Cherochak v. Unum Life Insurance Co. of America

586 F. Supp. 2d 522, 2008 U.S. Dist. LEXIS 95825
CourtDistrict Court, D. South Carolina
DecidedApril 29, 2008
DocketC.A. 9:07-3061-PMD, 9:07-0927-PMD
StatusPublished
Cited by4 cases

This text of 586 F. Supp. 2d 522 (Cherochak v. Unum Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, D. South Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cherochak v. Unum Life Insurance Co. of America, 586 F. Supp. 2d 522, 2008 U.S. Dist. LEXIS 95825 (D.S.C. 2008).

Opinion

ORDER

PATRICK MICHAEL DUFFY, District Judge.

This matter is before the court upon Defendant Unum Life Insurance Company of America’s (“Defendant”) Motion for Summary Judgment and upon Plaintiff Joseph G. Cherochak, Jr.’s (“Plaintiff’) Motion to Amend Complaint. For the reasons set forth herein, the court grants Plaintiffs Motion to Amend Complaint and grants in part and denies in part Defendant’s Motion for Summary Judgment.

BACKGROUND

On September 10, 2007, Plaintiff filed suit against Defendant in the United States District Court for the District of South Carolina, asserting that he purchased a group long-term disability benefits plan through his employer, Gambro Health Care, beginning on or about 1996. (Compl. in No. 3061 ¶ 4.) He further alleges that the premium payments for the policy were automatically deducted from *525 his paychecks. (Id.) On or about September 9, 1998, Plaintiff was involved in an automobile accident during the course of his employment which he alleges resulted in permanent injury and disability. (Id. ¶ 5.) Plaintiff made a claim for disability benefits from Defendant pursuant to the group policy, but such claim was denied by a letter dated December 7, 2000. (Id. ¶ 7.) This denial letter “stated that the Plaintiff was not entitled to any benefits as ... [it] allege[s] his condition was considered preexisting inasmuch as it was the Defendant’s position that the Plaintiff did not have an effective policy until January 1, 2000.” (Id. ¶ 8.) The Defendant claimed that Plaintiff had declined long term disability coverage for 1998. (Id. ¶ 9.)

On or about July 19, 2005, Defendant contacted Plaintiff by letter regarding a Claims Reassessment Process. (Id. ¶ 10.) The United States Department of Labor conducted an investigation regarding the Defendant’s claims handling practices involving claims covered by the Employee Retirement Income Security Act (“ERISA”), and Defendant entered into a Regulatory Settlement Agreement (“RSA”) in November of 2004. (Id.) Pursuant to that agreement, Defendant agreed to pay a $15 million fine and conduct a reassessment for certain long-term disability claims dating back as far as 1997. (Id.) Plaintiff elected to participate in the Claims Reassessment Process and filed the appropriate form on October 24, 2005. (Id.)

Plaintiff alleges that as part of the reassessment process, he requested a copy of his policy and claim file, and he received a copy of his policy on September 6, 2005. (Id. ¶ 12.) According to Plaintiff, “[t]his was the first time the Plaintiff had been afforded an opportunity to examine his claim file in possession of the Defendant.” (Id.) Plaintiff further alleged that

[t]he claim file did not contain any information supporting Defendant’s claim that Plaintiff did not have a valid policy for long term disability. The Plaintiffs policy included in the claim file clearly states that its effective date is March 1, 1998. Further, all in-house documents included in the file indicated the policy effective date of coverage as March 1, 1998. Nothing in the file indicated that the Plaintiff had declined long term disability coverage in 1998.

(Id. ¶ 13.) Defendant denied Plaintiffs benefits a second time through the Reassessment Process by letter dated July 26, 2006. (Id. ¶ 18.) Plaintiff alleges the basis of the denial was the same as that of the original denial — that Plaintiff was not covered during 1998. (Id.)

Plaintiff thus filed suit, listing six causes of action: (1) breach of fiduciary duty pursuant to ERISA § 502(a)(3); (2) fraud; (3) fraudulent concealment; (4) breach of contract; (5) unjust enrichment; and (6) breach of contract with fraudulent intent. (See Compl. in No. 3061.)

Before Plaintiff filed suit in federal court, he filed suit against Defendant in the Court of Common Pleas for Beaufort County on or about March 14, 2007, and Defendant filed a Notice of Removal on April 5, 2007. The allegations in that action are substantially similar to the allegations in the Complaint originally filed in federal court: Plaintiff purchased group long-term disability benefits beginning in 1996; Plaintiff was in a car accident in 1998; and Defendant denied benefits, asserting that Plaintiff did not have an effective policy until 2000. (See Compl. in 9:07-927-PMD.) This Complaint listed the following causes of action: (1) breach of contract; (2) bad faith refusal to pay first-party benefits; and (3) violation of the South Carolina Unfair Trade Practices Act. (See Id.) On November 27, 2007, *526 Plaintiff filed a motion to consolidate Case Numbers 9:07-3061-PMD and 9:07-0927-PMD, and that motion was granted on December 17, 2007.

Defendant filed a Motion for Summary Judgment on December 5, 2007, to which both a Response and a Reply have been filed. Plaintiff filed a Motion to Amend Complaint on December 24, 2007, to which a Response and Reply have also been filed.

STANDARD OF REVIEW

A. Motion to Amend Complaint

Rule 15(a) of the Federal Rules of Civil Procedure indicates that a court should “freely” give leave to amend a pleading “when justice so requires.” While this court is given discretion to deny the motion to amend, “that discretion is limited by the interpretation given Rule 15(a) in Foman [v. Davis, 371 U.S. 178, 83 S.Ct. 227, 9 L.Ed.2d 222 (1962)], ‘and by the general policy embodied in the Federal Rules favoring resolution of cases on their merits.’ ” Island Creek Coal Co. v. Lake Shore, Inc., 832 F.2d 274, 279 (4th Cir. 1987) (citation omitted). Upholding the letter and the spirit of this rule, “leave to amend a pleading should be denied only when the amendment would be prejudicial to the opposing party, there has been bad faith on the part of the moving party, or the amendment would be futile.” Edwards v. City of Goldsboro, 178 F.3d 231, 242 (4th Cir.1999) (quoting Johnson v. Oroweat Foods Co., 785 F.2d 503, 509 (4th Cir.1986)) (emphasis in original). A delay in bringing a proposed amendment is insufficient reason to deny leave to amend. Id.

For a motion to amend to be denied for futility, the amendment must be “clearly insufficient or frivolous on its face.” Oroweat Foods Co., 785 F.2d at 510-511; see also Rambus, Inc. v. Infineon Tech., AG, 304 F.Supp.2d 812, 819 (E.D.Va.2004) (“Courts generally favor the ‘resolution of cases on their merits’ ... [t]hus the substantive merits of a proposed claim [or defense] are typically best left for later resolution, e.g., under motions to dismiss or for summary judgment, ..., or for resolution at trial.”) (quoting Davis v.

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586 F. Supp. 2d 522, 2008 U.S. Dist. LEXIS 95825, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cherochak-v-unum-life-insurance-co-of-america-scd-2008.