Nesom v. Brown & Root USA, Inc.

790 F. Supp. 123, 1992 U.S. Dist. LEXIS 5576, 1992 WL 82163
CourtDistrict Court, M.D. Louisiana
DecidedApril 14, 1992
DocketCIV. A. 90-1003-B
StatusPublished
Cited by3 cases

This text of 790 F. Supp. 123 (Nesom v. Brown & Root USA, Inc.) is published on Counsel Stack Legal Research, covering District Court, M.D. Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Nesom v. Brown & Root USA, Inc., 790 F. Supp. 123, 1992 U.S. Dist. LEXIS 5576, 1992 WL 82163 (M.D. La. 1992).

Opinion

RULING ON CROSS MOTIONS FOR SUMMARY JUDGMENT

POLOZOLA, District Judge.

This case requires the Court to determine whether plaintiff is entitled to disability benefits under a policy issued by UNUM Life Insurance Company (UNUM) to Brown and Root USA, Inc. (Brown and Root). For reasons’ which follow, the Court finds that plaintiff’s motion for summary judgment should be granted.

The facts of this case are undisputed for purposes of this motion. Daniel Nesom suffered a work related injury in 1985, while working for Brown and Root, which rendered him permanently disabled. As a member of Brown and Root’s employee welfare benefit plan, plaintiff was entitled to disability benefits under policy number 316874 issued by UNUM directly to Brown and Root. Nesom paid 50% of the premiums, with Brown and Root contributing the remaining 50% as an employee benefit.

Nesom pursued a worker’s compensation claim in state court against Brown and Root. While the worker’s compensation claim was pending, UNUM paid Nesom $1,248 in monthly disability benefits pursu[125]*125ant to the disability policy.1 Between May 22, 1986, and June 22, 1990, Nesom was paid a total of $61,152 in long-term disability benefits at the rate of $1,248 monthly. UNUM concedes plaintiffs eligibility to recover disability benefits since he has established he is totally disabled within the meaning of the policy.

On April 25, 1990, the state court rendered judgment in favor of Nesom in the sum of $39,902.90 for past due worker's compensation benefits. The monthly compensation award of $814.15 was based on an award of $187.88 per week multiplied by 52 weeks and then divided by 12 to equal a monthly worker’s compensation benefit. The court found Nesom was entitled to temporary total disability benefits from May 23, 1986, to the time judgment was entered on April 25, 1990, and thereafter unless modified by the state court.

The amount of compensation awarded by the state court was calculated on the assumption that Nesom was entitled to receive disability benefits at the rate of $1,248 per month. Pursuant to Louisiana Revised Statutes 23:1225 C(1)2, an employer is entitled to offset any disability payments against the worker’s compensation payments because the disability benefit plan was funded 50% by the employer. The state court judgment specifically provided that the “weekly worker’s compensation benefit of $187.88 is to be paid in addition to Nesom’s disability income benefits of $1,248.00.” (Emphasis added.)

The policy issued by UNUM allows the insurer to “deduct other income benefits” which include “the amount for which the insured is eligible under: (a) worker’s or workmen’s compensation law.” In other words, after Nesom was awarded a retroactive worker’s compensation judgment, UNUM claimed it was entitled to a credit for the $814.15 per month that UNUM paid while the worker’s compensation claim was pending and which the state court found was owed by Brown and Root. UNUM maintains that it was required to pay Ne-som the difference between his monthly worker’s compensation benefit of $814.15 and his monthly disability benefit of $1,248.00, or a difference between the two benefits of $433.85 per month.

Since the worker’s compensation judgment was rendered, UNUM claims it is entitled to an offset of $39,902.90 in a lump sum payment under the terms of the policy. Specifically, UNUM contends this sum should be treated as “other income” which may be offset against payments made to Nesom under the terms of the policy. Ne-som has not paid UNUM for the alleged overpayment, and UNUM has begun recovering its overpayment by crediting the $39,-902.90 to the monthly benefit of $433.85 that it presently owes. Once the overpayment is recovered, UNUM concedes that it owes Nesom a monthly benefit of $433.85 assuming he is disabled and there is no other income benefit offset.

Plaintiff claims that UNUM is not entitled to offset worker’s compensation benefits against the disability benefit provided by UNUM to plaintiff because the worker’s compensation insurer is offsetting its benefits based on what the plaintiff has received from the disability insurer. Nesom contends that the state court judgment [126]*126awarded him a total of $2,055.88 per month, with UNUM paying $1,248 per month and Brown and Root paying $807.88 per month. In other words, plaintiff contends that if UNUM is entitled to an offset, both the disability benefit and the worker’s compensation benefit would be taking offsets against a single fund due the plaintiff.

The parties agree that the facts necessary to decide this motion are not in dispute. The issues before the Court are legal in nature and require the Court to interpret the language of the policy in accordance with relevant law. It is well established that courts have the authority to review de nova the legal issues which arise from application and interpretation of employee welfare benefit plans.3

The standard under which the Court must proceed to review the issues in this case was set forth by the United States Supreme Court in Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987). In Pilot Life4 the Court held that ERISA preempted an employee’s common law claims against an insurer, and that Congress intended that the general preemption clause and civil enforcement provisions provide the exclusive remedy for disputes arising out of claims for benefits under all ERISA-regulated employee benefit plans.5

Since Pilot Life, the Fifth Circuit has consistently held that claims to recover benefits or for improper handling of insurance claims are barred by ERISA’s preemption provisions.6 In short, when beneficiaries seek to recover benefits from an ERISA plan, their exclusive remedy is provided by ERISA.7

Fundamental to a determination of whether ERISA applies to a claim for benefits is whether, in fact, the benefits are being claimed from an ERISA plan. In Hansen v. Continental Ins. Co., 940 F.2d 971 (5th Cir.1991), the Fifth Circuit set forth the test for determining whether a “plan” is an “employee welfare benefit plan” for purposes of ERISA. In order for an employee welfare benefit plan to exist, there are two requirements: (1) an intent to benefit employees, and, (2) providing these benefits as described in 29 U.S.C. § 1002(1) and (2).

It is clear that the plan at issue in this case is an ERISA plan within the meaning of the Act. The insurance policy was issued directly to Brown and Root for its employees. Brown and Root purchased the insurance to insure its workers against dis[127]*127ability from both work related and non-work related illnesses and injury.

UNUM Policy No. 316874 meets the criteria of § 1002(1) of ERISA for a number of undisputed reasons. Brown and Root, Inc.

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Bluebook (online)
790 F. Supp. 123, 1992 U.S. Dist. LEXIS 5576, 1992 WL 82163, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nesom-v-brown-root-usa-inc-lamd-1992.