LeBlanc v. SULLIVAN TIRE CO., INC.

526 F. Supp. 2d 75, 2007 U.S. Dist. LEXIS 91521, 2007 WL 4357126
District Court, D. Maine·Decided December 12, 2007·No. Civil 06-197-P-H·Published

Opinion

DECISION AND ORDER ON MOTION FOR JUDGMENT ON THE ADMINISTRATIVE RECORD AND CROSS-MOTIONS FOR SUMMARY JUDGMENT

D. BROCK HORNBY, District Judge.

Introduction

In this case, an employee challenges the method by which his short-term and long-term disability benefits were calculated under his employer’s disability plan. I conclude that the plan language supports the benefit calculations.

Factual And Procedural History 1

The defendant Sullivan Tire Company, Inc. (“Sullivan Tire”) maintains a welfare benefits plan (“Plan”) providing various benefits for its employees. The Plan, governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), has two sections.

*77 Section I is captioned: “Employer-Funded Benefits Not Insured by Guardian.” That section deals with short-term disability benefits. It provides twice-monthly benefit payments (pro-rated for disabilities lasting only a portion of a week) for up to 13 weeks, GLIC-18-19. It calculates these benefits according to weekly earnings, GLIC-26, and is self-funded by Sullivan Tire. GLIC-9.

Section II is captioned: “Guardian Insurance.” It deals with a variety of group insurance benefits — among them, long-term disability benefits. The long-term disability provisions of the Plan provide monthly benefit payments (after a 90-day waiting period), GLIC-64, calculated according to monthly earnings, GLIC-76. The defendant The Guardian Life Insurance Company of America (“Guardian Life”) pays the long-term benefits, see, e.g., GLIC-38, as a result of insurance that Sullivan Tire buys from Guardian Life.

But Guardian Life is the Claims Fiduciary for both short-term and long-term benefits. It has “discretionary authority to determine eligibility for benefits and to construe the terms of the plan with respect to claims.” GLIC-31 (short-term benefits); GLIC-106 (long-term benefits). Although Guardian Life pays the long-term benefits, it explicitly bears no responsibility for payment of short-term benefits. GLIC-9.

Sullivan Tire employed the plaintiff Jeremy LeBlanc. As a result of a lumbar herniated disc, LeBlanc left work on November 29, 2005, and applied for short-term benefits. GLIC-456. Sullivan Tire paid LeBlanc short-term benefits for the maximum period the Plan allowed, 13 weeks. GLIC-344. On February 9, 2006, LeBlanc applied for long-term disability benefits. GLIC-213. On April 27, 2006, Guardian Life awarded LeBlanc long-term benefits as of February 27, 2006, the end of the 90-day post-disability waiting period the Plan required. GLIC-286. The calculation of both short-term and long-term benefits was based on the amount of Le-Blanc’s earnings that Sullivan Tire reported to Guardian Life, namely $800 per week. GLIC-456, 481-82 (short-term benefits); GLIC-268-69 (long-term benefits).

While Guardian Life was processing Le-Blanc’s long-term benefit claim, LeBlanc began questioning the method used to calculate his benefits. Through his lawyer, LeBlanc sent letters to Sullivan Tire and Guardian Life requesting that they include his monthly position incentive ($1,000) and his monthly commission base ($500) in the disability benefit calculation. 2 GLIC-272 (letter to Guardian Life); GLIC-383 (letter to Sullivan Tire). LeBlanc also raised this issue directly with Wayne Funder, Human Resources staff at Sullivan Tire. On April 3, 2006, Funder sent Guardian Life a letter with two questions, the first of which is relevant here; its subject was LeBlanc’s long-term disability benefits. In that regard, Funder provided a description of Sullivan Tire’s “pay program,” including compensation regularly paid to LeBlanc. GLIC-388. According to this letter, Sullivan Tire paid LeBlanc a “flat, weekly compensation” of $800. That is the amount on which Sullivan Tire paid premiums. Id. Funder reported to Guardian Life that LeBlanc also received a monthly payment of $1,000, a so-called *78 “position incentive” available to those working in an outside sales capacity (Le-Blanc’s case) or at a challenging location, so long as the employee continued working in that particular position or location. Id. Funder’s letter explained that “outside salesmen may receive a commission based on sales volume and gross profit each month,” but it did not provide a specific payment amount for LeBlanc. Id. Fun-der’s letter reported that LeBlanc believed that his monthly position incentive “should be figured into his base pay with [long-term disability] benefits being paid on this basis.” Id. Funder concluded by stating that he would “leave [the benefit] determination to [Guardian Life],” because Guardian Life has “final authority to make a decision concerning [long-term disability] coverage and compensation.” Id.

Delondria Terry, a Guardian Life Benefit Analyst, responded to Funder’s letter on April 11. She copied LeBlanc, but did not respond directly to the separate letter that LeBlanc’s lawyer had sent. GLIC-361, GLIC-268. Terry’s letter explained that her records showed that LeBlanc’s base salary was $800 per week, the amount that Sullivan Tire reported and on which it paid premiums. GLIC-362. Her letter concluded that, “based on the contract guidelines,” Guardian Life would calculate LeBlanc’s long-term benefits according to that amount and would exclude his position incentive. Id. The April 27 letter to Le-Blanc awarding him long-term benefits confirmed this interpretation; it explained that he would receive $2,080 per month, the benefit due a claimant with a weekly salary of $800. GLIC-286.

On July 19, 2006, LeBlanc’s lawyer sent Guardian Life a second letter, demanding that Guardian Life recalculate LeBlanc’s short- and long-term disability benefits based on larger earnings, specifically including his $1,000 position incentive and $500 commission base. GLIC-270. On August 18, 2006, Terry responded with a letter nearly identical to the one that she sent to Wayne Funder in April, explaining Guardian Life’s position that long-term benefits were based correctly on LeBlanc’s $800 per week base salary. GLIC-268-69.

In October 2006, LeBlanc filed a lawsuit in state court against Sullivan Tire and Guardian Life asserting state law claims of various sorts. See Pl.’s Compl. (Docket Item 1-2). Guardian Life, with the consent of Sullivan Tire, removed the case to this court pursuant to 28 U.S.C. § 1441. Notice of Removal (Docket Item 1). On February 2, 2007, LeBlanc amended his complaint to state only federal claims under ERISA against both Sullivan Tire and Guardian Life. Pl.’s Am. Compl. ¶¶ 15-23 (Docket Item 11-3). Subject matter jurisdiction is proper under 28 U.S.C. § 1331 (federal question).

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LeBlanc v. SULLIVAN TIRE CO., INC., 526 F. Supp. 2d 75, 2007 U.S. Dist. LEXIS 91521, 2007 WL 4357126 (D. Me. 2007).

526 F. Supp. 2d 75 (LeBlanc v. SULLIVAN TIRE CO., INC.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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