Gingold v. Unum Life Insurance

74 F. App'x 660
CourtCourt of Appeals for the Seventh Circuit
DecidedAugust 25, 2003
DocketNo. 02-3980
StatusPublished
Cited by1 cases

This text of 74 F. App'x 660 (Gingold v. Unum Life Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gingold v. Unum Life Insurance, 74 F. App'x 660 (7th Cir. 2003).

Opinion

ORDER

Dan Gingold filed a complaint against Unum Life Insurance Company of America to recover disability benefits allegedly due under an employee benefit plan governed by the Employment Retirement Income Security Act of 1974, as amended, 29 U.S.C. §§ 1001 et seq. (“ERISA”). The district court found that Unum’s denial of Gingold’s request for benefits was not arbitrary and capricious and granted Unum’s motion for summary judgment. Gingold now appeals, arguing that the district court’s decision was incompatible with the unambiguous language of the benefit plan. We affirm.

Gingold and Unum dispute the definition of “monthly earnings” used to calculate his benefits under a Group Long Term Disability Insurance Policy issued by Unum to Gingold’s employer, Accurate Die and Stamping, Inc. Until the onset of his disability, Gingold was Accurate’s CEO and principal owner. In addition, he owned the building in which Accurate was housed and collected rent from Accurate. Gin-gold’s total annual income was $115,000. For tax planning purposes, he characterized $84,000 of this amount as salary and $31,000 as rental income from Accurate for use of his property. According to Gingold, his monthly earnings for the purpose of calculating his disability benefits should include not only his salary as CEO of Accurate but also the rental income he received as Accurate’s landlord. But when Gingold filed his claim for benefits, Unum excluded this rental income from its computation of Gingold’s monthly earnings.

Accurate purchased a long-term group disability policy from Unum in 1994. The policy provided that a qualified employee who became disabled would receive 66 2/3 % of his or her “monthly earnings,” up to a maximum benefit of $10,000 a month. The policy defines “monthly earnings” as:

Your monthly earnings means your gross monthly income from your Employer in effect just prior to your date of disability. It includes your total income before taxes, but does not include deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plan, or flexible spending account. It does not include income received from commissions, bonuses, overtime pay, any other extra compensation, or income received from sources other than your Employer.

When Accurate applied for the policy, it submitted two different figures for Gin-gold’s income. On an application form provided by Unum, Accurate listed $115,000 for Gingold in a column entitled “Basic Monthly Earnings.” A note at the bottom of the form directs the applicant to list in this column the amount of income to be covered by the policy. Accurate also provided in a second document a census of all its employees’ salaries. This form listed Gingold’s annual salary as $84,000. Unum computed and collected Gingold’s premium payments based on the $115,000 figure.

In June 1999 Gingold injured his back and filed a claim with Unum for disability benefits. Unum approved Gingold’s claim but used $84,000, not $115,000, as the baseline and awarded him benefits totaling 66 2/3% of $6300 (his monthly salary of $7000 minus his monthly 401 (k) contribu[662]*662tion). Gingold contested Unum’s figures, pointing out that he had been paying premiums for five years based on monthly earnings of $9583, the monthly total of his salary and rental income. Unum reviewed its calculation of Gingold’s monthly earnings and sent the claim to a certified public accountant for further analysis. Based on its review and the CPA’s findings, Unum concluded that “monthly earnings” as defined in the policy did not include rental payments and that its original calculation of Gingold’s benefits was correct. Unum advised Gingold that it would refund his premium payments to the extent that they had been based on the rental income. Gingold appealed Unum’s decision, and his claim was forwarded to Unum’s Quality Review Section, which upheld the exclusion of the rental payments from Gingold’s monthly earnings. Gingold requested additional review of his claim; Unum conducted a second appellate review and upheld the previous appellate determination.

Having exhausted his administrative remedies, Gingold sued Unum under ERISA to recover the additional benefits. Observing that the policy granted the plan administrator discretion to interpret the terms of the plan, the district court reviewed Unum’s denial of additional benefits under the arbitrary and capricious standard. The court concluded that the policy’s definition of “monthly earnings” was susceptible to more than one interpretation but that Unum’s interpretation was reasonable. Thus the court found that it was within Unum’s discretion to exclude the rental income from its computation of Gingold’s monthly earnings.

We review a grant of summary judgment de novo and generally examine the record and the law under the same standard used by the district court. Cozzie v. Metropolitan Life Ins. Co., 140 F.3d 1104, 1107 (7th Cir.1998). Because the ERISA plan at issue here included unambiguous language granting the plan administrator the discretion to construe the terms of the policy, the district court correctly reviewed the denial of Gingold’s request for additional disability benefits using the deferential arbitrary-and-capricious standard. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989); Herzberger v. Standard Ins. Co., 205 F.3d 327, 331 (7th Cir.2000), and we do the same.

A plan administrator’s decision survives the arbitrary and capricious standard as long as the administrator considers relevant factors in its analysis and can offer a reasoned explanation for the denial of benefits based on the evidence and plan documents. Hess v. Hartford Life & Accident Ins., 274 F.3d 456, 461 (7th Cir.2001). When a plan term is open to more than one interpretation, we will not find the administrator’s decision arbitrary and capricious just because we would have reached a different conclusion or relied upon different authority had we been in the administrator’s shoes. Carr v. Gates Health Care Plan, 195 F.3d 292, 294 (7th Cir.1999). The general contract principle that ambiguous terms are construed in favor of an insured is not applicable when an ERISA plan explicitly grants the administrator such broad discretion. Ross v. Indiana State Teacher’s Assoc., 159 F.3d 1001, 1011 (7th Cir.1998). Thus, we will reverse only if we conclude that the administrator’s interpretation was “downright unreasonable.” Carr, 195 F.3d at 294.

Gingold argues that Unum’s interpretation of “monthly earnings” controverts the plain language of the policy and is thus arbitrary and capricious. But the plan gives Unum “discretionary authority ... to interpret the terms and provisions of the policy.” As used in the policy, “monthly earnings” is an ambiguous term, subject [663]*663to reasonable alternative interpretations. See Anstett v. Eagle-Picher Ind.,

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Bluebook (online)
74 F. App'x 660, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gingold-v-unum-life-insurance-ca7-2003.