Lundsten v. Creative Community Living Services, Inc.

126 F. Supp. 3d 1043, 2015 U.S. Dist. LEXIS 111052, 2015 WL 5010439
CourtDistrict Court, E.D. Wisconsin
DecidedAugust 20, 2015
DocketCase No. 13-C-108
StatusPublished

This text of 126 F. Supp. 3d 1043 (Lundsten v. Creative Community Living Services, Inc.) is published on Counsel Stack Legal Research, covering District Court, E.D. Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lundsten v. Creative Community Living Services, Inc., 126 F. Supp. 3d 1043, 2015 U.S. Dist. LEXIS 111052, 2015 WL 5010439 (E.D. Wis. 2015).

Opinion

DECISION AND ORDER

RUDOLPH T. RANDA, District Judge.

This matter comes before the Court on Jill M. Lundsten’s motion to alter or amend the Court’s judgment dismissing her action to recover longterm disability benefits under the Creative Community Living Services, Inc. (“CCLS”) Long Term Disability Plan (“the Plan”). Fed.R.Civ.P. 59(e). On cross-motions for summary judgment, the Court held that Lundsten’s claim was untimely pursuant to the contractual limitations period set forth in the Plan. 2015 WL 1143114 (E.D.Wis. March 13, 2015).

The Court now agrees, contrary to its prior ruling, that Lundsten’s claim is not time-barred. This error — and the waste of time and resources that it engendered— was avoidable, and not only because the defendants’ timeliness, argument is wrong. More perplexing is Lundsten’s failure to counter that argument, as she now has, with the point that state law provides the applicable limitations period, not the Plan language.

It is well-worn territory that Rule 59(e) should not be used to present arguments that could have been presented before the initial entry of judgment. Caisse Nationale de Credit Agricole v. CBI Indus., Inc., 90 F.3d 1264, 1270 (7th Cir.1996). This is not to say that district courts cannot consider newly-raised post-judgment arguments. As one court observed, Rule 59(e) “accords no right to make untimely post-judgment arguments,” but it does not impose “a limit on a trial court’s discretion to consider such arguments.” In re UAL Corp., 360 B.R. 780, 784 (Bankr.N.D.Ill.2007). The Court pre[1048]*1048fers to make the correct decision, not hide its head in the sand in the name of procedural formality. To that end, and for the reasons that follow, Lundsten’s motion to alter or amend the Court’s judgment is granted.

Since Lundsten’s action is not time-barred, the Court re-visited the substantive arguments in the parties’ cross-motions for summary judgment. The Court now finds that Lundsten is entitled to summary judgment on her claim that the Plan’s denial of benefits was arbitrary and capricious. Lundsten is also entitled to an award of attorney’s fees and costs under ERISA’s fee-shifting statute. Defendants, as previously held, are entitled to summary judgment on Lundsten’s claim that CCLS failed to provide Plan documents in a timely manner. Defendants are also entitled to summary judgment on their claim to recover social security disability benefits under the Plan’s offset provision. Contrary to the Court’s prior ruling, however, the defendants are not entitled to an award of fees and costs.

In accordance with the foregoing and the analysis that follows, this matter is remanded to the Plan administrator for further proceedings consistent with this opinion.

I. Motion to alter or amend

In ruling that Lundsten’s claim was time-barred, the Court relied upon the contractual limitations period set forth in the Plan documents. In so doing, the Court was not aware — because neither party highlighted this fact in their summary judgment papers — that the Plan is insured, not self-funded. See Amended Complaint, ¶ 5 (“Creative contracted with Aetna [Life Insurance Company] to pay LTD benefits under the Plan through a policy of insurance Aetna issued to Creative”). More to the point, Lundsten did not argue, in opposition to the defendants’ timeliness argument, that insured (as opposed to self-funded) plans are subject to state insurance regulations that apply in the instant case.

As relevant here, Wisconsin law provides that an “action on disability insurance coverage must be commenced within 3 years from the time written proof of loss is required to be furnished,” Wis. Stat. § 631.83(l)(b), and moreover, that no insurance policy may “Limit the time for beginning an action on the policy to a time less than that authorized by the statutes.” § 631.83(3)(a). These statutory provisions are not preempted by ERISA because they regulate insurance within the meaning of ERISA’s savings clause. 29 U.S.C. § 1144(b)(2)(A).

To determine whether a state law regulates insurance, courts first ask whether it does so from a “common-sense view of the matter.” UNUM Life Ins. Co. of Am. v. Ward, 526 U.S. 358, 367, 119 S.Ct. 1380, 143 L.Ed.2d 462 (1999). Then, courts consider three factors to determine whether the regulation fits within the “business of insurance” as that phrase is used in the McCarran-Ferguson Act, 15 U.S.C. § 1011 et seq.: first, whether the practice has the effect of transferring or spreading a policyholder’s risk; second, whether the practice is an integral part of the policy relationship between the insurer and the insured; and third, whether the practice is limited to entities within the insurance industry. Ward, 526 U.S. at 367, 119 S.Ct. 1380. These factors are “guideposts, not separate essential elements ... that must each be satisfied to save the State’s law.” Id. at 374, 119 S.Ct. 1380.

From a common-sense standpoint, the imposition of a minimum limitations period for disability insurance claims involves the regulation of disability insurance. This conclusion is bolstered by the [1049]*1049three guideposts. First, a limitations period that cannot be contractually lowered has the effect of transferring more risk to insurance companies. Second, the statute is an integral part of the policy relationship because it “dictates the terms of the relationship between the insurer and the insured, ...” Id. at 374-75, 119 S.Ct. 1380. Finally, the rule is limited to the insurance industry; indeed it is “aimed at it.” Id. at 375, 119 S.Ct. 1380.

A law saved from preemption may still be preempted if it falls within ERISA’s “deemer clause.” § 1144(b)(2)(B). State laws that purport to regulate insurance by “deeming” a plan to be an insurance company are outside the saving clause and remain subject to preemption, Ward at 367 n. 2, 119 S.Ct. 1380, but insured plans, such as the CCLS Plan, are “subject to indirect state insurance regulation. An insurance company that insures a plan remains an insurer for purposes of state laws ‘purporting to regulate insurance’ after application of the deemer clause.” FMC Corp. v. Holliday, 498 U.S. 52, 61, 111 S.Ct. 403, 112 L.Ed.2d 356 (1990); see also Moran v. Rush Prudential HMO, Inc., 230 F.3d 959, 970 (7th Cir.2000) (“The Supreme Court’s interpretation of the deemer clause ‘makes clear that if a plan is insured, a State may regulate it indirectly through regulation of its insurer and its insurer’s insurance contracts’ ” (quoting FMC Corp., 498 U.S. at 64, 111 S.Ct. 403)). Accordingly, Wisconsin’s regulation of insured disability plans is not preempted under the deemer clause.

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Bluebook (online)
126 F. Supp. 3d 1043, 2015 U.S. Dist. LEXIS 111052, 2015 WL 5010439, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lundsten-v-creative-community-living-services-inc-wied-2015.