Geter v. St. Joseph Healthcare Systems, Inc.

575 F. Supp. 2d 1244, 2008 U.S. Dist. LEXIS 78161, 2008 WL 4165482
CourtDistrict Court, D. New Mexico
DecidedAugust 28, 2008
DocketCiv-07-1132 LCS/ACT
StatusPublished
Cited by3 cases

This text of 575 F. Supp. 2d 1244 (Geter v. St. Joseph Healthcare Systems, Inc.) is published on Counsel Stack Legal Research, covering District Court, D. New Mexico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Geter v. St. Joseph Healthcare Systems, Inc., 575 F. Supp. 2d 1244, 2008 U.S. Dist. LEXIS 78161, 2008 WL 4165482 (D.N.M. 2008).

Opinion

MEMORANDUM OPINION AND ORDER OF REMAND

LESLIE C. SMITH, United States Magistrate Judge.

THIS MATTER comes before the Court on Plaintiffs Motion to Remand, filed on July 29, 2008. (Doc. 34.) The Court, acting upon consent and designation pursuant to 28 U.S.C. § 636(c) (see Docs. 5, 13), and having reviewed the motions and considered the submissions of counsel, relevant authorities, and being otherwise fully advised, finds that the motion should be GRANTED.

*1246 I. FACTS

This action arises out of a dispute about Plaintiffs long-term disability plan. Plaintiff, Mr. David Geter, worked for St. Joseph Healthcare Systems, Inc. [SJH] for ten years “until he claimed total disability and discontinued working in 2001.” (Doc. 23 at 2:1 (citing Doc. 14 at 1:3), Doc. 27 at 2:7.) SJH is a non-profit subsidiary of Catholic Health Initiatives [CHI]. (Doe. 1, Aff. of Nada Vanous at 1:2.) SJH offered its employees long-term disability benefits at no cost to the employees. (Doc. 1, Aff. of Nada Vanous at 1:5, Doc. 23, Ex. A at 3.) These benefits “were paid under a policy issued by Unum Life Insurance Company of America” [“Unum”]. (Doc. 1, Aff. of Nada Vanous at 1:5, Doc. 23, Ex. A at 1.)

In June, 2001, Plaintiff was diagnosed with Emery-Dreyfus Muscular Dystrophy. (Doc. 27 at 1:6.) “As a result of the diagnosis, Mr. Geter began working with St. Joseph [Healthcare’s] Human Resources Department to apply for long[-]term disability benefits.” (Doc. 14 at 2:7.) Upon applying for long-term disability benefits, Mr. Geter received “a booklet entitled ‘OPTIONS,’ dated July, 2001 (‘Options booklet’).” (Doc. 23 at 3:5 (citing Doc. 14), Doc. 32.) The Options booklet

describes in general terms all of the benefits available to St. Joseph Healthcare employees (including health insurance, dental insurance, vision care, life insurance, flexible spending accounts, health care spending accounts, holidays, bereavement leave, tax sheltered annuities, birthday meal cards, access to cosmetic surgery centers and health club memberships, on-line grocery shopping, group auto insurance, pet sitting and the like[) ].

(Doc. 23 at 3:5 — 4 (citing Doc. 14).)

With respect to long-term disability, the Options booklet briefly describes the benefits available:

Long-term disability is provided by SJH at no expense to all employees in a budgeted .8-1.0 FTE status beginning the first of the month following date of hire.
You must be continuously disabled for six (6) months to receive a benefit. The benefit is equal to 60 percent of base salary to a maximum of $5,000 per month.
If you become disabled and file a claim, you must contact the Human Resources Department to obtain claim application forms. An attending physician’s statement must be obtained and forwarded to the insurance company. The insurance company will investigate the claim and provide you with any additional assistance you need while on disability. To be sure that your benefits begin on time, you should complete the claim application forms and forward them to the insurance company 45 days prior to the time your benefits are scheduled to begin.
A long-term disability booklet is sent to employees when first enrolled. Additional booklets are available in the Human Resources Department. The booklet provides a comprehensive summary of the coverage and how the plan works.

(Doc. 32 at 15.) It is this abbreviated summary of benefits that Plaintiff relied on when making his long-term disability benefits claim. (See Doc. 14 at 3:8.) The Options booklet does not disclose that an employee’s long-term benefits will be offset by certain types of income or disability earnings. (See Doc. 32.) The final paragraph in the foregoing summary, however, makes it clear that the Options booklet is not the source for “comprehensive” information about long-term disability benefits. (Id. at 15.) Moreover, a disclaimer on the *1247 inside cover of the booklet expressly states that:

The information in this handbook is intended as a brief review of the various plan benefits. For more information, see the policies and/or plan documents for the appropriate benefit. In all cases where the policy and/or plan document differ from the information contained in this handbook, the provisions of the policy and/or plan document will govern. Employees are encouraged to pick up and review additional documents before signing up for benefits.

(Id., second scanned page of exhibit.) 1

The Options booklet also refers to a separate “Summary Plan Description” in at least three different places. (Id. at 9, 10, 16.) On pages 9 and 10, the booklet notes that “A complete description of the benefits and limitations can be found in the summary plan description.” (Id. at 9, 10.) In the Statement of Rights on page 16, beneficiaries are informed that they are entitled to “Examine without charge at the Plan Administrator’s office all Plan documents including insurance contracts and copies of all documents filed by the Plan such as Summary Plan Descriptions.” (Id. at 16.) The booklet also directs employees several times to examine additional information in the “plan documents” or other named sources, or by contacting the Human Resources Department. (Id. at 14, 15, 28, 35-37, 40-42.) While the Options booklet provides written notice that comprehensive information regarding benefits was available elsewhere, it is unclear from the record whether Plaintiff ever received or requested copies of these documents, or whether he examined the Plan documents at the Plan Administrator’s office. (Id. at 9, 10, 16, Doc. 27 at 2:8; see also Doc. 29, Ex. 1 at 49:3-25, 50:1-18, 55:22-25, 56:1-25.)

The more comprehensive long-term disability policy issued by Unum is entitled “CHI/St. Joseph Healthcare, Your Group Long Term Disability Plan (Policy No. 520686)” [The Plan], (Doc. 23, Ex. A Front Cover.) The document is not specifically marked as the “Summary Plan Description.” (See id., Ex. A.) The Plan clearly discloses to beneficiaries in at least six different provisions that any monthly long-term disability benefits provided would be reduced by deductible sources of income and disability earnings. (See id., Ex. A at 3,10-13, 22, 24.) Accordingly, when Plaintiff started receiving benefits in February, 2002, the benefits were offset by the amount Plaintiff receives under Social Security. (Doc. 14 at 3:12.)

The parties agree that at the time Plaintiff claimed disability and began receiving benefits, the long-term disability plan was a “church plan” as defined in 29 U.S.C § 1002(33)(A). 2

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Bluebook (online)
575 F. Supp. 2d 1244, 2008 U.S. Dist. LEXIS 78161, 2008 WL 4165482, Counsel Stack Legal Research, https://law.counselstack.com/opinion/geter-v-st-joseph-healthcare-systems-inc-nmd-2008.