Baldwin v. University of Pittsburgh Medical Center

PRECEDENTIAL

UNITED STATES COURT OF APPEALS
FOR THE THIRD CIRCUIT
_____________

No. 10-1673
_____________

DEBORAH L. BALDWIN,
as guardian of C.L.D., a minor, K.K.D., a minor,
and C.M.D., a minor,
Appellant

v.

UNIVERSITY OF PITTSBURGH MEDICAL CENTER (UPMC);
LIFE INSURANCE COMPANY OF NORTH AMERICA
_______________

On Appeal from the United States District Court
for the Western District of Pennsylvania
(Civil Action No. 09-cv-1220)
District Judge: Honorable Joy Flowers Conti
_______________

Argued
February 10, 2011

Before: JORDAN, GREENAWAY, JR., and GARTH, Circuit
Judges

(Opinion filed: March 29, 2011)

Patrick W. Murray, Esq. (Argued)
Stewart, Murray & Associates
437 Grant Street
Frick Building, Suite 600
Pittsburgh, PA 15219
Counsel for Appellant

John G. Ferreira, Esq.
Stephanie R. Reiss, Esq. (Argued)

1
Morgan Lewis & Bockius, LLP
One Oxford Centre, 32nd Floor
Pittsburgh, PA 15219
Counsel for Appellee Life Insurance Company of North
America

John J. Myers, Esq.
Andrew T. Quesnelle, Esq. (Argued)
Eckert, Seamans, Cherin & Mellott LLC
44th Floor, U.S. Steel Tower
600 Grant Street
Pittsburgh, PA 15219
Counsel for Appellee University of Pittsburgh Medical
Center (UPMC)

_______________

OPINION OF THE COURT
_______________

GARTH, Circuit Judge.

This appeal by the plaintiff-appellant Deborah L. Baldwin as
the adoptive mother of three Trent children requires us to decide
Baldwin‟s standing to claim the insurance proceeds of policies
subject to the Employee Retirement Income Security Act (ERISA),
29 U.S.C. §§ 1001-1461, which were purchased by the children‟s
biologic mother. The District Court denied relief to Baldwin,
holding that she, as the adoptive mother to Trent‟s three children,
has no standing to receive the insurance proceeds on behalf of the
children under ERISA. We hold that Baldwin is entitled to offer
evidence as to Trent‟s intent, i.e., understanding of the terms of her
insurance policies, in order to establish the facts she alleges in her
complaint. As a consequence, we will reverse the District Court‟s
judgment and remand to the District Court for further proceedings
as directed in this opinion.

2
 I.

In 2001, Victoria Trent, biologic mother of three minor
children, C.L.D., K.K.D., and C.M.D., began working for appellee
University of Pittsburgh Medical Center (UPMC). On June 6,
2003, at Trent‟s urging, Trent‟s lifelong family friend, Deborah
Baldwin, adopted the children and became their legal guardian.
New birth certificates were issued for the children.
Notwithstanding the adoption, Trent maintained a parental
relationship with the children, who still referred to her as “Mom”:
she lived with Baldwin and the children for three years after they
were adopted by Baldwin, and Trent spent all holidays and festivals
with Baldwin and the children.

Trent was employed at UPMC from 2001 to 2008. Trent
enrolled in four insurance plans offered by UPMC for the year
2008. The premiums for these were deducted from her salary each
pay period: 1) a $25,000 basic life insurance policy; 2) a $25,000
basic accidental death and dismemberment (AD&D) insurance
policy; 3) a $100,000 supplemental group life insurance policy; and
4) a $200,000 supplemental AD&D insurance policy. Trent
designated a beneficiary -- Baldwin -- for the $25,000 basic life
policy, but did not designate a beneficiary for the three remaining
policies.

Each of the life policies, as distinct from the ERISA statute,
contains the following language:

If there is no named beneficiary or
surviving beneficiary, Death Benefits
will be paid to the first surviving class
of the following living relatives: spouse;
child or children; mother or father;
brothers or sisters; or to the executors or
administrators of the Insured‟s estate.

To similar effect, the AD&D policies provide:

If there is no named beneficiary or
surviving beneficiary, or if the
Employee dies while benefits are
payable to him, We may make direct

3
 payment to the first surviving class of
the following classes of persons:
1) spouse;
2) child or children;
3) mother or father;
4) sisters or brothers;
5) Estate of the Covered
Person.

On December 23, 2008, Trent died in an accident at the age
of thirty-four. Following Trent‟s death, Baldwin timely sought
payment under each of Trent‟s insurance policies in accordance
with the applicable claims procedure. The insurer, Life Insurance
Company of North America (LINA), paid $25,000 due to Baldwin
as the designated beneficiary of Trent‟s basic life policy. However,
LINA rejected Baldwin‟s claims on behalf of the children for the
proceeds from the other three policies. LINA explained that as a
result of the adoption, the children were no longer considered
Trent‟s “children” for the purposes of the policies‟ default-
beneficiary provisions.

Baldwin appealed LINA‟s determination. In a May 15,
2009, letter, LINA, using Cigna Group Insurance (CIGNA) as
signatory, detailed the reasons why, after further review, it had
again concluded that the insurance proceeds were “not payable” to
the children:

While Mrs. Trent may have maintained
a relationship with her biological
children, this would not supersede the
fact that Ms. Trent waived all legal ties
with the children. As a result of the
adoption [C.L.D., K.K.D., and C.M.D.]
became the legal children of Ms.
Baldwin and would no longer be
eligible for benefits under these
policies as the children of Ms. Trent.

At the time of her death, there was no
beneficiary named by Ms. Trent for the
[$100,000 supplemental group life
policy and accidental death policies].
Therefore, the benefits of these policies

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 would be payable under the facility of
payment wording contained in this
policy. The facility of payment does
not contain provisions that allow for
payment of benefits to step-children or
any other child which may be in a close
familial relationship with the insured.
Since [C.L.D., K.K.D., and C.M.D.]
were not the children of Victoria Trent
at the time of her death, no benefits
were payable to them . . . .

....

This policy is a binding contract
between Victoria Trent and the insuring
company. Therefore, in an effort to
provide equitable claims administration
to our insureds we must honor all policy
provisions. Since Ms. Trent did not
designate [C.L.D., K.K.D., and C.M.D.]
to receive any proceeds from this
policy, we cannot honor payment to
them or any other person not designated
as beneficiary of record with the
employer prior to Ms. Trent‟s death or
the first class of surviving relatives.

Having exhausted all avenues of administrative review of her
claim, Baldwin, as guardian of the children, filed a complaint in the
District Court for the District of Western Pennsylvania against
UPMC and LINA.1 In the two-count complaint, Count One alleged
that UPMC and LINA had breached their fiduciary duty to Trent
and the children, in violation of ERISA, 29 U.S.C. § 1104(a)(1)(A)
and (B), by failing to act for the exclusive purpose of providing
benefits and inadequately managing the enrollment process; and

1
Although CIGNA originally was also named as a
defendant, it was removed by stipulation of the parties on
November 12, 2009. CIGNA was utilized by LINA as a business
name of LINA.

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Count Two alleged that the two defendants had arbitrarily and
capriciously denied the children benefits, which is a basis for
recovery under ERISA, 29 U.S.C. § 1132(a)(1)(B).

II.

The two defendants moved to dismiss the complaint for lack
of both subject-matter jurisdiction and statutory standing. The
District Court dismissed Baldwin‟s complaint for lack of subject-
matter jurisdiction under Federal Rule of Civil Procedure 12(b)(1).
A dismissal for lack of statutory standing is effectively the same as
a dismissal for failure to state a claim. See Vaughn v. Bay Envtl.
Mgmt., Inc., 567 F.3d 1021, 1024 (9th Cir. 2009) (citing Lanfear v.
Home Depot, Inc., 536 F.3d 1217, 1221-22 (11th Cir. 2008), and
Harzewski v. Guidant Corp., 489 F.3d 799, 803-04 (7th Cir. 2007)).
The standard for reviewing dismissals under Rules 12(b)(1) (for
lack of subject matter jurisdiction) and 12(b)(6) (for failure to state
a claim) “is the same: we accept as true plaintiffs‟ material
allegations, and construe the complaint in the light most favorable
to them.” Alston v. Countrywide Fin. Corp., 585 F.3d 753, 758 (3d
Cir. 2009) (citation omitted).

In a March 16, 2010, opinion and order, the District Court
granted defendants‟ motion to dismiss with prejudice, holding that
Baldwin had neither statutory nor prudential standing to bring her
claim under ERISA. ERISA does not specify who is a
“beneficiary” beyond “one who is[,] or may become entitled to[,] a
benefit,” 29 U.S.C. § 1002(8) -- a remarkably broad category. The
District Court held that the category of default beneficiaries
provided in the insurance policies determined who was to obtain the
benefits under the policies. The second category of default
beneficiaries specified by the insurance plans is “child or children.”
The definition of “child or children”2 is relevant to this appeal
because that phrase appears in the insurance plans at issue.

To define the term “children” as used in the insurance plans,
the District Court rejected Baldwin‟s request that it consult
Pennsylvania contract law. Instead, the District Court sought
elucidation from federal common law and the Pennsylvania
Intestate Succession Law, 20 Pa. Cons. Stat. Ann. §§ 2103, 2108,

2
For ease of reference in this opinion, we shorten “child or
children” to “children.”
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which the District Court concluded mandate that adoption severs
the legal link between birth parent and child. Under this
interpretation, the child becomes the child of the adoptive parent
only.

Importing that definition of “children” into the insurance
plans‟ language, the District Court held that the adopted children
were not entitled to benefits by default as Trent‟s “children.” Thus,
inasmuch as the children could not make out a colorable claim of
their entitlement to benefits, neither they, nor Baldwin, their
guardian, had standing to bring suit under ERISA, and the District
Court was therefore without subject-matter jurisdiction.

This appeal followed.

III.

This Court has plenary review over an order dismissing an
ERISA claim for lack of standing. See Leuthner v. Blue Cross &
Blue Shield of Ne. Pa., 454 F.3d 120, 124 (3d Cir. 2006); Miller v.
Rite Aid Corp., 334 F.3d 335, 340 (3d Cir. 2003). We must
“„accept all factual allegations as true, construe the complaint in the
light most favorable to the plaintiff, and determine whether, under
any reasonable reading of the complaint, the plaintiff may be
entitled to relief.‟” Pittsburgh Mack Sales & Serv., Inc. v. Int‟l
Union of Operation Eng‟rs, Local Union No. 66, 580 F.3d 185, 192
(3d Cir. 2009) (quoting McTernan v. City of York, Pa., 564 F.3d
636, 646 (3d Cir. 2009)). “„A complaint may not be dismissed
merely because it appears unlikely that the plaintiff can prove those
facts or will ultimately prevail on the merits.‟” Id. (quoting
McTernan, 564 F.3d at 646).

IV.

“To bring a civil action under ERISA, a plaintiff must have
constitutional, prudential, and statutory standing.” Leuthner, 454
F.3d at 125. To ensure that the latter two forms of standing are
satisfied in an ERISA case, a court must assure itself that the
“„plaintiff‟s grievance . . . arguably fall[s] within the zone of
interests protected or regulated by the statutory provision or
constitutional guarantee invoked in the suit.‟” Miller, 334 F.3d at
340 & n.1 (3d Cir. 2003) (quoting Bennett v. Spear, 520 U.S. 154,
162 (1997)); see also Leuthner, 454 F.3d at 126 (explaining that

7
“ERISA‟s statutory standing requirements are a codification of the
„zone of interest‟ analysis” typically used to determine prudential
standing).

ERISA § 502(a), 29 U.S.C. § 1132(a), entitles only “a
participant or beneficiary” to institute a civil action for benefits
against a plan administrator. Therefore, in the context of ERISA
claims for benefits, the “zone of interests” inquiry “is inexorably
tied to the question of whether a plaintiff can meet the definitions of
either a participant or beneficiary.” Miller, 334 F.3d at 340-41.

Because neither Baldwin nor the children she represents
were “participants” in the plans at issue, the only relevant definition
is that of a “beneficiary” -- that is, “a person designated by a
participant, or by the terms of an employee benefit plan, who is[,]
or may become entitled to[,] a benefit thereunder.” 29 U.S.C. §
1002(8). Alleged beneficiaries such as the children here must
demonstrate that they “may become entitled to a benefit” by
presenting “„a colorable claim that . . . [they] will prevail in a suit
for benefits.‟” Leuthner, 454 F.3d at 124 (quoting Firestone Tire &
Rubber Co. v. Bruch, 489 U.S. 101, 118 (1989)). The burden of
persuasion for establishing a colorable claim is less exacting than
that needed to establish a likelihood of success on the merits. Id.
(citing Daniels v. Thomas & Betts Corp., 263 F.3d 66, 78-79 (3d
Cir. 2001)).

V.

Claims for benefits based on the terms of an ERISA plan are
contractual in nature and are governed by federal common law
contract principles. Burstein v. Ret. Account Plan for Emps. of
Allegheny Health Educ. & Research Found., 334 F.3d 365, 381 (3d
Cir. 2003) (citing Feifer v. Prudential Ins. Co. of Am., 306 F.3d
1202, 1210 (2d Cir. 2002)); see also Kemmerer v. ICI Ams., Inc.,
70 F.3d 281, 287 (3d Cir. 1995) (noting that disputes arising out of
ERISA plan documents are governed by “breach of contract
principles, applied as a matter of federal common law”).
Accordingly, where claims put at issue the meaning of plan terms,
we apply the federal common law of contract to interpret those
terms. See Burstein, 334 F.3d at 381. Since the claims asserted by
Baldwin on behalf of C.L.D., K.K.D., and C.M.D. turn on the
meaning of “children” in the subject insurance policies, our task is
to interpret that term in accordance with the federal common law,

8
which of course draws heavily on generally established principles
of contract interpretation. See IUE AFL-CIO Pension Fund v.
Barker & Williamson, Inc., 788 F.2d 118, 124 (3d Cir. 1986)
(citation omitted).

“The paramount goal of contract interpretation is to
determine the intent of the parties.” Am. Eagle Outfitters v. Lyle &
Scott Ltd., 584 F.3d 575, 587 (3d Cir. 2009) (citations and internal
quotation marks omitted); see also Mellon Bank, N.A. v. Aetna
Bus. Credit, Inc., 619 F.2d 1001, 1009 (3d Cir. 1980) (“In
construing a contract, a court‟s paramount consideration is the
intent of the parties.” (citation and internal quotation marks
omitted)). Courts are to consider “not the inner, subjective intent of
the parties, but rather the intent a reasonable person would
apprehend in considering the parties‟ behavior.” Am. Eagle, 584
F.3d at 582 (citations and internal quotation marks omitted); see
also Mellon Bank, 619 F.2d at 1009 (“[C]ourts must eschew the
ideal of ascertaining the parties‟ subjective intent and instead bind
parties by the objective manifestations of their intent.”).

The strongest objective manifestation of intent is the
language of the contract. Mellon Bank, 619 F.2d at 1009; see also
Am. Eagle, 584 F.3d at 587 (acknowledging “the „firmly settled‟
principle that „the intent of the parties to a written contract is
contained in the writing itself‟” (citation omitted)). Thus, where the
words of the contract clearly manifest the parties‟ intent, a court
need not “resort to extrinsic aids or evidence.” Am. Eagle, 584
F.3d at 587 (citation and internal quotation marks omitted).

The words of the contract clearly manifest the parties‟ intent
if they are capable of only one objectively reasonable interpretation.
Tamarind Resort Assocs. v. Gov‟t of the Virgin Islands, 138 F.3d
107, 110-11 (3d Cir. 1998) (“We have consistently embraced the
basic common law principle that a contract is unambiguous if it is
reasonably capable of only one construction.” (citing, e.g.,
Sumimoto Mach. Corp. of Am., Inc. v. AlliedSignal, Inc., 81 F.3d
328, 332 (3d Cir. 1996), and Am. Flint Glass Workers Union, AFL-
CIO v. Beaumont Glass Co., 62 F.3d 574, 581 (3d Cir. 1995))). If
the words of the contract are capable of more than one objectively
reasonable interpretation, the words are ambiguous. Am. Eagle,
584 F.3d at 587. Ambiguous terms that appear clear and
unambiguous on their face, but whose meaning is made uncertain
due to facts beyond the four corners of the contract, suffer from

9
latent ambiguity. Duquesne Light Co. v. Westinghouse Elec. Corp.,
66 F.3d 604, 614 (3d Cir. 1995).

Courts have the responsibility to determine as a matter of
law whether contract terms are clear or ambiguous. Mellon Bank,
619 F.2d at 1011 (citation omitted); see also In re New Valley
Corp., 89 F.3d 143, 149 (3d Cir. 1996) (“Whether a document is
ambiguous presents a question of law properly resolved by this
court.” (citing Stendardo v. Fed. Nat‟l Mortg. Ass‟n, 991 F.2d
1089, 1094 (3d Cir. 1993))). To make that determination, a court
must consider “the words of the contract, the alternative meaning
suggested by counsel, and the nature of the objective evidence to be
offered in support of that meaning.” Mellon Bank, 619 F.2d at
1011; see also New Valley, 89 F.3d at 150 (applying common law
contract principles in an ERISA context and noting that, to address
potentially ambiguous contract terms, a court must “hear the proffer
of the parties and consider extrinsic evidence to determine whether
there is an ambiguity”). The objective, extrinsic evidence proffered
may include, for example, “the structure of the contract, the
bargaining history, and the conduct of the parties that reflects their
understanding of the contract‟s meaning.” New Valley, 89 F.3d at
150 (citing Teamsters Indus. Emps. Welfare Fund v. Rolls-Royce
Motor Cars, Inc., 989 F.2d 132, 135 (3d Cir. 1993)). Extrinsic
evidence notwithstanding, “the parties remain bound by the
appropriate objective definition of the words they use to express
their intent.” Mellon Bank, 619 F.2d at 1013.

The proper focus of the extrinsic evidence in resolving an
instance of latent ambiguity is the parties‟ “objectively manifested
„linguistic reference‟” regarding the ambiguous term, not their
expectations. Bohler-Uddeholm Am., Inc. v. Ellwood Grp., Inc.,
247 F.3d 79, 94 n.3 (3d Cir. 2001) (quoting Duquesne Light, 66
F.3d at 614).

For example, if the evidence show[s]
that the parties normally meant to refer
to Canadian dollars when they used the
term “dollars,” this [is] evidence of the
right type. Evidence regarding a party‟s
beliefs about the general ramifications
of the contract [is not] the right type to
establish latent ambiguity.

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Id. (citations omitted).

VI.

The issue here is whether the word “children” presents a
latent ambiguity -- that is, whether “children,” from the objectively
manifested linguistic reference point of the parties to the insurance
contracts, is susceptible of more than one objectively reasonable
meaning. More specifically, is it objectively reasonable to construe
“children” to mean “biologic children,” or is it only objectively
reasonable to construe “children” as “children recognized by state
intestacy and adoption law”? On the record before us, we are
unable to determine whether both of those interpretations are
objectively reasonable, and it does not appear that the District Court
attempted such a determination. Arguably, however, there is a
latent ambiguity in the term “children.” To establish standing,
Baldwin is only required to plead “enough fact to raise a reasonable
expectation that discovery will reveal evidence” demonstrating that,
regardless of any subsequent adoption, Trent and the defendants
understood C.L.D., K.K.D., and C.M.D. would be considered to be
Trent‟s “children” as that term is used in the subject contracts, even
if it were to appear “that actual proof of those facts is improbable,
and that recovery is very remote and unlikely.” Bell Atl. Corp. v.
Twombly, 550 U.S. 544, 556 (2007) (citation and internal
quotation marks omitted).

According to the allegations in the complaint, Trent took out
four policies, which were set to pay out a total of $350,000 in the
event of her death. Trent designated Baldwin, a lifelong family
friend and guardian of Trent‟s biologic children, as beneficiary of
the $25,000 basic life policy. Trent had lived together with
Baldwin and the children for several years after Trent began
working at UPMC. Until her death, Trent maintained a parental
relationship with the children. Trent had no spouse and no living
parents, yet continued to pay for life insurance more than five years
after her children were legally adopted by Baldwin. At oral
argument, we learned for the first time that Trent had a half-brother
and/or half-sister who were not named as beneficiaries of any of the
four insurance policies.

Those allegations, while insufficient to resolve the potential
ambiguity of “children,” are sufficient to make out a colorable
claim that such an ambiguity exists and that Trent‟s biologic

11
children are or may become entitled to benefits based on one
arguably objectively reasonable meaning of the term.3 Thus, the
children -- and Baldwin on their behalves -- have ERISA standing.
In so concluding, we are guided by the principle that ERISA is a
remedial statute that should be liberally construed to achieve its
ends, which include protecting plan participants and beneficiaries.
See Firestone, 489 U.S. at 113; Barker & Williamson, 788 F.2d at
127.

We acknowledge the District Court‟s thoughtful approach to
identifying and applying what it conceived to be the correct
governing law. The District Court attempted to resolve the issue
before it by seeking to interpret the term “children” in the subject
insurance policies. It looked for guidance to La Bove v.
Metropolitan Life Insurance Co., in which we examined state law to
construe the meaning of “children” in a life insurance policy
governed by the Federal Employees‟ Group Life Insurance Act of
1954. 264 F.2d 233, 234-36 (3d Cir. 1959). Nonetheless, when a
contract term is reasonably argued to be ambiguous, the better
approach, and the one that is consistent with the weight of
controlling authority, is to allow the parties to proffer evidence in
support of alternative interpretations of the term so that the court
may properly address the purported ambiguity.4 That is the
approach required by our precedent under ERISA, New Valley, 89
F.3d at 150, and it should guide the District Court on remand.

Because Baldwin has made out a colorable claim that the
children are, or may become, entitled to a benefit under the ERISA
plans at issue, we hold that she has prudential and statutory standing
to bring this civil action. Accordingly, we will vacate the order of
March 16, 2010, dismissing the complaint and remand to the
District Court for further proceedings consistent with this opinion.

3
The allegations are hence also sufficient to state a claim
for relief and so can withstand a motion to dismiss pursuant to Rule
12(b)(6) of the Federal Rules of Civil Procedure.
4
We recognize that this presents something of a conundrum,
because one could say that there can be no standing unless there is
actually an ambiguity, which has not yet been determined. We
think, however, that this “which came first, the chicken or the egg”
problem is best resolved by deciding that the potential ambiguity is
sufficient to establish standing.
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