Henderson v. Unum Life Insurance Co. of America

736 F. Supp. 100, 1989 U.S. Dist. LEXIS 16759, 1989 WL 205617
CourtDistrict Court, D. South Carolina
DecidedJune 5, 1989
DocketCiv. A. No. 3:87-489-16
StatusPublished
Cited by2 cases

This text of 736 F. Supp. 100 (Henderson v. Unum Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, D. South Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Henderson v. Unum Life Insurance Co. of America, 736 F. Supp. 100, 1989 U.S. Dist. LEXIS 16759, 1989 WL 205617 (D.S.C. 1989).

Opinion

ORDER

HENDERSON, District Judge.

This matter is before the Court on cross-motions for summary judgment and for attorney’s fees. For the reasons set forth below, the Court (1) grants the defendant’s summary judgment motion in part and denies it in part; (2) denies the plaintiff’s summary judgment motion in toto; and (3) denies both parties’ motions for attorney’s fees. Accordingly, the Court directs that final judgment be entered in favor of the defendant.

The following facts are not in dispute. The plaintiff has been a partner in the law firm of Nelson, Mullins, Riley & Scarborough (“Law Firm”) since 1983. All partners and full-time employees of the firm are covered under a long-term disability insurance plan provided by the defendant [102]*102insurer. The plaintiff, who has a history of coronary problems commencing with a heart attack in 1982, was hospitalized on October 29, 1985, complaining of tightness in his chest. He was released two days later but was readmitted with the same complaint on November 2, 1985. He was discharged four days later. On November 7, he was hospitalized for six days because of unstable angina. He was released on November 13 and sent home for further convalescence. He returned to work on December 4 and continued to work until December 23 when he and his family went to visit his wife’s mother for the holidays. He returned to Columbia on December 28 or 29 and worked part of the day on December 30. At 4:00 a.m. on December 31, 1985, the plaintiff suffered a heart attack and was hospitalized until January 7, 1986. He resumed part-time work on January 29, 1986, and has continued to work since that time.

Sometime in 1986, when it was clear the plaintiff was unable to work full time, he and his law firm reached an agreement under which he was to work part-time and receive a salary in lieu of a share in the partnership’s earnings. He had already received his full partnership share for the year 1985.

On May 20, 1986, the plaintiff completed an “Application for Disability Benefits” and submitted it to the defendant. Under the disability policy provided by the defendant, a disabled insured is entitled to receive disability benefits at the end of a 180-day “elimination period” and the amount of benefits is computed on the basis of his earnings during the calendar year preceding the year in which he becomes disabled.

On July 11, 1986, the defendant sent the plaintiff notice that his claim had been approved, together with checks for the period from April 28 to June 28, 1986. The amount of the benefit checks was based on the plaintiff’s average income during the year 1984. On July 17, 1986, the plaintiff returned the checks to the defendant accompanied by a letter explaining that since he did not become disabled until January 1, 1986, at the earliest, he did not become eligible for benefits until June 30, 1986. He also informed the defendant that, as his disability began in 1986, the amount of his benefits should be based on this 1985 income. Over the next several months, the parties were in frequent communication regarding this dispute. On October 1, 1986, the defendant wrote the plaintiff informing him its position was unchanged.

In February 1987, the plaintiff instituted this action alleging causes of action against the defendant for breach of contract, bad faith refusal to pay benefits and intentional infliction of emotional distress. The plaintiff asserted the defendant improperly calculated his benefits because his disability did not commence until 1986. In its answer, the defendant adhered to its earlier position that the plaintiff became disabled in 1985 and that his benefits should therefore be based on his 1984 earnings.

By Order filed November 25, 1987, the Court granted the defendant’s first summary judgment motion in part, holding the plaintiff’s claims are preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et seq. The Court denied the defendant’s motion, however, insofar as it sought judgment as a matter of law that the plaintiff was disabled during 1985.

The plaintiff subsequently amended his complaint to state a claim under ERISA, alleging causes of action for recovery of benefits under ERISA, for a declaratory judgment and for breach of fiduciary duty. All three causes of action challenged the defendant’s determination that the plaintiff became disabled in 1985 and asserted, instead, that the disability began in 1986. In addition, the amended complaint maintained that the plaintiff has been totally, rather than residually, disabled since 1986 and, consequently, is entitled to receive benefits for total, rather than residual, disability. In its amended answer, the defendant again took the position that the plaintiff became disabled in 1985 and that his benefits should therefore be computed on the basis of his 1984 income. The defendant also denied the plaintiff is entitled to [103]*103benefits for total disability and asserted a counterclaim to recover excess payments allegedly made to the plaintiff. After the amended pleadings were filed, the defendant renewed its motion for summary judgment on the plaintiffs claims and its own counterclaims. By Order filed May 11, 1988, the Court granted the defendant's motion as it related to the plaintiffs claim for total disability but denied the motion in all other respects.

The plaintiff then moved for summary judgment on his claim for disability benefits, asserting that as a matter of law his disability commenced on January 1, 1986. On May 16, the defendant renewed its motion for summary judgment, asserting that the plaintiff became disabled on either October 30, 1985, December 31, 1985, or July 1, 1986. By order dated May 20, 1988, the Court denied the defendant’s motion in to to and granted the plaintiff’s motion in part, holding that he was not disabled as of October 30, 1985, and remanded the matter to the administrator for a new determination.

By letter dated January 24, 1989, the administrator made a new determination, concluding that the plaintiff “first became disabled so as to satisfy the elimination period staring [sic] on December 31, 1985.” See Plaintiff’s Exh. A at 1. The administrator found that the plaintiff became “totally disabled” when he suffered his December 31,1985, heart attack and that total disability continued until he returned to work “on a limited basis” in January 1986. Id. at 2. The administrator further found that the plaintiff was continuously disabled from the time he returned to work on January 29, 1986, through the end of December 1986 because during that period he was “restricted to working on a part-time basis” and because his “earning records, although confusing, do reflect a loss of earned income for this period.” Id.

On March 13, 1989, the plaintiff moved for summary judgment, asserting he is entitled to judgment as a matter of law on the following issues: (1) he is currently residually disabled; (2) his period of residual disability began no earlier than January 1, 1986; (3) his disability benefits should be calculated on the basis of his 1985 earnings; and (4) his benefits should have commenced no earlier than July 1, 1986. In addition, the plaintiff has moved for attorney’s fees under 29 U.S.C. § 1132(g)(1).

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736 F. Supp. 100, 1989 U.S. Dist. LEXIS 16759, 1989 WL 205617, Counsel Stack Legal Research, https://law.counselstack.com/opinion/henderson-v-unum-life-insurance-co-of-america-scd-1989.