Jackson v. Delchamps Inc

Court of Appeals for the Fifth Circuit·Decided August 4, 1998·No. 96-60620·Unpublished

Opinion

UNITED STATES COURT OF APPEALS For the Fifth Circuit

No. 96-60620

PATSY L. JACKSON,

Plaintiff-Appellee-Cross-Appellant,

VERSUS

TRANSAMERICA OCCIDENTAL LIFE INS. CO., Defendant-Appellant-Cross-Appellee, and

DELCHAMPS, INC.

Defendant-Appellee-Cross-Appellant.

Appeal from the United States District Court For the Southern District of Mississippi (1:91-cv-156PR)

July 1, 1998

Before EMILIO M. GARZA,* STEWART, and DENNIS, Circuit Judges.

*

Emilio M. Garza, Circuit Judge, dissents.

DENNIS, Circuit Judge.** Appellant Transamerica Occidental Life Insurance Company appeals the district court’s determination that Patsy L. Jackson is entitled to death benefits under an accidental death and dismemberment policy issued by Transamerica to Jackson’s husband’s employer, Delchamps, Incorporated. Appellant Delchamps appeals the district court’s retention of jurisdiction in order to revisit the amount of damages it is to pay Jackson in the event that the Transamerica policy benefits are not available for any reason. Appellee Jackson files a cross-appeal with respect to the amount of attorneys’ fees awarded her by the district court. We affirm the district court’s judgment finding Jackson is entitled to benefits under the Transamerica policy and the award of attorneys’ fees; however, we amend the judgment to delete the retention of jurisdiction.

I.

Willie Joe Jackson (Mr. Jackson) began working for Delchamps, Incorporated (Delchamps) in September 1980. He was eventually promoted to a salaried management position. In November 1986, Mr. Jackson suffered an employment related back injury. As a result, Delchamps placed Mr. Jackson on disability leave and provided him workers’ compensation benefits. On February 9, 1988, Mr. Jackson died by accidental carbon monoxide poisoning unrelated to his employment. Mr. Jackson did not perform his job duties after his November 1986 injury.

**

Pursuant to 5TH CIR. R. 47.5, the Court has determined that this opinion should not be published and is not precedent except under the limited circumstances set forth in 5TH CIR. R. 47.5.4.

In 1987, while Mr. Jackson was on disability leave, Delchamps changed the carrier of the accidental death and dismemberment insurance it provided as an employee benefit from State Mutual Life Assurance Company of America (State Mutual) to Defendant Transamerica Occidental Life Insurance Company (Transamerica). The Transamerica policy became effective on August 1, 1987. After Mr. Jackson’s death, his wife, Patsy L. Jackson (Jackson), made a claim for death benefits under the Transamerica accidental death and dismemberment policy. Although Delchamps had continued paying premiums on behalf of Mr. Jackson until his death, Transamerica denied Jackson’s claim on the basis that Mr. Jackson was never eligible for coverage under its policy as he was not an active full-time employee working at least 30 hours per week as required by the “Eligible Persons” provisions of the policy.

After Transamerica refused to pay the accidental death benefits, Jackson filed suit in state court on March 11, 1991, seeking to collect these benefits from either Transamerica or Delchamps. In addition, she sought payment from Delchamps for other benefits allegedly due Mr. Jackson prior to his death because of his disability. The defendants in the court below removed the case to federal court.

After removal, Transamerica answered Jackson’s complaint by pleading that no coverage existed as Mr. Jackson was not an “active, full-time employee” under the Eligible Persons provision of the policy. On December 2, 1994, the district court denied Delchamps’ motion for summary judgment and instructed that the case be set for trial. Subsequently, Transamerica filed its own motion for summary judgment on August 23, 1995. On September 6, 1995, Jackson filed a response to Transamerica’s motion for

summary judgment and, in addition, filed her own motion for summary judgment. At the pretrial conference, the trial court denied Transamerica’s motion for summary judgment and “tentatively” granted Jackson summary judgment; however, the court reserved its final ruling pending a full trial as the case was to be tried before the court.

In tentatively granting Jackson’s motion for summary judgment, the trial court relied on the “Replacement of Coverage” provision of the Transamerica policy. If the required premiums have been paid, this provision waives the active employment and effective date requirements of the Transamerica policy for persons covered by the accidental death and dismemberment policy in effect prior to the Transamerica policy on the date the prior policy ceased to be effective.

After trial, the district court rendered judgment in Jackson’s favor against Transamerica in the sum of $136,000 for the policy benefits plus prejudgment interest for a total award of $250,241.82. The court further ordered Delchamps to pay Jackson $5,000 in penalties as a result of its failure to provide plan documents as required by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1132(c). In oral reasons given on November 16, 1995, the court ordered the parties to brief the question of the reasonableness and appropriateness of attorneys’ fees. In its written final judgment, filed August 29, 1996, the court found Jackson to be entitled to $28,875 in attorneys’ fees and $2,934.95 in costs with eighty percent assessed to Transamerica and twenty percent to Delchamps. The trial court further purported to retain jurisdiction to revisit the judgment against Delchamps in the event that the Transamerica policy benefits were not available to Jackson for any reason. In rendering judgment

against Transamerica, the district court found the policy to be ambiguous primarily because the word “active” within the Eligible Persons portion of the policy was not defined. The district court reasoned that the term “active” could “apply to working”; however, it also could have been “intended to exclude part-time help or sporadic help who might work a few months and terminate and then be reemployed.”1 As a result, the court construed the terms of the policy against the insurer and found the testimony of the Delchamps plan administrator, Heidi Eckert Finchem, probative with respect to coverage. Ms. Finchem testified that Delchamps had considered Mr. Jackson an active employee and had continued to pay premiums for his coverage during Mr. Jackson’s approved leave of absence. In addition, Ms. Finchem testified that Mr. Jackson had worked a minimum of thirty hours per week until he became disabled.

With respect to the policy’s requirement that an employee must work at least thirty hours per week to be eligible for coverage, the district court found Ms. Finchem’s

1 The district judge explained:

[the policy] doesn’t say whether he’s an active employee from the standpoint that he’s an active employee drawing workmen’s compensation benefits or whether he’s an active employee in any manner. It could mean that active applies to working, but they don’t say that. They could have very easily said here that this does not cover someone who’s disabled and drawing workmen’s compensation benefits. They didn’t say that.

The court continued:

[t]here is no definition at all of active. One could easily conclude that this language was intended to exclude part-time help, or sporadic help who might work a few months and then terminate and then be reemployed.

testimony to be undisputed. The district court evidently interpreted the policy to require that the employee’s normal work week be at least thirty hours per week and not that the employee must actually work thirty hours in order to maintain coverage during each week.

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