Caldwell v. Continental American Insurance (In Re Caldwell)

350 B.R. 182, 2006 Bankr. LEXIS 2504, 2006 WL 2790233
CourtUnited States Bankruptcy Court, E.D. Pennsylvania
DecidedSeptember 26, 2006
Docket19-10321
StatusPublished
Cited by1 cases

This text of 350 B.R. 182 (Caldwell v. Continental American Insurance (In Re Caldwell)) is published on Counsel Stack Legal Research, covering United States Bankruptcy Court, E.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Caldwell v. Continental American Insurance (In Re Caldwell), 350 B.R. 182, 2006 Bankr. LEXIS 2504, 2006 WL 2790233 (Pa. 2006).

Opinion

Opinion

STEPHEN RASLAVICH, Bankruptcy Judge.

I. Introduction

Debtor Bonnie J. Caldwell (the “Debtor” or the “Plaintiff’) filed this Adversary Proceeding against Defendants Continental American Insurance Co. fik/a United States Life Insurance Co. (“U.S.Life”) and Disability Reinsurance Management Services, Inc. (“DRMS”) (collectively, the “Defendants”) alleging breach of contract, seeking monetary and equitable relief, and asking the Court to reinstate certain long-term disability benefits. The Defendants oppose the relief requested and have filed three Counterclaims against the Plaintiff seeking declaratory and monetary relief. The Court presided over a trial on this matter on May 31, 2006, following the submission of all post-trial briefs, the Court took the matter under advisement. For the reasons discussed below, the Court enters judgment in the favor of the Defendants and against the Plaintiff.

II. Background

The Plaintiff is a former U.S. Airways employee who claims she suffers from Lyme Disease and that her illness entitles her to long-term disability benefits under her former company’s disability policy. In 1992, the Plaintiff began working for U.S. Airways as a part-time fleet servicer, a position in which she loaded baggage onto aircraft. In 1998, the Plaintiff became a full-time fleet servicer with U.S. Airways. As a full-time employee, she became eligible for long-term disability, and she enrolled in the company’s plan.

The Policy

The company’s long-term disability program is governed by a group disability policy (the “Policy”) that defined “Total Disability” or “Totally Disabled” to mean:

(1) during the first twenty-four (24) months of a period of disability, an injury or sickness required the employee to be under the regular care and attendance of a physician, and prevented her from performing the material duties of her regular occupation; and
(2) after the first twenty-four (24) months of total disability, an injury or sickness prevented her from performing the material duties of any occupation for which her education, training and experience qualified her.

See Ex. D-2 at 5 (emphasis added).

Plaintiffs Disability Claim

On or about February 3, 2003, the Plaintiff submitted a claim for disability benefits under the Policy, asserting that she was *186 disabled as a result of Lyme Disease. On the authenticated claim form, the Plaintiff specified March 18, 2001 as the “Date of Accident or Date Symptoms First Appeared.” See Ex. P-1 § 7. The claim form also questioned whether she had ever had the same or similar condition in the past. The Plaintiff responded in the negative. The Plaintiff later testified at trial, however, that she had been first diagnosed with Lyme Disease in 1993 1 and tested positive for Lyme Disease in October 2000. 2

At the time the Plaintiff submitted her disability claim form, her job responsibilities as a fleet servicer included physically demanding work, such as loading and unloading airplanes, driving airport equipment, and lifting bags and other cargo into aircraft bins. The Defendants initially granted the claim and began paying benefits to the Plaintiff in April 2003 in the amount of $1,785,000 per month. (N.T. 5/31/06 at 19; 103)

Income From Other Sources

On August 1, 2003, the Plaintiff executed an Agreement Concerning Benefits (“Agreement”) for the Defendant U.S. Life. (N.T. 5/31/06 at 20). The Agreement provided that the benefits would be reduced by any income that the Plaintiff received from other sources, including social security. The Policy likewise provided in a section addressing other income benefits that “[t]he scheduled amount [of other income benefits] will be reduced by the sum of any income or benefit you receive or for which you are eligible ... from ... the Federal Social Security Act.” See Ex. D-2 at 8-9. The Policy further provided that “[i]f you are totally disabled beyond 6 months you must provide proof of application for Social Security Disability Income benefits within 8 months of date of disability in order for your benefits under the Plan to continue so long as total disability continues.” See id.

In the Agreement, the Plaintiff elected to receive her monthly long-term disability benefit with no estimated reduction in benefits received from the Social Security Administration (“SSA”) but specifically acknowledged that “I understand that this may result in an overpayment on my Long Term Disability claim and agree to repay any overpayment in full immediately following receipt of award for said benefits.” See Ex. P-2. The Policy also provided in pertinent part for the adjustment of benefits in the event of an under or overpayment as follows: “We may reduce your benefit or stop paying benefits until the overpayment is recovered.” See id. at 9. The Plaintiff testified that she understood these provisions to mean that U.S. Life would want to recoup any monthly social *187 security amounts that she received. (N.T. 5/31/06 at 21)

Social Security Payments and Allegations of Overpayment

The Plaintiff applied for social security benefits in July 2003 and received a lump sum award on May 1, 2004 of $7,458.00. (N.T. 5/31/06 at 21; 29). At that time, she also received a lump sum award of $5,473.00 from the SSA payable to her as the custodian for her minor daughter. (N.T. 5/31/06 at 45). In addition, the Plaintiff received two monthly payments of $1,007.00 each for both April and May 2004 and a monthly payment of $503.00 for May 2004 on behalf of her daughter. The Plaintiff testified that she notified U.S. Life about the award by contacting them via telephone and speaking to a customer service agent. (N.T. 5/31/06 at 30).

The Defendants dispute that the Plaintiff notified them of the social security payments and claim that they did not discover that the Plaintiff had received an award from the SSA until June 2004 when they were informed by the agency. (N.T. 5/31/06 at 106) Furnished with this information, the Defendants adjusted the Plaintiffs monthly disability benefits accordingly. The Defendants also notified the Plaintiff by letter that an overpayment of $17,617.30 (later adjusted downward) was immediately due. The Plaintiff refused to reimburse the Defendants for the overpayment, disputing the claimed amount and claiming that, at most, she owed $9,094.00 as a result of an overpayment. (N.T. 5/31/06 at 36; 45-46) Because the Plaintiff failed to repay the overpayment, the Defendants suspended her benefits in June 2004. They subsequently terminated benefits effective April 2005, claiming that the Plaintiff no longer met the definition of “total disability” under the Policy.

Part of the dispute over the amount of overpayment owed stems from amounts that were received from social security for Ms. Caldwell’s minor daughter.

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Bluebook (online)
350 B.R. 182, 2006 Bankr. LEXIS 2504, 2006 WL 2790233, Counsel Stack Legal Research, https://law.counselstack.com/opinion/caldwell-v-continental-american-insurance-in-re-caldwell-paeb-2006.