Flynn v. Sun Life Assurance Co.

809 F. Supp. 2d 1175, 2011 U.S. Dist. LEXIS 89476, 2011 WL 3516146
CourtDistrict Court, C.D. California
DecidedAugust 10, 2011
DocketCase No. CV 10-4832 VBF (MANx)
StatusPublished
Cited by4 cases

This text of 809 F. Supp. 2d 1175 (Flynn v. Sun Life Assurance Co.) is published on Counsel Stack Legal Research, covering District Court, C.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Flynn v. Sun Life Assurance Co., 809 F. Supp. 2d 1175, 2011 U.S. Dist. LEXIS 89476, 2011 WL 3516146 (C.D. Cal. 2011).

Opinion

FINDINGS OF FACT AND CONCLUSIONS OF LAW

VALERIE BAKER FAIRBANK, District Judge.

The Parties tried this case to the Court based on an administrative record on July 19, 2011. Plaintiff was represented by Gary Tysch. Defendant Sun Life Assurance Company of Canada was represented by Daniel Maguire of Burke, Williams & Sorensen LLP. Defendant Pulau Electronics Corporation Employee Benefits Plan was represented by Roland Juarez and Jennifer Ellis of Hunton & Williams LLP. Having reviewed the administrative record, considered all timely submissions by the Parties, and the arguments of counsel at trial, the Court makes the following findings of fact and conclusions law. Parenthetical references are to the pages of the Administrative Record, filed on June 6, 2011. (Doc.31.)

FINDINGS OF FACT

A. The Benefit Plan Offered By Pulau

1. Plaintiff Karen Flynn is the widow of Edward Flynn (“Flynn”), one of a group of former Raytheon employees hired by Pulau Corporation on May 1, 2008. (133, 277, 280.)

2. Pulau provides program management, operation and maintenance, instructor/operator, logistics and supply chain management, vehicle repair and maintenance, live fire range and shoot house maintenance and training system relocations to the U.S. Government and other major prime contractors. (133, 280.)

3. In early 2008, Pulau began performing services for the U.S. Government at Fort Irwin, California when it was awarded a subcontract with Raytheon Technical Services Company, a company that provides services similar to those provided by Pulau. (Id.) Under the new contract arrangements, a large number of Raytheon employees left Raytheon and joined Pulau, as new hires. (Id.) Flynn, Plaintiffs deceased husband, was one of those employees and began his employment with Pulau on May 1, 2008. (133, 277, 280.)

4. New Pulau employees, including Flynn, were offered the opportunity to participate in Pulau’s ERISA-governed benefit plan. The Pulau benefit plan is self-administered. (270-71.) Pulau struc[1179]*1179tures the benefit package and is responsible for enrollment of eligible participants in all plan benefits. Pulau maintains all enrollment records, including enrollment forms and billing information. (Id.) The terms, conditions and limitations of the benefits are governed by the plan documents.

5. The new employees, including Flynn, could choose between two benefit options. (280.) Option 1, known as the “insurance option,” allowed participation in Pulau’s Group Health and Welfare Plan. (113-14, 283-84.1) This included a total package of medical, dental, vision, disability and life insurance under group insurance policies issued to Pulau by various insurers, among other Company benefits. (Id.)

6. Option 2, the “extra pay” option, offered an additional $3.16 per hour, in lieu of any participation in the Health & Welfare Plan. (113-14; 285-86.) The extra pay would enable the employee to purchase his or her own insurance, if they so desired. (285.)

7. Option 1 was all or nothing. The new hire could not pick and choose which of the insurance coverages he or she wanted. (113-14, 283-84.) The insurance package had to be accepted as a whole. Within Option 1, the life insurance benefit was funded by Pulau through a group insurance policy issued by Sun Life, effective October 1, 2003. (168.)

8. A Memorandum describing the choice between Options 1 and 2 and enclosing copies of both benefits options, was provided to the new Raytheon hires, including Flynn, by Memorandum dated May 1, 2008. (282-86.)

9. The group life insurance policy allowed Flynn to elect basic life coverage of $50,000. (171.) Under the guaranteed issue provision of the Sun Life policy, optional life insurance coverage was limited to the lesser of three times annual earnings or $50,000. (172, 123.) The guaranteed issue amount is defined as follows:

“Guaranteed Issue Amount means the maximum amount of insurance available under this Policy without Evidence of Insurability. If the Employee’s or Dependent’s amount of insurance exceeds the Guaranteed Issue Amount available under this Policy, any amount in excess of the Guaranteed Issue Amount is available to the Employee or Dependent only if he has furnished Evidence of Insurability to Sun Life and has been approved for any excess amount above the Guaranteed Issue Amount.” (176) (emphasis added).

10. Additional optional coverage up to the lesser of $500,000 or five times his annual earnings was available, but only if Flynn submitted, and Sun Life accepted, his Evidence of Insurability application. (171-72.) At the time of his death, Flynn’s Basic Annual Earnings were $50,000. (277.) Flynn acknowledged the Evidence of Insurability requirement on the enrollment form. (123.)

B. Flynn Initially Selected The Insured Option

11. In May 2008, Flynn initially selected Option # 1 — i.e., to participate in Pulau’s health and welfare plan. However, rather than enrolling in all of the benefits packages that make up Pulau’s Option # 1, [1180]*1180Flynn attempted to enroll in life, dental, vision, and disability insurance, and then attempted to decline participation in other benefits, such as medical insurance. (117, 120.) This was not a proper election of coverage. (283-286.)

12. Similarly, Flynn incorrectly completed the optional life insurance enrollment form. He attempted to apply for $500,000 in optional life insurance coverage, although his Optional Maximum Benefit was $250,000.2 (123.)

13. Although Flynn could not obtain optional life insurance coverage beyond $50,000 without providing evidence of insurability and obtaining approval from Sun Life for any excess amount above $50,000, he never submitted such evidence of insurability and never obtained any such approval from Sun Life. (5, 26,108.)

14. Because Flynn had selected Option # 1, which included the health insurance package (i.e., medical, dental, vision), short and long term disability insurance, and basic life insurance coverage, and because he never submitted evidence of insurability for optional life insurance above $50,000, Pulau began deducting the appropriate employee contributions, including $80.00 for health insurance beginning with his June 4, 2008 paycheck, and $15.95 for the $50,000 in optional life insurance, $14.03 for short term disability insurance, and $8.97 for long term disability insurance, beginning with Flynn’s June 18, 2008 paycheck. (124.)

15. Pulau enrolled the new hires in the Meritain health insurance policy in May and set-up the payroll deductions to begin in the employees’ June 4, 2008 paycheck. (124.) Pulau did not begin processing enrollments for the life insurance policy until June. (125, 133.) Although Vickie Wasik, HR Administrator at Pulau, set up Flynn’s payroll deductions for the $50,000 in optional insurance coverage to begin in his June 18, 2008 paycheck, she did not complete his enrollment with Sun Life because she wanted to speak with Flynn first. (276.)

16. In fact, when Ms. Wasik first received the life insurance enrollment forms, she noted Flynn’s improper election, and observed that he could only elect $100,000 of total coverage without evidence of insurability. (Id.) This is why Ms.

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Bluebook (online)
809 F. Supp. 2d 1175, 2011 U.S. Dist. LEXIS 89476, 2011 WL 3516146, Counsel Stack Legal Research, https://law.counselstack.com/opinion/flynn-v-sun-life-assurance-co-cacd-2011.