Hess v. Hartford Life & Accident Insurance

91 F. Supp. 2d 1215, 2000 U.S. Dist. LEXIS 4087, 2000 WL 340540
CourtDistrict Court, C.D. Illinois
DecidedMarch 22, 2000
Docket97-2051
StatusPublished
Cited by3 cases

This text of 91 F. Supp. 2d 1215 (Hess v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, C.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hess v. Hartford Life & Accident Insurance, 91 F. Supp. 2d 1215, 2000 U.S. Dist. LEXIS 4087, 2000 WL 340540 (C.D. Ill. 2000).

Opinion

ORDER

McCUSKEY, District Judge.

On March 18, 1997, Plaintiff Susan Hess filed a complaint against Defendants Hartford Life and Accident Company (“Hartford”) and Fleet Financial Group, Inc (“Fleet”) alleging three violations of the Employee Retirement Income Security Act (“ERISA”). 29 U.S.C. § 1001 et seq. Count I alleged that Hartford violated 29 U.S.C. § 1132(a)(1)(B) & (a)(3). Count II alleged that Fleet breached its fiduciary duty to Plaintiff under 29 U.S.C. § 1109(a). Finally, Count III alleged that Fleet violated 29 U.S.C. § 1132(a)(1)(A) & (c)(1).

On September 19, 1997, the court dismissed Count II on the recommendation of the Magistrate Judge. Thereafter, the parties agreed to submit the case to the court for a decision on stipulated facts. 1 A statement of undisputed facts was filed as to each defendant, and the parties filed briefs in support of their respective positions. The matter is now before the court for judgment on the stipulated facts.

BACKGROUND

The following facts are drawn from the parties’ statements of stipulated facts. Hess worked for Fleet Mortgage Company as a loan officer from December 8, 1986 through April 19,1996, when multiple sclerosis rendered her disabled. During that time, Hess participated in a group long-term disability (“LTD”) plan administered *1218 by Defendant Fleet, which is the parent company of Fleet Mortgage Company. Under this policy, Hartford provided group LTD insurance to eligible participants in Fleet’s plan. Hartford relied on Fleet to remit premiums and information for covered individuals. The policy provided that if Fleet gave Hartford any incorrect information, no person would be deprived of insurance to which she was otherwise entitled or receive benefits to which she was not otherwise entitled.

Under the policy, Hartford has authority to determine eligibility for benefits and to interpret the policy. The policy provides that a participant is paid a monthly benefit if she becomes disabled while, insured under the plan. A “monthly benefit” is defined as a “monthly sum payable to you while you are disabled, subject to the terms of the Group Insurance Policy.” In Hess’ case, the monthly benefit is her monthly rate of basic earnings multiplied by a benefit percentage set out in the schedule of insurance minus all other income benefits. The “monthly rate of basic earnings” (“MRBE”) means a participant’s regular monthly pay excluding “commissions, bonuses, overtime pay, or any other fringe benefit.”

In 1995, Hess worked for Fleet as an outside loan originator under a written agreement that provided that benefits would be founded upon “base compensation.” Base compensation was defined as annualized draw paid on a bi-weekly basis to all plan participants. A “draw” was an advance against anticipated commission payments. Commissions were paid on the basis of points on the amounts of loans procured by the loan officer. Although total compensation was the loan officer’s draw plus her commissions reduced by the amount of the draw, the agreement provided that only the draw would be used as the benefit base for calculating the loan officer’s LTD coverage.

In 1996, Hess and Fleet entered into a new written agreement defining the benefits for all outside loan officers. This agreement was executed on January 2, 1996, but was to be in effect from January 1, 1996 through December 31, 1996. The 1996 agreement provided that the base salary and draw would be the only basis for determining benefit levels, including long-term disability, and excluded from .that determination extra pay or other forms of extra compensation. Other than bonuses, commissions were the only other form of compensation payable to Hess on a biweekly or monthly basis. “Commissions” were defined as “compensation payable to the participant on closed loans.” The agreement did not, however, define “base salary” or “base compensation.” As under the previous agreement, “draw” was defined as “an advance against commission payments.” However, the new agreement also provided that the draw was to be terminated on April 5,1996.

Fleet, however, postponed the elimination of the draw until June 1, 1996. At that time, Fleet stipulates, the base for determining LTD benefits became a participant’s average earnings over two prior calendar years, including commissions. Fleet employees opting for LTD coverage were to pay the entire premium cost through automated payroll deductions. Accordingly, once the draw was terminated, Hess’ bi-weekly LTD insurance deductions increased from $8.73 to $16.87 based upon her prior earnings. Up until that time, Fleet had forwarded premiums to Hartford under the 1995 compensation agreement, which was based entirely on the amount of Hess’ draw.

Because Fleet had failed to eliminate the draw on April 5, 1996 as originally planned, Hess’ compensation was based solely on commissions against which she had a bi-weekly draw at the time she became disabled on April 19, 1996. On October 16, 1996, Hess was found eligible for LTD benefits under the policy. At that time, Hartford informed her that she would be entitled to receive a monthly benefit of $1300, which was two-thirds of her calculated monthly income of $1950. *1219 Hartford representative Dan Gerbino explained that Hess’ benefits had been determined based on Fleet’s LTD data form, which stated that her annual salary was $23,400. Gerbino did not request the earnings figures from Fleet. He instead relied solely on the LTD data form for Hess’ salary information, and therefore did not know that Hess’ salary was based on commissions.

On December 2,1996, Hess appealed the benefits determination to Fleet, arguing that her monthly benefit was calculated incorrectly. To this appeal, Hess attached her 1995 and 1996 agreements with Fleet. Fleet then forwarded the appeal to Gerbi-no on January 16,1997.

Gerbino, who no longer works for Hartford, worked solely on Fleet employees’ benefits claims at the time of Hess’ appeal. As well as making a decision on Hess’ initial claims for benefits, he also considered her appeal. On December 30, 1996, Gerbino talked to Fran DelSesto of Fleet’s corporate benefits office who explained that Hess’ earnings were based entirely on commissions, and that Fleet had originally used a draw against her salary base so that she would be covered under the plan. Nevertheless, she explained, Fleet intended fully-commissioned loan officers like Hess to be covered under the Fleet LTD plan.

Gerbino then reviewed the plan and concluded that commissions were excluded from the calculation of a participant’s MRBE. Despite DelSesto’s explanation of Fleet’s intention to include fully-commissioned loan officers, Gerbino concluded that participants whose sole source of income derived from commissions were excluded from coverage under the terms of the policy.

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Bluebook (online)
91 F. Supp. 2d 1215, 2000 U.S. Dist. LEXIS 4087, 2000 WL 340540, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hess-v-hartford-life-accident-insurance-ilcd-2000.