Peitrowski v. ACIA

65 F. Supp. 2d 614, 1999 U.S. Dist. LEXIS 15099, 1999 WL 782230
CourtDistrict Court, E.D. Michigan
DecidedSeptember 29, 1999
Docket99-70295
StatusPublished
Cited by1 cases

This text of 65 F. Supp. 2d 614 (Peitrowski v. ACIA) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Peitrowski v. ACIA, 65 F. Supp. 2d 614, 1999 U.S. Dist. LEXIS 15099, 1999 WL 782230 (E.D. Mich. 1999).

Opinion

OPINION AND ORDER REGARDING CROSS-MOTIONS FOR SUMMARY JUDGMENT

ROSEN, District Judge.

I. INTRODUCTION

On January 5, 1999, Plaintiffs Gerald *615 and Catherine Peitrowski 1 commenced this action in Wayne County Circuit Court, State of Michigan, alleging that Defendants unlawfully reduced their payments of benefits under Plaintiffs no-fault automobile insurance policy and his employer-sponsored disability plan upon his receipt of federal Social Security disability benefits. Specifically, although Plaintiff initially received full benefits under both the no-fault policy and the disability plan following his injury in an automobile accident, each of these benefits subsequently was reduced by the full amount of Plaintiffs Social Security benefits. Defendants Aet-na U.S. Healthcare and Daimler-Chryslér Corporation 2 removed the case to this Court on January 26, 1999, 3 construing the Complaint as seeking to recover benefits or enforce rights under an employee benefit plan, and asserting that such claims are preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq.

On July 14, 1999, each of the parties filed a motion for summary judgment. Defendant ACIA argues that a Michigan statute, Mich.Comp.Laws § 500.3109(1), requires the deduction of the full amount of federal Social Security disability benefits from the benefits otherwise payable to Plaintiff under his no-fault automobile insurance policy. For its part, Defendant Aetna contends that it likewise was entitled under the terms of Daimler-Chrysler’s ERISA plan to deduct the full amount of Plaintiffs Social Security benefits from the amounts owed to Plaintiff under his short- and long-term disability plans. Plaintiff, while acknowledging each insurer’s separate right to deduct Social Security benefits from the amount it must pay, argues that a full deduction by both insurers amounts to an inequitable “double set-off’ and should not be permitted.

On September 23,1999, the Court held a hearing on the parties’ cross-motions. Having considered the arguments of counsel at this hearing, and having reviewed the briefs and supporting documents submitted by the parties, the Court is now prepared to rule on the motions. This Opinion and sets forth the Court’s ruling.

II. FACTUAL BACKGROUND

A. Plaintiffs Injury and Claims for Benefits

On November 8, 1996, Plaintiff Gerald Peitrowski was injured in an automobile accident when another vehicle struck his pickup truck from behind. As a result of this collision, Plaintiff suffered numerous injuries, including a closed-head injury.

Following, this accident, Plaintiff, a twenty-five yegr employee of Defendant Daimler-Chrysler and a participant in his employer’s Life, Disability and Health Care Benefits Program (the “Daimler-Chrysler Plan”), applied for “Sickness and Accident” (ie., short-term disability) benefits under the Daimler-Chrysler Plan, identifying the nature of his disability as “mental.” Defendant Aetna paid these short-term disability benefits, in the amount of $612 per week, from December 23, 1996 until April 17, 1997, when Plaintiff returned to work.

On July 25, 1997, however, Plaintiff ceased working for Daimler-Chrysler, and has remained off the job since that date. After taking approximately two weeks of vacation time, Plaintiff again applied for short-term disability benefits under the Daimler-Chrysler Plan, this time identifying the nature of his disability as “nerves.” Aetna began payments of these disability benefits on August 14, 1997, again in the amount of $612 per week.

*616 Because his short-term disability was scheduled to terminate on August 11, 1998, Plaintiff applied for “Extended Disability” (ie., long-term disability) benefits under the Daimler-Chrysler Plan. On this application, Plaintiff identified himself as totally disabled, and described the nature of his disability as a “closed head injury.” He also stated that “I am not rec[ei]ving Social Security and I’ve heard nothing from them.” Aetna approved this application on August 31, 1998, effective August 12, 1998. Under the Plan, Plaintiff is eligible for long-term disability payments of $2,405 per month, subject to the Social Security setoff discussed below.

During this time, Plaintiff also applied for and received benefits from Defendant ACIA under his no-fault automobile insurance policy. In particular, the ACIA policy provides “personal protection insurance benefits,” which cover Plaintiffs medical expenses 4 and his lost income from work he “would have performed during the first 3 years after the date of the accident if he ... had not been injured.” Mich.Comp. Laws § 500.3107(l)(b). Effective August 28, 1997, ACIA began paying work-loss benefits to Plaintiff under his no-fault policy, in the apparent amount of $3545 per month. 5

Thus, as of August, 1997, Plaintiff was receiving a combined amount of approximately $6,000 per month in disability and no-fault work-loss benefits. Pursuant to Mich.Comp.Laws § 500.3107(l)(b), Plaintiffs work-loss benefits under his ACIA policy will expire on November 8, 1999, three years after the date of his accident.

B. The Reduction in Plaintiffs Disability and Work-Loss Benefits Following His Receipt of Social Security Benefits

In late June or early July of 1998, the federal Social Security Administration (“SSA”) notified Plaintiff that he was entitled to receive Social Security disability benefits effective May, 1997. 6 Accordingly, SSA awarded Plaintiff $18,314 in retroactive benefits covering the period from May, 1997 through May, 1998, and Plaintiff began receiving $1,433 per month in Social Security disability benefits.

This award of Social Security benefits affected both Plaintiffs disability benefits under the Daimler-Chrysler Plan and his work-loss benefits under the ACIA no-fault policy. First, the express terms of the Daimler-Chrysler Plan dictate that both “Sickness and Accident” (short-term) and “Extended Disability” (long-term) benefits are to be reduced by the amount of any disability benefits to which Plaintiff “is entitled ... under the Federal Social Security Act.” (Aetna’s Motion for Summary Judgment, Ex. A, Daimler-Chrysler Plan at 27, 34.) The Plan further authorizes Aetna to deduct from future benefit payments any amounts previously overpaid to Plaintiff:

If it is determined that any benefit or benefits paid to an employee under the group insurance referred to in Section I. *617

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Cite This Page — Counsel Stack

Bluebook (online)
65 F. Supp. 2d 614, 1999 U.S. Dist. LEXIS 15099, 1999 WL 782230, Counsel Stack Legal Research, https://law.counselstack.com/opinion/peitrowski-v-acia-mied-1999.