GIBLIN v. SUN LIFE AND HEALTH INSURANCE COMPANY et al
Filing
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OPINION. Signed by Judge Jose L. Linares on 10/16/12. (dc, )
NOT FOR PUBLICATION
UNITED STATES DISTRICT COURT
DISTRICT OF NEW JERSEY
KEVIN GIBLIN,
Civil Action No. 11-2603 (JLL)
Plaintiff,
OPINION
V.
SUN LIFE AND HEALTH INSURANCE
COMPANY, et a!.
Defendants.
LINARES, District Judge.
This matter comes before the Court by way of Defendant Sun Life and Health Insurance
Company (“Defendant”)’s motion for reconsideration of this Court’s August 20, 2012 Opinion
and Order denying Defendant’s motion for summary judgment. The Court has considered the
submissions made in support of and in opposition to the instant motion, and decides this matter
without oral argument pursuant to Fed. R. Civ. P. 78. For the reasons set forth below,
Defendant’s motion for reconsideration is denied.
I.
BACKGROUND
The facts of this case are more fully detailed in this Court’s August 20, 2012 Opinion,
and are repeated here only to the extent they are relevant to the instant motion for
reconsideration.
This case arises from Plaintiff Kevin Giblin (“Plaintiff’)’s claim for recovery of disability
income benefits pursuant to
§ 502(a)( 1 )(B) of the Employee Retirement Income Security Act
(“ERISA”). See 29 U.S.C.
§ 1 132(a)(1)(B). Plaintiff was a full-time employee of the New York
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City District Council of Carpenters (“NYDCC”) until August 7, 2007 when he ceased working
as a result of medical conditions which he alleges include pulmonary dysfunction and
cardiovascular disease. (Compi.
¶ 8.) As an employee of the NYDCC, Plaintiff participated in
the Employee Welfare Benefit Plan (the “Plan”) which provided Group Long Term Disability
Benefits to employees of the NYDCC. (See id.
¶J 6-7.)
After ending his employment, Plaintiff made a claim for benefits under the Plan. (Id.
¶
9.) As the insurer and claims fiduciary of the Plan, Defendant initially accepted Plaintiff’s claim
and paid benefits through November 1, 2009, at which time it terminated Plaintiffs benefits.
(Id.
¶ 10.) Upon Defendant’s termination of benefits, Plaintiff filed an administrative appeal in
accordance with 29 U.S.C.
§ 1133.
(Id.
¶ 12.) In support of his appeal, Plaintiff submitted
reports from his treating and examining physicians and other medical evidence in support of his
claim for disability benefits. (Id.) Additionally, Plaintiff was examined by Defendant’s
physician, Dr. Monroe Karetzky, who ultimately disputed the medical premise underlying
Plaintiffs disability claim. (CM/ECF No. 16-3 at ¶J 49-51.) Other physicians employed by
Defendant reviewed Plaintiffs medical records, and also disputed the medical premise upon
which Plaintiffs disability claim is based. (See, e.g., CM/ECF No. 16-3 at
¶J 17-18, 39-42, 4951.)
On April 13, 2012, the parties filed cross-motions for summary judgment. (See CM/ECF
Nos. 16, 17.) On August 30, 2012, this Court denied each party’s motion upon concluding that
conflicting medical evidence in the record created “issues of fact that prevent[edj the Court from
granting summary judgment.” (CMIECF No. 20 at 7.) Defendant filed the instant motion for
reconsideration on August 30, 2012.
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II.
LEGAL STANDARD
“Reconsideration is an extraordinary remedy” and should be “granted ‘very sparingly’.”
See L. Civ. R. 7.1(i) cmt. 6(d); see also Fellenz v. Lombard Investment Corp., 400 F. Supp. 2d
681 (D.N.J. 2005). A motion for reconsideration “may not be used to re-litigate old matters” or
argue new matters that could have been raised before the original decision was reached. See,
e.g., F. Schoenfeld Asset Mgmt., LLCv. Cendant Corp., 161 F. Supp. 2d 349, 352 (D.N.J. 2001).
To prevail on a motion for reconsideration, the moving party must “set
[] forth concisely
the matter or controlling decisions which the party believes the Judge or Magistrate Judge has
overlooked.” L. Civ. R. 7.1. When the assertion is that the Court overlooked something, the
Court must have overlooked “some dispositive factual or legal matter that was presented to it.”
McGovern v. City ofJersey City, No. 98-5 186, 2008 U.S. Dist. LEXIS 293, 2008 WL 58820, at
*2 (D.N.J. Jan. 2, 2008). The Court will reconsider a prior order only where a different outcome
is justified by: 1) an intervening change in law; 2) availability of new evidence not previously
available; or 3) a need to correct a clear error of law or manifest injustice. See N River Ins. Co.
v. CIGNA Reinsurance, Co., 52 F.3d 1194, 1218 (3d Cir. 1995).
III.
DISCUSSION
Defendant argues that in denying its motion for summary judgment, this Court
overlooked controlling precedent regarding the manner in which ERISA cases are decided. (See
CMIECF No. 21-1 at 3-7.) Defendant further argues that because the record establishes that its
decision to terminate Plaintiff’s benefits was not arbitrary and capricious, this Court should grant
summary judgment in its favor. (CM/ECF No. 21-1 at 7-8.) The Court will address each of
these arguments in turn.
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A.
Whether this Court Overlooked Controlling Precedent
Defendant contends that in denying its motion for summary judgment based on the
conflicting medical evidence in the record, this Court ignored Third Circuit precedent which has
recognized “motions for summary judgment as the only appropriate way to bring the issue of
eligibility for benefits [under the arbitrary and capricious standard of review] before the court.”
(CM/ECF No. 21-1 at 6, emphasis in original.) In support of its argument, Defendant relies on a
footnote in Lasser v. Reliance Std. Ins. Co., 344 F.3d 381 (3d Cir. 2003) which states that “de
novo fact finding is improper in reviewing a claims administrator’s decision under the arbitrary
and capricious standard of review.” Id. at 385 n.3.
Defendant’s reliance on Lasser is misplaced. Nothing in Lasser supports Plaintiffs
proposition that summary judgment is the only appropriate means by which a district court may
decide whether a plaintiff is eligible for benefits under the arbitrary and capricious standard of
review. As in this case, in Lasser the district court denied the parties’ cross-motions for
summary judgment because there was conflicting medical evidence in the record. Id. at 384 n.2.
It was only after the district court held a bench trial to determine whether the defendant
administrator had a conflict of interest that the court ruled on the plaintiffs claim.
This Court does not dispute that Lasser supports the proposition that this Court should
refrain from de novo fact finding in determining whether Defendant’s decision was arbitrary and
capricious. Nothing in Lasser, however, precludes this Court from considering evidence
presented during a bench trial to obtain a better understanding of the factual record upon which
Defendant relied in deciding to terminate Plaintiffs benefit, and make a determination as to
whether Defendant’s decision was arbitrary and capricious in light of that record.
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Indeed, there is ample authority within the Third Circuit recognizing the propriety of a
district court’s considering evidence that is not strictly within the administrative record for such
purposes. See, e.g., Kosiba v. Merck & Co., 384 F.3d 58, 69 (3d Cir. 2004) (“While the District
Court may take further evidence to aid in its understanding of the medical issues involved, it
must base its ultimate determination on the record before the plan administrator, not its own
judgment of whether [the plaintiff] was disabled.”) (emphasis added); see also Howley v. Mellon
Fin. Corp., 625 F.3d 788, 793 (3d Cir. 2004) (“A court may certainly consider evidence of
potential biases and conflicts of interest that is not found in the administrator’s record.”);
O’Sullivan v. Metropolitan Life Ins. Co., 114 F. Supp. 2d 303, 310 (D.N.J. 2000) (observing that
“evidence [outside the administrative recordj that assists the district court in understanding the
medical terminology or practice relating to a claim would be admissible, as such information
would not be beyond the scope of evidence before the administrator at the time of its decision.”).
Accordingly, this Court finds Defendant’s argument that summary judgment is the only
means by which this Court can adjudicate the instant case to be devoid of merit.
B.
Whether Defendant’s Denial of Plaintiff’s Benefits was Arbitrary and Capricious
Defendant’s argument that its motion for summary judgment should have been granted
because its “decision was not arbitrary and capricious” is not an adequate basis upon which a
motion for reconsideration may be granted. In its original summary judgment motion, Defendant
devoted approximately seven pages to arguing that its decision to terminate Plaintiffs benefits
was not arbitrary and capricious. (See CM/ECF No. 16-2 at 18-25.) Defendant’s attempt to re
litigate this issue in its motion for reconsideration is improper. See, e.g., P. Schoenfrld, 161 F.
Supp. 2d at 352 (“Reconsideration motions.
.
.
may not be used to re-litigate old matters.”).
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IV.
CONCLUSION
For the foregoing reasons, Defendant’s motion for reconsideration of this Court’s August
20, 2012 Opinion and Order denying its motion for summary judgment is denied. An
appropriate order follows.
Date: October
!, 2012
JØ L.
Linares
Vjjitèd States District Judge
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