Kerper v. Educators Mutual Life Insurance

71 Pa. D. & C.4th 413, 2004 Pa. Dist. & Cnty. Dec. LEXIS 114
Pennsylvania Court of Common Pleas, Berks County·Decided December 10, 2004·No. no. 99-8259·Published

Opinion

SCHMEHL, J.L., J,

The plaintiff, William W. Kerper, is an insured under a policy is[415] sued by the defendant, Educators Mutual Life Insurance Company, through plaintiff’s former employer, Reinsel & Company. The policy provides for payment of monthly benefits in the event of the insured’s disability. In 1995, Mr. Kerper suffered two serious injuries. He continued to work on a part-time, sporadic basis until the pain from his injuries compelled him to leave employment with Reinsel. At the beginning of 1997, he filed a claim with Educators. Disability payments were made from April of 1997 throughApril of 1999. However, in May of 1999, Educators sent Mr. Kerper a letter, advising him that his benefit eligibility had terminated because they were of the opinion that he suffered only from a mental illness and not from any physical disability.

The plaintiff subsequently instituted the instant action under the Employee Retirement Security Act of 1974 (ERISA), asserting that Educators breached its duty to pay benefits. Specifically, he alleged that the insurance policy entitles him to monthly benefits of $7,000 per month, less Social Security disability payments of$l,298, until April 2012, plus statutory attorneys fees.

A non-jury trial was held before this court on June 24, 2004. On July 6, 2004, this court issued a verdict in favor of the plaintiff and against the defendant in the total amount of $353,524 ($5,702 times 62 months). Both parties then filed post-trial motions, with Educators seeking a judgment n.o.v. or, in the alternative, a new trial, and Kerper arguing that the verdict should have included interest at the legal rate. On October 1, 2004, this court issued an order denying both parties’ post-trial motions. On October 18, 2004, Educators appealed this order to the Superior Court.

[416] In accordance with Rule 1925(b) of the Pennsylvania Rules of Appellate Procedure, this court ordered the defendant to file a concise statement of matters complained of on appeal. On November 4,2004, the defendant filed this statement, alleging the following:

(1) The trial court erred in heating the benefits claim of William W. Kerper, made under an employee benefit welfare plan, as a claim for breach of contract, as his claim was one for benefits under ERISA, permitting only a judicial review of the plan administrator’s benefits decision.

(2) The trial court erred in failing to treat Kerper’s claim for benefits, made under an employee welfare benefit plan, as permitting only a judicial review of the plan administrator’s benefits decision under the arbitrary and capricious standard.

(3) In the alternative, the trial court erred in failing to treat Kerper’s claim for benefits, made under an employee welfare benefit plan, as permitting only a judicial review of the plan administrator’s benefits decision under a heightened scrutiny/arbitrary and capricious standard.

(4) The trial court erred in failing to treat Kerper’s claim for benefits, made under an employee welfare benefit plan, as permitting only a judicial review of the plan administrator’s benefits decision and limited to the administrative record as it existed when the plan administrator made [his] decision.

(5) The trial court erred in awarding a verdict on Kerper’s claim for benefits, made under an employee benefit welfare plan, by considering testimony or other evidence from a treating physician regarding his opin[417] ions based on treatment beginning in 2002, when the trial court’s role was limited to a judicial review of the benefits decision made in 1999.

(6) The trial court erred in awarding a verdict on Kerper’s claim for benefits, made under an employee benefit welfare plan, by utilizing a standard of judicial review other than whether the plan administrator’s benefits decision was without reason, unsupported by substantial evidence and/or erroneous as a matter of law.

(7) The trial court erred in failing to grant Educators’ post-trial motions, and specifically by failing to find there was insufficient evidence to support the verdict following the trial in this matter, since the trial court’s verdict in effect overruled the plan administrator’s benefits decision which should have been accorded deference.

(8) The trial court erred in failing to grant Educators’ post-trial motions, and specifically by failing to grant Educators a judgment n.o.v. since, under the arbitrary and capricious standard of judicial review, insufficient evidence was produced by Kerper to overrule the plan administrator’s benefits decision.

(9) The trial court erred in failing to grant Educators’ post-trial motions, and specifically failing to award Educators a new trial, since, under the arbitrary and capricious standard of review, insufficient evidence was produced by Kerper to overrule the plan administrator’s benefits decision.

(10) The trial court erred in failing to grant Educators’ post-trial motions, and specifically by failing to award Educators a new trial, where the trial court improperly allowed the admissions of, and improperly considered [418] the testimony of, Dr. Gould, whose testimony was completely irrelevant to and not admissible on the question of whether the plan administrator’s benefits decision made in 1999 should have been overruled.

This opinion is written pursuant to Rule 1925(a) of the Pennsylvania Rules of Appellate Procedure and for the following reasons, this court asks that the instant appeal be denied.

THE COURT DID NOT ERR IN RENDERING A VERDICT IN FAVOR OF THE INSURED

The standard of review following a non-jury trial is as follows:

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Kerper v. Educators Mutual Life Insurance, 71 Pa. D. & C.4th 413, 2004 Pa. Dist. & Cnty. Dec. LEXIS 114 (Pa. Super. Ct. 2004).

71 Pa. D. & C.4th 413 (Kerper v. Educators Mutual Life Insurance) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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