Dillon v. Metropolitan Life Insurance

832 F. Supp. 2d 355, 2011 WL 6825252, 2011 U.S. Dist. LEXIS 149109
CourtDistrict Court, S.D. New York
DecidedDecember 28, 2011
DocketNo. 09 Civ. 7958(SHS)
StatusPublished
Cited by3 cases

This text of 832 F. Supp. 2d 355 (Dillon v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dillon v. Metropolitan Life Insurance, 832 F. Supp. 2d 355, 2011 WL 6825252, 2011 U.S. Dist. LEXIS 149109 (S.D.N.Y. 2011).

Opinion

OPINION & ORDER

SIDNEY H. STEIN, District Judge.

The issue for resolution is whether plaintiff Karen E. Dillon is entitled to recover $837,000 from each of two different life insurance policies issued by defendant Metropolitan Life Insurance Company (“MetLife”) to plaintiff’s late husband Jack Dillon. MetLife has now moved for summary judgment in its favor. Because Mr. Dillon’s group life insurance policy is governed by ERISA and the plan administrator was correct in determining that the group plan did not allow a participant to hold both a group policy and a conversion policy at the same time, MetLife’s motion for summary judgment is granted.

I. BACKGROUND

Unless otherwise noted, the following facts are not in dispute.

A. The Parties

Karen Dillon is the widow of Jack Dillon, a former employee of non-party Parker Hannifin Corporation. (Compl. ¶¶ 1, 4.) Mrs. Dillon is the legal representative of.her late husband’s estate. (Id. ¶ 1.) MetLife issued group term life insurance to eligible employees at Parker Hannifin. (Id. ¶ 2, 5.)

B. Mr. Dillon’s Group Life Insurance Policy

Parker Hannifin sponsored an employee benefit plan (the “Plan”) regulated by the Employee Retirement Income Security Act, 29 U.S.C. § 1001 et seq. (“ERISA”). (Def.’s Local Civil Rule 56.1 Statement of Undisputed Facts (“Def.’s 56.1”) ¶1.); (Pl.’s Local Civil Rule 56.1 Statement of Undisputed Facts (“PL’s 56.1”) ¶ 1.) Met-Life administered any claims under that plan in accordance with ERISA and the documents and instruments governing the [359]*359Plan. (Def.’s 56.1 ¶ 2; Pl.’s 56.1 ¶2.) Mr. Dillon, as an employee of Parker Hannifin, was enrolled for life insurance benefits pursuant to the Plan. (Def.’s 56.1 ¶ 3; Pl.’s 56.1 ¶ 3.) Mrs. Dillon was the primary beneficiary of Mr. Dillon’s group policy. (Compl. ¶ 6.)

The terms of Mr. Dillon’s life insurance benefits were set forth in Parker Hannifin’s Employee Benefit Plan (See Def.’s 56.1 ¶¶ 4-5; PL’s 56.1 ¶¶ 4-5.) The group plan specified that “[a]ll of your benefits will end on the date your employment ends.” (Def.’s 56.1 ¶4; PL’s 56.1 ¶4; Group Plan, Ex. A to Decl. of Patricia C. Reinhardt dated Feb. 4, 2010 at 81.) Employment ends when participants “cease Active Work as an Employee.” (Def.’s 56.1 ¶ 4; PL’s 56.1 ¶4.) However, when participants become sick or take a leave of absence from work, Parker Hannifin may deem them “to be in Active Work as an Employee only for the purpose of continuing [their] employment ... in order that certain of [their] benefits under This Plan may be continued.” (Def.’s 56.1 ¶ 4; PL’s 56.1 ¶ 4.) Participants’ benefits end on either (1) the date Parker Hannifin instructs MetLife to discontinue their benefits or (2) the last date for which Parker Hannifin has paid premiums to MetLife for them benefits. (Def.’s 56.1 ¶4; PL’s 56.1 ¶4.)

The group plan provides an option for participants to convert their group coverage to an individual policy when their employment ends. Specifically, MetLife will issue an individual policy to participants if they apply for it in writing during the application period (Def.’s 56.1 ¶5; PL’s 56.1 ¶ 5), which, as relevant here, is the thirty-one day period after the date a participant’s “Life Benefits end because [his or her] employment ends.” (Def.’s 56.1 ¶ 5; PL’s 56.1 ¶ 5.) The individual policy does not take effect until after the application period ends. (Def.’s 56.1 ¶ 5; PL’s 56.1¶ 5.)

The 2008 Parker Hannifin Summary Plan Description (the “SPD”), which is consistent with the terms of the group plan, states that if participants become “disabled” — meaning unable to perform the material duties of their regular job— their Basic Life Insurance coverage continues for twelve months from the onset of disability. (Def.’s 56.11 ¶ 6; PL’s 56.1 ¶ 6.) After their extended coverage ends, participants may convert their basic life insurance to an individual policy. (Def.’s 56.1 ¶ 7; PL’s 56.1 ¶ 7.) In a section titled “Converting your Coverage,” the SPD states that participants “may convert all or part of [their] Basic Life Insurance to an individual policy at rates set by MetLife if [their] insurance ends because” they “[e]nd active employment (or [their] extended coverage while on long-term disability ends).” (Def.’s 56.1 ¶ 7; PL’s 56.1 ¶7.) Parker Hannifin’s practice was to treat basic and optional life insurance benefits in the same manner with respect to eligibility issues. (Def.’s 56.1 ¶ 8.)1

C. Parker Hannifin Terminates Mr. Dillon’s Employment

In early 2008, Mr. Dillon was diagnosed with cancer. (Compl. ¶ 7.) As a result, he was unable to continue working and on March 24, 2008, Parker Hannifin placed [360]*360him on a medical leave of absence. (Def.’s 56.1 ¶ 9; Pl.’s 56.1 ¶ 9.) Contrary to the terms of the Plan and Parker Hannifin’s employment practices, Jack Dillon’s group basic and optional life insurance benefits “were mistakenly terminated” on or around September 24, 2008. (Def.’s 56.1 ¶ 11; Pl.’s 56.1 ¶ 11.)

D. The Conversion Policy and Reinstatement of the Group Policy

Approximately two weeks later, on October 8, 2008, Parker Hannifin contacted MetLife to inquire about whether Mr. Dillon could convert his group basic and optional life insurance benefits to an individual policy. (Def.’s 56.1 ¶ 12; Pl.’s 56.1 ¶ 12.) Two days later, Parker Hannifin sent a group conversion form to Mrs. Dillon. (Def.’s 56.1 ¶ 13; PL’s 56.1 ¶ 13; Group Conversion Notice Form, Ex. F to Reinhardt Decl.) The Dillons completed a group conversion application on October 13, 2008. (Def.’s 56.1 ¶ 14; PL’s 56.1 ¶ 14.) The face amount of the conversion application was $837,000, the same amount of coverage Mr. Dillon had had pursuant to his group policy. (See Exs. F and G to Reinhardt Decl.) On October 28, 2008, MetLife issued an individual policy to Mr. Dillon (the “conversion policy”). (Def.’s 56.1 ¶ 17; PL’s 56.1 ¶ 17.) He passed away three days later. (Defi’s 56.1 ¶ 20; PL’s 56.1 ¶ 20.)

Within days of Mr. Dillon’s death, Parker Hannifin realized that it should not have terminated Mr. Dillon’s group benefits and instructed MetLife to reinstate his group policy, which MetLife did.2 On October 30, 2008, MetLife determined that Mrs. Dillon was not eligible for benefits under both the group policy and the conversion policy. (Def.’s 56.1 ¶ 21; PL’s 56.1 ¶ 21.) On November 4, 2008, MetLife sent a letter to plaintiff stating that Parker Hannifin had advised MetLife that the conversion policy had been “issued in error and that [Mr, Dillon] remained covered under his group policy.” (Ex. L to Reinhardt Decl.) In the same letter, MetLife wrote that “we have rescinded” the conversion policy and have “enclosed a check for all premiums paid on [that policy], plus interest, from the date of issue, totaling $2393.44.” (Ex. L to Reinhardt Decl.)

Plaintiff filed claims with MetLife pursuant to both the reinstated group policy and the conversion policy. (Def.’s 56.1 ¶ 25, 26; PL’s 56.1 ¶ 25, 26.) On January 16, 2009, MetLife paid plaintiff $840,503.20, the coverage due under the group policy for group basic and optional life benefits, plus applicable interest. (Def.’s 56.1 ¶ 28; PL’s 56.1¶ 28.) MetLife has, however, refused to pay Mrs.

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832 F. Supp. 2d 355, 2011 WL 6825252, 2011 U.S. Dist. LEXIS 149109, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dillon-v-metropolitan-life-insurance-nysd-2011.