Thomas v. Cigna Group Insurance et al

Filing 106

MEMORANDUM AND ORDER. The Court declines to set a schedule for UNA's review ofPlaintiffs claim. The Court also declines to reconsider its order directing LINA to investigate the manner in which Countrywide furnished the SPD to its employees and endeavor to obtain a complete copy of the SPD(s) that were furnished to Decedent, unless Plaintiff"can point tocontrolling decisions or data that the court overlooked... that might reasonably be expected to alter the conclusion reached by the court.". Ordered by Judge Sandra L. Townes on 2/12/2013. (Siegfried, Evan)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF NEW YORK

----------------------------------------------------------)[
RAYMOND THOMAS,

MEMORANDUM AND ORDER

Plaintiff,
-against-

09-CV-5029 (SLT) (RML)
CIGNA GROUP INSURANCE, et al.,
Defendants.

----------------------------------------------------------)(
TOWNES, United States District Judge:
This is an action pursuant to the Employment Retirement Income Security Act, 29 U.S.C.
§1001 et seq., in which plaintiff Raymond Thomas ("Plaintiff') seeks to recover life insurance
benefits allegedly owed to him by the Countrywide Financial Corporation Group Insurance Plan,
an employee benefit plan administered by Life Insurance Company of North America ("LINA''),
following the death of his sister, Judith Thomas (the "Decedent"). In a Memorandum and Order
dated January 4, 2013, and entered January

ro, 2013 (the "Prior Order"), this Court concluded

that LINA 's denial of Plaintiffs claim for the life insurance benefits was arbitrary and capricious.
However, this Court also concluded that it could not simply order LINA to pay the claim. Citing to
Miller v. Untied Welfare Fund, 72 F.3d I 066, I 071 (2d Cir. 1995), for the proposition that a district
court "must remand to the [administrator] with instructions to consider additional evidence unless no
new evidence could produce a reasonable conclusion permitting denial of the claim or remand would
otherwise be a 'useless formality,"' this Court stated:
In this case, it is possible that further investigation regarding the
manner in which Countrywide furnished the SPD will uncover
evidence to establish that Countl)wide, in fact, acted in
accordance with the relevant regulations and that the SPD was
sufficient to place Decedent on notice of the Waiver of Premium
provisions. Accordingly, this Court remands this matter to LINA,
as Claims Administrator, with instructions to conduct that
investigation.

In addition, UNA should endeavor to obtain a complete copy of
the SPD(s) that were furnished to Decedent and should re-evaluate
Vaupel's assumption that the SPD placed Decedent on notice of
the need to file a Waiver of Premium claim in connection with the
Basic Life Insurance Plan.

Prior Order at 44.
In a letter dated January 30, 2013, Plaintiff requests "clarification" of the Prior Order. First,
alleging that LINA has not yet begun the investigation contemplated by the Prior Order, Plaintiff
urges this Court to "impose a schedule upon LINA within which to complete its review" of
Plaintiff's claim. Letter to Hon. Sandra L. Townes from Lowell B. Davis, dated Jan. 30,2013, at I.
Second, citing to Miller, supra, Plaintiff seeks to limit the scope ofLINA's review, implying that
because "district courts may consider only the evidence that the fiduciaries themselves
considered," LIN A's search for new evidence regarding the manner in which Countrywide
provided its SPD to its employees is a "useless formality." !d. at 2.
LINA opposes Plaintiffs request. First, citing to Solnin v. Sun Life & Health Ins. Co.,
766 F. Supp. 2d 380, 393-94 (E.D.N.Y. 2011), LINA argues that the time limitations set forth in
29 C.F.R. § 2560.503-l(i)(l) should apply in these circumstances and requests that, if the Court
imposes a time limitation, LINA be permitted 90 days in which to conduct its review of
Plaintiffs claim. Second, LINA asserts that Plaintiff"seems to confuse the role of a claim
administrator on remand with the role of the court in its review of an administrator's
determination" and that Plaintiff's request to limit LIN A's investigation is "contrary to the
[Prior] Order." Letter to Hon Sandra L. Townes from Emily A. Hayes, dated Feb. I, 2013, at 2
(brackets added).

2

With respect to the first issue, this Court finds ample support for UNA's assertion that
the time limitations set forth in 29 C.F.R. § 2560.503-1 apply to UNA's post-remand review of
Plaintiffs claim. See, e.g., Solnin, 766 F. Supp. 2d. at 393 (citing cases); Rappa v. Connecticut
General Life Ins. Co., No. 06-CV-2285 (CBA), 2007 WL 4373949, at *7 (E.D.N.Y. Dec. II,

2007). Plaintiff has not cited any legal authority to the contrary. Accordingly, this Court finds
that UNA's post-remand review of Plaintiffs claim should be conducted in accordance with the
provisions of 29 C.F.R. § 2560.503-l(i)(I).
In light ofthis finding, this Court sees no need to set a schedule for UNA's review of
Plaintiffs claim. Rather, time limits for UNA's review are established by§ 2560.503-l(i)(I),
which provides that, with certain exceptions that are inapplicable to this case:
[T]he plan administrator shall notify a claimant ... of the plan's
benefit determination on review within a reasonable period of time,
but not later than 60 days after receipt of the claimant's request for
review by the plan, unless the plan administrator determines that
special circumstances (such as the need to hold a hearing, if the
plan's procedures provide for a hearing) require an extension of
time for processing the claim. If the plan administrator determines
that an extension of time for processing is required, written notice
of the extension shall be furnished to the claimant prior to the
termination of the initial 60-day period. In no event shall such
extension exceed a period of 60 days from the end of the initial
period. The extension notice shall indicate the special
circumstances requiring an extension of time and the date by which
the plan expects to render the determination on review.
Assuming that UNA did not receive notification of the need to review Plaintiff's claim until the
Prior Order was entered onto this Court's Electronic Case Filing ("ECF") system on January 10,
2013, the initial60-day period will not expire until March II, 2013, and, under special

3

circumstances, may be extended to May 10, 2013, by following the steps set forth in the
regulation.
With respect to the second issue, Plaintiffs request to limit UNA's investigation appears
to misinterpret the teachings of Miller, 72 F.3d 1066. In that case, the Second Circuit stated:
We follow the majority of our sister circuits in concluding that a
district court's review under the arbitrary and capricious standard
is limited to the administrative record. Because district courts are
required to limit their review to the administrative record, it
follows that, if upon review a district court concludes that the
Trustees' decision was arbitrary and capricious, it must remand to
the Trustees with instructions to consider additional evidence
unless no new evidence could produce a reasonable conclusion
permitting denial of the claim or remand would otherwise be a
"useless formality."
!d. at 1071 (emphasis added). Nothing in Miller implies that a claim administrator is required to

limit its review to the administrative record upon remand. To the contrary, this language implies
that a claim administrator must consider additional evidence on remand if instructed to do so by
the district court. This language further requires the district court to remand a case "with
instructions to consider additional evidence unless no new evidence could produce a reasonable
conclusion permitting denial of the claim or remand would otherwise be a 'useless formality."'
In remanding this case, the Court expressly directed UNA, inter alia, to (I) investigate
the manner in which Countrywide furnished the SPD to its employees and (2) endeavor to obtain
a complete copy of the SPD(s) that were furnished to Decedent. Prior Order at 44. This Court
also explained why this evidence might prove consequential to UNA's review of Plaintiffs
claim, rather than a useless formality. This Court will not reconsider those determinations unless
Plaintiff "can point to controlling decisions or data that the court overlooked ... that might

4

reasonably be expected to alter the conclusion reached by the court." See Shrader v. CSX

Transp .. Inc .• 70 F.3d 255,257 (2d Cir. 1995).
CONCLUSION
For the reasons set forth above, this Court declines to set a schedule for UNA's review of
Plaintiffs claim since the time limits for UNA's review are already established by 29 C.F.R.
§2560.503-l(i)(I). The Court also declines to reconsider its order directing LINA to investigate
the manner in which Countrywide furnished the SPD to its employees and endeavor to obtain a
complete copy ofthe SPD(s) that were furnished to Decedent, unless Plaintiff"can point to
controlling decisions or data that the court overlooked ... that might reasonably be expected to
alter the conclusion reached by the court." See Shrader v. CSX Transp., Inc., 70 F.3d 255, 257
(2d Cir. 1995).

SO ORDERED.

s/ SLT

I SANDRA i. TOWNES
United States District Judge

Dated: February/~, 2013
Brooklyn, New York

5