Kirby v. Siemens Corp. Group Life, Medical, Dental, Vision, Hearing, & Long Term Disability Income Plan

927 F. Supp. 2d 1307, 56 Employee Benefits Cas. (BNA) 2444, 2013 WL 764770, 2013 U.S. Dist. LEXIS 27569
CourtDistrict Court, M.D. Florida
DecidedFebruary 28, 2013
DocketCase No. 6:10-cv-1228-Orl-28DAB
StatusPublished

This text of 927 F. Supp. 2d 1307 (Kirby v. Siemens Corp. Group Life, Medical, Dental, Vision, Hearing, & Long Term Disability Income Plan) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kirby v. Siemens Corp. Group Life, Medical, Dental, Vision, Hearing, & Long Term Disability Income Plan, 927 F. Supp. 2d 1307, 56 Employee Benefits Cas. (BNA) 2444, 2013 WL 764770, 2013 U.S. Dist. LEXIS 27569 (M.D. Fla. 2013).

Opinion

ORDER

JOHN ANTOON II, District Judge.

Larry Kirby brings the instant action pursuant to the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq. The case presents issues regarding Kirby’s entitlement to long-term disability (“LTD”) benefits and to paralysis benefits under a life insurance plan.1 The case is currently before the Court on cross-motions for summary judgment (Docs. 30 & 31).2 Having considered the [1309]*1309parties’ filings, the Court concludes that both motions must be granted in part and denied in part.

I. Background

Many of the facts are undisputed. Kirby was employed by Siemens Information and Communication Networks (“SICN”), a subsidiary of Siemens Corporation, from January 29, 1981, until his termination on March 5, 2002. While he was an employee of SICN, Kirby was a participant in the Siemens Corporation Group Life, Medical, Dental, Vision, Hearing, and Long Term Disability Income Plan (“the Siemens Corporation Group Plan”), the Siemens Information and Communication Networks, Inc. Short Term Disability Benefit Plan (“the SICN STD Plan”), and the Portable Term Life Insurance Benefit Plan (“the Portable Life Plan”).

Siemens Corporation — the parent of SICN — is the Plan Administrator and Plan Sponsor for the Siemens Corporation Group Plan. (See Summary Plan Description, Doc. 1-1, at 111; see also Doc. 31 at 3). Defendant Metropolitan Life Insurance Company (“MetLife”) is the Claims Administrator and the Insurer for LTD benefits under the Siemens Corporation Group Plan and is also the Claims Administrator for portable life benefits under the Portable Life Plan. (See Summary Plan Description at 113; see also Doc. 17 at 2). MetLife is also the Claims Administrator for STD benefits, but it has been in that role only since 2006 and was not the Claims Administrator for STD benefits during 2002 or 2003. (See Doc. 17 at 2).

In June 2003, Kirby filed a lawsuit (Case No. 6:03-ev-986-Orl-28DAB in this court) against SICN alleging that SICN terminated his employment because of his age. That case settled before trial, and in December 2003 Kirby signed a Settlement Agreement and Full and Final Release (“the Agreement”), (LTD A.R. 0531-0535),3 in connection with that lawsuit.

In February 2008, Kirby submitted a claim to MetLife, as the administrator of the Siemens Corporation LTD Group Plan, for LTD benefits. Initially, MetLife denied the LTD claim on April 29, 2008, as untimely, (LTD A.R. 0192-0193), but Met-Life changed its decision on August 28, 2008, and approved Kirby’s claim for LTD benefits based on “special circumstances,” (LTD A.R. 0316, 0528). MetLife then sent Kirby payments of $109,904.33 and $436,385.17 for retroactive LTD benefits covering the period September 1, 2002, through January 31, 2009. A monthly benefit of $6,607.95 was then instated, and payments in that amount were made to Kirby for February and March 2009.

After his claim for LTD benefits was approved, Kirby sought an award of STD benefits for the six-month period from March 5, 2002, to the LTD effective date of September 1, 2002. In March or April 2009, in the course of processing Kirby’s STD claim, MetLife became aware of and obtained a copy of the Agreement that Kirby had signed in resolution of his 2003 age discrimination lawsuit. MetLife, reading that document as a release of all of Kirby’s claims — including claims for STD [1310]*1310and LTD benefits — then terminated Kirby’s LTD benefits and denied his claim for STD benefits,4 notifying him of these decisions in a letter dated April 8, 2009. (LTD A.R. 0528-0530). In that letter, MetLife also requested that Kirby promptly return the LTD benefits totaling $559,505.40 that he had already been paid. (See id.).

Through counsel, Kirby administratively appealed MetLife’s termination of LTD benefits and denial of STD benefits. (LTD A.R. 0548-0549, 0554-0561). On February 26, 2010, MetLife affirmed both decisions, again relying on the Agreement. (LTD A.R. 0575-0581). Kirby filed this lawsuit in August 2010 seeking to recover LTD benefits from April 2, 2009, onward. (Compl., Doc. 1, Count I). In his initial Complaint, Kirby also sought to recover STD benefits for the period from March 5, 2002, to September 1, 2002, (id.), but he has voluntarily dismissed the portion of Count I that pertains to STD benefits.5

Additionally, Kirby seeks insurance benefits under the Life Plan, asserting that in February 2009 he made a claim for $189,000 in benefits under the Life Plan for paralysis of both of his legs. (Compl. Count II). Kirby also brings a breach of fiduciary duty claim against MetLife for failing to process or pay his claim for Life Plan benefits, asserting that MetLife has refused to process that claim or to notify him of any determination. (Compl. Count III).

Along with its Answer, MetLife filed a three-count Counterclaim alleging unjust enrichment (Count I), an equitable claim in which MetLife seeks return of the $559,505.40 in LTD benefits that it paid to Kirby (Count II), and breach of fiduciary duty (Count III). (Answer & Counterel., Doc. 17). MetLife has since withdrawn its breach of fiduciary duty claim. (See Docs. 32 & 40). The parties’ cross-motions for summary judgment as to all pending claims are now before the Court.6

II. Discussion

A. LTD Benefits

It is undisputed that after initially denying as untimely Kirby’s claim for LTD benefits, MetLife later granted his claim based on “special circumstances” but then, after making two sizeable payments for retroactive benefits as well as two monthly payments, terminated Kirby’s LTD benefits based on the Agreement. (See Apr. 8, 2009 Letter from MetLife to Kirby, LTD A.R. 0528-0530). Thus, the issue before [1311]*1311this Court is whether MetLife correctly determined that the Agreement bars Kirby’s claim for LTD benefits. That determination is reviewed de novo and requires analysis of the provisions of the Agreement, the construction and enforcement of which are, as noted by the parties, “governed by principles of Florida’s general contract law.” Schwartz v. Fla. Bd. of Regents, 807 F.2d 901, 905 (11th Cir.1987); see also Biggin v. RLI Ins. Co., No. 6:06-cv-104-Orl-19KRS, 2006 WL 1232620, at *4 (M.D.Fla. May 5, 2006) (“A litigation release of claims is a contract, and therefore it is construed according to the normal rules of contract interpretation.”).

“When the language of a contract is clear and unambiguous, courts must give effect to the contract as written and cannot engage in interpretation or construction as the plain language is the best evidence of the parties’ intent.” Talbott v. First Bank Fla., FSB, 59 So.3d 243, 245 (Fla. 4th DCA 2011). “Words in a contract are to be given their plain and ordinary meaning, and it is not for the court to add or subtract any language from the face of a clearly worded agreement.” Schwartz, 807 F.2d at 905.

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927 F. Supp. 2d 1307, 56 Employee Benefits Cas. (BNA) 2444, 2013 WL 764770, 2013 U.S. Dist. LEXIS 27569, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kirby-v-siemens-corp-group-life-medical-dental-vision-hearing-long-flmd-2013.