MARK E. FULLER, District Judge.
Before the Court are (1) Plaintiff Dorothy Snow's Motion for Summary Judgment (Doc. #31), and (2) Defendant Boston Mutual Insurance Company's Motion for Summary Judgment (Doc. #32). For the reasons set forth below, the Court finds that Plaintiff's motion is due to be DENIED, and Defendant's motion is due to be GRANTED IN PART and DENIED IN PART.
This is an ERISA
Plaintiff and Boston Mutual have filed cross-motions for summary judgment, each arguing in their briefs that they are entitled to judgment as a matter of law on both of Plaintiff's claims. Specifically, Plaintiff argues that: (1) under the terms of the policy at issue, and in accordance with 29 U.S.C. § 1132(a)(1)(B), she is entitled to approximately $115,000 in life insurance benefits as a matter of law; and (2) Boston Mutual breached certain fiduciary duties that it owed to her, thus entitling Plaintiff to equitable relief under 29 U.S.C. §§ 1132(a)(3) and 1133. Boston Mutual disagrees with Plaintiff, arguing that: (1) under the terms of the policy at issue, and in accordance with 29 U.S.C. § 1132(a)(1)(B), Boston Mutual is not obligated to pay any life insurance benefits to Plaintiff because her husband was not covered
In sum, this case boils down to two issues. First, does Boston Mutual owe Plaintiff any life insurance benefits under the policy at issue? Second, did Boston Mutual owe any fiduciary duties to Plaintiff and, if so, did it breach any of those duties, thereby entitling Plaintiff to any of the equitable remedies she seeks? Each of these issues is addressed in turn below.
The court has subject matter jurisdiction over this matter pursuant to 28 U.S.C. § 1331 (federal question) and 29 U.S.C. § 1132(e)(1) (ERISA). The parties do not contest personal jurisdiction or venue, and the court finds sufficient factual bases for both.
A motion for summary judgment looks to "pierce the pleadings and to assess the proof in order to see whether there is a genuine need for trial." Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). A court should grant summary judgment when the pleadings and supporting materials show that no genuine issue exists as to any material fact and that the moving party deserves judgment as a matter of law. Fed.R.Civ.P. 56(c); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). The party moving for summary judgment "always bears the initial responsibility of informing the district court of the basis for its motion, and identifying" the relevant documents that "it believes demonstrate the absence of a genuine issue of material fact." Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). To shoulder this burden, the moving party can present evidence to this effect, or it can show that the non-moving party has failed to present evidence in support of some element of its case on which it ultimately bears the burden of proof. Id. at 322-23, 106 S.Ct. 2548.
If the moving party meets its burden, the non-movant must then designate, by affidavits, depositions, admissions, or answers to interrogatories, specific facts showing the existence of a genuine issue for trial. Jeffery v. Sarasota White Sox, Inc., 64 F.3d 590, 593-94 (11th Cir.1995). A genuine issue of material fact exists when the non-moving party produces evidence that would allow a reasonable fact-finder to return a verdict in his or her favor. Waddell v. Valley Forge Dental Assocs., 276 F.3d 1275, 1279 (11th Cir. 2001). Thus, summary judgment requires the non-moving party to "do more than simply show that there is some metaphysical doubt as to the material facts." Matsushita, 475 U.S. at 586, 106 S.Ct. 1348. Indeed, a plaintiff must present evidence demonstrating that he can establish the basic elements of his claim, Celotex, 477 U.S. at 322, 106 S.Ct. 2548, because "conclusory allegations without specific supporting facts have no probative value" at the summary judgment stage. Evers v. Gen. Motors Corp., 770 F.2d 984, 986 (11th Cir.1985).
A court ruling on a motion for summary judgment must believe the non-movant's evidence. Anderson, 477 U.S. at 255, 106 S.Ct. 2505. It also must draw all justifiable
The Court will consider Plaintiff's claim under 29 U.S.C. § 1132(a)(1)(B), which arises from Boston Mutual's decision to deny payment of life insurance benefits, under the de novo standard of review because the policy at issue does not expressly grant "the administrator discretionary authority to make eligibility determinations or to construe the plan's terms." Anderson v. Unum Life Ins. Co., 414 F.Supp.2d 1079, 1094 (M.D.Ala.2006). The parties do not contest that this is the appropriate standard of review applicable to Plaintiff's § 1132(a)(1)(B) claim.
On August 26, 2011, Plaintiff filed a Complaint in the Circuit Court of Randolph County, Alabama against Boston Mutual. (Doc. #1-1.) The case was timely removed to federal court on September 28, 2011. (Doc. #1.) Plaintiff filed an Amended Complaint on November 22, 2011 (Doc. #18), and Boston Mutual answered on December 6, 2011 (Doc. #21). The parties agree that Plaintiff exhausted all of her administrative remedies before filing this suit, or that exhaustion of any such remedies would be futile.
As of the date of this Order, Meadowcraft, Mr. Snow's former employer and Boston Mutual's co-defendant in this case, has not appeared in or otherwise defended against this action. As a result, the Clerk of Court entered a default against it.
On October 3, 2012, Plaintiff and Boston Mutual filed cross-motions for summary judgment (Docs. #31 & 32), which are now before the Court and ripe for disposition.
The Court has carefully considered all deposition excerpts and other evidence submitted in support of and in opposition to the parties' summary judgment motions. The submissions of the parties, viewed in the light most favorable to the non-moving party, establish the following facts:
Plaintiff is the widow of Mr. Snow, who passed away on August 27, 2009. (Affidavit of Dorothy Snow ("Snow Aff."), Doc. #33-8, at ¶ 3.) Mr. Snow was sixty-six years and nine months old at the time of his death. (Certificate of Death, Doc. #33-2, at 16.) Plaintiff is the primary
Meadowcraft maintained Group Policy No. 24661 (the "Plan") for its full-time employees, which included Mr. Snow. (Doc. #33-1, at 1.) This Plan was underwritten and issued by Boston Mutual and became effective on August 1, 1999. (Doc. #33-1, at 1.) The amount of life insurance benefits at issue here is approximately $115,000, and if these benefits are due to be paid to Plaintiff, Boston Mutual would be solely responsible for paying them.
Under the Plan, when a disabled employee's Waiver of Premium claim is approved, his life insurance:
(Doc. #33-1, at 7) (emphasis added). Additionally, an employee's insurance under the Plan stops:
(Doc. #33-1, at 8) (emphasis added). The Plan defines "Normal Retirement Date" as the "normal retirement date provided for by the Policyholder's published or accepted personnel practices." (Doc. #33-1, at 3.)
Mary Beth Wilbanks ("Wilbanks") began working full-time for Meadowcraft as the Human Resources Coordinator for one of its plants in 1998. In 2002, Wilbanks was promoted to serve as the Corporate Human Resources and Benefits Manager at Meadowcraft's corporate headquarters, where she was responsible for administering benefit plans Meadowcraft provided to its employees. Wilbanks testified that her responsibilities included "adding new associates, deleting associates for whatever reason, termination, layoff, whatever we were experiencing, assisting associates with filling out claims if necessary, assisting associates with questions about their benefits." (Deposition of Mary Beth Wilbanks ("Wilbanks Dep."), Doc. #35-6, 12:5-11.) Wilbanks also testified that, in her position with Meadowcraft, she "handle[d] enrollments, provide[d] documents to associates, maintain[ed] records, handle[d] billing[.]" (Wilbanks Dep., Doc. #35-6, 52:17-53:8) (alterations to original).
Following his enrollment, Mr. Snow received a Group Insurance Certificate ("Certificate") distributed by Meadowcraft. (Snow Aff., Doc. #33-8, at ¶ 6.) Like the Plan, the Certificate contains language regarding Waiver of Premium and when an employee's insurance stops, but the language
Boston Mutual did not provide Mr. Snow with a copy of the Plan following his enrollment. (Def.'s Resp. to Pl.'s Interrog., Doc. #33-7, at No. 8.) Indeed, it was not until this litigation ensued that Plaintiff requested and received a copy of the Plan from Boston Mutual.
While employed with Meadowcraft, Mr. Snow became totally and permanently disabled with Chronic Obstructive Pulmonary Disease ("COPD") and hypertension, leaving him unable to work from May 17, 2002, until the time of his death on August 27, 2009. (Snow Aff., Doc. #33-8, at ¶ 4.) Boston Mutual approved Mr. Snow's long-term disability claim. Mr. Snow applied for a Waiver of Premium under the Plan, which Boston Mutual approved on October 16, 2002. In its approval letter, Boston Mutual advised Mr. Snow as follows:
(Doc. #35-2, at 2.)
In connection with its processing of Mr. Snow's Waiver of Premium claim, Boston Mutual requested that Meadowcraft fill
While the information sought by Boston Mutual in the Employer's Statement form was intended to pertain to Mr. Snow's life insurance coverage under the Plan, Wilbanks mistakenly listed on the form the policy number for an unrelated long-term disability policy (also provided through Boston Mutual), instead of the policy number for the group Plan. (Doc. #33-12, at 3.)
On November 20, 2007, Boston Mutual wrote to Mr. Snow and notified him that his group life insurance coverage under the Plan would terminate on November 21, 2007 (Mr. Snow's sixty-fifth birthday) "due to having reached the maximum age limit for this plan." (Doc. #35-2, at 20.) Boston Mutual further advised Mr. Snow of his right to convert any amount of his life insurance, up to the total amount of coverage under the Plan, to an individual policy, and enclosed a Conversion Privilege/Request for Application form. (Doc. #35-2, at 20-21.)
Mr. Snow completed the Conversion Privilege/Request for Application form on December 7, 2007, and returned it to Boston Mutual. In the form, Mr. Snow indicated that he was interested in applying for $100,000 of individual life insurance coverage. (Doc. #35-2, at 17.) On December 17, 2007, Boston Mutual sent Mr. Snow a letter acknowledging its receipt of his Conversion Privilege/Request for Application form. In this letter, Boston Mutual also informed Mr. Snow that $100,000 of individual life coverage would cost $452.55 per month and that he could enroll by returning an application along with his initial premium by December 30, 2007. (Doc. #35-2, at 16.) Plaintiff claims that Boston Mutual never sent the December 17, 2007 letter and that a conversion application was never provided to Mr. Snow. However, there is no dispute that Mr. Snow did not return a conversion application or ever submit any premiums to Boston Mutual for an individual policy. As a result, the Plan was not converted into an individual life policy.
Mr. Snow died on August 27, 2009. On December 17, 2010, Plaintiff made a claim
(Doc. #33-2, at 13.)
Plaintiff made another request to Boston Mutual for payment of benefits on April 29, 2011. In this request, Plaintiff claimed that Boston Mutual's contention that age 65 was the normal retirement age was false because "we have located numerous employees who were working at the plant past age 65." (Doc. #33-2, at 12.) Boston Mutual denied Plaintiff's claim on May 26, 2011, reasserting the same grounds for denial as it did in its January 4th letter. (Doc. #33-1, at 27.) Boston Mutual's denial decisions were not subject to review by Meadowcraft. (Wilbanks Dep., Doc. #33-9, 41:5-11.) Neither of Boston Mutual's denial letters notified Plaintiff of her right to sue to enforce the Plan under ERISA.
In Count I of the Amended Complaint, Plaintiff seeks to recover life insurance benefits under the Plan pursuant to 29 U.S.C. § 1132(a)(1)(B).
While there is evidence that Plaintiff understood the Certificate to be the Snows' policy, and while Plaintiff has placed significant emphasis on highlighting the differences between certain language contained in the Certificate and that contained in the Plan, particularly as to the Waiver of Premium and "When Your Insurance
With that being said, the Court must now determine whether a fact issue exists with respect to whether Boston Mutual's decision to deny Plaintiff life insurance benefits under the Plan was wrong. This requires the Court to interpret Boston Mutual's denial decision under a de novo standard of review, with no deference being given to its previous decisions. Applying that standard, the Court finds that a fact issue exists as to the appropriate interpretation of "Normal Retirement date" under the Plan.
The Waiver of Premium provision in the Plan provides that once an employee's waiver of premium has been approved, the employee's insurance:
(Doc. #33-1, at 7) (emphasis added). The Plan further provides that if an employee leaves his job due to a disability, Meadowcraft may keep his insurance in force until it either chooses to stop it or "until the employee's normal retirement date, whichever is earlier." (Doc. #33-1, at 8.) "Normal Retirement Date" is defined in the Plan as the "normal retirement date provided for by the Policyholder's published or accepted personnel practices." (Doc. #33-1, at 3.)
The parties have presented conflicting evidence on what is considered to be Meadowcraft's "Normal Retirement date." According to Boston Mutual, this term is unambiguous under the Plan. To support this position, Boston Mutual relies on Wilbanks' certification on the Employer's Statement form, dated October 2, 2002, that the "Current Normal Retirement age" at Meadowcraft was "65." Notably, however, Wilbanks does not certify on the form the "Normal Retirement date in effect as of the date of ... [Mr. Snow's]
Additionally, the Plan defines "Normal Retirement Date" as the "normal retirement date provided for by the Policyholder's published or accepted personnel practices." (Doc. #33-1, at 3.) There is no evidence before the Court of any published personnel policy from Meadowcraft designating its "Normal Retirement Date." Plaintiff, however, has presented substantial evidence that Meadowcraft had an accepted practice of allowing its employees to work and retire past the age of sixty-five. (Wilbanks Dep., Doc. #35-6, 35:15-17.) Indeed, Wilbanks testified that the individual employee ordinarily decided when to retire. (Wilbanks Dep., Doc. #35-6, 23:5-10.) At the very least, this evidence contradicts the Employer's Statement form and creates a factual dispute as to what is Meadowcraft's "Normal Retirement Date" based upon its "accepted personnel policies."
In construing life insurance plans governed by ERISA, the Court is guided by the federal common law rules of contract interpretation. Under those rules, the Court interprets the terms of a policy in an ordinary and popular sense, as would a person of average intelligence and experience. When terms in a plan are ambiguous, the Court must construe them strictly in favor of the insured; contract language is considered ambiguous if it is subject to more than one reasonable interpretation. See Cannon v. Wittek Companies, Intern., 60 F.3d 1282, 1284 (7th Cir.1995). In this case, the Court is satisfied that the term "Normal Retirement date" as defined in the Plan is ambiguous, as the evidence suggests that there is more than one reasonable interpretation. Accordingly, when construing the Plan language in favor of the insured, the Court finds that there is a genuine dispute of material fact as to what constitutes the "Normal Retirement Date" under the Plan. As such, both parties' motions for summary judgment as to Count I of Plaintiff's Amended Complaint are due to be DENIED.
In Count II of the Amended Complaint, Plaintiff seeks "equitable relief" for Boston Mutual's breaches of alleged fiduciary duties under ERISA's "catchall" provision, 29 U.S.C. 1132(a)(3).
Plaintiff alleges that Boston Mutual owed and breached the following fiduciary duties: (1) the Plan Administrator's duty to provide summary plan descriptions; (2) the Plan Administrator's duty to provide accurate and complete information; (3) the Plan Administrator's duty to provide all material information related to benefits and coverage; and (4) the claims adjudicator's duty to comply with ERISA's claims procedures. (Doc. #33, at 42-52.) As to the three Plan Administrator duties, Boston Mutual claims that it never owed Plaintiff these duties under the Plan. As to claims adjudicator duty, Boston Mutual likewise claims that it did not owe Plaintiff any such duty and further claims that, even if it did, there would be no substantive remedy for the breaches Plaintiff alleges.
Plaintiff alleges that Boston Mutual, as a Plan Administrator, owed her a fiduciary duty to supply adequate disclosures and properly report under 29 U.S.C. § 1021(a), which imposes disclosure duties upon Plan Administrators. Accordingly, to resolve this claim, the Court must first determine whether Boston Mutual is a Plan Administrator under ERISA.
ERISA places responsibility on Plan Administrators to furnish plan participants and beneficiaries with: (1) a summary plan description ("SPD") in accordance with § 1022(a)(1); and (2) other statutorily mandatory information described in § § 1021(f), 1024(b)(3), 1025(a), and 1025(c). 29 U.S.C. § 1021(a). Although the parties vigorously dispute in their briefs whether Boston Mutual is a Plan Administrator under ERISA, the statutory language provides clear guidance on who is considered a Plan Administrator for purposes of these duties.
ERISA defines the term "administrator" to mean:
29 U.S.C. § 1002(16)(A). ERISA defines "plan sponsor" to mean "the employer in the case of an employee benefit plan established or maintained by a single employer." 29 U.S.C. § 1002(16)(B)(i).
Nowhere in the Plan is Boston Mutual designated as the "administrator" (Doc. #33-1, at 1-15), and Plaintiff does not claim or provide any evidence demonstrating that Boston Mutual falls within the statutory definition of Plan Sponsor such that it worked to qualify as the Plan Administrator. See 29 U.S.C. § 1002(16)(A)(i)-(ii). Nor is there any evidence that the Secretary of Labor has designated Boston Mutual as the Plan Administrator. See 29 U.S.C. § 1002(16)(A)(iii). As such, there is no basis for finding Boston Mutual to be the Plan Administrator under ERISA.
To the contrary, the undisputed evidence establishes that Meadowcraft,
It is understandable that Plaintiff wishes to recover from Boston Mutual for alleged failures to report and disclose material Plan information, especially considering that Meadowcraft is no longer in operation and will likely be unable to satisfy any judgment that may be entered against it. This reality, however, still does not alleviate Plaintiff of her burden to establish the essential elements of her claim, which, when considering the clear statutory language and the evidence before the Court, she has failed to do as there is insufficient evidence that Boston Mutual qualifies as an administrator under the Plan.
In addition to her theories of recovery premised upon Plan Administrator duties, Plaintiff also seeks relief for Boston Mutual's alleged breach of its duty, as claims adjudicator, to comply with ERISA's claims procedure provision. See 29 U.S.C. § 1133.
The Eleventh Circuit has held that while "ordinarily, violations of ERISA's procedural requirements do not entitle a claimant to substantive relief[,]" a certain quantity of procedural violations "may work a substantive harm" by tainting the claim adjudication process such that a claimant may be entitled to substantive relief. Harris v. Pullman Standard, Inc., 809 F.2d 1495 (11th Cir.1987) (affirming district court's finding that defendant's procedural violations were so numerous and egregious that they established that defendant "acted arbitrarily and in bad faith when interpreting and implementing its policy," thus entitling plaintiffs to an award of benefits). Plaintiff alleges procedure violations in Boston Mutual's denial letters, namely, that Boston Mutual did not give Plaintiff required notice of her ERISA rights.
Given the lack of any evidence showing an alleged substantive harm to Plaintiff's ERISA rights caused by the alleged procedural violations in Boston Mutual's denial letters, Plaintiff's theory of relief premised on violations of 29 U.S.C. § 1133 fails as a matter of law. Accordingly, for the reasons set forth above, Boston Mutual's motion for summary judgment with respect to Count II of Plaintiff's Amended Complaint is due to be GRANTED, and Plaintiff's motion for summary judgment with respect to Count II of the Amended Complaint is due to be DENIED.
In accordance with this Memorandum Opinion and Order, Plaintiff Dorothy Snow's Motion for Summary Judgment (Doc. #31) is due to be and hereby is DENIED, and Defendant Boston Mutual Insurance Company's Motion for Summary Judgment (Doc. #32) is due to be and hereby is GRANTED as to Count II and DENIED as to Count I of Plaintiff's Amended Complaint.
(Doc. #33-1, at 19.)
(Doc. #33-1, at 20.)