Hines v. Unum Life Insurance Co. of America

110 F. Supp. 2d 458, 2000 U.S. Dist. LEXIS 12661, 2000 WL 1234059
CourtDistrict Court, W.D. Virginia
DecidedAugust 11, 2000
DocketCIV.A. 99CV00174
StatusPublished
Cited by14 cases

This text of 110 F. Supp. 2d 458 (Hines v. Unum Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, W.D. Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hines v. Unum Life Insurance Co. of America, 110 F. Supp. 2d 458, 2000 U.S. Dist. LEXIS 12661, 2000 WL 1234059 (W.D. Va. 2000).

Opinion

MEMORANDUM OPINION AND ORDER

GLEN M. WILLIAMS, Senior District Judge.

I INTRODUCTION

This case is before the court on cross motions for summary judgment. At issue here is entitlement to disability benefits under a Group Long Term Disability Policy issued by the Defendant, Unum Life Insurance Company. The Employee Retirement Income Security Act [ERISA], 29 U.S.C.A §§ 1001-1461 (West 1999), exclusively governs disputes involving employer-provided employee welfare plans, like the disability plan here.

The Plaintiff, Jeanette Hines, avers that Unum wrongfully denied her benefits initially, and wrongfully refused thereafter to fully and fairly review her claim in upholding the previous denial. Unum, however, claims that Hines’s condition did not meet the policy’s definitional preconditions for “total disability.”

This court shall grant summary judgment if it is clear from the record that there are no genuine issues as to any material fact and that the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c). In its examination of the record, the court must view all factual inferences in a light most favorable to the non-moving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). The non-moving party does have a duty here however; any alleged disputes must be reasonable. Sylvia Dev. Corp. v. Calvert County Md., 48 F.3d 810, 818 (4th Cir.1995).

As set forth by its reasoning below, the court denies the Defendant’s motion and grants the Plaintiffs motion. The record before the court showcases a scathing fail *461 ure by Unum Insurance to impartially administer the disability plan. Furthermore, the record contains a plethora of evidence supporting Ms. Hines’s claim and scant evidence to the contrary. In addition to disability benefits, the court awards to Ms. Hines reasonable attorneys’ fees and costs, as well as pre- and post-judgment interest on the amount owed dating from the initial claim for disability. The court finds that this result best effectuates the goals of ERISA and the proper administration of justice.

II STATEMENT OF THE CASE

There are really two questions the court must answer; the answer to the first dictates the substance of the second. For instance, should the proper standard of review be abuse of discretion, then the court must limit its inquiry to whether the Defendant’s decision was reasonable, even if the court disagrees. However, should the review be de novo, then the court shall decide for itself what conclusion the record brings. 1 This symbiotic paradigm ultimately leaves the court with these two questions: what degree of review should the court give to the record before it; and, has the Plaintiff carried the day in presenting the court with sufficient evidence of disability. Of course, the mere existence of the second question forecasts the court’s answer to the first.

A. STANDARD OF REVIEW

Congress enacted the Employee Retirement Income Security Act of 1974 in order to develop federal protections for private welfare and pension plans. Ronald J. Cooke, ERISA Practice and Procedure § 1:1, at 1-3 to 1-4 (2d ed.1996). In so doing, Congress intended that the courts develop a body of substantive federal law that would, inter alia, guarantee that vested benefits be received by eligible participants and assure an honest administration of the benefit plans. Id. In other words, Congress left it to the courts to craft a standard of review for plan administrator decisions.

Accordingly, when a welfare or benefit plan gives to an administrator the discretionary authority to interpret plan terms and participant eligibility, a court may reverse the administrator’s decision only upon finding an abuse of discretion. Elliott v. Sara Lee Corp., 190 F.3d 601, 605 (4th Cir.1999) (citing Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989)). Thus, an administrator’s decision shall remain intact so long as that decision was reasonable; that is, that the decision incorporated deliberation and was supported by substantial evidence. Id. (citing Brogan v. Holland, 105 F.3d 158, 161 (4th Cir.1997)).

There is an exception to this general rule, however. Where the plan administrator has a conflict of interest, namely, if the administrator is also the plan’s insurer, then the abuse of discretion standard must be modified to account for the accompanying potential for partisanship. Id. In deviating from the abuse of discretion standard, courts must do so only to the extent necessary to counteract evidence of undue influence. Id. (citing and quoting Ellis v. Metropolitan Life Ins. Co., 126 F.3d 228, 233 (4th Cir.1997)). While a conflict does not require such a deviation per se, it does create a “sliding scale,” Ellis, 126 F.3d at 233: the amount of deference given to an administrator’s denial of benefits is inversely proportional to the degree of self-dealing evident in the record. Cf. Martin v. Blue Cross & Blue Shield of Va., Inc., 115 F.3d 1201, 1206 (4th Cir.1997) (quoting Doe v. Group Hosp. *462 & Med. Servs., 3 F.3d 80, 85 (4th Cir.1993) (stating that the amount of deference given to a fiduciary’s decision must be lessened to the degree necessary to neutralize any untoward influence resulting from the conflict)).

Because the Defendant here is both the insurer and the administrator, and the disability plan confers upon the Defendant discretionary authority, 2 the court will review the record under the modified abuse of discretion standard. Moreover, it is apparent that the Defendant’s decision to deny the Plaintiffs claim is entitled to little deference: from the outset it is clear that the Defendant failed to administer the plan impartially, as required by the trust principles accompanying the Defendant’s fiduciary position under ERISA. 29 U.S.C.A. § 1002(21)(A) (West 1999).

The court makes this finding from the circumstances surrounding Unum’s initial denial of benefits. 3 Jeanette Hines worked as a legal secretary for twenty-eight years before filing a claim for disability on June 2, 1997, (R.

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Bluebook (online)
110 F. Supp. 2d 458, 2000 U.S. Dist. LEXIS 12661, 2000 WL 1234059, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hines-v-unum-life-insurance-co-of-america-vawd-2000.