Blum v. Spectrum Restaurant Group, Inc.

261 F. Supp. 2d 697, 2003 U.S. Dist. LEXIS 7235, 2003 WL 1957492
CourtDistrict Court, E.D. Texas
DecidedApril 28, 2003
Docket4:02-cv-00092
StatusPublished
Cited by9 cases

This text of 261 F. Supp. 2d 697 (Blum v. Spectrum Restaurant Group, Inc.) is published on Counsel Stack Legal Research, covering District Court, E.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Blum v. Spectrum Restaurant Group, Inc., 261 F. Supp. 2d 697, 2003 U.S. Dist. LEXIS 7235, 2003 WL 1957492 (E.D. Tex. 2003).

Opinion

MEMORANDUM OPINION AND ORDER

DAVIS, District Judge.

Defendants Spectrum Restaurant Group, Inc. (“SRG”) and the Group Life and Supplemental Life Plan for Employees of Spectrum Restaurant Group (the “SRG Plan”) and Hartford Life and Accident Insurance Company (“Hartford”) (collectively “Defendants”) have filed Motions for Summary Judgment (Docket Nos. 101 & 102). For the reasons articulated below, Defendants’ Motions for Summary Judgment are GRANTED.

*702 BACKGROUND

Robert F. Blum (“Mr.Blum”) was employed by Grandy’s, Ine., which is owned and otherwise controlled by SRG. As a Grandy’s employee, Mr. Blum was eligible to participate in certain benefit plans sponsored by SRG. One of those plans was the SRG Plan, a welfare benefit plan governed by ERISA that provided group term life insurance to eligible employees of SRG and its subsidiaries.

In October 1999, Custom Benefit Consultants, Inc. (“CBC”) entered into an insurance brokerage and administrative services contract with SRG under which CBC: (1) assisted SRG, the named Plan Administrator, in procuring life insurance for SRG’s employee benefit plans; and (2) agreed to provide services to SRG in connection with the administration of the SRG’s employee benefits plans, including the SRG Plan. These services included handling certain enrollment and paperwork related to the administration of SRG’s benefit plans, bringing insurance contracts to SRG, and handling communications regarding benefits.

In 2000, the SRG Plan offered basic and supplemental group term life insurance to eligible employees through the Principal Life Insurance Company (“Principal”). The SRG Plan consisted of two separate benefits: (1) a basic life insurance benefit affording life insurance to SRG employees such as Mr. Blum, which was purchased and paid for by SRG; 1 and (2) a voluntary supplemental life insurance benefit which could be purchased by SRG employees through their employment by way of a payroll deduction. Principal provided supplemental coverage to eligible employees for a guarantee minimum of $100,000, without proof of good health. Employees could also apply for additional supplemental coverage in an amount up to ten times one’s annual salary, subject to a limit of $1,000,000 with proof of good health.

On November 19, 1999, Mr. Blum completed his enrollment application and elected basic life insurance and supplemental life insurance coverage in an amount equal to ten times his annual salary. On the same form, Mr. Blum stated that his salary was $90,000. Mr. Blum later signed two nearly identical “Confirmation of Your Enrollment Elections” forms: one on February 15, 2000, and another on April 20, 2000. Those forms reveal that Mr. Blum’s “Elections” included $900,000 in supplemental life insurance. The forms remind Mr. Blum that “it is your responsibility to read and comply with the enclosed benefits policies.” This election triggered the requirement under SRG’s 2000 Plan that Mr. Blum (1) submit proof of good health, and (2) obtain the carrier’s approval before he became entitled to a supplemental life insurance benefit in excess of the Guarantee Issue Amount. There is not evidence that Mr. Blum submitted proof of good health.

On May 23, 2000 and June 1, 2000, CBC sent additional reminder letters to SRG employees who had requested supplemental life insurance from Principal in excess of the Guarantee Issue Amount, but who had not completed the required medical questionnaire. On more than one occasion, Robin Sylvia, CBC’s CEO, called Mr. Blum during 2000 about the requirement, reminding him that he needed to provide proof of good health.

On December 15, 2000, CBC sent Mr. Blum a memorandum explaining that Defendant Hartford Life and Accident Insurance Company (“Hartford”) would be the insurer providing the Plan’s life insurance in 2001. The memo further noted that *703 Hartford offered a guaranteed supplemental life insurance coverage benefit up to $200,000.00 rather than Principal’s guaranteed coverage of $100,000.00. This memorandum summarized Mr. Blum’s situation and again reminded him of the need to submit a medical questionnaire: 2

Our records indicate that you elected [$972,000] in supplemental life insurance. However, do [sic] to pending medical approval, your current amount of supplemental life insurance coverage is [$0]. Effective January 1, 2001, you will be covered for the amount you elected up to $200,000.... If you elected supplemental life insurance in an amount over $200,000, you will need to complete a medical questionnaire from Hartford, which I will be sending you in a few days. Once medical underwriting approved you, payroll will begin deducting for the full coverage the first of month following approval date.

On December 15, 2000, CBC sent another memo to Mr. Blum regarding the supplemental life insurance available from Hartford under the Plan. That memo explained to Mr. Blum as follows:

Hartford ... will only write coverage up to 5 X salary. Our records indicate that you elected 10 X salary for an amount of $972,000 in supplemental life insurance. Effective January 1, 2001 you will be covered for $200,000.

This memorandum further advised Mr. Blum that if he wished to obtain supplemental life insurance coverage in excess of the guaranteed amount, he would be required to complete a health statement and possibly complete a paramedical exam. 3

A Plan Booklet containing the terms of the Plan applicable in 2001 was distributed to eligible SRG/Grandy’s employees in 2001. The Plan Booklet contained a Hartford Certificate of Insurance and a Summary Plan Description. Mr. Blum received a copy of this Plan Booklet, as Mrs. Blum testified that she found a copy in Mr. Blum’s desk.

The Plan Booklet provides that the “Policy Effective Date” was “January 1, 2001,” with anniversary dates of January 1 of each year. The Plan Booklet explained that two types of life insurance were available: basic and supplemental. Under the heading “Basic Amount of Life Insurance,” the Plan Booklet stated that the Plan offered life insurance in “An amount equal to 1 times Your annual rate of basic Earnings, rounded to the next higher multiple of $1,000, subject to a maximum of $50,000.” Under the heading “Supplemental Amount of Life Insurance,” the Plan Booklet stated that the Plan offered additional life insurance in “a Guaranteed Issue Amount equal to 1, 2, 3, 4, or 5 times Your annual rate of basic Earnings, subject to a maximum of $200,000 without Evidence of Good Health” or in “a maximum amount equal to 1, 2, 3, 4, or 5 times Your annual rate of basic Earnings, subject to a maximum of $500,000 with Evidence of Good Health.” Further, the Plan Booklet noted that the “Guaranteed Issue Amount” was “the Amount of Insurance for which [Hartford] do[es] not require Evidence of Good Health.” “Evidence of Good Health” was defined to mean “information about a person’s health from which [Hartford could] determine if coverage or *704 increases in coverage will be effective.

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Bluebook (online)
261 F. Supp. 2d 697, 2003 U.S. Dist. LEXIS 7235, 2003 WL 1957492, Counsel Stack Legal Research, https://law.counselstack.com/opinion/blum-v-spectrum-restaurant-group-inc-txed-2003.