Fuller v. Liberty Life Assurance of Boston

302 F. Supp. 2d 525, 32 Employee Benefits Cas. (BNA) 2818, 2004 U.S. Dist. LEXIS 2184, 2004 WL 287143
CourtDistrict Court, W.D. North Carolina
DecidedFebruary 13, 2004
DocketCIV. 3:02CV498
StatusPublished
Cited by5 cases

This text of 302 F. Supp. 2d 525 (Fuller v. Liberty Life Assurance of Boston) is published on Counsel Stack Legal Research, covering District Court, W.D. North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fuller v. Liberty Life Assurance of Boston, 302 F. Supp. 2d 525, 32 Employee Benefits Cas. (BNA) 2818, 2004 U.S. Dist. LEXIS 2184, 2004 WL 287143 (W.D.N.C. 2004).

Opinion

MEMORANDUM AND ORDER

THORNBURG, District Judge.

THIS MATTER is before the Court on the Defendants’ motion for summary judgment which is opposed by the Plaintiff. For the reasons stated below, the motion is allowed.

I. STATEMENT OF FACTS

Plaintiff Sandra Fuller began working for First Union, the predecessor to Defendant Wachovia Corporation, 1 in February 1987. Plaintiffs Memorandum in Opposition to Defendant’s Motion for Summary Judgment (“Plaintiffs Memorandum”), filed September 9, 2003, at 7. In January 2000, Plaintiff was forced to stop working because of numerous health problems. Amended Complaint, ¶ 5. Plaintiff returned to work in April 2000 but was only able to work for eight days- because of her health problems. Plaintiffs Memorandum, at 2.

*528 Plaintiff was covered by the First Union Corporation Long Term Disability Plan, now known as the Wachovia Corporation Group Disability Plan (the “Disability Plan”). Amended Complaint, ¶4; Defendants’ Reply Brief in Support of Summary Judgment (“Defendants’ Reply Brief’), filed September 29, 2003, at 1. The Disability Plan is self-insured, meaning that the Employer, rather than an insurance company, is responsible for making the required payments. Exhibit 1, Administrative Record, attached to Defendants’ Brief in Support of Motion for Summary Judgment (“Defendants’ Brief’), filed August 14, 2003, at 438, 440; Defendants’ Brief, at 4. The Employer makes such payments out of a Voluntary Employees’ Beneficiary Association (“VEBA”) trust. Exhibit 2, Affidavit of James Beaver, attached to Defendants’ Brief, ¶ 3. The Employer’s contributions to the VEBA trust constitute a fraction of one percent of the company’s operating expenses. Id., ¶ 5.

The Disability Plan provides that “[t]he Employer is the administrator of the Plan,” but “[t]he Employer may appoint one or more Employees to conduct the general administration of the Plan, and to have the responsibility for carrying out its provisions.” Record, at 439. The Employer did, in fact, appoint employees to administer the Disability Plan. Those employees, Judy Shepard; Rick Winquist, and James Beaver, were known as the Benefits Committee. Beaver Affidavit, ¶ 4. By the terms of the Disability Plan, such appointment does “not constitute delegation of the Employer’s responsibility but rather shall be treated as the manner in which the Employer has determined internally to discharge such responsibility.” Record, supra. The Disability Plan does provide, however, that the “Employer may ... delegate to any person or entity any powers or duties of the Employer under the Plan.” Id.

The Employer hired Defendant Liberty Life Assurance of Boston (“Liberty Life”), a member of Defendant Liberty Mutual Group, to perform certain administrative duties associated with the Disability Plan. Group Disability Risk Management Agreement (“Risk Management Agreement”), attached to Supplemental Affidavit of James L. Beaver, attached as Exhibit 1 of Defendants’ Reply Brief. Among Liberty Life’s tasks are the determination of eligibility for benefits, claims processing, investigation of claims, and payment of claims. 2 Risk Management Agreement, at Annex B. If a claimant is dissatisfied with Liberty Life’s determination, he or she may appeal to the Employer, who makes a final decision. Id.; Record, at 441.

The Disability Plan further provides that the “Plan Administrator [the Employer] shall have the exclusive right and the sole discretionary authority to interpret the terms and provisions of the Plan and to resolve all questions arising thereunder, including, without limitation, the authority to determine eligibility for Benefits and the right to resolve and remedy ambiguities, inconsistencies or omissions in the Plan, and ... such action shall be exclusive.” Record, at 440.

Under the Disability Plan, benefits are to be the lesser of 60 percent of the participant’s pre-disability earnings or 66% percent of the participant’s pre-disability earnings less the benefits from other income. Id., at 432. “Benefits from other income” include “[t]he amount of any Disability Benefits, or Retirement Benefits the Participant voluntarily elects to receive as retirement payment under the Employer’s Retirement Plan” and “[t]he amount *529 of Disability and/or Retirement Benefits under the United States Social Security Act.” Id., at 424-25. The term “Retirement Benefits” means money that:

(a) is -payable under a Retirement Plan either in a lump sum or in the form of periodic payments;
(b) does not represent contributions made by an Employee (payments which represent Employee contributions are deemed to be received over the Employee’s expected remaining life regardless of when such payments are actually received); and
(c) is payable upon:
(1) early or normal retirement; or
(2) Disability, if the payment reduces the amount of money which would have been paid under the plan at the normal retirement age.

Id., at 428-29.

When a participant receives benefits from other income in a lump sum, the benefits from other income “will be prorated on a monthly basis over the time period to which the lump sum relates or the maximum benefit period ..., whichever is less.” Id., at 436. Furthermore, when a participant receives an overpayment from the Disability Plan, the participant must reimburse the Disability Plan within 60 days or the Disability Plan may reduce future benefits to recover the overpayment. Id., at 438.

Plaintiff received short-term disability benefits between January and July 2000. Amended Complaint, ¶ 5; Defendants’ Brief, at 5-6. On July 26, 2000, Liberty Life sent a letter to the Plaintiff advising that her claim for short-term disability benefits beyond July 27, 2000, would be denied. Record, at 321-22. The letter acknowledged that Plaintiff was unable to elevate her arm because of a June 15, 2000, operation. However, the letter further explained that Plaintiffs manager advised Liberty Life on July 19, 2000, that Plaintiffs job did not require her to “reach above shoulder level, climb, drive/travel or lift.” Id., at 321. Therefore, Liberty Life concluded there was “no objective medical information on file to support [Plaintiffs] inability to perform [her] job duties.” Id.

On September 21, 2000, Plaintiffs attorney sent a letter to Liberty Life appealing the decisions to deny Plaintiff short and long-term' disability benefits. Id., at 316-17. Plaintiffs attorney requested in the letter that Liberty Life “hold [its] file open for a short period of time so that we may supplement [the] file materials with those we have requested from Dr. Barron’s office.” Id., at 317.

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Bluebook (online)
302 F. Supp. 2d 525, 32 Employee Benefits Cas. (BNA) 2818, 2004 U.S. Dist. LEXIS 2184, 2004 WL 287143, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fuller-v-liberty-life-assurance-of-boston-ncwd-2004.