Bowers v. Life Insurance Co. of North America

21 F. Supp. 3d 993, 58 Employee Benefits Cas. (BNA) 2054, 2014 U.S. Dist. LEXIS 66133
CourtDistrict Court, D. Minnesota
DecidedMay 14, 2014
DocketCivil No. 13-891 ADM/JJG
StatusPublished
Cited by5 cases

This text of 21 F. Supp. 3d 993 (Bowers v. Life Insurance Co. of North America) is published on Counsel Stack Legal Research, covering District Court, D. Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bowers v. Life Insurance Co. of North America, 21 F. Supp. 3d 993, 58 Employee Benefits Cas. (BNA) 2054, 2014 U.S. Dist. LEXIS 66133 (mnd 2014).

Opinion

MEMORANDUM OPINION AND ORDER

ANN D. MONTGOMERY, District Judge.

I. INTRODUCTION

On March 7, 2014, the undersigned United States District Judge heard oral argument on Plaintiff Mark S. Bowers’s and Defendant Life Insurance Co. of North America’s (“LINA”) cross-motions for summary judgment [Docket Nos. 22, 28]. The parties dispute whether Bowers is eligible for a life waiver of premium benefit under a plan administered by LINA.1 For the reasons set forth below, Bowers’s motion- for summary judgment is granted and LINA’s motion for summary judgment is denied.

II. BACKGROUND

A. Employment with C.H. Robinson

Plaintiff Bowers began working for C.H. Robinson Worldwide, Inc. (“C.H. Robinson”) on March 1, 1996, and eventually reached the position of Corporate Sales Director. Michael T. Berger Aff. [Docket No. 25] Ex. 1 (“Admin. Record”) at 509.2 On December 26, 2007, Bowers stopped working due to coronary artery disease. Two days later, on December 28, 2007, Bowers underwent emergency quadruple bypass surgery. See id. at 910, 1479. Bowers’s recovery was arduous and prolonged. He suffered from a staph infection requiring four or five debridement operations, and underwent extensive physical therapy. Id.

On June 27, 2008, Bowers returned to work. Bowers and C.H. Robinson agreed Bowers would return at a lower position, that of Consulting Services Manager. [997]*997Bowers received the same salary as before but his potential for earning bonus compensation was significantly reduced. Bowers also agreed to a reduced work schedule with the goal of increasing his hours to full-time. Id. at 1214.

Approximately one year later, on June 13, 2009, Bowers again left his employment due to health concerns. In August 2009, Bowers underwent a “total sternal reconstruction procedure,” as well as a muscle flap reconstruction involving his pectoralis muscles. Id. at 910. Bowers did not return to employment.

Also in August 2009, Bowers applied for long-term disability (“LTD”) benefits under the benefits plan administered by LINA (the “Plan”).. In his application for benefits, Bowers’s former counsel wrote that C.H. Robinson had accommodated Bowers’s disability by moving him to a “staff consultant” position. Counsel also wrote that Bowers had been able to work only “about 25 hours per week due to his ongoing disability.” Id. at 1196. In November 2009, C.H. Robinson employee Robyn Kippley prepared an employment summary, reviewed it for accuracy with Bowers, and then forwarded it to LINA. Id. at 1212. On December 21, 2009, LINA approved Bowers’s claim for LTD benefits, finding his disability to have started on December 27, 2007. Id. at 401.

B. Waiver-of-Premium Benefits

In addition to LTD benefits, the Plan provides employees with life insurance coverage through a policy issued by LINA (the “Life Policy”). Id. at 1825-57. The Life Policy divides employees into three classes, and states that a Class 2 Employee will only qualify for the life insurance benefit if he has been “regularly working a minimum of 30 hours per week.” Id. at 1827. The parties agree C.H. Robinson categorized Bowers as a Class 2 Employee.

The Life Policy waives the payment of premiums (referred to as the “WOP” benefit) for employees qualified as “disabled.” An employee is “disabled” under the Life Policy when the employee “is unable to perform the material and substantial duties of his or her occupation” due to injury or sickness. Id. at 1855. This is referred to as the “own occupation” standard of disability. After 12 months, however, the employee will only continue to be considered “disabled” if “he or she is unable to perform the material and substantial duties of any occupation for which he or she is or may reasonably become, qualified for.” Id. at 1855 (emphasis added). This is often referred to as the “any occupation” standard, or “total disability.” After a 180-day “Benefit Waiting Period,” an employee qualifying for the WOP benefit receives coverage under the Life Policy without paying premiums, and the coverage continues until the employee is no longer disabled or a maximum benefit period is reached. See id. at 1842.

1. Initial Claim

In December 2009, the same month LINA approved LTD benefits, Bowers also applied for the WOP benefit. On January 19, 2010, LINA approved Bowers’s claim in part. Id. at 384-85. LINA agreed Bowers retroactively qualified for the WOP benefit from June 27, 2008, until December 26, 2008. Id. LINA concluded Bowers first became “disabled” under the “own occupation” standard when he left work for his quadruple bypass surgery on December 26, 2007. The 180-day “Benefit Waiting Period” then 'delayed Bowers’s WOP benefit until June 27, 2008, at which time it applied until December 26, 2008. Id. At that point, however, LINA essentially concluded that Bowers had fallen in [998]*998the coverage gap between “totally disabled” and regular “employee.” See id. After 12 months under the “own occupation” standard of “disability,” the Life Policy moved to the “any occupation” standard. Because Bowers had returned to work as a sales consultant by this time, he did not qualify as “disabled” under the “any occupation” standard. At the same time, LINA concluded Bowers had not been “regularly working a minimum of 30 hours per week,” meaning Bowers had not met the basic life insurance eligibility requirements for Class 2 Employees. LINA thus denied the remainder of Bowers’s claim, finding Bowers had failed to demonstrate that he had re-established himself as a full-time employee able to claim Life Policy benefits. Id.

2. First Appeal

On June 14, 2010, Bowers appealed his claim for the WOP benefit. In his appeal letter, Bowers stated that when he initially returned to C.H. Robinson, he worked about 25 hours per week for “the first couple of months,” after which he resumed a normal workload of 34.5 hours per week until the end of 2008. Bowers also stated that he worked up to 45 hours per week when a deadline or other situation required it. Id. at 1874. Bowers also stated C.H. Robinson had categorized him as a full time employee, and that his supervisor, Gary Rogers, could confirm his workload. Id.; see also id. at 1880. As a salaried employee, Bowers noted, no other documents or timesheets existed which might more specifically document his hours. Id. at 1875.

As part of its review process, LINA’s designated Appeal Specialist Rui Cuinha requested Bowers’s workload information from C.H. Robinson. C.H. Robinson confirmed that no timesheets or other specific documents existed, and referred LINA to documents prepared in connection with Bowers’s LTD claim. These documents included an “employment summary” written by C.H. Robinson employee Robyn Kippley. Id. at 1212. In the summary, dated November 17, 2009, Kippley wrote that C.H. Robinson and Bowers agreed he would “initially resume work on a part-time basis and work back up to a full time work load.” Id. at 1214. Kippley noted Bowers was working “about 25 hours a week by Labor Day” in 2008, but Bowers continued to have “severe fatigue issues and cardiac symptoms.” Id.

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21 F. Supp. 3d 993, 58 Employee Benefits Cas. (BNA) 2054, 2014 U.S. Dist. LEXIS 66133, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bowers-v-life-insurance-co-of-north-america-mnd-2014.