HARTQUIST v. EMERSON ELECTRIC CO. A/K/A EMERSON ELECTRIC COMPANY et al
Filing
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MEMORANDUM OPINION AND ORDER signed by MAG/JUDGE JOI ELIZABETH PEAKE on 03/30/2017, that Plaintiff's Supplemental Motion for Summary Judgment [Doc. # 72 is DENIED. FURTHER that Defendants' Supplemental Motion for Summary Judgment [Doc. # 70 is GRANTED, and this action is DISMISSED with prejudice. (Taylor, Abby)
IN THE UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF NORTH CAROLINA
SCOTT L. HARTQUIST,
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Plaintiff,
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v.
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EMERSON ELECTRIC CO., THE
)
EMERSON ELECTRIC MANUFACTURING )
COMPANY, and EMERSON APPLIANCES & )
TOOLS, INC.,
)
)
Defendants.
)
1:11CV1067
MEMORANDUM OPINION AND ORDER
This matter comes before the Court on the parties’ supplemental cross motions for
summary judgment [Docs. #70 and #72]. This action has been referred to the undersigned
to conduct all proceedings pursuant to 28 U.S.C. § 636(c) [Doc. #16]. For the reasons set
forth below, the Court will grant Defendants’ Supplemental Motion for Summary Judgment
and deny Plaintiff’s Supplemental Motion for Summary Judgment.
I.
FACTS, CLAIMS, AND PROCEDURAL HISTORY
This case involves claims made by Plaintiff Scott L. Hartquist (“Plaintiff”) pursuant to
the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq., against his
former employer, Emerson Electric Co., The Emerson Electric Manufacturing Company, and
Emerson Appliances & Tools, Inc. (collectively, “Defendants” or “Emerson”) as Plan
Sponsor and Plan Administrator of a Long Term Disability Plan.
On or about June 13, 2003, while working at a Home Depot store on behalf of
Defendants, several ladders fell and struck Plaintiff on the back of the head, allegedly causing
severe injury and exacerbating certain pre-existing conditions. (Hartquist Aff. [Doc. #28]
¶¶ 2-3.) Plaintiff contends that this incident rendered him disabled and that the resulting
disability caused him to resign from his employment with Defendants six months later, on
December 9, 2003. (Id. ¶ 4; Compl., Ex. E, G [Docs. #6-6, #6-8].)
At the time of Plaintiff’s resignation, Defendants maintained long-term disability
insurance coverage for their employees under the UNUM Group Corporation (“UNUM”)
Group Plan (the “Plan”). (Compl., Ex. I, K [Docs. #6-9, 6-11]; Plan [Doc. #63-1]; Defs.’
Mot. Sum. J., Ex. 2 [Doc. # 21-2].) Defendants served as the Plan Sponsor and Administrator.
(Answer to Am. Compl. [Doc. #64] ¶ 14). Plaintiff had received a Benefits Sheet at the time
he was hired in January 2003 that included a description of the Plan. (Pl.’s Decl. [Doc. #28]
¶ 8.) Plaintiff kept the Benefits Sheet, along with other job-related documentation, in his
personal files. (Pl.’s Decl. [Doc. #28] ¶ 10.) However, Plaintiff asserts that at the time he
resigned, Defendants did not specifically notify him of his potential eligibility under the Plan,
and Plaintiff contends that he therefore assumed that he could not qualify for long term
disability benefits. (Hartquist Aff. [Doc. #28] ¶ 14; see also Compl., Ex. I, K [Docs. #6-9, 611]).
Following his injury and resignation, Plaintiff sought benefits under the North Carolina
Workers’ Compensation Act, and the Parties settled that claim by Agreement dated October
13, 2004, signed by Plaintiff on November 30, 2004. (See Compl., Ex. F [Doc. #6-7].)
Six years later, in November 2010, Plaintiff contacted Defendants requesting reevaluation of his prior workers’ compensation claim. (Compl., Ex. G [Doc. #6-8].) That
request was denied. Plaintiff contends that around that same time, in November 2010, he
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happened to be reviewing his personal file of job-related documents and discovered the
Benefits Sheet in his records. (Compl., Ex. I [Doc. #6-9]; Hartquist Aff. [Doc. #28] ¶¶ 1516.) On November 27, 2010, Plaintiff sent a letter to Defendants asserting that he was eligible
for benefits under the Plan at the time of his resignation in December 2003. (Compl., Ex. I
[Doc. #6-9].)
Defendants reviewed Plaintiff’s file and informed him by letter on January 20, 2011
that he was “not offered LTD at the time of [his] resignation,” that he was “entitled to apply
for LTD benefits and may do so at this time,” and that the insurer “will make the final
determination, not Emerson.”
(Compl., Ex. K [Doc. #6-11].)
Plaintiff subsequently
submitted his application for benefits, and included medical records and other materials he
wanted considered. (Record, Part 1 [Doc. #71-1] at 28-45; Record, Part 2 [Doc. #71-2];
Record, Part 3 [Doc. #71-3] at 1-3.) Defendants then forwarded Plaintiff’s application to
UNUM for review. 1 (Defs.’ Mot. Sum. J., Ex. 2 [Doc. #21-2]). However, Defendants
subsequently informed Plaintiff that UNUM would not review his application because
“UNUM insurance policies contain a provision requiring notification of a disability within one
year of occurrence in order to be eligible for benefits.” (Id.)
Despite UNUM’s denial, Defendants subsequently retained GENEX Services, Inc.
(“GENEX”), a medical review firm, to review Plaintiff’s claim as an independent consultant
“before making any final determination on [Plaintiff’s] request for benefits.” (Id.) GENEX
Defendants initially forwarded Plaintiff’s application to The Hartford for review. After realizing that UNUM
was the insurer that provided disability benefits at the time Plaintiff resigned, Defendants forwarded his
application to UNUM. (Defs.’ Mot. Sum. J., Ex. 2 [Doc. #21-2].)
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concluded that “[t]here is no evidence submitted that would indicate [Plaintiff] had
impairments that would render him disabled as of 12/09/03.” (Id., Ex. 3 [Doc. #21-3].)
Defendants informed Plaintiff of this denial by way of letter dated August 31, 2011. (Id., Ex.
2 [Doc. #21-2].) In the same letter, Defendants stated, “[W]e have fulfilled our obligation to
allow you to apply for Long Term Disability benefits. Your claim unfortunately has been
denied.” (Id. at 2.)
As a result of these events, Plaintiff filed suit and now asserts claims against Defendants
for (1) Breach of Fiduciary Duties in violation of 29 U.S.C. §§ 1109 and 1132; (2) Breach of
Contract in violation of 29 U.S.C. §§ 1132(a)(1)(A), 1132(a)(1)(B), and 1132(c); (3) Failure to
Notify in violation of 29 U.S.C. § 1132(c); (4) Common Law Negligence; and (5) Common
Law Breach of Fiduciary Duty. (Am. Compl. [Doc. #63].)
Defendants previously moved for summary judgment [Doc. #65], contending, inter alia,
that Plaintiff’s ERISA claims were barred by the applicable statute of limitations and that
Plaintiff’s state common law claims were preempted by ERISA. By Order dated March 31,
2016, the Court granted in part and denied in part the Motion. (Mar. 31, 2016 Order [Doc.
#69].) Specifically, the Court found that ERISA preempted Plaintiff’s state common law
claims (id. at 7-10). See also Prince v. Sears Holdings Corp., 848 F.3d 173 (4th Cir. 2017)
(confirming the scope of ERISA preemption). In addition, with respect to Plaintiff’s ERISA
claims under 29 U.S.C. § 1132(c) based on Defendants’ alleged failure to provide notification
regarding the Plan at the time of Plaintiff’s resignation, the Court noted that Plaintiff was
relying on 29 U.S.C. § 1166, which relates to COBRA and is inapplicable to the instant case.
See also Austell v. Raymond James & Assoc., Inc., 120 F.3d 32, 34 (4th Cir. 1997) (affirming
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district court’s conclusion that COBRA does not require employee welfare benefit plan
sponsors to offer continuation of coverage for disability insurance). The Court further
concluded that Plaintiff’s claims under 29 U.S.C. § 1132(c) were time-barred. (Mar. 31, 2016
Order at 15-18). With respect to Plaintiff’s ERISA Breach of Fiduciary Duty claim (Count 1),
the Court noted that Plaintiff did not appear to state a claim under 29 U.S.C. § 1109 and
§ 1132(a)(2) since Plaintiff was not seeking remedies to protect the Plan, and was instead
seeking individual relief; that to the extent Plaintiff’s claim was a claim for benefits, the claim
could be considered as part of Plaintiff’s claim under § 1132(a)(1)(B); and that to the extent
the claim related to the time period prior to Plaintiff’s resignation, it appeared barred by the
applicable statute of limitations (id. at 18-22). However, the Court found that Plaintiff’s
ERISA Breach of Contract claim challenging the denial of benefits in 2011 and his related
ERISA Breach of Fiduciary Duty claim were not time-barred. (Id. at 13-15, 22.) Noting that
Plaintiff’s remaining claims would be for a bench trial, the Court permitted the parties to file
cross motions for summary judgment, which are now before the Court. (Id. at 14-15.)
In support of their instant Motion for Summary Judgment, Defendants contend that
Plaintiff’s Breach of Contract claim is untenable because: 1) Plaintiff failed to satisfy threshold
eligibility requirements under the Plan; 2) UNUM employed a reasonable review process and
did not abuse its discretion in denying Plaintiff’s claim for benefits as untimely; 3) UNUM, as
the only entity with authority to determine Plaintiff’s eligibility, is a necessary party to this
action who Plaintiff failed to join; and 4) Plaintiff failed to comply with the Plan’s contractual
limitation period for filing suit. (Defs.’ Br. [Doc. #71] at 1-2, 9.) Further, Defendants argue
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that Plaintiff cannot pursue a separate Breach of Fiduciary Duty claim since his claim is for
denial of benefits. (Id. at 1.)
In support of Plaintiff’s instant Motion for Summary Judgment, Plaintiff argues that
his medical evidence establishes that he was totally disabled both in December of 2003 when
he resigned from his job with Emerson and in August of 2011 when he submitted his claim
for benefits. (Pl.’s Br. [Doc. #73] at 6-9.) Plaintiff contends that “with the plain language of
the Plan providing for benefits in the case of total disability, Plaintiff is entitled to recover
benefits due him under the Plan as a matter of law.” (Id. at 9.)
II.
STANDARD
A court must grant summary judgment if 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). Material
facts are those that “might affect the outcome of the suit under the governing law.” Anderson
v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). A genuine issue of fact exists if the evidence
presented could lead a reasonable fact-finder to return a verdict in favor of the non-moving
party. Id. The proponent of summary judgment “bears the initial burden of pointing to the
absence of a genuine issue of material fact.” Temkin v. Frederick Cnty. Comm’rs, 945 F.2d
716, 718 (4th Cir. 1991) (citing Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986)). If the
movant carries this burden, then the burden “shifts to the non-moving party to come forward
with facts sufficient to create a triable issue of fact.” Id. at 718-19 (citing Anderson, 477 U.S.
at 247-48). A court considering a motion for summary judgment must view all facts and draw
all reasonable inferences from the evidence before it in the light most favorable to the
non-moving party. Anderson, 477 U.S. at 255. “In considering cross motions for summary
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judgment, a district court should ‘rule upon each party’s motion separately and determine
whether summary judgment is appropriate as to each under the Rule 56 standard.’” Adamson
v. Columbia Gas Transmission, LLC, 987 F. Supp. 2d 700, 703 (E.D. Va. 2013) (quoting
Monumental Paving & Excavating, Inc. v. Pa. Mfrs.’ Ass’n Ins. Co., 176 F.3d 794, 797 (4th
Cir. 1999)). Therefore, the Court will consider each party’s Motions for Summary Judgment
separately.
III.
DISCUSSION
a. Defendants’ Supplemental Motion for Summary Judgment
Plaintiff’s ERISA Breach of Contract claim arises out of Defendants’ alleged wrongful
denial of Plaintiff’s claim for benefits on August 31, 2011. (Am. Compl. [Doc. #63] ¶ 44.)
Pursuant to 29 U.S.C. § 1132(a)(1)(B), a plan beneficiary may bring an action to recover
benefits wrongfully denied. See Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 108
(1989).
In support of their Motion for Summary Judgment, Defendants argue, as a threshold
matter, that they are not proper parties to this action, and that Plaintiff failed to join the Plan
itself as a necessary party. (Defs.’ Br. [Doc. #71] at 16-19.) In a claim for wrongful denial of
benefits, “the proper party defendant is the entity which holds the discretionary decisionmaking authority over the denial of ERISA benefits.” Ankney v. Metro. Life Ins., 438 F. Supp.
2d 566, 574 (D. Md. 2006). Federal courts in North Carolina have consistently held that a
plan beneficiary may assert a claim under § 1132(a)(1)(B) “against the [] plan itself as an entity
and any fiduciaries who control the administration of the [] plan.” McRae v. Rogosin
Converters, Inc., 301 F. Supp. 2d 471, 475 (M.D.N.C. 2004).
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Here, Defendants contend that UNUM possessed sole discretionary authority to
determine eligibility for benefits under the Plan, and that Defendants had no role in making
the decision to deny Plaintiff’s claim for benefits. (Defs.’ Br. [Doc. #71] at 17.) In support
of this position, Defendants point to the express terms of the Plan, which state, in relevant
part, “When making a benefit determination under the policy, Unum has discretionary
authority to determine your eligibility for benefits and to interpret the terms and provisions of
the policy.” (Plan [Doc. #63-1] at 12.) Further, Defendants point to their discovery responses
in which they “confirmed . . . that [they] had no authority to evaluate Hartquist’s LTD claim,
and UNUM alone made the final benefits decision.”
(Defs.’ Br. [Doc. #71] at 17.)
Additionally, in the January 28, 2011 letter allowing Plaintiff to apply for benefits, Defendants
informed Plaintiff that the “[insurer] will make the final determination, not Emerson.”
(Compl., Ex. K [Doc. #6-11].)
Plaintiff contends that other evidence suggests that
Defendants played a more direct role in the denial of Plaintiff’s claim for benefits. Most
notably, after UNUM initially denied Plaintiff’s claim as untimely, Defendants informed
Plaintiff that they would submit his claim to GENEX for review “before making any final
determination on your request for benefits.” (Defs.’ Mot. Sum. J., Ex. 2 [Doc. #21-2].)
However, Defendants contend that even if they voluntarily undertook further review beyond
that required by the Plan, any recovery of benefits under the Plan would be against the Plan,
not Defendants, and the Plan is still a necessary party.
Having considered the evidence presented, the Court concludes that Defendants raise
legitimate concerns regarding Plaintiff’s failure to include the Plan or UNUM as parties to the
case with respect to Plaintiff’s claim seeking to recover benefits under the Plan. However, the
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Court need not address this issue further, because the Court concludes that even if Plaintiff
could assert his § 1132(a)(1)(B) claim against Defendants without joining UNUM or the Plan,
Defendants would still be entitled to summary judgment for the reasons set out below. See
Cappuccio v. Pfizer, Inc., No. CIV.A. 2:07-CV-0549-LDD, 2007 WL 2593704, at *4 (E.D. Pa.
Aug. 31, 2007) (noting that “the Court need not resolve the question of whether Pfizer is a
proper party to the ERISA claim because regardless of to whom the claim is directed, Plaintiff
is not entitled to severance benefits.”) (footnote omitted).
Specifically, the Court concludes that Plaintiff has failed to present a genuine issue of
material fact with respect to his claim challenging the decision to deny his application for
benefits under the Plan. The decision to deny a claim for benefits is reviewed under a de novo
standard of review unless the plan vests the administrator or fiduciary with discretionary
authority to make benefit decisions, in which case the court reviews the denial under an abuse
of discretion standard. See Firestone, 489 U.S. at 115; Woods v. Prudential Ins. Co. of Am.,
528 F.3d 320, 322 (4th Cir. 2008). In this case, the Plan gave UNUM discretionary authority
to make benefit determinations and to interpret the terms and provisions of the policy, which
means the Court reviews only for abuse of discretion. Moreover, even if the more extensive
de novo review is proper, there still can be no dispute that Plaintiff failed to satisfy the Plan’s
eligibility requirements. In reviewing Plaintiff’s eligibility under the Plan, the Court “places
great emphasis upon adherence to the written provisions in [the] employee benefit plan.”
Coleman v. Nationwide Life Ins. Co., 969 F.2d 54, 56 (4th Cir. 1992), as amended (July 17,
1992). Here, the Plan states, in relevant part:
Written notice of a claim should be sent within 30 days after the date your
disability begins. However, you must send Unum written proof of your claim
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no later than 90 days after your elimination period. If it is not possible to give
proof within 90 days, it must be given no later than 1 year after the time proof
is otherwise required except in the absence of legal capacity.
(Plan [Doc. #63-1] at 7.) The Plan goes on to define the “elimination period” as ninety days
of continual disability. (Id. at 16, 28.)
Plaintiff alleges a disability onset date of December 9, 2003. (See Pl.’s Br. [Doc. #73]
at 7-8.) His “elimination period” under the Plan, therefore, ran from December 9, 2003 to
March 8, 2004 (ninety days of continual disability). The Plan thus required Plaintiff to provide
UNUM with written proof of his claim by June 7, 2004 (ninety days after his elimination
period). If it was not possible to have provided proof of his claim by that time, the Plan
allowed Plaintiff, at the very latest, to submit the required proof of claim by June 7, 2005 (one
year after the time proof is otherwise required). Plaintiff does not dispute that he first applied
for benefits under the Plan on June 22, 2011, more than six years after the latest conceivable
date the Plan would have allowed him to submit proof of his claim. Thus, there is no genuine
dispute of material fact that Plaintiff failed to timely comply with the Plan’s proof of claim
requirement. Thus, the determination by UNUM that Plaintiff’s claim was untimely was
correct, whether under a de novo review or an abuse of discretion review.
In his Response, Plaintiff contends that “Defendants should be estopped from
asserting a timeliness defense” because Defendants invited Plaintiff to apply for benefits in
2011 and “also aided him in doing so.” (Pl.’s Resp. [Doc. #74 at 2.) However, Plaintiff’s time
for presenting proof of claim under the Plan had passed six years earlier, and Defendants’
actions in 2011 did not cause Plaintiff to miss the deadline. In addition, Plaintiff admits that
he had information regarding the Plan in his possession from the time he was hired in 2003,
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and he failed to “discover” that information until he was going through his own papers several
years after his resignation. These undisputed facts indicate that Plaintiff failed to act with
reasonable diligence, and Plaintiff has failed to present a sufficient basis for equitable relief
from the Plan requirements. Moreover, in the correspondence that Defendants sent to
Plaintiff in 2011, Defendants made clear that while Plaintiff could submit an application, any
final determination would be made by UNUM. Plaintiff has failed to present any facts to
support the conclusion that Defendants made a material misrepresentation to Plaintiff that
would require the Court, in equity, to modify the terms of the ERISA Plan to extend deadlines
that had long since passed. 2
To the extent Plaintiff seeks judicial review of GENEX’s independent determination
that Plaintiff was not entitled to benefits when he resigned from Emerson, Plaintiff is not
entitled to such review. Plaintiff’s instant claim for wrongful denial of benefits is governed by
the terms of the Plan, which did not obligate Defendants to submit Plaintiff’s claim to an
independent reviewer following the initial denial. That is, GENEX’s independent review of
Plaintiff’s claim did not create additional grounds on which Plaintiff could challenge the denial
of benefits under the Plan. Accordingly, any denial of Plaintiff’s claim based on GENEX’s
determination does not provide Plaintiff with an alternative avenue for relief.
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In addition, the Court notes that under the terms of the Plan, Plaintiff was required to file suit “60 days after
proof of claim has been given and up to 3 years from the time proof of claim is required.” (Plan [Doc. #63-1]
at 14.) Defendants contend that Plaintiff failed to meet this requirement because the proof of claim was
required, at the latest, in June 2005, and three years from that date was June 2008. Plaintiff did not file suit
until November 2, 2011, and thus failed to meet the filing deadlines provided in the Plan. See Heimeshoff v.
Hartford Life & Accident Ins. Co., 134 S. Ct. 604 (2013).
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Therefore, the Court will grant summary judgment in favor of Defendants on Plaintiff’s
ERISA claim for Breach of Contract.
The Court additionally notes that it previously left open the possibility that Plaintiff
may have a viable Breach of Fiduciary Duty claim based on Defendants’ handling of Plaintiff’s
claim for benefits. (Mar. 31, 2016 Order [Doc. #69] at 22.) In their Motion for Summary
Judgment, Defendants argue that Plaintiff has failed to present any separate breach of fiduciary
duty claim. Plaintiff did not respond to this argument in his Response. Defendants have
pointed to an absence of a genuine issue of material fact on Plaintiff’s Breach of Fiduciary
Duty claim, and have thus “shift[ed] [the burden] to [Plaintiff] to come forward with facts
sufficient to create a triable issue of fact.” Temkin, 945 F.2d at 718-19 (citing Anderson, 477
U.S. at 247-48). By not responding to this argument, Plaintiff has failed to carry that burden,
and summary judgment in favor of Defendants is therefore proper on Plaintiff’s Breach of
Fiduciary Duty claim. See Wimbush v. Donahoe, No. 1:09CV00358, 2012 WL 848036, at *10
(M.D.N.C. Mar. 13, 2012) (granting summary judgment in favor of the defendant as
unopposed where the plaintiff did not address certain claims in response to the defendant’s
motion for summary judgment).
Based on the foregoing, the Court will grant Defendants’ Supplemental Motion for
Summary Judgment on all of Plaintiff’s remaining claims.
b. Plaintiff’s Supplemental Motion for Summary Judgment
Plaintiff has moved for summary judgment on his ERISA Breach of Contract claim
under 29 U.S.C. § 1132(a)(1)(B). Because the Court will grant judgment as a matter of law in
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favor of Defendants on all of Plaintiff’s remaining claims, as discussed above, the Court will
deny Plaintiff’s Supplemental Motion for Summary Judgment. 3
IV.
CONCLUSION
IT IS THEREFORE ORDERED that Plaintiff’s Supplemental Motion for Summary
Judgment [Doc. #72] is DENIED.
IT IS FURTHER ORDERED that Defendants’ Supplemental Motion for Summary
Judgment [Doc. #70] is GRANTED, and this action is DISMISSED with prejudice.
This, the 30th day of March, 2017.
/s/ Joi Elizabeth Peake
United States Magistrate Judge
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The Court also notes that even if Plaintiff’s claim were timely, and even if Plaintiff could establish that he was
disabled at the time of his resignation in December 2003, other issues remain that would preclude an award of
benefits as requested by Plaintiff. Indeed, it does not appear that Plaintiff would be entitled to any net recovery
under the terms of the Plan. Specifically, the Court notes that Plaintiff seeks, as benefits under the Plan, 60%
of his $30,000 per year salary, which would result in a monthly benefit of $1,500.00 per month beginning March
2004 after the 90-day elimination period. However, the Plan provides that after 24 months of disability
payments, “if your monthly disability earnings exceed 60% of your indexed monthly earnings, Unum will stop
sending you payments and your claim will end.” (Plan [Doc. #63-1] at 18.) Plaintiff’s Application reflects that
he worked at Nationwide Insurance from January 2007 to April 2007, with total earnings of $15,500, reflecting
average monthly earnings of $3,875.00. (Application [Doc. #71-1 at 32].) The Application also reflects work
at Signature Garage Interiors from February 2008 to November 2008, with total earnings of $15,200, reflecting
average monthly earnings of $1,520.00. (Id.) Either of these periods of employment would have triggered the
Plan provisions ending the claim. Thus, even if Plaintiff’s claim had been allowed, he would have been entitled,
at most, to $1,500.00 per month from March 2004 to December 2006 (34 months), reflecting a total of
$51,000.00. However, the Plan also provides for deduction of any amounts awarded as Worker’s
Compensation. In this case, Plaintiff was awarded $60,000.00 in Worker’s Compensation, which exceeds any
amounts he would have been entitled to under the Plan. The Court includes this note not as part of the findings
on summary judgment, but simply to reflect the multiple remaining issues even if the time bar and procedural
hurdles were removed and even if Plaintiff could establish that he was disabled in December 2003.
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