Kulkarni v. Metropolitan Life Insurance

187 F. Supp. 2d 724, 26 Employee Benefits Cas. (BNA) 238, 2001 U.S. Dist. LEXIS 9613, 2001 WL 1776809
CourtDistrict Court, W.D. Kentucky
DecidedJuly 11, 2001
DocketCIV.A.3:00CV-159-H
StatusPublished
Cited by3 cases

This text of 187 F. Supp. 2d 724 (Kulkarni v. Metropolitan Life Insurance) 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
Kulkarni v. Metropolitan Life Insurance, 187 F. Supp. 2d 724, 26 Employee Benefits Cas. (BNA) 238, 2001 U.S. Dist. LEXIS 9613, 2001 WL 1776809 (W.D. Ky. 2001).

Opinion

MEMORANDUM OPINION

HEYBURN, District Judge.

The Court now considers Defendants’, Metropolitan Life Insurance Company, (“MetLife”) and Praxair, Inc., (“Praxair”) respective motions for summary judgment. Plaintiff, Vinodini Kulkarni, (“Mrs.Kulkar-ni”), the widow of Sunil B. Kulkarni (“Mr.Kulkarni”), has brought four causes of action: wrongful denial of benefits; breach of fiduciary duty; arbitrary and capricious determination of ineligibility for benefits; and violation of disclosure duties.

I.

Mr. Kulkarni died in an automobile accident on February 27, 1999. He had begun employment with Praxair nearly two months earlier on January 1, 1999, having accepted Praxair’s job offer in April of 1998. As an employee at Praxair, Mr. Kulkarni was automatically enrolled in an employee benefits plan administrated by Praxair and underwritten by MetLife (the “Plan”). These benefits included the Praxair Basic Life Plan, providing basic life insurance, and eligibility for an optional supplemental life insurance plan (the “Supplemental Plan”). Praxair mailed Mr. Kulkarni an enrollment form and information regarding the Supplemental Plan on January 29, 1999. He received the enrollment form at his home February 6, 1999, completed it, and appears to have returned it to Praxair on February 11,1999. 1 Prax-air states it sent the form on to MetLife. MetLife claims it did not receive the form prior to Mr. Kulkarni’s death.

With this form Mr. Kulkarni choose supplemental coverage at the rate of five times his salary or approximately $390,000 and doubled his accidental death coverage for an additional $390,000. Sections of the plan entitled “Enrollment,” “Effective Coverage Dates,” and “Statement of ERISA rights” are particularly relevant:

Enrollment
You can enroll without evidence if insur-ability at any time within 90 days after you start work provided you have not been hospitalized in the past 90 days. If you do not enroll in the Plan within 90 days after you start work, MetLife may require medical evidence of insurability and depending on the results, you could be denied enrollment....
Effective Coverage Dates If the enrollment form is approved by the Group Universal Life Administration Unit on or before the 15th of the month, coverage will become effective on the first day of the following month, provided you are actively at work on the last scheduled work day prior to the effective day of coverage and evidence of insurability is not required. If the enrollment form is approved by the Group Universal Life Administration after the 15th of the month, coverage will become effective on the first day of the second following month, provided you are actively at work on the last scheduled work day prior to the effective date of coverage and evidence of insurability is not required ...
Statement of ERISA Rights
... In carrying out their responsibilities under the Plan, the plan Administrator and other Plan fiduciaries shall have full discretionary authority to interpret the *727 terms of the Plan and to determine eligibility for entitlement to Plan benefit, in accordance with the terms of the Plan. An interpretation or determination made pursuant to such discretionary authority shall be given full force and effect, unless it can be shown that the interpretation or determination was arbitrary and capricious.

On April 1, 1999 Plaintiff, through counsel, requested a copy of the Plan and an application for benefits. Praxair did not respond. Another request was made on May 28, 1999. Praxair responded on July 6,1999 claiming that Mr. Kulkarni was not eligible for coverage. Neither Defendant has ever provided Plaintiff with the requested Plan documents.

II.

Plaintiffs claims in Counts I and III are essentially the same, that she was denied a contractual right under the Plan. These are ERISA claims which must be brought under 29 U.S.C. § 1132(a)(1)(B). (West 2000). Any other claims not provided by ERISA would be pre-empted.

Here, the “Statement of ERISA Rights” section of the Plan gives Defendants discretionary authority to interpret Plan terms. Defendants are also acting under a conflict of interest when they determine whether a particular employee is eligible for benefits. Accordingly, the Court will review Defendants’ decision to deny Plaintiff benefits under an arbitrary and capricious standard of review with appropriate weight given to Defendants’ conflict of interest. Firestone Tire and Rubber Co., v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989); Peruzzi v. Summa Medical Plan, 137 F.3d 431, 433 (6th Cir.1998).

MetLife and Praxair both determined Mr. Kulkarni was ineligible for supplemental life insurance benefits because he was not enrolled in the Supplemental Plan. Defendants based their determination on the facts that he died before the earliest possible date coverage could begin, that MetLife had not approved his application, and because they regarded his application as incomplete. The earliest possible date Praxair or MetLife could have acted on the application was just prior February 15,1999. Mr. Kulkarni signed the form on February 11, 1999. Taking disputed facts in the light most favorable to the Plaintiff, Praxair can be deemed to have received the application by February 15, 1999. Under the section entitled “Effective Coverage Dates” the Plan plainly states that for an application approved by the fifteenth of the month, coverage will begin on the first of the following month. Even if the application were approved the same day it was received (a degree of diligence not necessarily required by ERISA fiduciary duties) coverage could not have begun until March 1, 1999, two days after Mr. Kulkarni’s death. On this basis alone, MetLife and Praxair correctly determined Mr. Kulkar-ni’s Supplemental Plan was not effective at the time of his death.

The Court concludes that Defendants’ determination of ineligibility was supported by substantial evidence and was neither arbitrary nor capricious. Therefore, Plaintiffs claims in Counts I and III of the Amended Complaint must be dismissed.

III.

29 U.S.C. § 1132(a) allows a participant or beneficiary of an ERISA plan to bring a civil action to enforce the terms of the Plan, § 1132(a)(1), or to obtain “appropriate equitable relief’ to redress violations of ERISA. Section 1132(a)(3) is a “catchall” provision which acts as a safety net offering appropriate equitable relief for injuries caused by violations that § 1132 does not remedy elsewhere. Varity Corp. v. Howe, 516 U.S. 489, 512, 116 S.Ct. 1065, 134 L.Ed.2d 130 (1996).

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Cite This Page — Counsel Stack

Bluebook (online)
187 F. Supp. 2d 724, 26 Employee Benefits Cas. (BNA) 238, 2001 U.S. Dist. LEXIS 9613, 2001 WL 1776809, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kulkarni-v-metropolitan-life-insurance-kywd-2001.