Lutheran Medical Center of Omaha v. Contractors, Laborers, Teamsters & Engineers Health & Welfare Plan

814 F. Supp. 799, 1993 U.S. Dist. LEXIS 2099, 1993 WL 49942
CourtDistrict Court, D. Nebraska
DecidedFebruary 18, 1993
DocketCV89-0-715
StatusPublished
Cited by14 cases

This text of 814 F. Supp. 799 (Lutheran Medical Center of Omaha v. Contractors, Laborers, Teamsters & Engineers Health & Welfare Plan) is published on Counsel Stack Legal Research, covering District Court, D. Nebraska primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lutheran Medical Center of Omaha v. Contractors, Laborers, Teamsters & Engineers Health & Welfare Plan, 814 F. Supp. 799, 1993 U.S. Dist. LEXIS 2099, 1993 WL 49942 (D. Neb. 1993).

Opinion

MEMORANDUM AND ORDER

KOPF, District Judge.

This matter comes on to consider Plaintiffs’ Application for Attorney Fees, (Filing 127), and supplemental application, and Defendant’s Response to Application for Attorney Fees (Filing 130). I shall grant Plaintiffs’ applications, but I shall reduce the amount requested by $5,188.51, and grant a *801 total award of attorney fees in the amount of $49,299.69. 1

I.

Following a five-day nonjury trial, I entered findings of fact and conclusions of law, (Filing 123), that Defendant had acted arbitrarily and capriciously in denying Plaintiffs’ claim for benefits, thereby violating the Employee Retirement Income Security Act (ERISA) of 1974, 29 U.S.C. §§ 1001-1461 (1988). I found that the plaintiffs — a hospital and a doctor — were entitled to recover from Defendant virtually all of their charges— $66,000.27, together with costs and prejudgment interest.

I specifically found that the injury or sickness for which Mrs. Rodriguez (the spouse of the Plan participant who had assigned benefits to Plaintiffs) was treated during each of her three hospitalizations was not an injury or sickness resulting from any attempt at suicide or from any intentionally self-inflicted injury. Thus, the Plan provisions excluding such charges were inapplicable.

Furthermore, I found that until suit was filed the only reason given for denial of Mrs. Rodriguez’ claim was based on an exclusion having to do with suicide. I found that after suit was filed Defendant asserted various other pretextual grounds for denying the claim which were designed to insulate Defendant from its prior erroneous claims determination that coverage did not exist.

I also specifically found that Defendant’s acts were arbitrary and capricious for, among other reasons, each and all of the following:

1.Defendant’s reading of the policy language was unreasonable and internally inconsistent;
2. Defendant relied- upon improper and extraneous information in denying the claim;
3. Defendant waited until after suit was filed before endeavoring to develop all relevant information about the claim;
4. Defendant treated a similar claim inconsistently;
5. If Defendant truly had a room limit of $190.00 per day, that limit was imposed without notice and substantially contradicted the 1985 summary Plan description, thereby conflicting with the policies of ERISA

As a result, Plaintiffs filed an “Application for Attorney Fees,” (Filing 127), seeking to recover fees of $51,260.56 2 and expenses of $2,603.09. Plaintiffs then supplemented their fee application, requesting additional fees of $624.55 based upon work related to the fee question. Attorney fees sought are now $51,885.11, together with expenses of $2,603.09, for a total award of $54,488.20.

Plaintiffs’ counsel claims to have spent approximately 676 hours 3 preparing and trying this matter. The bench trial in this case lasted about five days, and approximately 130 exhibits were offered and received. Approximately nine witnesses were called to testify, including three experts.

Defendant submitted its “Response to Application for Attorney Fees,” (Filing 130), asserting that I should not allow attorney fees in this ease but that if I did allow such fees, they should be limited to “the generally accepted charging practices of the legal community.”

II.

There are two issues to be decided. First, I must determine whether, in the exercise of my discretion, I should award attorney fees *802 pursuant to 29 U.S.C. § 1132(g) (ERISA gives the court discretion to “allow a reasonable attorney’s fee and costs of action to either party”). If the answer to this question is in the affirmative, I must then determine the appropriate amount of attorney fees.

A.

Given the remedial purposes underlying ERISA, the United States Court of Appeals for the Eighth Circuit has indicated that a plan beneficiary successfully seeking to enforce rights under an ERISA plan “should ordinarily recover an attorney’s fee unless special circumstances would render such an award unjust.” Landro v. Glendenning Motorways, 625 F.2d 1344, 1356 (8th Cir.1980) (quoting Newman v. Piggie Park Enters., 390 U.S. 400, 402, 88 S.Ct. 964, 966, 19 L.Ed.2d 1263 (1968)). See also Gunderson v. W.R. Grace & Co. Long-Term Disability Income Plan, 874 F;2d 496, 500 (8th Cir.1989). The burden of demonstrating the “special' circumstances” necessary to overcome the presumption in favor of an award of fees to a prevailing ERISA beneficiary rests upon the losing party. Landro at 1356 n. 19; Gunderson at 500.

As I endeavor to exercise my discretion, I must consider the following factors:

1. The degree of the. opposing party’s culpability or bad faith;
2. The ability of the opposing party to satisfy an award of attorney fees;
3. Whether an award of attorney fees against the opposing party could deter other persons acting under similar circumstances;
4. Whether the parties requesting attorney fees sought to benefit all participants and beneficiaries of an ERISA plan or to resolve a significant legal question regarding ERISA itself;
5. The relative merits of the parties’ positions.

Jacobs v. Pickands Mather & Co., 933 F.2d 652, 659 (8th Cir.1991) (citing Lawrence v. Westerhaus, 749 F.2d 494, 495 (8th Cir.1984) (quoting Iron Workers Local No. 272 v. Bowen, 624 F.2d 1255 (5th Cir.1980))).

With the foregoing in mind, I turn to the five-factor analysis I must undertake in order to prudently exercise my discretion.

1. Culpability

Defendant’s culpability in this case is significant. I found that Defendant’s claims decision was arbitrary and capricious in substance and not supported by the language of the Plan. Moreover, I found that numerous defenses and other grounds for denial raised after suit was filed were a “pretext” designed to protect Defendant from its prior ill-advised decision to deny the claim.

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Bluebook (online)
814 F. Supp. 799, 1993 U.S. Dist. LEXIS 2099, 1993 WL 49942, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lutheran-medical-center-of-omaha-v-contractors-laborers-teamsters-ned-1993.