The opinion
Case: 20-10994 Document: 00516209171 Page: 1 Date Filed: 02/18/2022
United States Court of Appeals
for the Fifth Circuit United States Court of Appeals
Fifth Circuit
FILED
February 18, 2022
No. 20-10994
Lyle W. Cayce
Clerk
James W. Newsom,
Plaintiff—Appellee,
versus
Reliance Standard Life Insurance Company,
Defendant—Appellant.
consolidated with
_____________
No. 21-10519
_____________
James W. Newsom,
Plaintiff—Appellee,
versus
Reliance Standard Life Insurance Company,
Defendant—Appellant.
Appeals from the United States District Court
for the Northern District of Texas
USDC No. 3:19-CV-1446
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Before Higginbotham, Stewart, and Wilson, Circuit Judges.
Cory T. Wilson, Circuit Judge:
This is an Employee Retirement Income Security Act (ERISA) case.
Lereta, LLC maintained an ERISA-governed benefits plan that provided
short-term disability (STD) and long-term disability (LTD) to its employees,
including James W. Newsom. Reliance Standard Life Insurance Company
issued the policies that funded these benefits and served as the benefits
claims administrator. Newsom filed this suit following Reliance’s
determination that he was ineligible for LTD benefits. The parties agreed to
a trial upon submission of documentary evidence but disagreed upon the
issues properly before the district court. The district judge entered an order
in favor of Newsom, both finding that he was eligible for LTD benefits and
awarding them. Reliance appealed.
We affirm the judgment of the district court as to Newsom’s eligibility
for LTD benefits and alleged date of disability. But we vacate the judgment
as to Newsom’s entitlement to LTD benefits and remand with instructions
for the district court to remand Newsom’s claim to the administrator for
further proceedings consistent with this opinion.
I.
In 2017, Newsom worked as a software architect for Lereta, where he
had been employed for 23 years. He had health problems dating back to 1999,
including chronic fatigue syndrome, fibromyalgia, depression, and attention
deficit hyperactivity disorder. By September 2017, his health deteriorated to
the point that he could no longer work a 40-hour week. Lereta reduced
Newsom’s scheduled work week to 32 hours (eight hours per day, Monday
through Thursday), which was still considered full time. But Newsom was
unable consistently to work even a full 32-hour week. He was last scheduled
2
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to work 32 hours the week of October 16–20, 2017. Thereafter, Lereta placed
Newsom on part-time status, scheduling him for less than 30 hours per week.
Newsom continued to work part time until January 30, 2018, when he became
unable to work at all.
On February 22, 2018, Newsom submitted an Initial Statement of
Claim for STD benefits to Reliance. Reliance did not receive that paperwork,
so he resubmitted it on March 23, 2018. On the claim form, Newsom listed
his last day of work as January 30, 2018, and noted that he was “first unable
to work because of [his] disability” on January 29, 2018. Newsom’s treating
physician likewise indicated that Newsom became “continuously unable to
work” on January 29, 2018. However, Newsom’s physician also estimated
that he would be able to return to work by August 1, 2018. Lereta indicated
on the claim form that Newsom had worked four days per week for seven
hours per day (28 hours/week) before he stopped working altogether.
Based on this information, Reliance initially denied Newsom’s STD
claim, referencing January 31, 2018, as the date of loss and noting that Lereta
indicated Newsom had been working only 28 hours per week prior to that
date, meaning he did not qualify as a full-time active employee and thus did
not qualify for benefit coverage. Citing the termination language in the STD
policy, Reliance explained that Newsom was no longer “eligible” for
coverage because he was not working “full time” prior to becoming disabled.
Certain provisions of the applicable Reliance policies 1 are particularly
pertinent to Newsom’s claim and Reliance’s evaluation of it, as they set forth
who was eligible for benefits and defined covered disabilities:
1
The provisions are excerpted from Reliance’s LTD policy. Reliance’s STD
policy is substantially similar; however, its definition of “Partially Disabled” is distinct
from that in the LTD policy, in that the STD policy defines the term as “the Insured is
3
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ELIGIBLE CLASSES: Each active, Full-time employee of
LERETA, . . . effective November 1, 2015, as amended through
January 1, 2018, except any person employed on a temporary
or seasonal basis . . . .
...
“Full-time” means working for you for a minimum of 30 hours
during a person’s regular work week.
...
“Totally Disabled” and “Total Disability” mean, that as a
result of an Injury or Sickness:
(1) during the Elimination Period and for the first 24
months for which a Monthly Benefit is payable, an
Insured cannot perform the material duties of his/her
Regular Occupation;
(a) “Partially Disabled” and “Partial Disability”
mean that as a result of an Injury or Sickness an
Insured is capable of performing the material
duties of his/her Regular Occupation on a part-
time basis or some of the material duties on a full-
time basis. An Insured who is Partially Disabled
will be considered Totally Disabled, except
during the Elimination Period;
(b) “Residual Disability” means being Partially
Disabled during the Elimination Period. Residual
Disability will be considered Total Disability;
and
(2) after a Monthly Benefit has been paid for 24 months,
an Insured cannot perform the material duties of Any
Occupation. We consider the Insured Totally Disabled
if due to an Injury or Sickness he or she is capable of only
unable to perform the material duties of his/her own job and is under the regular care of a
Physician.”
4
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performing the material duties on a part-time basis or
part of the material duties on a full-time basis.
...
TERMINATION OF INDIVIDUAL INSURANCE: The
insurance of an Insured will terminate on . . . the date the
Insured ceases to meet the Eligibility Requirements . . . .
(Emphasis added). Critically for this case, the policies did not define
“regular work week.”
Relying on these policy provisions, Newsom appealed Reliance’s
initial denial of his STD claim, contending that Reliance had incorrectly
determined his date of “disability,” i.e., when Newsom could no longer
“perform the material duties of his/her regular [o]ccupation.” He asserted
the true date of disability occurred the week of October 16, 2017—his last
scheduled 32-hour work week—because his disability required him to work a
reduced schedule (28 hours/week) after that week. Newsom further
contended that the number of hours that he actually worked per week was
irrelevant because his “regular” work week, i.e., his schedule set by Lereta,
was full time (30+ hours/week) through the week of October 16, 2017. Upon
further review, Reliance’s STD claim examiner agreed, determining that
Newsom’s date of disability was October 23, 2017. Reliance thus paid
Newsom STD benefits for the 26-week maximum STD benefit period
(October 30, 2017 (Newsom’s eighth day of disability, per the terms of the
policy) to April 30, 2018). 2
Newsom also applied for LTD benefits. But Reliance’s LTD
examiner denied Newsom’s claim. As with Newsom’s initial STD denial,
the LTD examiner determined that Newsom’s date of disability was January
2
Newsom received partial disability benefits from October 30, 2017 to January 29,
2018, when he became unable to work at all. He received full STD benefits thereafter.
5
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31, 2018, and that because Newsom did not work at least a 30-hour week (i.e.,
full time) in the weeks prior to that date, he was ineligible for LTD benefits.
Newsom appealed the denial, but unlike his STD appeal, Reliance affirmed
its decision to deny Newsom LTD benefits.
Newsom then filed this action, challenging Reliance’s denial of LTD
benefits under 29 U.S.C. § 1132(a)(1)(B) of ERISA. He also sought to
recover attorneys’ fees and costs pursuant to § 1132(g). In his complaint,
Newsom contended that Reliance’s interpretation of the “full-time”
provision in its LTD policy was unreasonable because an employee would fall
in and out of coverage based on the number of hours that employee actually
worked each week. The parties agreed to a trial upon submission of
documentary evidence, 3 and the district court ruled for Newsom, concluding
that Reliance erroneously denied Newsom LTD benefits.
The district court’s holding rested on its interpretation of the term
“regular work week” as used in the definition of “full-time” in the LTD
policy. The district court agreed with Newsom that “regular work week”
essentially meant “normal, ordinary, standard work week” or “scheduled
work week” and disagreed with Reliance’s view that “actual hours worked”
were determinative. To arrive at this conclusion, the district court
conducted a textual analysis of the word “regular” using the Oxford English
Dictionary definition (“Having the usual, typical, or expected attributes,
qualities, parts, etc.; normal, ordinary, standard.”) as well as the Merriam-
Webster dictionary definition (“normal, standard”).
The court noted several advantages to its “scheduled work week”
definition, including that “it removes minor variations in actual hours
worked from the eligibility determination and makes eligibility more
3
This included the administrative record as well as trial briefing by the parties.
6
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predictable and ascertainable.” Along these same lines, the court concluded
that it “leaves the employer in control over which employees are full time
and which are part time.” Applying its definition, the district court
determined that because Newsom was scheduled to work 32-hour weeks
through the week of October 16, 2017, 4 he was a full-time employee for the
purposes of the LTD policy regardless of whether he actually worked more
than 30 hours each of those weeks.
The district court next resolved Newsom’s date of disability.
Newsom, consistent with the STD claim examiner, asserted that his date of
disability was October 23, 2017. Reliance and the LTD claim examiner
disagreed, asserting that Newsom’s date of disability was January 31, 2018—
the day after Newsom became unable to work at all. The district court again
agreed with Newsom, finding that as of October 23, 2017, “Newsom was
unable to perform the material duties of his job on a full time basis,” and
concluded Newsom was therefore partially disabled as of that date. 5 Based
on these findings, the court without further analysis concluded “that the
undisputed record show[ed] that Newsom is disabled and entitled to [LTD]
benefits in the amount of $194,290.72.”
Reliance timely appealed, contending (1) the district court erred in its
interpretation of “regular work week” under the LTD policy, rendering its
determination that Newsom was eligible for LTD benefits erroneous; (2) the
district court erred in finding October 23, 2017, as Newsom’s date of
4
The district court explained that although “the exact date is unclear[,]” “Lereta
placed Newsom on part-time status (scheduled <30 hours per week) on or around October
23, 2017.”
5
The court was also persuaded by Reliance’s own determination that, for his STD
claim, October 23, 2017 was Newsom’s date of disability. The court concluded that based
on the record, “it [wa]s undisputed that Newsom was partially disabled beginning October
23, 2017, and totally disabled beginning January 31, 2018.”
7
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disability; and (3) even if the district court was correct in finding that
Newsom was eligible for benefits, it should have remanded the claim back to
Reliance for an analysis of whether Newsom was disabled. We address these
issues in turn.
II.
We “review de novo a nondiscretionary denial of benefits challenged
under ERISA, regardless of whether the denial is based on factual
determinations or interpretation of the plan’s language.” Miller v. Reliance
Standard Life Ins. Co., 999 F.3d 280, 283 (5th Cir. 2021). Notwithstanding,
the parties disagree as to how we should review the district court’s factual
findings made after trial of Newsom’s claim on the documentary record.
Newsom asserts that under Federal Rule of Civil Procedure 52(a), the district
court’s findings “must not be set aside unless clearly erroneous.” Reliance,
on the other hand, asserts that there are no Fifth Circuit decisions that
discuss the standard of this court’s factual review since Ariana M., which
overturned prior precedent and held that the district court should apply de
novo review even “when [a plan administrator’s] denial is based on a factual
determination.” Ariana M. v. Humana Health Plan of Texas, Inc., 884 F.3d
246, 256 (5th Cir. 2018) (en banc). Reliance also refers us to Pike v. Hartford
Life and Accident Insurance Co., 368 F. Supp. 3d 1018 (E.D. Tex. 2019), a case
that surveyed other circuits and applied de novo review of the ERISA claim in
its entirety, including a factual review. But as Reliance’s own brief concedes,
Ariana M. refers to a district court’s review of an administrator’s factual
findings, not to our review of the district court’s factual findings.
Accordingly, we will not set aside the district court’s factual findings unless
they are clearly erroneous. Fed. R. Civ. P. 52(a)(6).
8
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III.
A.
Reliance first contends that the district court erred in its interpretation
of “regular work week” under the LTD policy. We disagree. In fact, we
need not tarry long on this question because this court effectively answered
it in Miller, see 999 F.3d at 285.
“When construing ERISA plan provisions, courts are to give the
language of an insurance contract its ordinary and generally accepted
meaning if such a meaning exists.” Id. at 283 (quoting Green v. Life Ins. Co.
of North America, 754 F.3d 324, 331 (5th Cir. 2014)). “We apply the rule
of contra proferentem to ambiguous terms—construing them strictly in favor
of the insured—but ‘[o]nly if the plan terms remain ambiguous after applying
ordinary principles of contract interpretation.’” Id. (quoting Ramirez v.
United of Omaha Life Ins. Co., 872 F.3d 721, 725 (5th Cir. 2017)).
In Miller, we reviewed the same Reliance policy language at issue here
and agreed with the Sixth Circuit that the term “full time” and its reference
to a “regular work week,” as set forth in the policy’s “eligible class”
provision, is ambiguous and should thus be interpreted in favor of the insured
pursuant to the rule of contra proferentem. Id. at 285; see also Wallace v.
Oakwood Healthcare, Inc., 954 F.3d 879, 894 (6th Cir. 2020) (construing
Reliance’s policy language). Following Miller, we again reject Reliance’s
assertion that “regular work week” has an unambiguous, narrow meaning:
namely, the “hours actually worked.” And, mindful of the rule that
ambiguous language must be construed in favor of the insured, we conclude
that the district court did not err by interpreting the term “full time” and its
reference to a “regular work week” to mean the “scheduled work week” set
by Lereta for Newsom.
9
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B.
Likewise, the district court did not err in finding October 23, 2017, as
Newsom’s date of alleged disability. 6 As discussed above, we review the
district court’s factual findings for clear error. Fed. R. Civ. P. 52(a)(6).
This is a high standard, meaning “[w]e will not conclude that a district
court’s finding of fact was clearly erroneous based only on our belief that, had
[we] been sitting as the trier of fact, [we] would have weighed the evidence
differently and made a different finding.” United States v. Rodriguez, 630
F.3d 377, 380 (5th Cir. 2011) (internal quotation marks and citation omitted).
We will only reverse “if a review of all the evidence leaves us with the definite
and firm conviction that a mistake has been committed.” Id. (internal
quotation marks and citation omitted). Reviewing the record here, we are
not left with such a conviction.
Based on the relevant policy definitions, quoted supra in Part I, the
district court concluded that Newsom was Partially Disabled as of October
23, 2017, the date Lereta cut Newsom’s hours to 28 hours per week, because
he was unable to perform the “material duties” of his job on a “full-time
basis.” The court also concluded that the Elimination Period started on
October 23, 2017, and that Newsom was thus Partially Disabled during the
Elimination Period. 7 Finally, the court concluded that Newsom had a
6
By reaching this conclusion, we are not agreeing or disagreeing with the district
court that Newsom was disabled, as defined by the LTD policy; as discussed infra, we
conclude that issue was not yet ripe for the court to decide. Nonetheless, determining the
date of Newsom’s alleged disability is necessary because it is intertwined with Newsom’s
eligibility determination.
7
The policy defines “Elimination Period” as “a period of consecutive days of
Total Disability, as shown on the Schedule of Benefits page, for which no benefit is payable.
It begins on the first day of Total Disability.” The Schedule of Benefits page provides that
the Elimination Period for employees working outside of the State of California, such as
Newsom, is “180 consecutive days of Total Disability.”
10
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Residual Disability, and therefore a Total Disability, as of October 23, 2017,
making that date Newsom’s date of alleged disability. The court noted that
this finding was “consistent with Reliance’s own determination in
connection with Newsom’s STD claim,” which it found “very probative.”
In other words, the court viewed Newsom’s alleged disability as progressive,
not as two independent losses.
Reliance counters that its STD decision should have no bearing on the
separate LTD decision. And in a somewhat circular argument, Reliance
contends that Newsom’s disability date could not be October 23, 2017,
because his time records reflect that he worked 30 or more hours, i.e., full
time, during a few subsequent weeks. But this contention again presumes
that “regular work week” as used in Reliance’s LTD policy means “hours
actually worked.” We rejected that contention above, and Reliance’s
argument fails in this instance for the same reasons. Regardless, accepting
arguendo Reliance’s position that the district court should not have
considered the STD decision, the district court reached the same conclusion
by applying the LTD policy language to the facts before it. We find no clear
error in the district court’s analysis.
C.
Reliance last contends that even if the district court was correct in
finding that Newsom was eligible for benefits, it should have remanded the
claim for Reliance to develop a full factual record and make the initial
decision on whether to award benefits, and in what amount. Newsom, on the
other hand, contends that “[r]emand would amount to an impermissible
‘second bite at the denial apple’” and was, and is, unnecessary due to the
district court’s de novo standard of review. We ultimately agree with Reliance
that remand is necessary in this case.
11
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Newsom primarily cites Vega v. National Life Insurance Services, Inc.,
188 F.3d 287 (5th Cir. 1999) (en banc), overruled on other grounds by Metro.
Life Ins. Co. v. Glenn, 554 U.S. 105 (2008), in support of his position that we
should decline to order a remand to Reliance for further record development.
In Vega, the court encouraged parties to make their record prior to coming to
federal court and stated that “allow[ing] the administrator another
opportunity to make a record discourages this effort.” Vega, 188 F.3d at 302
n.13. However, Vega’s applicability to this case is more limited than
Newsom’s reading, as Vega itself suggests:
In some special circumstances a remand to the administrator
for further consideration may be justified. [In Vega], however,
the only issue in dispute was whether a material
misrepresentation was made. [The Vega court] decline[d] to
remand to the administrator to allow him to make a more complete
record on this point.
Id. (emphasis added). Here, unlike in Vega, a remand to the administrator
would not be to make “a more complete record” on whether Newsom was
eligible for LTD benefits. Rather, a remand would be for a merits
determination about Newsom’s entitlement to LTD benefits—a separate
issue, and one on which Reliance did not develop a record after finding
Newsom ineligible for LTD benefits. 8
8
Newsom cites other cases for the general proposition that piecemeal litigation is
discouraged. However, these cases are also distinguishable because, unlike the case at
hand, they concern matters in which the plan administrators had previously addressed the
grant or denial of benefits on the merits. That said, we are sympathetic to Newsom’s
concern that remand will prolong his wait for benefits, and we accordingly emphasize that
the purpose of remanding his claim is not to relitigate Newsom’s eligibility for LTD
benefits. Instead, on remand Reliance should expeditiously evaluate the record as to the
merits of Newsom’s LTD benefits claim—i.e., as discussed infra above the line, Reliance
should determine whether his inability to work resulted from “Injury or Sickness” as
defined in the policy and award benefits as warranted. And consistent with our precedent,
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Schadler v. Anthem Life Insurance Co., 147 F.3d 388 (5th Cir. 1998),
cited by Reliance, is more analogous to this case. In Schadler, the plan
administrator initially denied the insured’s claim based on coverage
eligibility. 147 F.3d at 395. After the administrator retreated from its initial
position that the insured lacked coverage, we instructed the district court to
remand the case to the plan administrator “for the development of a full
factual record and for the making of the decision on whether to grant or deny
benefits . . . .” Id. at 398.
The distinction that keeps Schadler from simply settling this issue for
Reliance, however, is that the plan in Schadler “vest[ed] the administrator
with the discretion to interpret its terms[,]” such that the district court was
required to review the administrator’s decision for abuse of discretion. Id. at
394–95. Here, by contrast, we address a nondiscretionary plan, and the
district court was required to review the administrator’s decision de novo. See
Ariana M., 884 F.3d at 256. This is a notable distinction because the standard
of review played at least some role in the Schadler court’s decision to remand
to the administrator. See Schadler, 147 F.3d at 398 (“Because Defendants
denied that coverage ever existed until the matter was before the district
court, the administrator never had occasion to exercise any discretion to
interpret the terms of the Plan.”).
According to Reliance, remand is nonetheless proper here because
“the disability issue did not ripen into an apple ready to be bitten until after
an initial finding of eligibility.” Reliance offers Pakovich v. Broadspire, 535
F.3d 601 (7th Cir. 2008), as persuasive authority for its contention that
Reliance will only have one opportunity to make a disability determination on the merits.
Vega, 188 F.3d at 302 n.13.
13
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remand is warranted “when the plan has not made a decision on an element
of the claim.” In Pakovich, the Seventh Circuit reasoned that
it is unnecessary for plans to hedge their bets on a possible
reversal on appeal by requiring that, after a plan has already
found that an employee does not qualify for disability benefits
under the “own occupation” standard, it also must determine
whether the employee is disabled from “any occupation.”
Id. at 605. We find this reasoning persuasive.
The district court declined to follow Pakovich, reasoning that “[h]ere,
the question before the Court—own occupation benefits—is the precise
question Reliance decided at the administrative level, and this Court’s review
of that decision is de novo, not deferential.” But the record indicates that
Reliance only made an eligibility determination, namely that Newsom was not
eligible for LTD benefits because he was not a full-time employee. Reliance
did not further evaluate the record to reach the merits of Newsom’s claim or
otherwise make an alternative decision beyond its eligibility determination. 9
This is a distinction that makes all the difference: Where the question for
eligibility is whether Newsom was an “active, full time employee of
LERETA, LLC,” the question for determining Total Disability is whether
Newsom “as a result of an Injury or Sickness . . . cannot perform the material
duties of his . . . Regular Occupation.” (Emphasis added.) Indeed, the
9
Although the parties agreed to a trial upon submission of documentary evidence,
the record is clear that Reliance’s agreement was limited to trying Newsom’s challenge to
its decision regarding Newsom’s eligibility for LTD benefits. In the district court,
beginning with its answer to Newsom’s complaint, Reliance framed its view of the scope of
the trial: “no decision was made on whether Plaintiff was Totally Disabled because he was
not eligible for coverage under the policy”; “Plaintiff’s claim was denied due to lack of
coverage and Reliance Standard was therefore not required to consider whether he was
Totally Disabled under the [LTD] plan . . . . [O]nly in the event that coverage is
established—which is denied, remand to Reliance Standard to consider the question of
disability is necessary.”
14
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district court did not connect Newsom’s inability to work after October 23,
2017—which we agree gave rise to his eligibility for benefits—with his
“injury” or “sickness” as required to support a conclusion that Newsom was
disabled under the policy. Instead, the district court appears to have
conflated the issues of eligibility and disability, which are in fact distinct.
This perhaps also explains why the district court summarily
concluded “the undisputed record shows that Newsom is disabled and
entitled to benefits in the amount of $194,290.72.” The court provided no
explanation for how it reached the amount of disability that Newsom should
be awarded beyond notating that “there is no evidence of any offset or
reduction to which Reliance is entitled.” In ERISA cases judicial review is
limited to the administrative record, Katherine P. v. Humana Health Plan,
Inc., 959 F.3d 206, 207–08 (5th Cir. 2020), and the record tried by the district
court in this case was limited to Reliance’s eligibility determination.
Although that factual record contains medical records Newsom submitted
during Reliance’s evaluation of his claim, the merits evidence is at best
incomplete and thus undermines the district court’s benefits determination.
But even if that were not the case, the court’s benefits determination
does not fully square with the record. For example, the record reflects that
Newsom’s own treating physician indicated that Newsom was unable to
work by the end of January 2018, but estimated that Newsom could return to
work by August 1, 2018. This is not addressed in the district court’s order. 10
Further, although the district court did not state as much, the $194,290.72
10
Along these same lines, the policy provides that other income benefits were to be
subtracted from the “benefit amount payable” to the policy holder. But as noted in
Reliance’s briefing, “[t]wenty-four months of benefits would have ended on April 20,
2020, using the onset date selected by the district court.” Because the administrative
record closed on May 17, 2019, the district court could not have considered any potential
offset or reduction in benefits occurring thereafter.
15
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awarded appears to equate to $6,699.68 per month for 29 months (May 2018
to September 2020), presumably based on Newsom’s calculation set forth in
his trial briefing. 11 Assuming this is true, it conflicts with the policy provision
that after a monthly benefit has been paid for 24 months, there must be a
finding that “an Insured cannot perform the material duties of Any
Occupation”; the district court expressly stated that it did “not address ‘any
occupation’ disability and express[ed] no opinion regarding future benefits.”
At the end of the day, however, squaring these circles is secondary to
the question of whether Newsom was disabled “as a result of an Injury or
Sickness” as defined by the LTD policy, and therefore entitled to LTD
benefits. An administrative record answering these questions was simply not
before the district court, irrespective of its de novo review. Once it
determined that Newsom was not eligible for LTD benefits, Reliance
stopped. Once the district court determined that Newsom was in fact eligible
for LTD benefits, and the date on which his eligibility began, it should have
stopped as well and remanded the case for Reliance to make the separate
disability determination.
IV.
As a final matter, Reliance separately appealed the district court’s
order entered April 26, 2021, granting Newsom’s motion for attorney’s fees,
which was filed after this appeal was noticed. See Notice of Appeal, at 1,
Newsom v. Reliance Standard Life Ins., No. 21-10519, (May 20, 2021). The
second appeal was dismissed by the Clerk on July 15, 2021, for failure to file
a brief and record excerpts. Reliance filed a motion to reinstate its appeal of
11
Newsom alleged that he was owed a monthly LTD benefit of $6,699.68 per
month—60% of his $11,166.13 monthly earnings. Newsom further alleged that the
administrative record contained no evidence of income that would create an offset under
the terms of the policy.
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Case: 20-10994 Document: 00516209171 Page: 17 Date Filed: 02/18/2022
No. 20-10994
c/w No. 21-10519
the attorney’s fees award, consolidate that appeal with this one, and adopt
the briefs and argument submitted in this case for both appeals. In the light
of our conclusion that this case should be remanded for a determination by
Reliance of LTD benefits to which Newsom is entitled, we conclude that the
district court’s order awarding Newsom attorney’s fees must likewise be
revisited on remand. By separate order entered in appeal No. 21-10519, we
accordingly grant Reliance’s motion to reinstate that appeal and consolidate
the cases for the purpose of remanding Newsom’s claim, including his
entitlement to attorney’s fees, for further proceedings. We express no
opinion on the merits of Newsom’s motion for attorney’s fees pending
resolution of his LTD benefits claim.
* * *
For the foregoing reasons, we AFFIRM the judgment of the district
court as to Newsom’s eligibility for LTD benefits and Newsom’s date of
disability; we VACATE the judgment of the district court as to Newsom’s
entitlement to LTD benefits; we likewise VACATE the district court’s
order granting Newsom’s motion or attorney’s fees; and we REMAND to
the district court with instructions to remand Newsom’s claim to the
administrator for further proceedings consistent with this opinion.
AFFIRMED in part; VACATED in part; REMANDED.
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