Wilson v. Provident Life and Accident Insurance Company

Filing 38

RULING : The Court GRANTS Provident Life and Accident Insurance Company's 22 Motion for Summary Judgment Seeking Dismissal of Plaintiff's Claim for Failure to Timely Provide Notice and Proof of Loss and Failure to Timely Institute Legal Proceedings. The Court denies the Motion to Establish the Case is Governed by ERISA filed by Provident Life. The 16 , 23 Cross Motions for Summary Judgment on the administrative record filed by Woodrow W. Wilson andProvident Life and Accident Insurance Company, shall be dismissed as moot. Signed by Judge Shelly D. Dick on 3/14/2016. (LLH)

UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF LOUISIANA

WOODROW K. WILSON

CIVIL ACTION

VERSUS
14-499-SDD-EWD
PROVIDENT LIFE AND ACCIDENT
INSURANCE COMPANY

RULING
The Court takes up several Motions: (1) Provident Life and Accident Insurance
Company’s (“Provident”) Motion to Establish that Case is Governed by ERISA,1 (2)
Provident’s Motion for Summary Judgment Seeking Dismissal of Plaintiff’s Claim for
Failure to Timely Provide Notice and Proof of Loss and Failure to Timely Institute Legal
Proceedings,2 and (3) cross Motions for Summary Judgment based on the administrative
record filed by both Parties.3 The Parties have extensively briefed the issues. For the
following reasons, the Court GRANTS Provident’s Motion for Summary Judgment
Seeking Dismissal of Plaintiff’s Claim for Failure to Timely Provide Notice and Proof of
Loss and Failure to Timely Institute Legal Proceedings and DENIES as moot Provident’s
Motion to Establish that Case is Governed by ERISA and the Parties’ cross motions for
summary judgment based on the administrative record.

1

Rec. Doc. 21.
Rec. Doc. 22.
3
Rec. Doc. 16; Rec. Doc. 23.
2

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1

I.

BACKGROUND
This case was initiated in this Court by the Plaintiff, Woodrow K. Wilson (“Wilson”),

invoking the Courts diversity jurisdiction. The Court has examined and confirms its subject
matter jurisdiction.
Wilson is a shareholder employee of the Woodrow Wilson Construction Company,
Inc. (“WWCC”), a closely held4 domestic business corporation.5 Wilson submitted an
application for individual disability income insurance from Provident Life & Accident
Insurance Company (“Provident”) dated August 3, 1993.6 In his application, Wilson
represented that he was an employee of WWCC and that his employer would pay all of
the disability coverage with no portion of the premium to be included in his taxable
income.7 Provident issued a Disability Income Policy to the Plaintiff, Woodrow K. Wilson,
effective on September 1, 1993. WWCC also acquired disability policies from Provident
for the other 2 shareholders, Plaintiff’s brothers, Jim A. Wilson and Mark A. Wilson.8
WWCC did not offer nor provide disability policies to any other employees.9 Provident
billed WWCC directly for the disability policies issued to the Woodrow brothers, and
WWCC paid the monthly premiums.
Wilson began “developing physical difficulties in late 2008”.10 Wilson claims that
his physical problems continued to progress to include his shoulder, his left knee, and his
lower back. According to Wilson, “[i]n late 2008, when his physical condition began to

4

WWCC is wholly owned by 3 brothers, Woodrow K. Wilson, Jim A. Wilson and Mark A. Wilson.
Rec. Doc. 21-4.
6
Rec. Doc. 21-2, p. 4.
7
Rec. Doc. 21-2, p. 4.
8
Rec. Doc. 21-2, p. 19. Wilson is a beneficiary under Disability Income Policy No. 06-337-B-7714427
issued by Provident.
9
Rec. Doc. 16-2, p. 1.
10
Rec. Doc. 20, ¶12.
5

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deteriorate”11 his “limitations from osteoarthritis and other degenerative conditions began
to affect his ability to work”12. Wilson alleges that his deteriorating physical conditions
have caused him to remain under the continuous and regular care of physicians from
2008 to the present.13 Wilson claims that he “is entitled to disability benefits under the
policy from October 13, 2008, the date of his first treatment . . . and the time from which
he was unable to perform the substantial and material duties of his occupation.”14
Wilson submitted an Individual Disability Claim Form to Provident on April 18,
2013.15 Wilson reported his date of disability as October 13, 2008 in an early phone
conversation with Provident16 and submitted a statement from his physician, Dr. Leo
Blaize, who likewise stated that the onset of Wilson’s disability--degenerative arthritis-was October 13, 2008.17 In a letter dated November 14, 2013, Provident informed Wilson
that his claim had been denied for the following reasons:18
Decision/Reason:
We have determined that you are able to perform the duties of your
occupation. Because you are not disabled according to the policy, benefits
are not payable.19

11

Rec. Doc. 20, ¶17.
Rec. Doc. 20, ¶34.
13
Rec. Doc. 20, ¶19.
14
Rec. Doc. 20, ¶36.
15
Rec. Doc. 10-2, pp. 46-53 (under seal). This followed an initial notice of his intention to file a claim for
disability benefits, dated April 17, 2013. Rec. Doc. 27-1, #7. See also, Rec. Doc. 1, ¶18.
16
Rec. Doc. 10-2, p. 163 (under seal).
17
Rec. Doc. 10-2, pp. 61-63 (under seal).
18
Rec. Doc. 10-8, pp. 227-233 (under seal).
19
Rec. Doc. 10-8, p. 228 (under seal). Under the Policy, “Total Disability or totally disabled” meant “that
due to Injuries or Sickness: 1. You are not able to perform the substantial and material duties of your
occupation, and 2. You are receiving care by a Physician which is appropriate for the condition causing the
disability.”
12

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Information that Supports Our Decision:
****
According to the initial claim forms received, it is our understanding that you
are claiming disability due to a sickness that has prevented you from
performing the on-site project management duties of your occupation
beginning on October 13, 2008…..Although you are claiming a disability that
began on October 13, 2008, we did not receive notification of your claim
until April 17, 2013 and did not receive any written proof of loss until April
22 and June 11, 2013 … Under the terms of the policy, written notification
of claim should be provided to the company within 20 days of the onset of
disability. Written proof of loss should be provided within 90 days. These
requirements exist because, with the passage of time, it has become more
difficult and essentially impossible for us to verify the extent and severity of
the disability claimed. Important information may be lost, destroyed, or
otherwise unavailable. Late submission also impaired our ability to monitor
your disability as it progressed, to obtain contemporaneous information and
to exercise our right to have you examined.20
Based on our review of your file, the medical information received does not
support medical restrictions or limitations dating back to 2008 when you
reportedly ceased performing on-site project management duties.21
****
Wilson sought a review of Provident’s decision and offered additional support for
his claim.22 On April 2, 2014, Provident again denied Wilson’s claim.23 In its denial,
Provident explained that “[they had] determined that the restrictions and limitations, and
thus disability, are not supported back to October 2008” as an on-site project manager.24
Subsequently, Wilson provided additional medical information and appealed Provident’s
decision.25 After completing its appeal review on June 4, 2014, Provident once again

20

Rec. Doc. 10-8, pp. 228 and 230 (under seal).
Rec. Doc. 10-8, p. 230 (under seal).
22
Rec. Doc. 10-8, pp. 241-250 (under seal).
23
Rec. Doc. 10-9, pp. 4-6 (under seal).
24
Rec. Doc. 10-9, p. 5 (under seal).
25
Rec. Doc. 10-9, pp. 21-28; 38-41 (under seal).
21

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denied Wilson’s claim26 concluding that Wilson was “fully able to perform the substantial
and material duties of his occupation”; therefore, “Total Disability benefits [were] not
payable.”27
On August 11, 2014, Wilson filed the instant lawsuit against Provident seeking a
declaratory judgment that he is entitled to coverage under his Disability Income Policy
and for an order instructing Provident to pay said benefits and attorney’s fees.28 The
subject motions ensued.
II.

SUMMARY JUDGMENT LEGAL STANDARD
“The court shall grant 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.”29 “An issue is material if its resolution could affect the outcome of the action.”30
“When assessing whether a dispute to any material fact exists, we consider all of the
evidence in the record but refrain from making credibility determinations or weighing the
evidence.”31 “A party moving for summary judgment ‘must “demonstrate the absence of
a genuine issue of material fact,” but need not negate the elements of the nonmovant’s
case.’”32 If the moving party satisfies its burden, “the non-moving party must show that
summary judgment is inappropriate by setting ‘forth specific facts showing the existence

26

Rec. Doc. 10-9, pp. 77-82 (under seal).
Rec. Doc. 10-9, p. 78 (under seal).
28
Rec. Doc. 1.
29
Fed. R. Civ. P. 56(a).
30
DIRECTV Inc. v. Robson, 420 F.3d 532, 536 (5th Cir. 2005).
31
Delta & Pine Land Co. v. Nationwide Agribusiness Ins. Co., 530 F.3d 395, 398-99 (5th Cir. 2008)(citing
Reeves v. Sanderson Plumbing Prods., Inc., 530 U.S. 133, 150 (2000); see also Matsushita Elec. Indus.
Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986)).
32
Guerin v. Pointe Coupee Parish Nursing Home, 246 F.Supp.2d 488, 494 (M.D.La. 2003)(quoting Little v.
Liquid Air Corp., 37 F.3d 1069, 1075 (5th Cir. 1994)(en banc)(quoting Celotex Corp. v. Catrett, 477 U.S.
317, 323-25).
27

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of a genuine issue concerning every essential component of its case.’”33 However, the
non-moving party’s burden “is not satisfied with some metaphysical doubt as to the
material facts, by conclusory allegations, by unsubstantiated assertions, or by only a
scintilla of evidence”.34
Notably, “[a] genuine issue of material fact exists, ‘if the evidence is such that a
reasonable jury could return a verdict for the nonmoving party’”.35 The Court must resolve
all reasonable factual inferences in favor of the nonmoving party.36 However, “[t]he court
has no duty to search the record for material fact issues. Rather, the party opposing the
summary judgment is required to identify specific evidence in the record and to articulate
precisely how this evidence supports his claim”.37 “Conclusory allegations unsupported
by specific facts, however, will not prevent an award of summary judgment; ‘the plaintiff
[can]not rest on his allegations . . . to get to a jury without ‘any significant probative
evidence tending to support the complaint.’”38

33

Rivera v. Houston Independent School Dist., 349 F.3d 244, 247 (5th Cir. 2003)(quoting Morris v. Covan
World Wide Moving, Inc., 144 F.3d 377, 380 (5th Cir. 1998)).
34
Willis v. Roche Biomedical Laboratories, Inc., 61 F.3d 313, 315 (5th Cir. 1995)(quoting Little v. Liquid Air
Corp., 37 F.3d 1069, 1075 (5th Cir. 1994)(internal quotations and citations omitted)).
35
Pylant v. Hartford Life and Accident Insurance Company, 497 F.3d 536, 538 (5th Cir. 2007)(quoting
Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986)).
36
Galindo v. Precision American Corp., 754 F.2d 1212, 1216 (5th Cir. 1985).
37
RSR Corp. v. International Ins. Co., 612 F.3d 851, 857 (5th Cir. 2010)(citing Ragas v. Tenn. Gas Pipeline
Co., 136 F.3d 455, 458 (5th Cir. 1998)).
38
Nat’l Ass’n of Gov’t Employees v. City Pub. Serv. Bd. of San Antonio, Tex., 40 F.3d 698, 713 (5th Cir.
1994)(quoting Anderson, 477 U.S. at 249)(citation omitted)).

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III.

ANALYSIS
A. Does ERISA govern the subject disability policy?
In order for a disability policy to be an “employee benefit plan,” which includes

“employee welfare benefit plan[s],” regulated by ERISA, the “plan must be established or
maintained by an employer for the benefit of employees.”39
Wilson argues that the disability policy is exempt from ERISA because the only
people covered by the benefit plan were the three working owners of WWCC. In making
his argument, Wilson relies upon DOL regulations and jurisprudence which provide that
plans benefiting only partners or sole owners and their spouses fall outside of ERISA’s
reach.40
Provident maintains that Wilson’s reliance on these DOL regulations is misplaced
because Wilson is not a “sole” owner and WWCC is not a partnership. Provident cites a
2004 Fifth Circuit case, Provident Life and Accident Ins. Company v. Sharpless, as
dispositive of the issue.41
Sharpless, involved a disability benefits plan that insured only the employeeshareholder physicians of the Anesthesia Research Specialists of Baton Rouge, a
professional medical corporation whose physicians owned all of the corporation’s

39

Meredith v. Time Ins. Co., 980 F.2d 352, 358 (5th Cir. 1993).
Rec. Doc. 16-1; Rec. Doc. 29. (e.g., Raymond B. Yates, M.D.,P.C. Profit Sharing Plan v. Hendon, 124
S.Ct. 1330 (2004) explained how “[p]lans that cover only sole owners or partners and their spouses … fall
outside [ERISA’s] domain”; Robertson v. Alexander Grant & Co., 798 F.2d 868 (5th Cir. 1986) holding that
a retirement plan benefitting only partners was not covered by ERISA).
41
Provident Life and Accident Ins. Co. v. Sharpless, 364 F.3d 634 (5th Cir. 2004) (hereinafter “Sharpless”).
40

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shares.42 However there is a distinction between the facts in Sharpless and the facts
here, namely, unlike WWCC’s shareholders, the shareholders in Sharpless had no
familial ties. This Court can conceive of no reason to treat a closely held family enterprise
different from a sole shareholder and spouse or partnership for purposes of ERISA.
However, the Court need not reach the issue of ERISA coverage because the
Court finds that, for the reasons which follow, that regardless of whether ERISA or
Louisiana law controls, Plaintiff’s notice of claim, proof of loss and, ultimately, his suit are
untimely.
B. Timeliness of Providing Notice, Proof of Loss, and Instituting Legal
Proceedings
Provident moves dismissal alleging that Wilson failed to timely provide notice of
his claim, proof of loss, and failed to institute legal proceedings in accordance with the
terms of the Policy.
1. Contractual Limitations Periods
Even were the Court to find that the subject policy is governed by ERISA, it is well
established that “ERISA does not … specify a statute of limitations for filing suit under §
502(a)(1)(B)”43 and contractually agreed upon limitations periods are enforceable unless
they are unreasonable or there is a controlling statute to the contrary.44 Looking to
Louisiana’s insurance statutes for guidance, the Court concludes that the limitations

42

Id. at 637. The Anesthesia Research Specialists of Baton Rouge offered two plans—one, which covered
all employees, including shareholders—and one available only to shareholding employees. Only the latter
was at issue in Sharpless.
43
Heimeshoff v. Hartford Life & Acc. Ins. Co., 134 S.Ct. 604, 608 (2013)(hereinafter “Heimeshoff”).
Therefore, courts generally “‘apply the most closely analogous statute of limitations under state law.’”
Kennedy v. Elec. Pension Plan, IBEW No. 995, 954 F.2d 1116, 1120 (5th Cir. 1992)(quoting DelCostello v.
Teamsters, 462 U.S. 151, 158 (1983)); see also, Heimeshoff, 130 S.Ct. at 609.
44
Heimeshoff, 130 S.Ct. at 610.

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periods specified in the disability policy at issue here are reasonable. La. R.S. 22:975
sets forth minimum requirements for health and accident insurance policies issued in the
State of Louisiana. La. R.S. 22:975(A)(3) requires that a notice of claim be given to an
insurer within twenty days of the date of the accident causing injury or the commencement
of the disability from injury or sickness. La. R.S. 22:975(A)(5) requires that proof of loss
“be furnished to the insurer … in case of claim for loss of time from disability within ninety
days after the termination of the period for which the insurer is liable.”
The Court finds that the provisions regarding notice of claim and proof of loss in
Provident’s disability policy are wholly consistent with those required under Louisiana law.
As for the allowable statute of limitations for filing suit, Provident’s disability policy is
actually more generous than state law. Under La. R.S. 22:975(A)(11), “[n]o legal action
shall be brought after the expiration of one year after the time proof of loss is required to
be filed.” In contrast, Provident’s policy allows a three year time period from providing
proof of loss within which a party may institute legal proceedings. The Court finds that
whether analyzed under ERISA’s reasonableness standard or state insurance law, the
Provident disability policy at issue is in conformance with law.
2. Do Material Issues of Fact Remain?
Wilson contends that, because Provident determined that he was not disabled as
of October 13, 2008, there was no “covered loss” and, thus, the reporting requirements
under the policy were never triggered. According to Wilson, a genuine issue of material
fact exists as to when the 20 day notice of loss period, the 90 day written proof of loss,

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and three year limitations period for filing suit were actually triggered.45 Wilson argues
that his notice of loss (4/17/2013), proof of claim (4/18/2013), and filing of his lawsuit
(8/11/2014), may, in fact, be timely depending upon when his disability or “covered loss,”
began.
By this argument, Provident’s claim denial has the effect of completely negating
the reporting requirements under the policy. The loss reporting requirements of the policy
would not be triggered unless and until Provident determines the claim as compensable.
Provident disputes that Wilson was disabled as of October, 2008. But there is no dispute
that Wilson seeks “disability benefits under the policy from October 13, 2008.”46 There is
no dispute that Wilson alleges that, as of October 13, 2008, he “was unable to perform
the substantial and material duties of his occupation.”47 In support of summary judgment,
Wilson submits as an undisputed fact that “[i]n 2008, Mr. Wilson was no longer able to
perform his duties as a project manager and lead on site construction representative for
WWCC.”48 Provident denies that “medical records support a conclusion that Wilson had
restrictions and limitations in 2008 that prevented him from performing the substantial and
material duties of his occupation.”49 Most certainly, whether or not Wilson was disabled
in October of 2008 for purposes of entitling him to benefits under the policy is in dispute.
However, there is no dispute that Wilson claims his disability commenced in October of

45

For the first time in his memorandum opposing Provident’s motion (Rec. Doc. 27), Wilson suggests that
he may not have been disabled in October of 2008, and offers an alternative date of April 13, 2013 as the
date of his disability or covered loss.
46
Rec. Doc. 20, ¶36.
47
Id.
48
Rec. Doc. 16-4, #10.
49
Rec. Doc. 24-2, #9.

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200850 and there is no dispute that Plaintiff first submitted an Individual Disability Claim
Form on April 18, 2013.51
The Court cannot ignore the record which is replete with admissions made by
Wilson that he deemed October 13, 2008 to be the date his disability began and the date
from which he should be entitled to recover benefits.52 It is undisputed that Wilson has
repeatedly claimed that he has been unable to perform the substantial and material duties
of his occupation since October 13, 2008.53 Hence, the Court finds that there is no
genuine issue of material fact in dispute as to when Wilson had knowledge of a medical
condition allegedly affecting his ability to perform the substantial and material duties of
his occupation, thereby triggering notice of claim reporting under the policy. Based on
the evidence in the record, no reasonable trier of fact could find that Wilson believed his
disability or covered loss began on any other date besides October 13, 2008.
The Court also finds that Provident’s denial of Wilson’s disability claim does not
bar it from asserting its contractual defenses of timely filing notice of claim, proof of loss,
and instituting legal proceedings. In denying Wilson’s disability claim, Provident
determined that Wilson had failed to provide Provident with documentation demonstrating
an inability to work as of the time he claimed he was no longer able to perform the
substantial and material duties of his occupation on October 13, 2008. Pursuant to Rule
8(d)(2) of the Federal Rules of Civil Procedure, “[a] party may set out 2 or more

50

Rec. Doc. 20, ¶36 and record citations in Note 52, infra.
Plaintiff’s Statement of Undisputed Facts, Rec. Doc. 16-4, #14.
52
See, Rec. Doc. 1, ¶9; Rec. Doc. 16-2, pp. 2-3; Rec. Doc. 16-1, p. 4; Rec. Doc. 16-1, p. 16; Rec. Doc. 164, n. 10; Rec. Doc. 20, ¶36.
53
According to Wilson, his restrictions and limitations began in 2008-he has repeatedly alleged that and in
documentation this is also reflected. (Rec. Doc. 10-3, p. 55. Benefits Research Information Field Report
dated July 23, 2013).
51

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statements of a claim or defense alternatively or hypothetically.” Moreover, “[a] party may
state as many separate claims or defenses as it has, regardless of consistency.”54
Provident raised the defense of timeliness in its Answers.55 The record also reflects that,
from the inception of Wilson’s claim for disability coverage, Provident openly raised
concerns about Wilson’s failure to timely comply with the filing requirements under the
Policy. Therefore, based upon the evidence in the record, Provident’s timeliness
argument is properly before the Court.
Wilson admits that he did not submit a notice of claim to Provident within 20 days
of October 13, 2008, or by November 2, 2008.56 Wilson also admits that he did not submit
a proof of loss for his claimed disability by May 13, 200957, or within the one year outer
time limit of May 13, 2010.

In fact, Wilson did not provide written notification of his

intention to file a disability claim until April 17, 2013, which was followed by a disability
claim form dated April 18, 2013.58 Under the terms of the Policy, Wilson’s 2013 notice
of claim and proof of loss forms are untimely.
The Policy allows an untimely proof of his claim--after the 90 days of the start
period for which payment was owed--if it was not reasonably possible for the insured to
timely submit a proof of claim. In any event, the policy requires that a proof of claim be
submitted no later than one year beyond the 90 day proof of loss reporting period, unless
the insured was legally unable to do so. Although the Policy provided such exceptions,

54

Fed. R. Civ. P. 8(d)(3).
Rec. Doc. 6, pp. 1-2, (Second, Third, and Fourth Defense); Rec. Doc. 25, pp. 1-2 (Second, Third, Fourth,
and Fifth Defenses).
56
Rec. Doc. 27-1, #8 and #12.
57
Rec. Doc. 27-1, #13.
58
Rec. Doc. 27-1, #7 and #9.
55

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the record is devoid of any evidence showing that “it was not reasonably possible” for
Wilson to file his proof of loss by May 13, 2009, or that he was “legally unable to do so”
by May 13, 2010. The closest attempt made by Wilson to justify the delay in filing his
proof of claim appears in his July 23, 2013 response to an inquiry from Provident. When
asked by the Provident representative why he had not filed his claim sooner, Wilson
explained when he saw his physician in October of 2008 for his knee, he received
injections, engaged in physical therapy, and had hoped that his condition might improve.59
The Court finds that such an explanation does not amount to a reasonable explanation
for the delay, or qualify as a legal explanation for the belated filing of his proof of claim.
Moreover, the explanation was offered approximately five years from the date, that by his
own account, Wilson’s alleged disability began. Therefore, construing Wilson’s claim in
a light most favorable to him, the Court finds that Wilson’s explanation does not
demonstrate that it was not reasonably possible for him to file his notice and proof of loss
timely. Accordingly, the Court finds that Wilson has failed to create a genuine issue of
material dispute as to when the “covered loss” occurred and when the 20 day notice of
claim and 90 day proof of claim were due.
3. Timeliness of Plaintiff’s Suit
Under both Louisiana law and ERISA, the Court finds that Wilson has failed to
timely file his lawsuit in the instant matter. “[U]nder Louisiana law, the parties to an
insurance policy may contractually agree to limit the period within which suit must be filed,
such that a contractual period of prescription is valid so long as is it does not contravene

59

Rec. Doc. 10-3, p. 33 (under seal).

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a state statute or public policy.”60 As previously discussed by the Court, the disability
policy at issue specifies a three year statute of limitations period for filing suit from the
time proof of loss is required. The Court finds this statute of limitations period is more
favorable than the one year statute of limitations period permitted under La. R.S.
22:975(A)(11).
The three year statute of limitations is also viable under ERISA, even though the
prescriptive period begins to run from the time proof of loss is required, and not from the
time a claim is denied. The United States Supreme Court held in Heimeshoff v. Hartford
Life & Acc. Ins. Co., that “a participant and a plan may agree by contract to a particular
limitations period, even one that starts to run before the cause of action accrues, as long
as the period is reasonable.”61 The only way the presumption of enforceability may be
overcome is by a showing that the limitations period is unreasonable or exceeds the
applicable statute of limitations. The Court finds that no such showing has been made
by Wilson.
As previously discussed, the record in this case is replete with admissions by
Wilson that he deemed October 13, 2008 to be the date he could no longer perform his
job duties and the date his disability began. He also seeks to recover benefits starting
from this date. Therefore, contrary to Wilson’s jurisprudentially unsupported arguments
otherwise, whether Provident ultimately deemed Wilson was able to work on October 13,
2008, does not create a genuine issue of material fact as to when his claim should have
been filed under the express terms of the Policy. Had Wilson timely filed a claim at this

60
61

Noland v. Sun Life Assurance Co. of Canada, 252 F.3d 436, *1 (5th Cir. 2001).
Heimeshoff v. Hartford Life & Acc. Ins. Co., 134 S.Ct. 604, 610 (2013).

29047v.2
14

time, under the terms of the Policy, his proof of loss would have been due no later than
May 13, 2010. After that date, the only acceptable reason for not submitting proof of
claim would have been if Wilson was legally unable to do so. Wilson’s reason for not
filing his claim in October of 2008, however, is not premised on any legal basis; rather,
he deferred filing a claim because he hoped his condition would improve through physical
therapy. Therefore, Wilson would have had three years from May 13, 2010, or May 13,
2013, to file his lawsuit. It is undisputed that Wilson did not file his lawsuit until August
11, 2014. The Court finds that Wilson has failed to create a genuine issue of material fact
as to when the statute of limitations period for instituting his lawsuit should have been
triggered under the Policy. Accordingly, Wilson’s claim must be dismissed because his
claim has prescribed under the terms of the Policy.

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IV.

CONCLUSION
Wherefore, the Court GRANTS Provident Life and Accident Insurance Company’s

Motion for Summary Judgment Seeking Dismissal of Plaintiff’s Claim for Failure to Timely
Provide Notice and Proof of Loss and Failure to Timely Institute Legal Proceedings.62
Considering that the Court has found that Woodrow K. Wilson’s claim has
prescribed, the Court denies the Motion to Establish that Case is Governed by ERISA63
filed by Provident Life and Accident Insurance Company’s and the cross Motions for
Summary Judgment on the administrative record filed by Woodrow W. Wilson and
Provident Life and Accident Insurance Company, and they shall be dismissed as moot.64
IT IS SO ORDERED.
Signed in Baton Rouge, Louisiana on March 14, 2016.

S

JUDGE SHELLY D. DICK
UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF LOUISIANA

62

Rec. Doc. 22.
Rec. Doc. 21.
64
Rec. Doc. 16 and Rec. Doc. 23.
63

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