Donald Van Loo v. Cajun Operating Co.

703 F. App'x 388
CourtCourt of Appeals for the Sixth Circuit
DecidedJuly 18, 2017
Docket16-1980
StatusUnpublished
Cited by8 cases

This text of 703 F. App'x 388 (Donald Van Loo v. Cajun Operating Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Donald Van Loo v. Cajun Operating Co., 703 F. App'x 388 (6th Cir. 2017).

Opinion

HELENE N. WHITE, Circuit Judge.

This Employee Retirement Income Security Act of 1974 (ERISA) action arises from the denial of a claim under Cajun Operating Company d/b/a Church’s Chicken’s (Church’s) employer-sponsored life-insurance plan in which Donna Van Loo (Van Loo), an in-house attorney for Church’s, participated. Van Loo elected and paid for life-insurance coverage offered through her employment, from 2007 until her death in 2013. Church’s, however, failed to obtain a required medical-underwriting form from Van Loo, resulting in its insurance provider’s denying benefits to plaintiffs, Van Loo’s parents, that exceeded a minimum guaranteed-coverage amount. Plaintiffs sued, claiming that Church’s violated its duties as an ERISA fiduciary in making material misrepresentations regarding Van Loo’s coverage level, which she relied on to her detriment. On the parties’ cross-motions for summary judgment, the district court granted summary judgment to plaintiffs, awarding $314,000 for benefits that exceeded the insurer’s guaranteed coverage. On appeal, Church’s does not dispute its status as an ERISA fiduciary or that it made material misrepresentations; it disputes only that plaintiffs proved detrimental reliance. Because plaintiffs met their burden as to detrimental reliance, and because Church’s failed to rebut plaintiffs’ showing, we AFFIRM.

I

Van Loo joined Church’s as an in-house real-estate attorney in 2007. She was diagnosed with esophageal cancer in late December 2012, went on disability leave, and passed away on March 4, 2013. 1 Van Loo’s starting annual salary was $100,000 and, after a promotion and annual merit raises, her annual salary at the time of her death was $122,200.

As an employee benefit,' Church’s provided basic life insurance at lx annual salary, and offered employee-paid elective supplemental life insurance. Both coverages were provided by Reliance Standard Life Insurance Company (Reliance) under a group life-insurance policy. The schedule of benefits in Church’s policy 2 offered the following coverage levels:

Basic Life ....
One (1) times Earnings, rounded to the next higher $1,000, subject to a maximum Amount of Insurance of $200,000..,,
Supplemental Life ...
*390 Choice of: One (1), Two (2), Three (3), Four (4) or Five (5) times Earnings, rounded to the next higher $1,000, subject to a maximum Amount of Insurance of $750,000 ....
Amounts of insurance over $300,000 are subject to [Reliance’s] approval of a person’s proof of good health.... During an [open-enrollment] period, applications for employees ... who were previously eligible and are now applying for initial or additional coverage will not require proof of good health for a one level increase in coverage, provided: (1) the application is complete, signed, and received by [Church’s] during the [open-enrollment period], and (2) the applicant was not previously declined for insurance coverage by us, postponed, had their application withdrawn, or voluntarily terminated their insurance with us.... Employees who exceed the combined Basic and Supplemental Life Insurance guarantee issue amount of $300,000 [and] employees ... who exceed a one level increase in insurance are subject to our approval of proof of good health and such amounts of insurance will not be effective until approved by us.

R. 78-3, PID 2022-23.

Church’s self-administered its group life-insurance plan, meaning that it was “responsible for ensuring that coverage elections (including any required proof of good health) are processed in accordance with the terms and conditions of the applicable policy and that premium remittances are accurate and timely.” R. 78-4, PID 2045. Church’s calculated premiums and deducted them from payroll, and, absent a need for medical underwriting on coverage over $300,000 or on coverage increased by more than one level, did not provide Reliance with the names or ages of insured employees.

When she was hired in 2007, Van Loo elected 2x supplemental insurance. This meant that she was covered for a total of $300,000 (lx her $100,000 annual salary in basic life, plus 2x that salary in supplemental life), The enrollment form Van Loo completed did not include a requirement to prove insurability or state whether such proof would be required in the future.

Later in 2007, during open enrollment, Van Loo increased her supplemental-coverage election to 3x her annual salary, effective for the 2008 benefits year. The supplemental-insurance section of the enrollment form stated: “If you wish to increase your supplemental life coverage, you may be required to submit an evidence of insurability form. If so, one will be mailed to you.” R. 78-7, PID 2057. Van Loo’s coverage election put her over the $300,000 “guarantee issue” threshold after which proof of good health is required for coverage. The record does not show that Church’s provided an evidence-of-insura-bility form (EIF) to Van Loo at that time, nor does Church's claim that it did.

During 2010 open enrollment, Van Loo again increased her election, this time to 4x her annual salary. In 2011, she received a 2012 employee-benefits guide. In the section related to life insurance, the guide stated:

When is Evidence of Insurability Required?
Supplemental Life Insurance — If you want to increase your coverage during open enrollment, you may increase by one level (such as from lx salary to 2x salary). Increases of more than this, or more than $150,000, may require an [EIF].

R. 78-14, PID 2084.

In 2012, Van Loo received a guide for 2013 with identical language. The record does not contain a benefits guide or similar *391 document that was provided to Van Loo prior to 2011. 3

Several months before her cancer diagnosis, Van Loo completed her 2013 benefits election. She again elected supplemental insurance at 4x her annual salary, at a $97.31 monthly premium. Church’s manages its open-enrollment process over its corporate intranet; after Van Loo completed the process, a confirmation screen displayed the message “CONGRATULATIONS on completing your benefits enrollment for 2013.” R. 78-9, PID 2061. This screen also cautioned that “[the information you submitted] is open to investigation and verification, and is subject to the eligibility provisions of the plans.” Id. By this point, Van Loo’s total coverage was $615,000 (5x her $122,200 annual salary, rounded to the next-higher $1,000 per the group-life policy). 4

After Van Loo took disability leave in early 2013, she no longer received a paycheck and thus her insurance premiums were not deducted from payroll. On February 21, 2013, Church’s sent her a letter requesting that she pay the company directly for her benefits, listing her supplemental life insurance as one of those benefits.

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Bluebook (online)
703 F. App'x 388, Counsel Stack Legal Research, https://law.counselstack.com/opinion/donald-van-loo-v-cajun-operating-co-ca6-2017.