Miller v. Monumental Life Insurance

376 F. Supp. 2d 1238, 2005 U.S. Dist. LEXIS 14369, 2005 WL 1661429
CourtDistrict Court, D. New Mexico
DecidedJune 30, 2005
DocketCIV 04-0970 JB/RHS
StatusPublished
Cited by5 cases

This text of 376 F. Supp. 2d 1238 (Miller v. Monumental Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. New Mexico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Miller v. Monumental Life Insurance, 376 F. Supp. 2d 1238, 2005 U.S. Dist. LEXIS 14369, 2005 WL 1661429 (D.N.M. 2005).

Opinion

MEMORANDUM OPINION AND ORDER

BROWNING, District Judge.

THIS MATTER comes before the Court on: (i) the Plaintiffs Motion for Summary *1242 Judgment, filed April 29, 2005 (Doc. 27); and (ii) Defendant Monumental Life Insurance Company’s Motion for Summary Judgment, filed May 6, 2005 (Doc. 29). The primary issue is whether the Employee Retirement Income Security Act (“ERISA”) Plan’s policy requirement that a claimant receive a “Social Security Disability Award” includes an award for Supplemental Security Income (“SSI”) as well as for Social Security Disability Insured (“SSDI”). Because the Court believes that disability benefits does not include SSI benefits, even when they are based on disability, the Court denies Plaintiff Rodney Miller’s motion for summary judgment and grants Monumental’s motion.

FACTUAL BACKGROUND

The issue raised by both motions is whether Miller is entitled to Continuous Total Disability Benefits under the Policy. Because the Court, however, does not believe that it needs to decide all issues that Monumental raises to decide both motions, the Court will set forth only the facts and law relevant to the issue whether the phrase “Social Security Disability Award” includes SSI payments. From the pleadings and responses to discovery, it appears that the parties do not dispute the following facts.

1. The Policy.

Monumental issued a Master Group Policy to Aycock Transportation, Inc. in Texas. See Monumental Life Insurance Company Master Policy at 1 (executed June 19, 1996)(hereinafter “Policy”). Monumental subsequently issued to Miller a Certificate of Insurance under the Master Group Policy. The Policy’s and the Certificate’s terms and conditions are the same.

The Policy requires the Insured Person to receive a “Social Security Disability Award” before he can receive Continuous Total Disability benefits. Policy at 10. Specifically, the Policy provides, in pertinent part, that Monumental will pay Continuous Total Disability benefits when it receives, among other things, proof that the Insured is “Totally Disabled,” “the Insured Person has been granted a Social Security Disability Award for such disability,” and the Total Disability “resulted solely and directly from Injury.” Id. The Policy further provides that such benefit payments will end if, among other things, “the Insured’s Social Security Disability Award ceases.” Id. The Schedule of Benefits provides that “Continuous Total Disability ... Benefit will be paid as long as the Insured Person continues to receive a Social Security Disability Award or to age 65.” Id. at 7.

The Policy states that the weekly benefit allowed under the Continuous Total Disability Benefit is calculated by taking “70% of the Insured Person’s Average Weekly Earnings, reduced by his primary Social Security Disability Award; or ... the Maximum Weekly Benefit shown in the Schedule of Benefits, whichever is less.” Id. at 10. The Schedule of Benefits provides that benefits are reduced “100% of primary Social Security Disability Award.” Id. at 7. At the hearing, the parties agreed that, although it is not in the record, Miller would receive $2,000 monthly if he received the Continuous Total Disability Benefits. See Transcript of Hearing at 3:22 — 4:7; id. at 10:25 — 11:5 (taken June 30, 2005)(hereinafter “Transcript”). 1 The parties are also in agreement that, by receiving the $2,000 monthly sum under the Policy, Miller’s income would be too great *1243 to receive SSI payments, which would be reduced to zero. See id. at 4:20-25; id.- at 11:6-9.

The Policy’s definition of “Totally Disabled” for purpose of Continuous Total Disability Benefits provides in pertinent part that the Insured Person must have been “granted a Social Security Disability Award.” Policy at 5. The Policy also contains the following definition: “Social Security Disability Award: means Social Security disability benefits for which the Insured Person has submitted a claim and been approved for payment by the Social Security Administration.” Id.

2. Miller’s Award.

Miller is a New Mexico resident. Miller was a contract driver leased to the policy holder, Aycock Transportation, insured with Monumental for disability. See Policy at 1-17; Complaint for ERISA Plan Benefits ¶ 3, at 1 (attached to Notice of Removal, filed August 27, 2004 (Doc. l))(hereinafter “Complaint”). On September 15, 1997, 2 and while an Aycock employee, Miller was involved in a motor vehicle accident and became disabled. See Complaint ¶¶ 3, .7, 8, 9, at 2-3; Monumental’s Answer ¶ 9, at 2, filed September 3, 2004 (Doc. 6). At the time of this accident, the Policy was in effect and Miller is an insured under the Plan.

Miller received twenty-four months of Temporary Total Disability Benefits from September 1997 to September 1999 at $2,000.00 per month, and certain medical benefits were paid on his behalf under the Policy. See Affidavit of Rodney Miller ¶ 8, at 1 (executed Aril 29, 2005). The requirements for such benefits are different from those for Continuous Total Disability Benefits. See Policy at 5. Miller would not be entitled to SSI benefits until after the expiration of Short Term Disability because of his income.

On December 23, 1998, Miller received a letter from the Plan Administrator that advised, if Miller was to receive Continuous Total Disability Benefits after September 22, 1999, when his Temporary Total Disability ended, he would need to have been granted a Social Security Disability Award. See Letter from Cheryl Arms to Rodney Miller at 2 (dated December 23, 1998)-. Miller applied for a Social Security Disability Award. The Social Security Administration denied his application because of the lack of all insured status; he had not worked in eighteen quarters in the ten years before the disability onset. See Decision of Social Security Administrative Law Judge at 3 (dated August 28, 2003). The Administrative Law Judge (“ALJ”) concluded that Miller “is not entitled to a period of disability and disability insurance benefits because of lack of status.” Id. at 2, 3. In so finding, the ALJ noted that Miller, at another hearing, was determined to “not [be] insured for disability insurance benefits[,]” but that the earlier hearing “resulted in a favorable decision with respect to SSI benefits.” Id. at 1. According *1244 to the ALJ: “An SSI application is an application for all Social Security benefits for which an individual may be entitled.” Id. After reviewing Miller’s alleged basis for asserting insured status, the ALJ concluded that Miller “has not established that he has sufficient quarters of coverage to confer disability insured status and that ... he is not entitled to a period of disability and disability insurance benefits because of lack of status.” Id.

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Bluebook (online)
376 F. Supp. 2d 1238, 2005 U.S. Dist. LEXIS 14369, 2005 WL 1661429, Counsel Stack Legal Research, https://law.counselstack.com/opinion/miller-v-monumental-life-insurance-nmd-2005.