Phillips, Joann v. Metropolitan Life Insurance Company & Verizon Employee Benefits

405 S.W.3d 880, 2013 WL 1928518, 2013 Tex. App. LEXIS 5839
CourtCourt of Appeals of Texas
DecidedMay 10, 2013
Docket05-11-00678-CV
StatusPublished
Cited by4 cases

This text of 405 S.W.3d 880 (Phillips, Joann v. Metropolitan Life Insurance Company & Verizon Employee Benefits) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Phillips, Joann v. Metropolitan Life Insurance Company & Verizon Employee Benefits, 405 S.W.3d 880, 2013 WL 1928518, 2013 Tex. App. LEXIS 5839 (Tex. Ct. App. 2013).

Opinion

OPINION

Opinion by

Justice MURPHY.

JoAnn Phillips appeals from a summary judgment rendered in favor of Metropolitan Life Insurance Company and The Verizon Employee Benefits Committee (VEBC) on her claim that MetLife, acting on behalf of VEBC, improperly withheld long-term disability benefits to which she was entitled. We affirm.

I. BACKGROUND

During her employment as a benefit specialist with a subsidiary of Verizon Communications, Inc., Phillips participated in an employee welfare benefit plan (the Plan) governed by the Employee Retirement Income Security Act of 1974 (ERISA). 29 U.S.C.A. §§ 1001-1461. VEBC is the Plan administrator; MetLife is the Plan’s claims administrator.

Phillips suffered from various health conditions. In April 2002, Verizon approved her request for an accommodation under the Americans with Disabilities Act to transition to a twenty-hour work week. Phillips ultimately stopped working in 2007 and became eligible for disability benefits under the Plan. Her date of disability is February 16, 2007. After receiving fifty-two weeks of short-term disability benefits, Phillips applied for and began receiving LTD benefits in 2008. Although the parties agree that Phillips is disabled and thus entitled to benefits, they disagree about the amount of monthly benefits due.

A. The Plan

LTD claims under the Plan are paid from the Verizon Long Term Disability Trust for Active Employees, which is funded with employee contributions. MetLife, as the claims administrator, received a fee to process disability claims and had the authority to make final determinations regarding eligibility and benefit claims. The Verizon summary plan description (SPD) 2 provided to Phillips specifically identifies MetLife’s authority as including discretion to (1) interpret the disability income program based on “provisions and applicable law and make factual determinations about claims,” (2) determine eligibility for benefits, (3) decide “the amount, form and timing of benefits,” and (4) resolve “any other matter” under the program raised by a participant or beneficiary or identified by the claims administrator. The SPD also provides that “[i]n case of an appeal, the claims administrators’ decisions are final and binding on all parties to the full extent permitted under applicable law,” unless the participant or beneficiary later proves the “decision was an abuse of administrator discretion.”

*887 The SPD describes the details related to a participant’s disability coverage, but it advises that the person’s health and well-being benefits, such as disability coverage, are governed by the official plan document, labeled “The Plan for Group Insurance.” Both the SPD and the Plan expressly incorporate the SPD by reference into the Plan as “the source of specific information relating to [a participant’s] disability benefits.” 3

B. LTD Benefit Calculation

According to the SPD, Phillips’s LTD benefit calculation is based on her “annual benefits compensation” and the LTD coverage option she was enrolled in at that time. The figure used for Phillips’s “annual benefits compensation” is determined “at the time [she] first became totally disabled” under the short-term disability plan and is made up of the following amounts as of July 1 of the previous calendar year:

• Base pay, including any temporary increases.
• Short-term incentives, such as Verizon Incentive Plan awards.
• Commissions (based on a rolling 12-month period, beginning July 1).
• Foreign service premiums.

Overtime pay, discretionary awards, sales draws, and bonuses are excluded from annual benefits compensation. The SPD defines “pay” as a participant’s “annual base salary,” which does not include overtime pay, incentives, or “[a]ny other element of compensation other than base recurring salary.”

Phillips’s “monthly unreduced LTD benefit” is calculated by dividing her “annual benefits compensation by 12 to arrive at [her] monthly benefits compensation amount.” That amount is then multiplied by Phillips’s benefit level, which was 50%. The monthly LTD benefit amount also is reduced by benefits provided from “[o]ther sources of disability income,” such as social security disability income and “[p]ension benefits from a Verizon pension plan, if [Phillips] elect[s] to receive them.” If the monthly LTD benefit is reduced by other sources of disability income, the monthly benefit “will not be reduced below whichever of these is greater”: 10% of her unreduced monthly LTD benefit or $100. But this minimum monthly benefit amount does not apply if the participant receives an overpayment of benefits.

C. Phillips’s Claim for LTD Benefits

MetLife approved Phillips’s claim for LTD benefits by letter dated September 30, 2008. For the period beginning February 15, 2008 (the date she became eligible for LTD benefits) through December 31, 2009, Phillips was paid LTD benefits based on an annual benefits compensation figure of $47,400, for an unreduced LTD benefit of $1,975.00 per month. 4 That monthly benefit also was reduced by Phillips’s social security disability income. On December 2, 2008, MetLife wrote to Phillips that it had reduced her monthly benefit by an additional amount of $760.25 per month based on her receipt of pension benefits effective November 2008. After the second reduction, her LTD benefit was $197.50 per month, which was the minimum monthly benefit amount under the Plan (10% of her unreduced monthly LTD benefit).

The reduction in Phillips’s monthly LTD benefit based on pension benefits followed her certification, signed November 17, *888 2008, that she had “elected the Lump Sum option from the Verizon Management Pension Plan to commence on November 1, 2008.” This “payment option” paid $160,963.40. That same day, her spouse also signed a consent form in which he certified his consent “to [his] spouse’s election to begin benefits now.”

When she elected the lump sum option, Phillips chose to roll over her pension benefits into a traditional IRA. And in accordance with her election, the Verizon benefits center sent Phillips a check payable to ING Bank for deposit into the “IRA OF JOANN H PHILLIPS.” The check stub described the payment amount as a “CASH DISTRIBUTION.” Phillips signed an IRA deposit form, indicating she was enclosing a check for deposit; the “deposit type” was for “Employer Plan to IRA Rollover.”

On January 8, 2010, MetLife informed Phillips by letter that her salary from which the annual benefits compensation was derived was “incorrectly reported” and the correct unreduced benefit payable was $1,402.08 per month, not $1,975.00 per month. This corrected amount was based on an annual benefits compensation figure of $33,650.

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Bluebook (online)
405 S.W.3d 880, 2013 WL 1928518, 2013 Tex. App. LEXIS 5839, Counsel Stack Legal Research, https://law.counselstack.com/opinion/phillips-joann-v-metropolitan-life-insurance-company-verizon-employee-texapp-2013.