Dandurand v. Unum Life Insurance Co. of America

150 F. Supp. 2d 178, 26 Employee Benefits Cas. (BNA) 2186, 2001 U.S. Dist. LEXIS 10723, 2001 WL 826931
District Court, D. Maine·Decided July 23, 2001·No. Civil 00-220-P-C·Published·Cited by 5 cases

Opinion

MEMORANDUM OF DECISION AND ORDER

CARTER, District Judge.

This ERISA case involves a dispute over the entitlement of Plaintiff, Lucien Dandu-rand, to long-term disability benefits under Defendant Unum’s Group Long Term Disability Insurance Policy Number 379228 (hereinafter “the Policy”), Dandurand’s Claim File, Defendant’s Ex. 25, at UA-791, between July 20, 1994, and August 28, 1999, and whether Plaintiff or Defendant, Unum Life Insurance Company of America (hereinafter “Unum”), should now bear the cost of a five-year-long mistake made by Unum in its calculation of Dandurand’s eligibility for disability benefits under the Policy. A bench trial was held to determine whether Unum should recoup any overpayment it made to Dandurand during the relevant time period. Consideration of the evidence and the parties’ legal arguments has led the Court to conclude, for the reasons discussed below, that Unum should not recoup any overpayment it *180 made to Dandurand under the Policy between July 20, 1994, and August 28, 1999.

FACTUAL BACKGROUND

Dandurand has been an employee of the Dingley Press for sixteen years. The Dingley Press has maintained a long-term disability insurance plan for its employees, provided by Group Long Term Disability Insurance Policy No. 379228, since September 1, 1993. See The Policy at LI. Unum issued and serves as administrator of the Policy. As an employee of the Dingley Press, Dandurand is entitled to benefits under the Policy.

In 1994, Dandurand was diagnosed with cardiomyopathy, an inflammation of the heart muscle. This condition causes Dan-durand to experience a lack of energy and fatigue, and it reduces his ability to handle stress. Because of this condition, Dandu-rand had to reduce his working hours in 1994, and he submitted a claim for disability benefits under the Policy. In September 1994, Unum approved Dandurand’s benefits claim and began issuing Dandu-rand long-term disability benefits (hereinafter “LTD benefits”) that month. 1

Dandurand continued to work part time at the Dingley Press and received LTD benefits under the Policy’s partial disability provision, see The Policy at L-DEF-4, on an ongoing basis until August 19, 1999. Unum paid Dandurand a sum of $85,442.55 in LTD benefits between July 20, 1994, and August 19, 1999. See Joint Stipulations ¶ 1. Because a participant’s benefit for a partial disability varies according to a participant’s basic monthly earnings and other income benefits under the terms of the Policy, see The Policy at L-BEN-1, Dandurand’s LTD benefits varied throughout this time period. Dandurand testified that, throughout this period, the combination of his LTD benefits and his income from the Dingley Press generally resulted in an amount approximate to the income that he had been earning prior to the onset of his disability — about $60,000 per year. During the time period between July 1994 and August 1999, the responsibility of managing Dandurand’s claim file passed through a series of four Unum employees: Thomas Grant, Leigh Quinn, Tracy Sawyer, and Craig Beaulieu.

In August 1999, Unum determined that it had erroneously failed to include Dandu-rand’s bonuses in its calculation of Dandu-rand’s current earnings while determining Dandurand’s eligibility for LTD benefits for the years 1995 to 1999. While this error was made on a number of occasions between the years 1995 and 1999, the first and most significant exclusion of Dandu-rand’s bonus income consisted of Grant’s failure to include a bonus that Dandurand had received in 1995 in determining whether Dandurand was partially disabled in 1995. Because the Policy defines partial disability in terms of loss in current earnings due to an individual’s injury or sickness, see The Policy at L-DEF-4, the inclusion of this bonus as part of Dandu-rand’s 1995 current earnings would have rendered Dandurand nondisabled under the terms of the Policy for that year. 2 *181 However, Grant had not included this bonus in its calculation of Dandurand’s 1995 current earnings because, instead of using box 2 of Dandurand’s 1995 W-2 form to determine these earnings, he had taken Dandurand’s 1995 weekly earnings, multiplied them by 52, and then divided this product by 12. Grant engaged in this calculation despite the fact that he was aware of the bonus and had the relevant W-2 forms available to him at the time that he determined Dandurand’s 1995 eligibility. This error went undetected by at least the three other Unum employees who were responsible for Dandurand’s file throughout the years 1995 to 1999 and who continued to derive Dandurand’s current earnings from his weekly earnings instead of using box 2 of his W-2 forms. Grant’s initial exclusion of bonus income in 1995 had ramifications for Dandurand’s eligibility for disability benefits and the calculation of Dandurand’s disability benefits for the subsequent years during this time period. 3 Unum claims that, because of the mistaken exclusion of the 1995 and other bonus income from Dandurand’s current earnings, it overpaid Dandurand by $67,957.18 through August 28, 1999. See Joint Stipulation ¶ 3.

In August 1999, Unum also determined that Dandurand was no longer eligible for benefits under the Policy. Dandurand appealed this decision and Unum’s determination that it had overpaid him through August 1999. As a result of this appeal, Unum determined that Dandurand was still disabled within the meaning of the Policy and resumed payment of his benefits. However, Unum did not change its determination that it had overpaid Dandu-rand through August 1999, 4 and Unum began deducting from Dandurand’s reinstated monthly benefits to recoup that amount. Each month since August 1999, Unum has retained the entire amount of Dandurand’s benefits in furtherance of its goal to recoup the $67,957.18 that it contends Dandurand has been overpaid under the Policy. Through this recoupment effort, Unum offset $17,277.60 in benefits through March 31, 2000. See id. ¶ 4.

*182 The 1995 bonus that is the source of Unum’s claimed erroneous $67,957.18 overpayment to Dandurand was awarded to Dandurand in recognition of his efforts to return to work despite his disabling condition. This bonus was significantly larger than other yearly bonuses that have been awarded to Dandurand, amounting to $7,266.12. See Letter from Michael Le-tourneau to Thomas Grant (January 12, 1996), Plaintiffs Ex. 5. Letourneau testified that before the Dingley Press awarded Dandurand that bonus, Letourneau called Grant some time in December 1994 to ensure that the bonus would not negatively affect Dandurand’s LTD benefits. According to Letourneau, Grant stated that because the bonus had nothing to do with weekly earnings and was a one-time bonus, it would not affect Dandurand’s LTD benefits.

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Dandurand v. Unum Life Insurance Co. of America, 150 F. Supp. 2d 178, 26 Employee Benefits Cas. (BNA) 2186, 2001 U.S. Dist. LEXIS 10723, 2001 WL 826931 (D. Me. 2001).

150 F. Supp. 2d 178 (Dandurand v. Unum Life Insurance Co. of America) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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