Forrest v. Paul Revere Life Insurance

662 F. Supp. 2d 183, 2009 U.S. Dist. LEXIS 97296
CourtDistrict Court, D. Massachusetts
DecidedJuly 31, 2009
DocketCivil Action 08-40123-FDS
StatusPublished
Cited by2 cases

This text of 662 F. Supp. 2d 183 (Forrest v. Paul Revere Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Forrest v. Paul Revere Life Insurance, 662 F. Supp. 2d 183, 2009 U.S. Dist. LEXIS 97296 (D. Mass. 2009).

Opinion

MEMORANDUM AND ORDER ON DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT

SAYLOR, District Judge.

This is a civil action arising out of a claim for long-term disability benefits. Plaintiff Anne Forrest contends that defendant The Paul Revere Life Insurance Company (a wholly owned subsidiary of The Paul Revere Corporation, which is a wholly owned subsidiary of Unum Group) improperly denied her request for benefits. 1 The matter arises under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. Forrest seeks to recover benefits that she alleges were wrongfully denied as well as attorneys’ fees and costs pursuant to 29 U.S.C. §§ 1132(a)(1)(B) and 1132(g).

Forrest’s claim for benefits was first denied in February 1998. Her file was then marked closed in March 2000 after an unsuccessful appeal. In 2006, Forrest initiated — but did not complete — a reassessment of her claim pursuant to a settlement between Unum and various state insurance agencies and the Department of Labor. That request for reassessment was denied on the grounds that Forrest had not submitted the necessary documentation by the deadline of October 1, 2006.

Unum has moved for summary judgment. The central issue presented is whether the claim is time-barred.

Unum contends that the claim is barred by both the policy’s contractual limitations period and the relevant statute of limitations. In response, Forrest contends that the policy’s contractual limitations provision is ambiguous and inapplicable to her claim and that the action, allowing for tolling during her ineffectual reassessment attempts, was timely filed under the statute.

For the reasons stated below, defendant’s motion will be granted.

I. Background

Except where noted, the following facts are undisputed. 2 Where disputed, the *186 facts are presented in the light most favorable to plaintiff, the non-moving party.

A. The Initial Claim for Benefits

As of 1997, Anne Forrest was a Senior Economist at the Environmental Law Institute, with a B.A. from Yale University and a Ph.D. in economics from Duke University. She was a participant in a welfare benefit plan funded by an insurance policy issued by Unum to ELI. The Plan is governed by ERISA.

In June 1997, Forrest was in a car accident that left her with various injuries, including some loss of cognitive abilities. 3 In July 1997, she applied for long-term disability benefits. By letter dated February 27, 1998, Unum informed her that she did not meet the requirements of “total disability,” as defined in the plan, and denied her claim. She was advised of her right under ERISA and the Plan to appeal that determination.

On May 6, 1998, Forrest appealed the decision. On July 28, 1998, Unum informed her by letter that it would need to conduct additional testing before rendering its determination on her appeal. In addition, the letter stated as follows: “As we shall be unable to conduct the neuropsychological testing and conduct a full and fair review of the contents prior to [the deadline for deciding the appeal under ERISA], we shall be willing to exceptionally provide, benefits until this review has been completed. These benefits shall be made on a good faith basis, and should not be construed as a waiver of any of the rights afforded to Us under the group Policy.” (Curtis Aff. at Ex. E). The letter stated that the benefits, retroactive to December 25, 1997, would continue to be paid “until such time that we have completed the review and rendered our final determination on the request for appeal.” (Id.).

On March 10, 2000, Unum informed Forrest by letter that she would be ineligible to receive long-term disability benefits beyond December 25, 1999. 4 According to the letter, the Plan limited “Mental Disorder” benefits without hospitalization to a maximum of 24 months. (Curtis Aff. at Ex. F). 5 Unum reviewed Forrest’s claim and medical history and concluded that she “is not precluded from performing her occupational duties as a result of a physical condition, and that all evidence supports that her Disability is due to a Psychiatric Disorder.” (Id.). In closing, the letter stated as follows: “The administrative remedies have now been exhausted under the plan, and there will thus be no further appeals available to Ms. Forrest. We have now marked her file as closed.” (Id.).

The Plan contains a contractual limitations period. In a section entitled “LE *187 GAL ACTIONS AND LIMITATIONS,” it provides as follows:

No action at law or in equity may be brought to recover under this Policy unless proof of loss has been filed according to the terms of this Policy. In addition, the claimant must wait 60 days after filing proof of loss before taking action. If any action is to be taken, it must be taken within three years from the end of the 60-day time period. If any time limit in this Policy is less than the law specifies in the state where the claimant lives at the time this Policy is issued, We extend the time limit to agree with the minimum period specified by such law.

(Curtis Aff. at Ex. A). At the time the policy was issued, Forrest apparently resided in Connecticut.

B. The Claim Reassessment Process and Forrest’s Initial Contacts

In November 2004, Unum and its affiliated entities entered into a Regulatory Settlement Agreement (“RSA”) with various state and federal regulatory agencies concerning its long-term disability claims-handling practices. Under the RSA, Unum agreed to provide a Claim Reassessment Process for certain claimants.

According to Forrest, in December 2004 she learned from a former college classmate, Loretta Sherblom, that Unum had entered into a settlement agreement in which it agreed to review certain previously denied and terminated claims. On January 12, 2005, Sherblom contacted George Sells, a Unum employee, on Forrest’s behalf to inquire whether her claim was eligible for the reassessment program. On January 24, 2005, a different Unum employee, Kelly Dieppa, responded to Sherblom by e-mail, stating that “she is not in an eligible group” because “her claim was closed.” However, Dieppa also explained that Forrest “may dispute her eligibility status (basically, just ask her to state her case and ask for a review under the Agreement) by sending in a letter specifically asking for a review of her eligibility under the Multi-State Agreement.

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Related

MacLennan v. Provident Life & Accident Insurance
676 F. Supp. 2d 57 (D. Connecticut, 2009)

Cite This Page — Counsel Stack

Bluebook (online)
662 F. Supp. 2d 183, 2009 U.S. Dist. LEXIS 97296, Counsel Stack Legal Research, https://law.counselstack.com/opinion/forrest-v-paul-revere-life-insurance-mad-2009.