SARAH W. HAYS, UNITED STATES MAGISTRATE JUDGE.
Plaintiff, as personal representative of the Estate of Terry Allen Engle, originally filed her declaratory judgment action in state court requesting that the court declare "that any and all benefits under the policy or plan administered by Land O'Lakes, Inc. be payable to the Estate of Terry Allen Engle, deceased, so that said monies will accrue to the benefits of the sole and only heirs of the Estate, the surviving children of the Decedent." (Doc. # 1-1, at 4) Defendants Land O'Lakes, Inc. and Unum Life Insurance Company of America removed the matter to federal court, in part, on the grounds that the matter is preempted by the Employee Retirement Income Security Act of 1974 ("ERISA"), and that the cause of action should thus be treated as being brought under ERISA. (Doc. # 1, at 2) On April 15, 2017, Defendants filed a motion for summary judgment. (Doc. # 22, at 12-15) After argument on the motion, this Court denied the motion for summary judgment and remanded the matter to Unum, the Plan Administrator, for the development of an adequate record in accordance with the Court's Order. (Doc. # 28)
On remand, the Plan Administrator, issued a determination that found no evidence to support plaintiff's assertion that "someone other than Jaclyn Jones is entitled to the policy proceeds." (Doc. # 35-1, at 18) Unum upheld that determination on appeal. (Doc. # 35-1, at 64)
Now before this Court are defendants' motion for summary judgment (doc. # 34) and plaintiff's motion for summary judgment (doc. # 37).
A moving party is entitled to summary judgment "if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(a). A party who moves for summary judgment bears the burden of showing that there is no genuine issue of material fact for trial.
The initial burden of proof on a motion for summary judgment is placed on the moving party to establish the absence of any genuine issue of material fact.
The following facts are uncontroverted unless otherwise noted:
1. Terry Engle ("decedent") was hired by defendant Land O'Lakes, Inc. ("Land O'Lakes") as a full time employee on November 4, 2012. (Doc. 1-1, at ¶ 1) [Defendants' Statement of Uncontroverted Material Facts (hereafter "DSUMF") # 1]
2. Defendant Unum Life Insurance Company of America ("Unum") issued a group insurance policy to Land O'Lakes bearing policy number 99345 003 (hereafter "the Policy") to fund a welfare benefit plan (hereafter "the Plan") providing, among other things, life and accidental death and dismemberment insurance benefits to qualifying employees of Land O'Lakes. (Doc. # 22-1
3. The Effective Date of the Policy was January 1, 2013. (Doc. # 22-1, at 43, 45, 52) [DSUMF # 3]
4. The Plan is governed by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq. (Doc. 1; Doc. # 22-1, at 110-17) [DSUMF # 4]
5. Land O'Lakes is the designated Plan Administrator and named fiduciary of the Plan. (Doc. # 22-1, at 110) [DSUMF # 5]
6. Land O'Lakes, as the Plan Administrator, delegated "to Unum and its affiliate Unum Group discretionary authority to make benefit determinations under the Plan." (Doc. # 22-1, at 117)
7. The Policy further grants Unum discretionary authority to interpret the Plan:
(Doc. # 22-1, at 117) [DSUMF # 6]
8. The General Provisions section of the Policy contains two headings; one entitled
(Doc. # 22-1, at 75, 76) [DSUMF # 7] (modified)
9. Regarding beneficiaries, the Claim Information sections of the Policy for both Life Insurance and Accidental Death and Dismemberment Insurance state:
(Doc. # 22-1, at 58-59, 62) [DSUMF # 8] (modified)
10. Terry Engle died on April 8, 2014, in an automobile accident. (Doc. # 1-1, at ¶ 2; Doc. # 22-1, at 173, 186) [DSUMF # 9]
11. Plaintiff Sharon Engle (Terry Engle's mother) is the personal representative of Terry Engle's estate. (Doc. # 1-1, at ¶ 1; Doc. # 22-1, at 179, 181; Doc # 35-1, at 38) [DSUMF # 10]
12. Jaclyn Jones and Ms. Engle were appointed guardians of Mr. Engle's children. (Doc. # 35-1, at 36, 38, 67) [DSUMF # 11]
13. Terry Engle is survived by two children, Tori and Aiden. (Doc. # 1-1, at ¶ 3) [DSUMF # 12]
14. Tori and Aiden are the only heirs of Terry Engle's estate. (Doc. # 1-1, at ¶ 3) [DSUMF # 13]
15. Tori and Aiden were both listed on decedent's insurance coverage. (Doc. # 22-1, at 28) [Plaintiff's Additional Statement of Uncontroverted Material Facts (hereafter "PSUMF # 49)] (modified)
16. Terry Engle had divorced the mother of Tori and Aiden, Melissa Engle, on November 20, 2012, and, at the time of his death, he was not married. (Doc. # 1-1, at ¶ 4) [DSUMF # 14]
18. Neither Land O'Lakes, nor Unum, were able to locate a beneficiary designation form completed by Terry Engle. (Doc. # 1-1, at ¶ 9; Doc. # 22-1, Doc. # 22-1, at 19, 143, 151; Doc. # 35-1, at 311-316, 366) [DSUMF # 16] (modified)
19. Unum contacted plaintiff, the mother of the deceased, by letter on both April 9, 2014, and on April 11, 2014, requesting beneficiary determination information. (Doc. # 22-1, at 151, 159) [PSUMF # 51)
20. On April 11, 2014, Unum wrote to Sharon Engle asking for information to support the claim for life insurance benefits. (Doc. # 22-1, at 159-64) [DSUMF # 19]
21. On April 18, 2014, Sharon Engle submitted a Facility of Payment Affidavit, which included information that Jaclyn Jones was the domestic partner of Mr. Engle. (Doc. # 22-1, at 178-81) [DSUMF # 20] (modified)
22. On the first page of the Affidavit, at the top, the Affidavit states that, "The information provided on this form will help us to identify the correct beneficiary(ies) for Terry Engle." (Doc. # 22-1, at 178) [DSUMF # 21]
23. On the last page of the Affidavit, right above her notarized signature, Sharon Engle swore that, "The above statements are true and complete to the best of my knowledge and belief.... I understand that if the claim is payable, benefits will be paid according to the beneficiary provision in the policy based on the information I have provided on this form." (Doc. # 22-1, at 181) [DSUMF # 22]
24. On April 29, 2014, Unum wrote to Jaclyn Jones and included a "Domestic Partner Affidavit" for her to complete. (Doc. # 22-1, at 193-96) [DSUMF # 23]
25. Jaclyn Jones signed the Domestic Partner Affidavit on May 5, 2014. (Doc. # 22-1, at 203) [DSUMF # 24] (modified)
26. In the Domestic Partner Affidavit, Jaclyn Jones swore as follows:
(Doc. # 22-1, at 203) [DSUMF # 25]
27. On April 29, 2014, Sharon Engle contacted Unum by phone. During the conversation, she inquired about the status of benefits. Unum advised that it was waiting on the Domestic Partner Affidavit from Jaclyn Jones, but it appeared Jones would be the beneficiary. Sharon Engle asked if that was like "common law," and Unum advised that it was similar. According to Unum, Sharon Engle responded "good," and that Terry Engle and Jaclyn Jones "lived together and were to be married."
28. On May 7, 2014, Unum determined that the life insurance benefit was due and payable to Jaclyn Jones, and it paid her the $133,000 benefit amount. (Doc. # 22-1, at 223-25) [DSUMF # 27]
29. Unum continued to investigate the claim as it related to the accidental death benefit, ultimately approving the claim and paying Jaclyn Jones $133,000 on June 9, 2014. (Doc. # 22-1, at 267-68) [DSUMF # 28] (modified)
30. On September 10, 2014, Sharon Engle contacted Unum to express her disagreement with the decision to pay benefits to Jaclyn Jones, rather than to Terry Engle's estate and/or his children. (Doc. # 22-1, at 275) [DSUMF # 29] (modified)
31. On August 12, 2015, plaintiff filed a Petition for Declaratory Judgment in the Circuit Court of McDonald County, Missouri, which was later removed to this Court. (Doc. ## 1, 1-1)
32. On March 10, 2017, this Court denied defendants' motion for summary judgment and remanded to the Plan Administrator for the development of an adequate record in accordance with the decision of the Court. (Doc. # 28)
33. Following the Court's remand, and pursuant to an April 7, 2017 letter, Unum upheld its earlier decision to pay benefits to Ms. Jones. (Doc. # 35-1, at 18-21) [DSUMF # 30]
34. Unum's letter recounts additional attempts to locate decedent's designation of beneficiaries and recites the same facts as stated in the Statement of Facts 19-21, 24-25, and 27-28,
35. Ultimately, Unum determined that the Plan included "domestic partner" as a "surviving family member" in the beneficiary designation provision of the Plan. (Doc. # 35-1, at 19-20) [DSUMF # 35]
36. Unum stated that the "Domestic Partner Affidavit is the standard form that Unum uses to verify the status of a claimed domestic partner when it considers payment of benefits to a domestic partner." (Doc. # 35-1, at 20) [DSUMF # 36] (modified)
37. Plaintiff appealed Unum's decision in a letter dated June 15, 2017. (Doc. # 35-1, at 24-27) [DSUMF # 37] (modified)
38. Plaintiff argued that Unum's decision was unreasonable for two reasons: 1) the sections entitled "Claim Information" do not allow for the payment of life insurance claims and accidental death and dismemberment claims to a domestic partner, and, in the alternative, 2) if Unum's reading of the policy applying the General Provisions to the payment of claims is correct, the language of the policy would not allow for the payment of the claims to Ms. Jones where the decedent had not filed a declaration of a domestic partnership. (Doc. # 35-1, at 24-25)
39. Unum affirmed its earlier decision in a June 26, 2017 letter. (Doc. # 35-1, at 64-70) [DSUMF # 38]
40. In affirming the decision, Unum noted that they have "discretionary authority to make benefit determinations including determining eligibility for benefit and the amount of benefits, resolving factual disputes, and interpreting and enforcing the provisions of the Plan. The benefit determinations must be reasonable and based on the terms of the Plan and the facts and circumstances of the claim." (Doc. # 35-1, at 68-69)
41. In response to plaintiff's argument on appeal that the claims language of the policy does not contain any provision allowing for payment to a domestic partner, Unum stated that the "domestic partner
The Plan at issue is subject to the requirements of the Employee Retirement Income Security Act of 1974 (hereafter "ERISA"), 29 U.S.C. § 1001 et seq. Where, as here, the plan gives discretionary authority to the plan administrator "to determine eligibility for benefits or to construe the terms of the plan[,]" the court reviews the administrator's decision for an abuse of discretion.
In deciding whether the administrator's determination is reasonable, courts look to a number of factors commonly referred to as the "
The touchstone, nonetheless, is reasonableness. Therefore, if an administrator's decision "offers a reasonable explanation, their decision should not be disturbed even if another reasonable, but different, interpretation may be made."
In the instant matter, Unum, the Plan Administrator, determined that the proceeds should be paid to Ms. Jones. Unum based its determination on two provisions found in the Plan. (Doc. # 35-1, at 19-20) The first provision is the language of the Plan that states "`Spouse' wherever used includes domestic partner" (hereafter referred to as "the spousal enlargement language"). (Undisputed Fact (hereafter "UF") # 8,
(UF # 9,
Plaintiff, on the other hand, argues that the spousal enlargement language does not apply to the payment of proceeds to a beneficiary. (Doc. # 38, at 14-17) Essentially, plaintiff argues that the domestic partner language applies only to individuals who are eligible for life coverage as a dependent of the employee. In the alternative, plaintiff argues that if the spousal enlargement language includes payment to beneficiaries, Ms. Jones was still not entitled to the proceeds because she did not meet the requirements to be considered a domestic partner. (Doc. # 38, at 17-18)
This Court has carefully scrutinized the Plan as well as the Administrator's reasoning for awarding benefits. Various interpretations of the Plan have been advanced. After reviewing all interpretations of the Plan, the Court concludes that Unum's interpretation is contrary to the clear language of the Plan.
Unum's interpretation of the Plan would have this Court focus on one line in the General Provisions section of the Plan and disregard language immediately preceding and following that line. The General Provisions section of the Plan consists of a number of headings. Two of the headings are entitled "What Dependents are Eligible for Life Coverage" and "What Dependents are Eligible for Accidental Death and Dismemberment Coverage". (UF # 8,
(UF # 8,
Utilizing the
Even if this Court were to accept Unum's interpretation that the spousal enlargement language applies to the entire Plan, this Court cannot ignore the fact that directly following the spousal enlargement language the Plan defines who is a domestic partner. There are multiple requirements for establishing who is a domestic partner. These requirements include the following:
(UF # 8,
On appeal from the initial claim decision, Unum stated that the language defining a domestic partner "pertain only to a dependent's eligibility [for] group Life insurance coverage. The definition and requirements do not pertain to the payments of proceeds." (UF # 41,
Thus, the second and fifth
The first and third
Allowing an individual to declare themselves a domestic partner of a covered employee after the death of an employee is not consistent with creating clarity in the award of benefits. As discussed earlier, Unum's interpretation of the Plan, which posits that the domestic partner definition only pertains to a dependent's eligibility for coverage and not to those seeking payment of proceeds, would mean there is no set of requirements for someone seeking payment of proceeds as a domestic partner. Therefore, whether the employee intended to declare someone as a domestic partner would not be a requirement under Unum's interpretation. Nor would the requirement that the employee and the domestic partner must share a residence be part of the analysis. Therefore, there is no explanation, under Unum's interpretation, as to what criteria would be used in considering a claim filed by a "domestic partner".
By arguing that an individual seeking benefits may deem themselves to be a domestic partner of a covered employee, Unum potentially opens themselves up to a host of individuals who claim to be domestic partners with no meaningful way to assess such a claim. One can understand why an employee would need to designate a domestic partner. Where an employee does not name a beneficiary then the Plan allows for payment to an estate or to certain family members. Those family members are spouse, child or children, mother or father, or sisters or brothers. The specified family members are consistent with the general rules of descent.
ERISA requires that the plan administrator, the fiduciary, "shall discharge his duties with respect to a plan solely in the interest of the participants and beneficiaries and (A) for the exclusive purpose of: (i) providing benefits to participant and their beneficiaries;...." 29 U.S.C.A. § 1104(a)(1). ERISA defines an employee as a participant and beneficiaries as "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.A. § 1002(7) & (8). ERISA clearly recognizes that the intentions of the participant are to be honored when stated. When no beneficiaries are stated then the terms of the plan govern. As discussed earlier the Administrator's determination in the instant case does not follow the terms of the Plan as interpreted by Unum. Therefore, the Plan Administrator's determination is not in accordance with ERISA's dictates.
Finally, with regard to the fourth factor, there is no evidence that Unum regularly pays life insurance benefits and accidental death and dismemberment insurance benefits to domestic partners. Unum attempts to show that it regularly awards benefits to a domestic partner by pointing to the Domestic Partner Affidavit, but that attempt misses the mark.
While Unum's Domestic Partner Affidavit seems to suggest that Unum provides life insurance benefits to domestic partners of deceased employees, it also suggests that the domestic partnership definition set forth in the Plan applies in such circumstances. Under the instructions the form states "If you are the Domestic Partner of the deceased and are claiming Life Insurance benefits, please sign and date this form, and have it notarized." (Doc. # 22-1, at 203) Therefore, the form is in line with Unum's assertion that the spousal enlargement language applies throughout the Policy. However, Unum did not present any evidence to suggest that it regularly utilizes the Domestic Partner Affidavit to pay benefits to individuals who have not been designated as a domestic partner by the covered employee prior to the employee's death. The Domestic Partner Affidavit merely shows that an individual is being asked to attest to matters which mirror the language defining domestic partner. This Court cannot infer that the form was regularly used to allow an individual to declare themselves to be a domestic partner of a deceased covered employee where no declaration from the employee was submitted.
Therefore, this Court finds that the Plan Administrator's determination was unreasonable. Unum's interpretation is not in line with the general formatting of the Plan. Furthermore, Unum's argument that spouse includes a domestic partner is not consistent with their own interpretation of the Plan. Therefore, Defendant's motion for summary judgment is denied. Plaintiff's cross-motion for summary judgment is granted. Although plaintiff requests that judgment in the amount of $266,000 be entered in her favor, this Court finds that the matter should be remanded to the Plan Administrator for a determination of the proper recipient in accordance with this decision.
Based on the foregoing, it is