Kennedy v. Life Insurance Co. of North America

262 F. Supp. 3d 481
CourtDistrict Court, W.D. Kentucky
DecidedJuly 7, 2017
DocketCIVIL ACTION NO. 3:15-CV-00741-CRS-DW
StatusPublished
Cited by2 cases

This text of 262 F. Supp. 3d 481 (Kennedy v. Life Insurance Co. of North America) is published on Counsel Stack Legal Research, covering District Court, W.D. Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kennedy v. Life Insurance Co. of North America, 262 F. Supp. 3d 481 (W.D. Ky. 2017).

Opinion

Memorandum Opinion

Charles R; Simpson III, Senior Judge

I. Introduction

This matter is before the Court on the motion of Defendant Life Insurance Company of North America (LINA) for summary judgment under Federal Rule of Civil Procedure.56(a), ECF-No. 27. Plaintiff William Kennedy responded, ECF No. 31. LINA replied, ECF No. 34.

Kennedy filed a cross-motion' for summary judgment, ECF No. 28. LINA responded, ECF No. 30. Kennedy replied, ÉCF No. 35. '

Because LINA and Kennedy’s motions for summary judgment involve similar issues and the same facts, the Court will address them in a single memorandum opinion and order. For. the reasons explained below, the Court will grant LINA’S motion for summary judgment. The Court will deny Kennedy’s cross-motion for summary judgment.

II. Background

In 2002, Kennedy began working as a training supervisor for Perma Fix Environmental Services. Admin. R. 277, ECF No. 11. His job duties included (1) managing the RADCON Alliance Training Program, (2) ensuring that the training and qualifications of the RADCON Alliance staff were properly validated and documented, and (3) directing continued training and requalification. Id. at 539.

As part of his Perma Fix Environmental Services employee benefits, Kennedy, was insured -under a short term disability polk cy, Policy Number LK-750398.- Id. at 130-77. He also was insured, under a long term disability -policy, Policy Number LK-961385. Lodi Deel. 5, ECF No. 27-2. LINA issued both disability policies. Id.\ Admin. R. -277, ECF No.. 11. Perma Fix Environmental Services appointed LINA to adju[484]*484dicate claims submitted under the policies. Lodi Decl. 5, EOF No. 27-2; Admin. R. 174-75, EOF No. 11.

A. Relevant Terms of the Long Term Disability Policy

The long term disability policy under which Kennedy was insured defines “disability/disabled” as “unable to perform the material duties of his or her Regular Occupation” and “unable to earn 80% or more of his or her Indexed Earnings from working in his or her Regular Occupation.” Lodi Decl. 8 EOF No. 27-2. The policy provides, “[t]he Insurance Company will pay Disability Benefits if an Employee becomes disabled while covered under this Policy.... He or she must provide the Insurance Company, at his or her own expense, satisfactory proof of Disability before benefits will be paid.” Id. at 35. The policy further states, “[t]he Insurance Company will, from time to time, review the Employee’s status and will require satisfactory proof of earnings and continued Disability.” Id.

The policy provides that the elimination period — the time during which an employee must meet the definition of disability but before benefits are paid — for a long term disability claim is ninety days. Id. at 11. To receive long term disability benefits, an eligible employee must give LINA written or telephonic notice of a claim within thirty-one days of the event that led to his becoming disabled. Id. at 21. The employee must also provide written proof of loss within ninety days after becoming disabled. Id. at 22. If an employee is unable to submit proof of loss within ninety days, he may do so up to a year after the end of the ninety-day period. Id. The policy states that “[i]f written proof of loss, or proof by any other electronic/telephonic means authorized by the Insurance Company, is provided outside of these time limits, the claim will be denied.” Id.

The policy specifies the procedure for appealing LINA’s denial of long term disability claims. Id. at 29. The policy states, “A written request for appeal must be made to the Insurance Company within 60 days (190 in the case of any claim for disability benefits) from the date the denial was received.” Id. If an insured employee fails to timely submit a written request for appeal, he waives his right to appeal the denial of a claim for long term disability benefits. The policy then explains that LINA has between forty-five and sixty days to review the appeal and render its decision. Id.

B. Relevant Terms of the Short Term Disability Policy

The short term disability policy under which Kennedy was insured is similar to the long term disability policy. The short term disability policy defines “disability/disabled” as “unable to perform the material duties of his or her regular job” and “unable to earn 80% or more of his or her Indexed Earnings from working in his or her Regular Job.” Admin. R. 136, ECF No. 11. The policy provides for a seven-day elimination period, and benefits are paid up to twelve weeks. Id. at 136-37. Employees approved for short term disability benefits receive up to 66.67% of their weekly covered earnings or $750.00 per week, whichever is the lesser amount. Id. at 136. “Weekly covered earnings” means an employee’s wage or salary, excluding bonuses, commissions, overtime pay, and other additional compensation. Id.

The short term disability policy further states that LINA will pay disability benefits only if the employee satisfies the elimination period, is under the appropriate care of a physician, and meets all other terms and conditions of the policy. Id. at 140. Additionally, the employee must “provide the Insurance Company, at his or her [485]*485own expense, satisfactory proof of Disability before benefits will be paid.” Id.

To receive short terra disability benefits, the employee must notify LINA of his claim within thirty-one days of becoming disabled or “as soon as reasonably possible.” Id. at 133. After LINA is notified of the short term disability claim, it sends the employee claim forms for filing proof of loss. Id. at 145. The employee must give written proof of loss to the insurance company within ninety days after the day that she became disabled. Id. If an employee cannot submit his proof of loss within ninety days, he may do so up to a year after the end of the ninety-day period. Id.

The long term disability policy specifies the procedure for appealing LINA’s denial of claims. Id. at 152. The policy states, “A written request for appeal must be made to the Insurance Company within 60 days (180 in the case of any claim for disability benefits) from the date the denial was received.” Id. An employee who fails to timely appeal the denial of his claim waives the right to such an appeal. Id. The policy then explains that LINA had between forty-five and sixty days to review the appeal of a denial of a claim for long term disability benefits and provide its decision on the appeal. Id.

C. LINA’s Short-Term-to-Long-Term-Disability-Claims Procedure

In limited circumstances, LINA transitions claims for short term disability benefits into claims for long term disability benefits. Lodi Decl. 33, ECF No. 27-2. The short-term-to-long-term-disability-elaims policy that was in effect when Kennedy filed his claim for short term disability benefits was revised in November 2009. Id. Under the revised policy, LINA -transitions claims for short term disability benefits into claims for long term disability benefits when the claims for short term disability benefits reach “maximum duration.”

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262 F. Supp. 3d 481, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kennedy-v-life-insurance-co-of-north-america-kywd-2017.