O'Bryhim v. Reliance Standard Life Insurance

997 F. Supp. 728, 1998 U.S. Dist. LEXIS 4095, 1998 WL 111306
CourtDistrict Court, E.D. Virginia
DecidedFebruary 23, 1998
DocketCiv.A. 95-335-A
StatusPublished
Cited by8 cases

This text of 997 F. Supp. 728 (O'Bryhim v. Reliance Standard Life Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
O'Bryhim v. Reliance Standard Life Insurance, 997 F. Supp. 728, 1998 U.S. Dist. LEXIS 4095, 1998 WL 111306 (E.D. Va. 1998).

Opinion

MEMORANDUM OPINION

CACHERIS, District Judge.

This matter comes before the Court on Plaintiffs Motions to reopen case after remand; for additional benefits and relief; and for attorney’s fees and costs. For the reasons set forth below, Plaintiffs Motion is GRANTED in part.

I.

Plaintiff, Ray A. O’Bryhim (“O’Bryhim”) filed a Complaint in this Court on March 17, 1995, pursuant to 29 U.S.C. 1132(a)(1)(B) and (a)(3), the ERISA statute, seeking to recover employee benefits due under the terms of a group long-term disability insurance policy *731 covering employees of the Pohanka Automotive Group.

Prior to filing with this Court, O’Bryhim filed an administrative claim with Reliance Standard Life Insurance Company (“Reliance”), which was denied on October 28, 1993. O’Bryhim appealed this administrative decision three separate times, on December 16,1993, April 8,1994, and on June 22,1994.

Following trial, in a Memorandum Opinion dated May 10,1996 this Court found that the actions of Reliance were arbitrary and capricious in denying O’Bryhim’s claim. The Court also made several findings of fact. The Court found that during his employment with Pohanka, O’Bryhim contracted chronic fatigue syndrome (“CFS”). The Court further found that O’Bryhim’s disability occurred on September 1, 1992, based on the medical evidence submitted on O’Bryhim’s behalf.

The Court then remanded the case back to the Plan Administrator so he could fully hear the evidence presented in Court to arrive at a decision on whether or not to award O’Bryhim benefits. The Court specifically directed the Plan Administrator, on remand, to consider O’Bryhim’s additional telephone calls that were not fully recorded by Reliance’s claims examiners regarding his condition, and also to consider certain information testified to by Dr. Levine.

On November 20, 1996, the Defendant issued its decision on remand awarding O’Bryhim long-term disability benefits, but limiting the time period for which it would pay such benefits. Specifically, the Defendant found that Plaintiff was not disabled until the date of January 1, 1993, four months later than September 1, 1992, the date on which this Court found Plaintiff had been disabled. The Defendant also found that Plaintiff was not suffering from CFS, contradictory to this Court’s findings, but that Plaintiff was instead suffering from a mental or emotional disorder, for which Plaintiff was entitled to no more than two years of benefits.

II.

Defendants argue that this Court did not retain jurisdiction over this matter and therefore has no ability to hear this motion. The Court, however, specifically retained jurisdiction over this matter by Order dated May 21,1996.

Defendants also argue that O’Bryhim has failed to exhaust his administrative remedies since he did not appeal the decision upon remand through the Plan Administrator within sixty days. Section 1132(a)(1)(B) of ERISA specifically empowers employee benefit plan participants and beneficiaries to bring a federal civil action to recover benefits or enforce rights under the plan. “There is no explicit requirement that administrative remedies be exhausted before seeking federal court relief; however, it is within the district court’s discretion to require that such administrative avenues be pursued before resort is had to any judicial remedy.” Keel v. Group Hospitalization Med. Services, Inc., 695 F.Supp. 223, 227 (E.D.Va.1988).

The Court first notes that, following O’Bryhim’s initial claims denial on October 28, 1993, O’Bryhim made three separate appeals to Reliance. Only after these three individual appeals were exhausted did O’Bryhim file a case in federal court. After trial, on remand, the decision regarding benefits due to O’Bryhim was made by the appeal section of Reliance. If O’Bryhim were to appeal the decision on remand, the same individuals would again determine O’Bryhim’s claim. The Court thus finds that Plaintiff has made a “clear and positive” showing that any further administrative appeal would be futile. See Makar v. Health Care Corp. of Mid-Atlantic, 872 F.2d 80, 83 (4th Cir.1989).

Accordingly, the Court finds that it has jurisdiction to consider Plaintiff’s claims for additional relief and for attorney’s fees and costs.

III.

O’Bryhim moves this Court for the following additional relief:

(1) Four Months of Additional Long Term Disability Benefits Less Other Income Offset $17,975.00

(2) Additional Pre-Judgment Interest Due $19,763.00

(3) Sales Commissions Paid By Plaintiff On Sale of Residence $16,320.00

(4) Additional Income Tax Liability Paid by Plaintiff Due to Invasion of Retirement Plan $ 8,666.00

*732 A. Four Months Additional Benefits Plus Pre-Judgment Interest

In this Court’s Memorandum Opinion dated may 5, 1996, the Court found as a matter of fact that O’Bryhim’s disability occurred on September 1, 1992. On remand, Defendant determined that O’Bryhim was not disabled on September 1, 1992, but rather became disabled on January 1, 1993. Defendant also upset this Court’s finding of fact that O’Bryhim was suffering from CFS, and found, rather, that O’Bryhim was suffering from a mental or emotional condition. Under the plan, a mental or emotional disability can be covered only up to a period of two years.

Plaintiff argues that to allow Defendant to adopt a wholly new view of this case on remand, ignoring the Court’s specific findings of fact, would render the court’s review of administrative decisions essentially a nullity, if the administrator can reverse the court.

The Court finds that Defendant substituted its own findings of fact for the Court’s findings as set forth in its Memorandum Opinion dated May 5, 1996 and that such actions are arbitrary and capricious. Accordingly, the Court GRANTS in part Plaintiffs Motion for Additional Relief. Specifically, the Court finds that Defendant shall pay Plaintiff the sum of $17,975.00 for four months of additional long term disability benefits plus $11,225.00 additional pre-judgment interest 1 , for the total of $29,200.00.

B. Sales Commissions from Sale of House and Tax Resulting from Early k01(k) withdrawal

O’Bryhim claims that he was forced to withdraw funds from his retirement savings and was caused to pay income tax on these withdrawals. In addition, he claims that he was forced to sell his family’s home because he was no longer able to afford to pay the mortgage.

The law is unclear as to whether allowances for these kinds of damages may be made under the portion of ERISA providing for “other equitable relief.” While the Court is sympathetic to O’Bryhim’s losses, the Court finds that Defendant’s denial of this type of benefit, was not arbitrary and capricious. Accordingly, Plaintiffs Motion for Additional Relief is DENIED in part.

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Bluebook (online)
997 F. Supp. 728, 1998 U.S. Dist. LEXIS 4095, 1998 WL 111306, Counsel Stack Legal Research, https://law.counselstack.com/opinion/obryhim-v-reliance-standard-life-insurance-vaed-1998.