Taylor v. Metro. Life Ins. Co.
Taylor v. Metro. Life Ins. Co.
Opinion of the Court
On cross-motions for summary judgment in this ERISA
I
Stephanie's late husband, Jonathan H. Taylor ("Jonathan"), was an employee of Cardinal Health, Inc. ("Cardinal Health") who participated in basic and optional life insurance benefits under Cardinal Health's Group Life Insurance Plan (the "Plan"), which is governed by ERISA.
As a result of a disability, the last day Jonathan worked at Cardinal Health was October 20, 2015, and his employment with Cardinal Health ended on or about April 19, 2016. In accordance with the terms of the Plan, Jonathan's life insurance benefits were to end the date his employment ended. Under certain circumstances defined in the Plan, a plan participant has the option to port or to convert his life insurance coverage. Moreover, if the plan participant's employment ends as the result of a disability, he can apply for the continuation *813of certain insurance. If the plan participant's claim for continuation is approved, his insurance coverage will be continued under the Plan, and no premium payment will be required.
In March 2016 Jonathan applied for the continuation of certain insurance while totally disabled. Before MetLife issued a decision on Jonathan's claim for continuation, Jonathan also elected to port his optional life insurance. According to the Plan and an April 2016 letter, because Jonathan's employment ended due to a reason other than retirement, he had the option of porting-or continuing under another group policy-his optional life insurance.
As a result of Jonathan's choice to port his optional life insurance, MetLife issued a new certificate of insurance for $ 273,000, effective June 2, 2016 (the "Portable Policy"). Jonathan and Stephanie paid monthly premiums on the Portable Policy from June to September 2016. In September 2016 MetLife informed Jonathan that he met the requirements for total disability under the Plan and that MetLife approved his claim for continuation of, inter alia , his basic and optional life insurance, at no cost to him.
Jonathan died in October 2016. The next month, Stephanie submitted a life insurance claim form to MetLife on the Plan and the Portable Policy. MetLife approved and paid Stephanie's claim for benefits under the Plan, but denied her claim under the Portable Policy. Stated in monetary terms, MetLife approved and paid Stephanie's claim for $ 407,000 in basic and optional life insurance benefits due under the Plan ($ 136,000 in basic life plus $ 271,000 in optional life), but denied Stephanie's claim for $ 273,000 in optional life insurance benefits under the Portable Policy.
In January 2017 Stephanie's counsel sent an appeal letter to MetLife. Shortly thereafter, MetLife sent another denial letter, this time including notice that Stephanie's claim is governed by ERISA. Stephanie, through counsel, submitted an administrative appeal to MetLife in June 2017. She contended that she was entitled to $ 273,000 in optional life insurance benefits under the Portable Policy in addition to the benefits that MetLife paid because *814MetLife sent Jonathan an "Election of Portable Coverage" form, Jonathan completed the form, MetLife issued the Portable Policy to Jonathan with an effective date in June 2016, and Jonathan and Stephanie paid premiums on the Portable Policy through September 2016.
On appeal, MetLife upheld the denial of Stephanie's claim. Via letter to Stephanie's counsel, MetLife stated that, according to the Plan, "Portable insurance ends when continuation of coverage due to disability is approved." D. App. 126. MetLife also stated that "coverage is not a guarantee" and "premium payments are not a guarantee of coverage as premiums can be refunded," which, in this case, MetLife attempted to do. Id.
Stephanie filed suit against MetLife in January 2018 in Texas state court, alleging that MetLife had wrongfully denied her claim and appeals. MetLife timely removed the action to this court. Both parties now move for summary judgment on Stephanie's ERISA claim.
II
MetLife is moving for summary judgment on a claim for which Stephanie will have the burden of proof at trial. Because Stephanie will have the burden of proof, MetLife's burden at the summary judgment stage is to point the court to the absence of evidence of any essential element of Stephanie's claim. See Celotex Corp. v. Catrett ,
Because Stephanie will have the burden of proof at trial on her ERISA claim, to be entitled to summary judgment she "must establish 'beyond peradventure all of the essential elements of the claim[.]' " Bank One, Tex. N.A. v. Prudential Co. of Am. ,
Further, in a non-jury case, such as this ERISA action, "a district court has somewhat greater discretion to consider what weight it will accord the evidence." Johnson v. Diversicare Afton Oaks, LLC ,
III
The court turns to the question whether MetLife's denial of Stephanie's claim was proper.
A
MetLife avers that-regardless whether the court applies the de novo or the abuse of discretion standard of review-its denial of benefits should be upheld. Stephanie contends that-under either standard-MetLife's denial of benefits should be reversed. The court agrees that the standard of review is not dispositive of this case because the outcome would be the same under either de novo or abuse of discretion review: MetLife properly denied Stephanie's claim to recover death benefits under the Portable Policy.
"[A] denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe terms of the plan." Firestone Tire & Rubber Co. v. Bruch ,
De novo review would apply if ERISA does not preempt the Texas statute rendering discretionary clauses unenforceable. See, e.g. , Woods v. Riverbend Country Club, Inc. ,
If ERISA did preempt the Texas antidelegation statute, however, the court would review MetLife's benefits determination under an abuse of discretion standard because the Plan delegates discretionary authority to MetLife. See Rittinger v. Healthy All. Life Ins. Co. ,
B
The primary issue in this case is whether Jonathan had separate and distinct coverage under both the Plan and the Portable Policy, such that Stephanie was entitled to recover benefits on both. Stephanie maintains that she is entitled to recover under both because "[t]here was never any notice of cancellation or repudiation [of the Portable Policy] until after [Jonathan's] death," and the other elements of a contract for insurance were met. P. Br. 9-10. MetLife counters that the unambiguous terms of the Plan and Portable Policy prohibit the type of "double recovery" Stephanie seeks. D. Br. 14. After a de novo review of the Plan and the Portable Policy, the court concludes that their written terms are not ambiguous and that they plainly prohibit simultaneous recovery.
The Plan provides for the precise scenario in which an insured both applies for a continuation of his insurance coverage due to disability and elects to port his insurance coverage before receiving approval for continuation of insurance:
If You are Totally Disabled on the date Your employment ends and You elect to Port as provided in this subsection, You may at a later date become approved for the continuation of insurance under the section entitled LIFE INSURANCE: ELIGIBILITY FOR CONTINUATION IF LIFE INSURANCE ENDS WHILE YOU ARE TOTALLY DISABLED. If You are so approved, all Ported insurance continued under this Portability subsection will end, including Life Insurance and Dependent Life Insurance.
D. App. 20. The undisputed summary judgment evidence shows that Jonathan was totally disabled on the date his employment ended, that he elected to port his optional life insurance, and that, after porting, he became approved for the continuation of his insurance. Accordingly, all of Jonathan's ported insurance ended as of the date of approval.
Moreover, under the section discussing eligibility for continuation, entitled "EFFECT OF PREVIOUS ELECTION TO PORT COVERAGE," the Plan explicitly states that MetLife "will not pay insurance under both this [Plan] and the [ported] policy." D. App. 26 (emphasis added). These terms are not ambiguous. Recovery under both the Plan and another coverage that stems from the Plan is prohibited.
The same result is mandated by the unambiguous terms of the Portable Policy. The Portable Policy provides:
In the event that: (a) You are disabled; (b) as a result of Your being disabled, *817You are approved under the Former Plan for continuation of Insurance; and (c) as a result of that approval, premiums are waived under the Former Plan; then the corresponding insurance under this certificate will end on the date You become approved for that continuation of Insurance.
D. App. 49. "Former Plan" is defined as "the policy of group insurance under which You were provided the option of Porting certain insurance provided under such plan." D. App. 45. Because the option of porting arose as a result of the insurance Jonathan had under the Plan, it is the "Former Plan" as the term is used in the Portable Policy. It is evident based on the language in the Portable Policy that it "was intended to provide fallback coverage only if [Jonathan] was not granted a waiver for his premiums under [the Plan]." Metro. Life Ins. Co. v. Yitao Sun ,
Stephanie fails to demonstrate that there is a genuine issue for trial. She does not contest the validity of the Plan or Portable Policy, argue that their provisions are inapplicable, or cite any evidence that suggests that their provisions are inapplicable. Instead, she contends that "fundamental insurance contract principles" preclude summary judgment in MetLife's favor. P. Resp. Br. 10. In effect, Stephanie is asking the court to consider the fact that she and Jonathan paid premiums on the Portable Policy without regard to the existence of the Plan or the express terms of the Portable Policy. But her contention is unsupportable. The Portable Policy itself acknowledges that it does not exist in isolation. Without the Plan, Jonathan would have had no insurance to port. And without the written terms of the Plan and Portable Policy, there would be no way to know what the coverage was-or to know the parties' intent with respect to that coverage. Cf.
Courts confronted with similar contracts and facts agree: double recovery is barred by the express terms of the contracts. See, e.g. , White v. Provident Life & Acc. Ins. Co. ,
Stephanie's payment of premiums on the Portable Policy does not entitle her to a different outcome.
C
The court would reach the same result under an abuse of discretion standard.
To ascertain whether MetLife abused its discretion in denying Stephanie's claim for benefits, the court first determines the legally correct interpretation of the Plan and Portable Policy and whether MetLife's interpretation accords with the proper legal interpretation. Vercher ,
Accordingly, under either de novo or abuse of discretion review, MetLife's denial of benefits under the Portable Policy should be upheld.
* * *
For the reasons explained, the court grants MetLife's motion for summary judgment, denies Stephanie's motion for summary judgment, and enters judgment in favor of MetLife dismissing this action with prejudice.
SO ORDERED .
Employee Retirement Income Security Act of 1974,
Because both sides move for summary judgment, the court will recount the evidence that is undisputed, and, when it is necessary to set out evidence that is contested, will do so favorably to the side who is the summary judgment nonmovant in the context of that evidence. See, e.g., GoForIt Entm't, LLC v. DigiMedia.com L.P. ,
As the April 2016 letter details, Jonathan also had the option of converting his insurance to a permanent individual life insurance policy. Stephanie's brief in support of her motion for summary judgment states that her husband "accepted" MetLife's offer for "Conversion Life insurance benefits," and that it was the converted benefits that were paid and "are not in dispute." P. Br. 5. As evidence, Stephanie cites a page in the record titled "Notice of Group Life Insurance Conversion Privilege." But the notice expressly states: "[t]his Notice is not a conversion application or policy." P. App. 190 (emphasis added). Thus based on this evidence, no reasonable trier of fact could find that Jonathan converted his plan to a permanent individual life insurance policy. Instead, the evidence would only permit the reasonable finding that Jonathan applied for a continuation of his insurance, and, while that application was pending, he ported (not converted) his optional life insurance.
According to MetLife, the difference in optional life insurance coverage from $ 271,000 to $ 273,000 was the result of an increase in Jonathan's income from 2015 ($ 90,018.56 when his Plan benefits were determined) to 2016 ($ 90,918.75 when he applied for the Portable Policy benefits). Jonathan's elected optional life benefits were for three times his basic annual income, rounded to the next higher $ 1,000. Applying this formula to Jonathan's 2015 and 2016 income accounts for the benefit difference. Stephanie does not address the discrepancy.
Although the Fifth Circuit has expressly declined to address this preemption question, in Ariana M. v. Humana Health Plan of Texas, Inc. ,
The court notes that Stephanie does not specifically allege "waiver" in her complaint or summary judgment briefing, but because it is possible to read her argument regarding premium payments as one of waiver, the court briefly addresses the applicability of waiver.
Reference
- Full Case Name
- Stephanie TAYLOR v. METROPOLITAN LIFE INSURANCE COMPANY
- Cited By
- 1 case
- Status
- Published