Gooden v. Unum Life Insurance Co. of America

181 F. Supp. 3d 465, 2016 U.S. Dist. LEXIS 75363, 2016 WL 3059752
CourtDistrict Court, E.D. Tennessee
DecidedMarch 30, 2016
Docket1:14-CV-280
StatusPublished
Cited by8 cases

This text of 181 F. Supp. 3d 465 (Gooden v. Unum Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, E.D. Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gooden v. Unum Life Insurance Co. of America, 181 F. Supp. 3d 465, 2016 U.S. Dist. LEXIS 75363, 2016 WL 3059752 (E.D. Tenn. 2016).

Opinion

MEMORANDUM

CURTIS L. COLLIER, UNITED STATES DISTRICT JUDGE

Before the Court is a motion to remand filed by Plaintiff Gregory P. Gooden. (Doc. 12.) Plaintiff argues that the Court does not have jurisdiction over this action because the Employee Retirement Income Security Act, 29 U.S.C. §§ 1001, et seq. (“ERISA”), does not apply to the insur-[468]*468anee policy in question. Defendants Unum Life Insurance Company (“Unum Life”) and Unum Group Corporation (“Unum Group”) filed a response (Doc. 17), and Plaintiff filed a reply (Doc. 20). Also before the Court is Defendants’ motion to file a surreply (Doc. 21), to which Plaintiff responded in opposition (Doc. 22). For the following reasons, the Court will DENY Defendants’ motion to file a surreply,1 GRANT Plaintiffs motion to remand, and REMAND this case to the Circuit Court for Hamilton County, Tennessee.

I. BACKGROUND

Plaintiff was a physician with the Ges-sler Clinic, P.A. in Winter Haven, Florida from September 1987 to January 2007.2 During this time period, the Gessler Clinic offered a group long-term-disability insurance policy to all of its active, full-time physicians and administrators through Continental Casualty Company (“CNA”).

In 1991, the Gessler Clinic allowed Jim Tollerton, an insurance agent, to come into the clinic to meet privately with “a limited number of highly compensated” physi-dans, including Plaintiff, regarding their insurance needs. (Doc. 14-5 at ¶¶ 5, 6.) The clinic did not attend or supervise any of these meetings. It also did not “contract with Mr. Tollerton to sell individual Unum policies, did not advertise Unum policies, [and] did not include in brochures or employee handbooks any mention of individual Unum policies.” (Doc. 14-5 at ¶ 12.)

On August 22,1991, as a result of meeting with Mr. Tollerton, Plaintiff completed an application for disability insurance from Unum Life. Unum Life subjected the application to individual underwriting with an insurability date of August 22, 1991, and issued an individual disability insurance policy to Plaintiff with an effective date of October 1, 1991. Unum Life issued individual policies to other physicians at the Ges-sler Clinic around the same time, also as a result of those physicians’ respective meetings with Mr. Tollerton at the clinic.

Unum Life offers group discounts on insurance policies through its FlexBill program. The FlexBill program requires that at least three individuals who are working full time with the same company have [469]*469their premiums for qualifying insurance products billed to and paid through their company. Participants in a FlexBill program receive a discount of up to 35% on their premiums and are eligible for a higher benefit amount than insureds who pay their own premiums directly. Because at least three Gessler Clinic physicians bought qualifying insurance products that were billed to the Gessler Clinic, Unum Life established a FlexBill program for the Gessler Clinic on August 26, 1991, four days after Plaintiff completed his insurance application but more than a month before the effective date of his policy. Plaintiff and the other insured physicians received premium discounts of approximately 15% when paying their premiums through the FlexBill program.

The Gessler Clinic did not negotiate with Mr. Tollerton or Unum Life to be included in the FlexBill program, nor did it negotiate the size of the discount its insured physicians would receive. It did not pay any portion of the insurance premiums for any of the physicians’ policies from the clinic’s own funds. It did, however, agree to collect premium payments for the insured physicians’ policies through payroll deductions and remit those premium payments to Unum Life as billed through the FlexBill program. The Gessler Clinic also received (and in some eases presumably responded to) such correspondence from Unum Life as a request for updated income information for the insured physicians (Doc. 18-6), a letter stating that Plaintiff would no longer be offered a “Benefit Indexing Option” because his coverage exceeded Unum Life’s guidelines (Doc. 18-7), and a notice of overdue premiums (Doc. 18-8). Sharon H. Hart of the Gessler Clinic completed and signed a benefit claim form on Plaintiffs behalf on June 7, 2005, for a claim that is apparently unrelated to the current dispute. (Doc. 14-13.)

On January 17, 2007, the Gessler Clinic notified Unum Life by letter that Plaintiffs last day at the clinic had been January 10, 2007, and asked Unum Life to “send him any necessary paperwork so he may continue this policy if he so desires.” (Doc. 14-14.) Unum Life sent, responsive information to Plaintiff and Plaintiff continued the policy, paying the premiums directly and no longer receiving the Flex-Bill discount.3

Plaintiff submitted a claim for benefits under his Unum Life policy in April 2013. On August 19, 2014, Plaintiff filed a complaint against Defendants in the Circuit Court of Hamilton County, Tennessee, alleging breach of contract and bad-faith failure to pay his claim under Tennessee law. (Doc. 1-1.) Defendants removed the matter to this Court on September 24, 2014, alleging federal-question jurisdiction under 28 U.S.C. § 1331 on the grounds that the policy is governed by ERISA. (Doc. 1.) Plaintiff disputed the removal and the application of ERISA to his policy (Docs. 5, 6), and the Court allowed the parties to conduct discovery on the limited issue of whether ERISA applies to determine whether the Court has subject-matter jurisdiction over this action (Doc. 9),

Plaintiff filed a motion to remand on July 1, 2015, supported by a memorandum of law, a declaration of Ms. Hart of the Gessler Clinic, and various exhibits. (Docs. 12-14.) Defendants filed a response on July 27, 2015, supported by a declaration of Carol A. Bigelow of Unum Group, a declaration of John E. Ellis IV of the Gessler Clinic, and various exhibits. (Docs. 17-19.) Plaintiff replied on August 6, 2015. [470]*470(Doc. 20.) Defendants filed their motion for leave to file a surreply on August 14, 2015, with a copy of their proposed surreply attached as an exhibit (Doc. .21), and Plaintiff responded in opposition on August 17, 2015 (Doc. 22).4

II. STANDARD OF REVIEW

The party seeking removal to federal court bears the burden of establishing the district court has original jurisdiction over the matter. Long v. Bando Mfg. of Am,., Inc., 201 F.3d 754, 757 (6th Cir.2000). Removal petitions are strictly construed, with all doubts resolved against removal. Her Majesty the Queen in Right of the Province of Ontario v. City of Detroit, 874 F.2d 332, 339 (6th Cir.1989).

III. DISCUSSION

Defendants contend the Court has federal-question jurisdiction because the disability insurance policy at issue is part of an employee welfare benefit plan that is governed by ERISA. ERISA defines an “employee welfare benefit plan” to include the following: 29 U.S.C. § 1002(1).

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181 F. Supp. 3d 465, 2016 U.S. Dist. LEXIS 75363, 2016 WL 3059752, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gooden-v-unum-life-insurance-co-of-america-tned-2016.