl y t he "pl an

i nst r ument " - - t o use her words - - can i mpose a cl ai ms procedur e

t hat a cl ai mant must exhaust bef or e goi ng t o cour t . From t hat

pr emi se, Tet r eaul t ar gues t hat her sui t may pr oceed - - despi t e her

f ai l ur e t o exhaust - - because t he rel evant "pl an i nst r ument " never

set f or t h t he 180- day appeal s deadl i ne.

Ot her cour t s ( i ncl udi ng t he Di st r i ct Cour t i n t hi s case)

have consi dered whether ERI SA i mposes t he r equi r ement Tet r eaul t

descr i bes. See, e. g. , Kauf mann v. Pr udent i al I ns. Co. of Am. , 840

F. Supp. 2d 495 ( D. N. H. 2012) ; Mer i gan v. Li ber t y Li f e Assurance

Co. of Bos. , 826 F. Supp. 2d 388 ( D. Mass. 2011) . But we need not

j oi n i n t hat i nqui r y. That i s because Tet r eaul t i s wr ong t o

cont end t hat i n t hi s case t he "pl an i nst r ument " omi t t ed t he 180- day

deadl i ne.

To expl ai n why we r each t hi s concl usi on, we f i r st need t o

say a bi t mor e about t hat l ast quot ed phr ase - - "pl an i nst r ument . "

Those wor ds do not act ual l y appear i n ERI SA. But a provi si on i n

ERI SA does r equi r e a benef i t pl an t o be "est abl i shed and mai nt ai ned

pur suant t o a wr i t t en i nst r ument . " 29 U. S. C. 1102( a) ( 1) . We

t hus underst and Tet r eaul t t o ar gue t hat t he benef i t pl an document

known under ERI SA as t he "wr i t t en i nst r ument " must set f or t h a

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cl ai ms pr ocedur e. And so, we st ar t by l ooki ng t o see i f t he

wr i t t en i nst r ument i n t hi s case cont ai ns t he appeal s deadl i ne

Tet r eaul t says was mi ssi ng. 1

The Li mi t ed Long Term Di sabi l i t y Pr ogram and Rel i ance

St andar d bot h say t he wr i t t en i nst r ument does cont ai n t he deadl i ne.

For suppor t , t hey poi nt t o t he document s t hat concer n the 2005

ver si on of t he benef i t pl an. The f i r st of t hese document s r ef er s

t o i t sel f as "t he f or mal pl an document . " Among ot her t hi ngs, i t

speci f i es t he pr ocedur es f or f undi ng, amendi ng, and admi ni st er i ng

t he benef i t pl an, j ust as ERI SA r equi r es of a "wr i t t en i nst r ument . "

29 U. S. C. 1102( b) ( 1) - ( 3) . Ther e i s t hus no quest i on t hi s

document i s t he wr i t t en i nst r ument f or t he 2005 ver si on of t he

benef i t pl an, and t he par t i es do not cont end ot her wi se.

Thi s document does not , however , set f or t h t he appeal s

deadl i ne. I nst ead, i t "i ncor por at es by r ef er ence . . . t he t er ms

1 Sect i on 1102( b) of ERI SA speci f i es what must be i ncl uded i nt he wr i t t en i nst r ument . Among ot her t hi ngs, t hat pr ovi si on ofERI SA r equi r es t he i nst r ument t o "speci f y t he basi s on whi chpayment s ar e made t o and f r om t he pl an. " 29 U. S. C. 1102( b) ( 4) .But Tet r eaul t does not r el y on t hi s pr ovi si on f or her ar gument t hatERI SA r equi r es cl ai ms pr ocedur es t o be set f or t h i n t he wr i t t eni nst r ument . She i nst ead appears t o argue t hat t he r equi r ementst ems f r om sect i on 1133, whi ch r equi r es "ever y empl oyee benef i tpl an" to pr ovi de cl ai ms pr ocedur es. I d. 1133. I t i s not at al l

cl ear t hat t he t ext of t hi s pr ovi si on i s best r ead t o mandat e abenef i t pl an t o set f or t h i t s cl ai ms pr ocedur es i n t he wr i t t eni nst r ument . But t hat i s of no moment her e. Because we concl udet hat t he wr i t t en i nst r ument i n t hi s case i ncl udes t he r el evantpr ocedur e, we do not need t o deci de whether ERI SA r equi r ed t hat i tdo so, l et al one whi ch pr ovi si on of ERI SA, si ngl y or i ncombi nat i on, mi ght suppor t such an argument .

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of t he [ Li mi t ed Long Ter m Di sabi l i t y] Pr ogr am as set f or t h i n"

anot her document . Thi s ot her document i s the summary pl an

descr i pt i on f or t he 2005 ver si on of t he benef i t pl an, and i t i s

t hi s document t hat expr essl y set s f or t h t he benef i t pl an' s cl ai ms

pr ocedur es, i ncl udi ng t he 180- day appeal s deadl i ne. 2

Agai nst t hi s backgr ound, t he quest i on we must deci de i s

a st r ai ght f orward one of l aw t hat we r evi ew de novo, Or ndor f v.

Paul Rever e Li f e I ns. Co. , 404 F. 3d 510, 516- 17 ( 1st Ci r . 2005) :

does ERI SA per mi t t he benef i t pl an t o i ncor por at e the appeal s

deadl i ne i nt o t he wr i t t en i nst r ument t hr ough t he 2005 summary pl an

descr i pt i on? I f so, t hen t he wr i t t en i nst r ument cont ai ns t he ver y

t er m Tet r eaul t says i t omi t s.

Backgr ound l egal pr i nci pl es st r ongl y suggest t hat such

expr ess i ncor por at i on i s per mi t t ed. The Supr eme Cour t i n Fi r est one

Ti r e & Rubber Co. v. Br uch hel d t hat "est abl i shed pr i nci pl es of

t r ust l aw" ar e r el evant i n const r ui ng ERI SA document s. 489 U. S.

101, 115 ( 1989) . The wr i t t en i nst r ument f or The Li mi t ed Long Ter m

2 Thi s document speci f i es t hat cl ai ms must be sent t o"Met Li f e, " even t hough Rel i ance St andar d by 2009 had assumed t her ol e of admi ni st er i ng cl ai ms f or t he benef i t pl an. But whi l eTet r eaul t t r i es t o at t ach si gni f i cance t o t hi s r ef er ence t oMet Li f e, Tet r eaul t ' s counsel cor r esponded di r ect l y wi t h Rel i anceSt andar d, negat i ng any suggest i on t hat Tet r eaul t was mi sl ed as t o

who t he benef i t pl an' s cl ai ms admi ni st r at or was. Nor di d Tet r eaul tat t empt t o f i l e an appeal wi t h Met Li f e. And Tet r eaul t does notdevel op i n her br i ef , and t hus has wai ved, any ar gument t hat t hi sr ef er ence t o Met Li f e r ender ed t he appeal s deadl i ne unenf or ceabl e.See Har r on v. Town of Fr ankl i n, 660 F. 3d 531, 535 n. 2 ( 1st Ci r .2011) ( decl i ni ng t o consi der "per f unct ory ar gument s" made wi t houtci t at i ons or f act s) .

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Di sabi l i t y Pr ogr am i dent i f i es Ohi o l aw as t he r el evant st at e l aw

f or const r ui ng i t , and we t hus l ook t o t hat st at e' s t r ust l aw f or

gui dance on t hi s i ssue. I n Ohi o, "[ i ] nt er pr et i ng a t r ust i s aki n

t o i nt er pr et i ng a cont r act , " Ar not t v. Ar not t , 972 N. E. 2d 586, 590

( Ohi o 2012) , so we t r eat Ohi o' s cont r act - l aw r ul es as i nst r uct i ve

her e. And what we f i nd i s, not sur pr i si ngl y, t hat , "[ i ] n Ohi o,

under gener al pr i nci pl es of cont r act l aw, separat e agr eement s may

be i ncor por at ed by r ef er ence i nt o a si gned cont r act . " KeyBank

Nat ' l Ass' n v. Sw. Gr eens of Ohi o, LLC, 988 N. E. 2d 32, 39 ( Ohi o Ct .

App. 2013) ; cf . Nash v. Tr s. of Bos. Uni v. , 946 F. 2d 960, 967 ( 1st

Ci r . 1991) ( f ol l owi ng "Massachuset t s cont r act pr i nci pl es gover ni ng

f r aud i n t he i nducement [ as] an appr opr i at e model f r om whi ch t o

f ashi on f eder al common l aw pr i nci pl es" appl i cabl e under ERI SA) .

As a gener al mat t er , ERI SA does not hi ng to di st ur b these

backgr ound l egal r ul es per mi t t i ng i ncor por at i on by ref er ence.

ERI SA cer t ai nl y per mi t s mor e t han one document t o make up a benef i t

pl an' s r equi r ed wr i t t en i nst r ument . See Wi l son v. Moog Aut o. , I nc.

Pensi on Pl an, 193 F. 3d 1004, 1008- 09 ( 8t h Ci r . 1999) ( where t he

"Pensi on Pl an expl i ci t l y r ef er s t o, and at t empt s t o i ncor por at e" a

separ at e document , t hat document " i s a pl an document " t hat "cannot

be i gnor ed" and "i t i s not t r ue . . . t hat t he wr i t t en i nst r ument

ERI SA r equi r es i s t he Pensi on Pl an al one") ; Hor n v. Ber don, I nc.

Def i ned Benef i t Pensi on Pl an, 938 F. 2d 125, 127 ( 9t h Ci r . 1991)

( accept i ng "document s cl ai med t o col l ect i vel y f or m t he empl oyee

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benef i t pl an" even i f not f or mal l y l abel ed as a "wr i t t en

i nst r ument ") ; cf . Fent on v. J ohn Hancock Mut . Li f e I ns. Co. , 400

F. 3d 83, 88- 89 ( 1st Ci r . 2005) ( di scussi ng t he need t o i dent i f y

whi ch "document s and i nst r ument s" set f or t h t he ter ms of t he pl an,

al t hough concl udi ng on t he f act s t hat onl y one document di d) . And,

at l east pr i or t o t he Supr eme Cour t ' s deci si on i n CI GNA Cor p. v.

Amara, 131 S. Ct . 1866 ( 2011) , cour t s r egul ar l y concl uded t hat

ERI SA al so count ed summary pl an descr i pt i ons as bei ng among t he

document s t hat coul d make up a benef i t pl an' s wr i t t en i nst r ument .

See Pet t away v. Teachers I ns. & Annui t y Ass ' n of Am. , 644 F. 3d 427,

434 ( D. C. Ci r . 2011) ( ci t i ng cases) .

The onl y possi bl e concer n wi t h t he wr i t t en i nst r ument ' s

expr ess i ncor por at i on of t he summar y pl an descr i pt i on i n t hi s case,

t hen, ar i ses f r om some l anguage i n t he Supr eme Cour t ' s deci si on i n

Amara t hat dr ew di st i nct i ons bet ween summary pl an descr i pt i ons and

wr i t t en i nst r ument s. 131 S. Ct . at 1877- 78. Amar a expl ai ned t hat

a summar y pl an descr i pt i on i s, l i ke a pl an' s wr i t t en i nst r ument , a

cr eat ur e of ERI SA. I d. ( ci t i ng 29 U. S. C. 1022) . And Amar a

emphasi zed t hat ERI SA di st i ngui shes between these two t ypes of

document s as t o bot h t hei r or i gi ns and t hei r f unct i ons.

As t o the t wo types of document s' or i gi ns, Amara sai d t he

di st i nct i on ar i ses because, under ERI SA, t he benef i t pl an' s sponsor

creat es t he wr i t t en i nst r ument t hat est abl i shes t he benef i t pl an

and set s f or t h i t s t er ms, whi l e a di f f er ent ent i t y, t he benef i t

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pl an' s admi ni st r at or , t ypi cal l y wr i t es t he summar y pl an

descr i pt i on. I d. Amar a observed t hat , i n consequence, maki ng t he

summary pl an descr i pt i on aut omat i cal l y bi ndi ng woul d "mi x [ t hose]

r esponsi bi l i t i es by gi vi ng t he admi ni st r at or t he power t o set pl an

t er ms i ndi r ect l y by i ncl udi ng t hem i n t he summar y pl an

descr i pt i on. " I d. at 1877. Gi vi ng t he admi ni st r at or such power ,

Amar a sai d, mi ght al l ow t he pl an admi ni st r at or t o ci r cumvent t he

wr i t t en i nst r ument ' s r equi r ed "' pr ocedur e' f or maki ng amendment s. "

I d.

As t o t he t wo t ypes of document s' f unct i ons, Amara

expl ai ned t hat t he summar y pl an descr i pt i on i s i nt ended t o gi ve

benef i ci ar i es a reader - f r i endl y account of t he t er ms t hat t he

wr i t t en i nst r ument est abl i shes. I d. at 1877- 78. Thus, Amar a

st at ed, summar y pl an descr i pt i ons " do not t hemsel ves const i t ut e t he

t er ms of t he pl an. " I d. at 1878. Amar a f ur t her expl ai ned t hat t he

"synt ax" of t he st at ut or y pr ovi si on t hat r equi r es summar y pl an

descr i pt i ons t o descr i be r i ght s "' under t he pl an[ ] ' suggest s t hat

t he i nf or mat i on about t he pl an pr ovi ded by t hose di scl osur es i s not

i t sel f par t of t he pl an. " I d. at 1877 ( ci t i ng 29 U. S. C.

1022( a) ) .

Tet r eaul t sei zes on Amar a' s descr i pt i on of t hese

di st i nct i ons t o ar gue t hat The Li mi t ed Long Ter m Di sabi l i t y

Progr am' s at t empt t o i ncorporate t he summary pl an descr i pt i on i nt o

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t he wr i t t en i nst r ument was i mpermi ss i bl e. But Amara does not

suppor t Tet r eaul t ' s cont ent i on.

The probl em f or Tet r eaul t i s t hat Amar a di d not concer n

a case of expr ess i ncor por at i on at al l . I nst ead, i t concer ned a

case i n whi ch t he wr i t t en i nst r ument f or t he benef i t pl an at i ssue

was si l ent as t o t he si gni f i cance of t he l anguage set f or t h i n t he

benef i t pl an' s summar y pl an descr i pt i on. Amar a t hus hel d onl y t hat

t er ms f r om summar y pl an descr i pt i ons shoul d not "necessari l y . . .

be enf or ced" as t er ms of t he benef i t pl an, and t he Cour t set f or t h

t he di st i nct i ons i t i dent i f i ed bet ween wr i t t en i nst r ument s and

summar y pl an descr i pt i ons sol el y i n suppor t of t hat concl usi on.

I d. ( emphasi s added) . Amara, i n other words, si mpl y di d not

addr ess whether summary pl an descr i pt i on t erms coul d be enf orced

when t he wr i t t en i nst r ument expr essl y i ndi cat ed t hat t hey shoul d

be.

Amar a' s si l ence on t hat poi nt i s what mat t er s f or our

pur poses. For whi l e i t i s t r ue t hat , st andi ng al one, a document

t hat mer el y advi ses par t i ci pant s and benef i ci ar i es of "t hei r r i ght s

and obl i gat i ons ' under t he pl an' " does not i t sel f creat e r i ght s and

dut i es, i d. , t hat may change when t he document t hat unquest i onabl y

does cr eate such r i ght s and dut i es - - namel y, t he document t hat

ERI SA cal l s t he "wr i t t en i nst r ument " - - expr essl y st at es t hat t he

l anguage i n t he advi sor y document does t oo. I t i s not sur pr i si ng,

t her ef or e, t hat ever y cour t t hat has consi der ed t he i ssue has hel d

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t hat Amara poses no aut omat i c bar t o a wr i t t en i nst r ument ' s expr ess

i ncor por at i on of t er ms cont ai ned i n a summar y pl an descr i pt i on.

See, e. g. , Eugene S. v. Hor i zon Bl ue Cr oss Bl ue Shi el d of N. J . , 663

F. 3d 1124, 1131 ( 10t h Ci r . 2011) ; Langl oi s v. Met r o. Li f e I ns. Co. ,

833 F. Supp. 2d 1182, 1185- 86 (N. D. Cal . 2011) ; Henderson v.

Har t f ord Li f e & Acci dent I ns. Co. , No. 2: 11CV187, 2012 WL 2419961,

at *5 ( D. Ut ah J une 26, 2012) . 3

Of cour se, i t i s possi bl e t hat , even t hough gener al l y

per mi ssi bl e, t he wr i t t en i nst r ument ' s expr ess i ncor por at i on of t he

t er ms of a summar y pl an descr i pt i on coul d i n cer t ai n appl i cat i ons

r ai se concerns under ERI SA. For exampl e, such expr ess

i ncor por at i on mi ght i n some cases rai se concer ns t hat a "pl an' s

admi ni st r at or " - - r at her t han a "pl an' s sponsor " - - had changed t he

t er ms of t he wr i t t en i nst r ument t hr ough i t s r evi si on of t he

expr essl y i ncor por at ed summar y pl an descr i pt i on af t er t he t i me at

whi ch t he summary had been f i r st i ncorporat ed. Amara, 131 S. Ct .

at 1877. But t hat possi bi l i t y does not provi de a r eason t o

pr ohi bi t expr ess i ncor por at i on of t he summar y pl an descr i pt i on i n

al l cases, as t he expr ess i ncor por at i on i nvol ved i n t hi s case

demonst r ates. The wr i t t en i nst r ument i n t hi s case i ncor por at ed t he

t er ms set f or t h i n t he 2005 summary pl an descr i pt i on, and t he

summar y pl an descr i pt i on t er m at i ssue her e - - t he deadl i ne - - was

3 I n Pet t away, i ssued onl y t wo mont hs af t er Amara, t he D. C.Ci r cui t r eached t he same hol di ng wi t hout addr essi ng Amar a at al l .644 F. 3d 427.

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not subsequent l y r evi sed. Thus, t her e i s no concer n - - nor any

cont ent i on by Tet r eaul t - - t hat t he i ncor por at i on i n t hi s case

r esul t ed i n t he r evi si on of t he r el evant par t s of t he wr i t t en

i nst r ument t hr ough some means t hat ERI SA mi ght pr ohi bi t .

Si mi l ar l y, t hi s case shows t her e i s no r eason t o wor r y

t hat , i n consequence of expr ess i ncorporat i on, t he summary pl an

descri pt i on wi l l necessar i l y f ai l t o "descri be pl an t er ms" i n t he

"cl ear , si mpl e communi cat i on" t hat ERI SA i nt ends f or such summary

document s. I d. at 1877- 78. That i s because t he i ncor por at i on i n

t hi s case concer ns a par t i cul ar t ype of t er m - - a deadl i ne f or

maki ng an i nt er nal appeal - - whi ch by r egul at i on t he summary pl an

descr i pt i on must not mer el y summar i ze, but i nst ead must set f or t h

i n f ul l . 29 C. F. R. 2520. 102- 3( s) ( r equi r i ng t hat " t he pr ocedur es

gover ni ng cl ai ms f or benef i t s, " i ncl udi ng "appl i cabl e t i me l i mi t s, "

be i ncl uded i n t he summary pl an descr i pt i on) . And t he summary pl an

descri pt i on at i ssue her e di d exact l y t hat i n set t i ng f or t h t he

180- day deadl i ne.

Our hol di ng i s a nar r ow one. We do not deci de t hat

cl ai ms procedur es must be i ncl uded i n a benef i t pl an' s wr i t t en

i nst r ument . Nor do we addr ess i ssues not pr esent ed i n t hi s case

but t hat , i n t heor y, mi ght ar i se f r om t he expr ess i ncor por at i on of

a summary pl an descr i pt i on. We deci de onl y t hat a benef i t pl an may

expr essl y i ncor por at e i t s i nt er nal appeal s deadl i ne i nt o t he

wr i t t en i nst r ument t hr ough a summary pl an descr i pt i on and t hat ,

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when a benef i t pl an does so, a benef i ci ar y' s f ai l ur e t o meet t hat

deadl i ne may bar her at t empt t o chal l enge an adver se benef i t

deci si on i n cour t . Havi ng deci ded t hat much, t hough, we have

necessar i l y deci ded an i mpor t ant i ssue i n t hi s appeal : Tet r eaul t ' s

pr i mar y ar gument f or excusi ng her f ai l ur e t o compl y wi t h t he

i nt er nal appeal s deadl i ne must f ai l . 4

I I I .

I n an at t empt t o over come t hi s obst acl e, Tet r eaul t ar gues

i n t he al t er nat i ve t hat she di d not have t o f ol l ow t he cl ai ms

pr ocedur es set f or t h i n t he 2005 ver si on of t he benef i t pl an at

al l . She ar gues she needed t o f ol l ow onl y t he pr ocedur es set f or t h

i n t he 1998 ver si on. And because, as al l par t i es agr ee, t he

wr i t t en i nst r ument f or t he 1998 ver si on nei t her cont ai ned nor

i ncor por at ed t he i nt er nal appeal s deadl i ne, Tet r eaul t cont ends we

4

Tet r eaul t ar gues hal f - hear t edl y t hat she act ual l y di d compl ywi t h t he deadl i ne because her counsel ' s J une 15t h l et t er st at i ngt hat she "w[ oul d] be appeal i ng" " ar guabl y" was suf f i ci ent t o br i ngher i nt o compl i ance wi t h t he r equi r ement t hat she "not i f y t hecl ai ms admi ni st r at or i n wr i t i ng wi t hi n 180 days of r ecei vi ng t hedet er mi nat i on. " The cl ai ms pr ocedur es f ur t her r equi r e, however ,t hat t he wr i t t en not i ce speci f y "[ t ] he r eason you bel i eve t he cl ai mshoul d be pai d" and pr ovi de " [ d] ocument s, r ecords or otheri nf or mat i on t o suppor t your appeal . " The l et t er f r om Tet r eaul t ' scounsel pr ovi ded no such i nf ormat i on, and Tet r eaul t does notaddr ess i t s absence i n her br i ef , nor does she el abor at e on her"ar gu[ ment ] " i n t hi s r egar d beyond si mpl y st at i ng i t . We t hus deem

her ar gument t hat she i n f act met t he 180- day deadl i ne wai ved. SeeHarr on, 660 F. 3d at 535 n. 2. I n addi t i on, because we concl ude t hatThe Li mi t ed Long Term Di sabi l i t y Pr ogram i ncor porat ed t he cl ai mspr ocedur es i nt o i t s wr i t t en i nst r ument , we need not consi derwhether Tet r eaul t woul d have to show t hat she was prej udi ced by t hedeadl i ne' s omi ssi on i n or der t o be excused f or f ai l i ng t o haveappeal ed wi t hi n t he 180- day per i od.

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must f or t hat r eason excuse her f ai l ur e t o f i l e her appeal wi t hi n

t he 180- day per i od. 5

Tet r eaul t bases t hi s ar gument on her cont ent i on t hat The

Li mi t ed Long Ter m Di sabi l i t y Pr ogr am shoul d be est opped f r om

enf or ci ng t he appeal s deadl i ne. She r est s her est oppel cl ai m on

t he f act t hat Rel i ance St andar d di d pr oduce t he wr i t t en i nst r ument

f or t he 1998 ver si on of t he benef i t pl an but f ai l ed t o pr oduce t he

document s concerni ng t he 2005 ver si on of t he benef i t pl an - -

i ncl udi ng the cor r espondi ng summary pl an descr i pt i on - - when her

counsel sent t he J anuary 2009 l et t er r equest i ng "t he Summary Pl an

Descr i pt i on and t he Pl an document s f or t he LTD pl an. "

But even i f such an argument f or est oppel wer e cogni zabl e

under ERI SA, an i ssue we have pr evi ousl y decl i ned t o r each, see

Ci t y of Hope Nat ' l Med. Ct r . v. Heal t hPl us, I nc. , 156 F. 3d 223, 230

n. 9 ( 1st Ci r . 1998) , est oppel woul d not f r ee Tet r eaul t f r om havi ng

t o sat i sf y t he 180- day appeal s deadl i ne. We have pr evi ousl y

5 At or al ar gument , Tet r eaul t f or t he f i r st t i me of f er ed anaddi t i onal argument as t o why t he 1998 ver si on of t he benef i t pl anshoul d cont r ol . She cont ended t hat because her benef i t s "vest ed"under t hat ear l i er ver si on of t he benef i t pl an, she was bound onl yby the pr ocedur es cont ai ned i n t he wr i t t en i nst r ument f or t hatver si on. Ther e i s no Ci r cui t pr ecedent di r ect l y on poi nt , t hought he Thi r d Ci r cui t has expl ai ned i n a di f f er ent cont ext t hat wi t hr espect t o "[ p] r ocedur al pr ovi si ons" of ERI SA pl ans, cour t s "l ook

t o t he pl an i n ef f ect at t he t i me benef i t s wer e deni ed. " Smat her sv. Mul t i - Tool , I nc. / Mul t i - Pl ast i cs, I nc. Emp. Heal t h & Wel f ar ePl an, 298 F. 3d 191, 196- 97 ( 3d Ci r . 2002) . I n any event , Tet r eaul tdi d not r ai se t he ar gument bel ow, or i n her br i ef t o t hi s cour t ,and we t hus consi der i t wai ved. Uni t ed St at es v. Ri char dson, 225F. 3d 46, 52 n. 2 ( 1st Ci r . 2000) ( hol di ng t hat ar gument s present edf or t he f i r st t i me at or al ar gument ar e wai ved) .

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expl ai ned t hat , i f an est oppel cl ai m coul d be r ai sed under ERI SA,

i t woul d r equi r e a showi ng of bot h a "def i ni t e mi sr epr esent at i on of

f act " and r easonabl e r el i ance on t hat mi sr epr esent at i on. See Law

v. Er nst & Young, 956 F. 2d 364, 368 ( 1st Ci r . 1992) . Her e,

however , any r el i ance by Tet r eaul t on t he wr i t t en i nst r ument f or

t he 1998 ver si on of t he benef i t pl an was unr easonabl e.

Rel i ance St andar d war ned Tet r eaul t ' s counsel , t wi ce, t hat

a 180- day i nt er nal appeal s deadl i ne appl i ed t o her case.

Tet r eaul t ' s counsel appar ent l y bel i eved t hat t hi s st at ement

cont r adi ct ed t he benef i t pl an' s wr i t t en i nst r ument , yet he never

asked Rel i ance St andar d about t he i nconsi st ency. I n consi der i ng

est oppel i n anot her cont ext , we have expl ai ned t hat " [ t ] he l aw does

not . . . count enance r el i ance on one of a pai r of cont r adi ct or i es

si mpl y because i t f aci l i t at es t he achi evement of one' s goal . "

Tr i f i r o v. N. Y. Li f e I ns. Co. , 845 F. 2d 30, 34 ( 1st Ci r . 1988) .

I nst ead, when " [ c] onf r ont ed by such conf l i ct [ , ] a r easonabl e per son

i nvest i gat es mat t er s f ur t her . " I d. at 33. Tet r eaul t of f er s no

r eason why t hi s pr i nci pl e shoul d not appl y equal l y i n t hi s case,

par t i cul ar l y wher e she had l egal counsel , and di scer ni ng none

our sel ves, we must r ej ect Tet r eaul t ' s est oppel ar gument .

I V.

Tet r eaul t presses t wo ot her cl ai ms. She f i r st seeks

st atut ory penal t i es of one hundr ed and t en dol l ars per day under 29

U. S. C. 1132( c) ( 1) ( B) . She cl ai ms she i s owed t hose penal t i es

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because of Rel i ance St andar d' s f ai l ur e t o pr ovi de compl et e and

cur r ent copi es of t he "Pl an document s" i n r esponse t o her J anuar y

14, 2009 r equest . She al so seeks t o hol d Rel i ance St andar d l i abl e

f or br each of f i duci ar y dut y f or not pr oduci ng t he document s

concer ni ng t he 2005 ver si on of t he benef i t pl an i n r esponse t o that

r equest . Li ke t he Di st r i ct Cour t , we hol d t hat Tet r eaul t ' s f i r st

cl ai m l acks mer i t and t hat her second cl ai m has been wai ved.

A.

Tet r eaul t bases her cl ai mf or st at ut or y penal t i es agai nst

Rel i ance St andard on t wo pr ovi si ons of ERI SA: 29 U. S. C. 1021( a)

and 1132( c) ( 1) ( B) . They r equi r e t he benef i t pl an' s "admi ni st r at or "

t o pr oduce cer t ai n document s wi t hi n t hi r t y days of a wr i t t en

r equest f r om a benef i ci ar y. See i d. 1132( c) ( 1) ( B) . They al so

i mpose penal t i es of up t o one hundr ed and t en dol l ars per day f or

t he "admi ni st r at or [ ' s] " f ai l ur e t o do so. I d. 1132. 6

Tet r eaul t ar gues t hat Rel i ance St andar d count s as t he

"admi ni st r at or " wi t hi n t he meani ng of t he ERI SA penal t i es

pr ovi si ons because Rel i ance St andard i s The Li mi t ed Long Ter m

Di sabi l i t y Pr ogr am' s "cl ai ms admi ni st r at or . " And she ar gues t hat

Rel i ance St andar d, as t he "admi ni st r at or , " shoul d pay such ERI SA

6 The st at ut e i t sel f pr ovi des f or penal t i es of up t o onehundr ed dol l ars per day, but t he Depart ment of Labor has r ai sed i tt o up t o one hundr ed and t en dol l ars pur suant t o the DebtCol l ect i on I mpr ovement Act of 1996. See Fi nal Rul e Rel at i ng t oAdj ust ment of Ci vi l Monet ar y Penal t i es, 62 Fed. Reg. 40, 696 ( J ul y29, 1997) .

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penal t i es because i t di d not send her bot h t he wr i t t en i nst r ument

est abl i shi ng t he 2005 ver si on of t he benef i t pl an and t he

cor r espondi ng summary pl an descr i pt i on.

But Tet r eaul t i s wr ong to char act er i ze Rel i ance St andar d

as t he "admi ni st r at or " t o whi ch t he st at ut e r ef er s.

"Admi ni st r at or " i s a def i ned t er m under ERI SA. The

"admi ni st r at or , " t he stat ut e t el l s us, i s "( i ) t he per son

speci f i cal l y so desi gnat ed by the t er ms of t he i nst r ument under

whi ch t he pl an i s oper at ed; or ( i i ) i f an admi ni st r at or i s not so

desi gnat ed, t he pl an sponsor ; or ( i i i ) i n t he case of a pl an f or

whi ch an admi ni st r ator i s not desi gnated and a pl an sponsor cannot

be i dent i f i ed, such ot her per son as t he Secr et ar y may by regul at i on

pr escr i be. " I d. 1002( 16) ( A) . When t he wr i t t en i nst r ument does

desi gnat e an "admi ni st r at or , " cour t s of t en r ef er t o i t as t he "pl an

admi ni st r at or . " See, e. g. , Law, 956 F. 2d at 372. That ent i t y i s

a "t r ust ee- l i ke f i duci ar y" r esponsi bl e f or "manag[ i ng] t he pl an. "

Amara, 131 S. Ct . at 1877. And, consi st ent wi t h Amara' s

descri pt i on of t hat st at ut or y r ol e, see i d. , t he 2005 wr i t t en

i nst r ument f or t hi s benef i t pl an desi gnat es a "Pl an Admi ni st r at or "

and gr ant s i t " [ t ] he aut hor i t y t o cont r ol and manage t he oper at i on

and admi ni st r at i on of t he [ Long Ter m Di sabi l i t y] Pr ogr am. " The

r ecor d does not concl usi vel y est abl i sh who t hat "Pl an

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Admi ni st r at or " i s, but t he par t i es agr ee t hat t he wr i t t en

i nst r ument does not desi gnate Rel i ance St andard as such. 7

The 2005 wr i t t en i nst r ument does r ef er t o a "Cl ai ms

Admi ni st r at or , " and t hat i s t he r ol e Rel i ance St andar d f i l l ed. But

t he "Cl ai ms Admi ni st r at or " i s not t asked i n t he wr i t t en i nst r ument

wi t h "manag[ i ng] " t he Pr ogr am as a whol e. I d. I nst ead, t he

wr i t t en i nst r ument pr ovi des t hat t he "Cl ai ms Admi ni st r at or , " who i s

sel ect ed by t he "Pl an Admi ni st r at or , " i s aut hor i zed onl y t o

"r ecei ve, r evi ew and pr ocess cl ai ms f or Progr am benef i t s. " For

t hi s r eason, t he wr i t t en i nst r ument does not desi gnat e Rel i ance

St andar d t o be t he "admi ni st r at or " t o whi ch t he penal t i es

pr ovi si ons i n ERI SA r ef er , and Rel i ance St andar d i s t hus not

subj ect t o st at ut or y penal t i es under 29 U. S. C. 1132( c) ( 1) ( B) .

To avoi d t hi s r esul t , Tet r eaul t ar gues t hat Rel i ance

St andar d shoul d be t r eat ed as t he "admi ni st r ator " despi t e t he

wr i t t en i nst r ument ' s cont r ar y desi gnat i on. And she bases t hat

argument on her cont ent i on t hat Rel i ance St andard act ed as t he de

f act o "admi ni st r at or " when i t r esponded t o the r equest f or benef i t

pl an document s Tet r eaul t ' s counsel sent i n J anuar y of 2009.

7 The 2005 wr i t t en i nst r ument pr ovi des t hat t he "Pl anAdmi ni st r at or " "means t he Pl an Admi ni st r at or under t he Heal t hBenef i t s Pl an, " and t he "Heal t h Benef i t s Pl an" document i s not i nt he r ecord. The 2005 summary pl an descr i pt i on, however , l i st s"Li mi t ed Br ands, I nc. Wel f ar e Benef i t s Pl an Assoc. Benef i t sCommi t t ee" as t he "Pl an Admi ni st r ator , " and Tet r eaul t does notcont est t he accur acy of t hat i dent i f i cat i on.

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To make t hi s ar gument , Tet r eaul t r el i es on t hi s Ci r cui t ' s

deci si on i n Law. But Law does not hel p Tet r eaul t . I n Law, t he

cl ai mant asked f or benef i t pl an document s f r omhi s f ormer empl oyer

r at her t han f r om hi s f or mer empl oyer ' s r et i r ement commi t t ee.

Cont endi ng t he f or mer empl oyer di d not make an adequat e response,

t he cl ai mant t hen sought st atut or y penal t i es agai nst t he f or mer

empl oyer , even t hough t he wr i t t en i nst r ument f or t he benef i t pl an

desi gnated t he r et i r ement commi t t ee as t he "admi ni st r ator . " Law,

956 F. 2d at 372. The Cour t hel d t hat t he empl oyer ( r ather t han t he

r et i r ement commi t t ee) was t he de f acto "admi ni st r ator" under ERI SA

not onl y because t he empl oyer r esponded t o t he cl ai mant ' s r equest ,

but al so because t her e was ot her evi dence t hat t he empl oyer i n f act

cont r ol l ed t he r et i r ement commi t t ee. I d. at 373. And, on t hat

basi s, t he Cour t hel d t he empl oyer was subj ect t o penal t i es even

t hough t he wr i t t en i nst r ument di d not desi gnat e i t as t he

"admi ni st r at or . " I d.

I n so hol di ng, however , Law was car ef ul t o di st i ngui sh

t he case bef or e i t , whi ch i nvol ved an empl oyer wi t h "l i t t l e, i f

any, separ at e i dent i t y" f r omt he i nt er nal r et i r ement commi t t ee t hat

had been desi gnat ed as t he "pl an admi ni st r at or , " f r om cases

i nvol vi ng "at t empt s t o r ecover agai nst ent i t i es whi ch wer e cl ear l y

di st i nct f r om t he pl an admi ni st r at or . " I d. at 374. And t hi s same

di st i nct i on t akes car e of Tet r eaul t ' s ar gument her e. Tet r eaul t

seeks penal t i es f r om an ent i t y - - Rel i ance St andar d - - t hat i s

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ent i r el y separ at e f r om t he expr essl y desi gnat ed "admi ni st r at or . "

For t hat r eason, t he mer e f act t hat Rel i ance St andard r esponded t o

a l et t er seeki ng document s r el evant t o t he benef i t pl an does not

make Rel i ance St andard t he de f acto "admi ni st r ator . " We t hus

af f i r m t he Di str i ct Cour t i n di smi ssi ng Tet r eaul t ' s st at ut or y

penal t i es cl ai m.

B.

Fi nal l y, Tet r eaul t cont ends Rel i ance St andar d br eached

i t s f i duci ar y dut y t o her when i t pr oduced onl y t he wr i t t en

i nst r ument f or t he 1998 ver si on of t he benef i t pl an i n response t o

her 2009 r equest f or t he "Pl an document s. " I n suppor t of t hi s

ar gument , Tet r eaul t ar gues t hat ERI SA f i duci ar i es have a dut y t o

"speak the t r ut h" t o pl an benef i ci ar i es, see Var i t y Cor p. v. Howe,

516 U. S. 489, 506 ( 1996) , and t hat Rel i ance St andard br eached t hat

dut y by sendi ng onl y t he document t hat est abl i shed t he 1998 ver i son

of t he benef i t pl an and not t he document s t hat concerned t he 2005

ver si on. But t hi s cl ai m i s not pr oper l y bef or e us.

The Di st r i ct Cour t f ound t hat Tet r eaul t f ai l ed t o i ncl ude

t hi s cl ai m i n her second amended compl ai nt , and t hen deni ed

Tet r eaul t ' s mot i on t o amend her compl ai nt a t hi r d t i me t o add i t .

Because Tet r eaul t advances no ar gument f or r ej ect i ng t he Di st r i ct

Cour t ' s det er mi nat i on of wai ver , nor any reason f or concl udi ng t he

Di st r i ct Cour t abused i t s di scret i on i n decl i ni ng t o per mi t her t o

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amend her compl ai nt , we af f i r m t he di smi ssal of any separ at e

f i duci ar y dut y cl ai m Tet r eaul t advances.

V.

We concl ude t hat Tet r eaul t f ai l ed t o meet a deadl i ne f or

appeal i ng i nt er nal l y t he deci si on t o cut of f her l ong- t er m

di sabi l i t y benef i t s. We f ur t her concl ude t hat her benef i t pl an had

expr essl y i ncor por at ed t hat deadl i ne i nt o t he benef i t pl an' s

wr i t t en i nst r ument . On t hat basi s, we af f i r m t he Di st r i ct Cour t ' s

di smi ssal of her benef i t s chal l enge. We al so concl ude t he Di st r i ct

Cour t di d not er r i n r ul i ng t hat Tet r eaul t coul d not r ecover

st at ut or y penal t i es agai nst Rel i ance St andar d or t hat she had

wai ved her cl ai m f or br each of f i duci ar y dut y. Accor di ngl y, we

af f i r m t he Di st r i ct Cour t ' s di smi ssal of t hose cl ai ms as wel l .

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Tetreault v. Reliance Standard Life Ins., 1st Cir. (2014)

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Transcript of Tetreault v. Reliance Standard Life Ins., 1st Cir. (2014)