Knox v. United of Omaha Life Ins. Co.

357 F. Supp. 3d 1265
CourtDistrict Court, M.D. Georgia
DecidedJanuary 30, 2019
DocketCASE NO.: 7:17-CV-168 (WLS)
StatusPublished

This text of 357 F. Supp. 3d 1265 (Knox v. United of Omaha Life Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, M.D. Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Knox v. United of Omaha Life Ins. Co., 357 F. Supp. 3d 1265 (M.D. Ga. 2019).

Opinion

W. LOUIS SANDS, SR. JUDGE

Before the Court are cross Motions for Judgment on the Record pursuant to Fed.R.Civ.P. 52, filed by Plaintiff and Defendant on June 29, 2018. (Docs. 14 & 15.) Upon review of the administrative record, the arguments of counsel, and the relevant legal authorities, the Court hereby GRANTS Plaintiff's Motion for Judgment on the Record (Doc. 14) and DENIES Defendant's Motion for Judgment on the Record (Doc. 15).

PROCEDURAL BACKGROUND

Plaintiff Harry Knox brought this action pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001, et seq. , against Defendant United of Omaha Life Insurance Company ("United") on September 29, 2017. (Doc. 1.) In his Complaint, Plaintiff alleges that Defendant denied his claims for long-term disability insurance benefits and asks the Court to award him those benefits with interest, as well as attorneys' fees and costs. Id. Plaintiff's claims are brought under ERISA's civil enforcement statute, 29 U.S.C. § 1132(a)(1)(B).

On June 15, 2018, as the discovery period was ending, the Court entered the Parties' Consent Order that "[t]he Court's review of the evidence in this case will be limited to the 'administrative record' " to be filed with the Court, and that the Parties would file dispositive motions with a supporting brief of no more than fifty pages in length based on that record by June 29, 2018. (Doc. 12.) The Court also agreed to "apply a de novo standard of review in reviewing the record and deciding the issues in this case." Id. at 2. Both Parties complied and each filed a Motion for Judgment on the Record. (Docs. 14 & 15.) Both Parties timely filed a response and reply. (Docs. 16, 17, 19, 20.) Defendant also filed the administrative record for the Court's review. (Doc. 13-1.) Accordingly, the cross Motions for Judgment on the Record (Docs. 14 & 15) are ripe for the Court's review.

LEGAL STANDARD

The Federal Rules provide that "[i]n an action tried on the facts without a jury or with an advisory jury, the court must find the facts specially and state its conclusions of law separately.... Judgment must be entered under Rule 58." Fed.R.Civ.P. 52(a)(1). Consistent with Fed.R.Civ.P. 52 and the previously-entered Consent Order (Doc. 12), the Court will apply de novo review in determining the facts and issues in this case.1 Thus, the *1268Court must determine de novo whether the claim administrator's decision to deny benefits was right or wrong. Lee v. BellSouth Telecomms., Inc. , 318 F. App'x 829, 835-36 (11th Cir. 2009) (citation omitted). The Court must "act as an insurance adjuster and substitute its judgement for the judgement of the claims administrator," "reviewing the evidence and making a determination on its own as to whether [the claimant] is entitled to disability benefits." Kinser v. Plans Admin. Committee of Citigroup, Inc. , 488 F.Supp.2d 1369, 1379 (M.D.Ga. 2007) ; Smith v. Cox Enterprises, Inc. , 81 F.Supp.3d 1366, 1378-1379 (N.D.Ga. 2015).

"ERISA has two central goals: (1) protection of the interests of employees and their beneficiaries in employee benefit plans, [ ]; and (2) uniformity in the administration of employee benefit plans." Horton v. Reliance Standard Life Ins. Co. , 141 F.3d 1038, 1041 (11th Cir. 1998) (citations omitted). Plaintiff has the burden of proving his entitlement to plan benefits. Acree v. Hartford Life & Accident Ins. Co. , 917 F.Supp.2d 1296, 1305 (M.D. Ga. 2013). If Plaintiff proves his claims by a preponderance of the evidence, the Court must determine that United's decision to deny him benefits was de novo wrong. Doyle v. Liberty Life Assur. Co. of Boston , 542 F.3d 1352, 1356-57 (11th Cir. 2008). If the Court makes that determination, it has discretion in fashioning an appropriate remedy, which may include reinstating benefits retroactively. Otero v. Unum Life Ins. Co. of Am. , 226 F.Supp.3d 1242, 1279 (N.D. Ala. 2017) ; Wagner v. American United Life Ins. Co. , 731 Fed.Appx. 495 (6th Cir. 2018).

FACTUAL FINDINGS

Pursuant to Fed.R.Civ.P. 52(a), the Court makes the following findings of fact.

From July 16, 2012 to May 2, 2016, Knox was employed as the CEO and President of Religious Coalition for Reproductive Choice ("RCRC"), a non-profit interfaith organization advocating for women's reproductive health rights and gay rights. (Doc. 13-1 at 892; Doc. 15-1 at 1; Doc 14-1 at 4.) Knox was covered under a group policy of disability insurance issued by Defendant as part of RCRC's employee welfare benefit plan. (Doc. 15-1 at 1; Doc. 14-1 at 1.) The insurance plan provides in relevant part:

Disability and Disabled mean that because of an Injury or Sickness, a significant change in Your mental or physical functional capacity has occurred in which:

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Related

Doyle v. Liberty Life Assur. Co. of Boston
542 F.3d 1352 (Eleventh Circuit, 2008)
Byars v. Coca-Cola Co.
517 F.3d 1256 (Eleventh Circuit, 2008)
Firestone Tire & Rubber Co. v. Bruch
489 U.S. 101 (Supreme Court, 1989)
Fred Brown v. Blue Cross and Blue Shield of Alabama, Inc.
898 F.2d 1556 (Eleventh Circuit, 1990)
Kinser v. Plans Administration Committee of Citigroup, Inc.
488 F. Supp. 2d 1369 (M.D. Georgia, 2007)
Suzanne Lee v. BellSouth Telecommunications, Inc.
318 F. App'x 829 (Eleventh Circuit, 2009)
Williams v. International Paper Co.
227 F.3d 706 (Sixth Circuit, 2000)
Smith v. Cox Enterprises, Inc.
81 F. Supp. 3d 1366 (N.D. Georgia, 2015)
Otero v. Unum Life Insurance Co. of America
226 F. Supp. 3d 1242 (N.D. Alabama, 2017)
Acree v. Hartford Life & Accident Insurance
917 F. Supp. 2d 1296 (M.D. Georgia, 2013)

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Bluebook (online)
357 F. Supp. 3d 1265, Counsel Stack Legal Research, https://law.counselstack.com/opinion/knox-v-united-of-omaha-life-ins-co-gamd-2019.