Pocchia v. Prudential Insurance

74 F. Supp. 2d 240, 23 Employee Benefits Cas. (BNA) 3003, 1999 U.S. Dist. LEXIS 17471, 1999 WL 1029653
CourtDistrict Court, E.D. New York
DecidedNovember 5, 1999
Docket96 CV 5607(ILG), 98 CV 961(ILG)
StatusPublished
Cited by5 cases

This text of 74 F. Supp. 2d 240 (Pocchia v. Prudential Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pocchia v. Prudential Insurance, 74 F. Supp. 2d 240, 23 Employee Benefits Cas. (BNA) 3003, 1999 U.S. Dist. LEXIS 17471, 1999 WL 1029653 (E.D.N.Y. 1999).

Opinion

MEMORANDUM and ORDER

GLASSER, District Judge.

Plaintiffs in these consolidated actions are former full-time employees of defendant Daily News, L.P. (“DNLP”), who, since 1994, have been receiving benefits under a long-term disability plan (the “LTD Plan,” or the “Plan”), which is one of the benefits made available to employees under the Daily News, L.P. Benefits Program (the “DNLP Benefits Program,” or the “Program”), also a defendant in this case. Benefits under the LTD Plan are provided and underwritten by defendant insurer, Prudential Insurance Company (“Prudential”). Plaintiffs allege that their rights under the LTD Plan and under controlling provisions of the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), 29 U.S.C. § 1001 et seq., were violated when defendants reduced, or sought to reduce, their Plan benefits by the amount they were receiv *242 ing in disability benefits from other sources, including Workers’ Compensation and Social Security. Defendants allege in response that those reductions in benefits are binding on the plaintiffs, pursuant to offset provisions specifically set forth in the terms of the contract between DNLP and Prudential under which the Plan was made available to plaintiffs, and under settled principles of ERISA jurisprudence. Accordingly, the defendants have interposed counterclaims against plaintiffs Pocchia and Molina seeking return of excess payments made before offset amounts had been calculated. 1

Plaintiffs here seek summary judgment on their claims, and dismissal of defendants’ counterclaims. Defendants move in turn for summary judgment dismissing plaintiffs’ claims, and granting their counterclaims. Prudential also seeks a judgment, pursuant to 28 U.S.C. § 2201, declaring that its reductions of plaintiffs’ benefits pursuant to the Plans offset provisions have been proper, and an award of costs, and attorneys’ fees pursuant to 29 U.S.C. § 1132(g). For the reasons that follow defendants’ motions for summary judgment dismissing plaintiffs’ claims and granting their counterclaims are granted in their entirety; plaintiffs’ motion for summary judgment is denied, and their action is dismissed; Prudential’s action for a declaratory judgment is granted to the extent that the judgment they seek is set forth in this memorandum and order; and Prudential’s motion for an award of costs and attorneys’ fees is denied.

FACTS

A. The DNLP Benefits Program

Plaintiffs were all longtime employees of DNLP and its predecessors, who left full-time employment at different times in 1994 and were subsequently awarded disability benefits. Plaintiffs were non-union, supervisory employees, and as such, their benefits were administered under the DNLP Benefits Program. The Program’s benefits package includes medical and dental insurance, life insurance, a 401(k) program, and both short-term and long-term disability plans.

In 1991, following a strike by delivery drivers against the Daily News, the paper was acquired by Robert Maxwell. By 1993, Maxwell had run the Daily News into bankruptcy, and it was acquired by its current publisher, DNLP. The DNLP Benefits Program was established at that time, under new insurance contracts with Prudential, to replace the benefits program that had existed during the years of Maxwell’s proprietorship. (DNLP’s Rule 56.1 Statement at ¶¶ 3-5; Prudential’s Rule 56.1 Statement, Exh. I.) Part of DNLP’s motivation in contracting for a new employee benefits regime was to cut costs. Thus, under the new Plan, long-term disability benefits were capped at 60 percent of income. Under the previous long-term disability plan, that figure had been 66% percent. (Id. at ¶ 7.) 2

Prudential began insuring eligible DNLP employees, and DNLP began pay *243 ing premiums in consideration of that coverage, on January 8, 1993. (Rado Aff. at ¶ 7.) In September, 1993, Prudential presented DNLP with a draft “Benefit Booklet” for “Contract No. GW-22581,” setting forth a detailed summary of the terms governing coverage under all of the insurance and benefits plans comprising the DNLP Benefits Program. (Prudential’s Rule 56.1 Statement, Exh. I.) The draft Benefit Booklet contains a description of the “Offset Amount” applicable to awards of long-term disability benefits under the Plan, which makes clear that such awards will be reduced by amounts received under workers’ compensation laws, and the United States Social Security Act, inter alia. (Id. at 7-8, 15-17.) The Benefits Booklet also contains this passage, pertinent to the dispute between the parties concerning the significance of the “Reimbursement Agreement” Prudential asks long-term disability beneficiaries to sign:

Until you give Prudential written proof that you have completed [the process of applying for and securing Social Security benefits, or appealing any denial of such benefits through the Administrative Law Judge level], Prudential may: (1) estimate your monthly Social Security benefit; and (2) use that amount to determine your Adjusted Benefit. But, Prudential will not estimate Social Security benefits while your application and appeals are pending if you sign Prudential’s Reimbursement Agreement.

(Id. at 16.) It is not disputed that the Benefits Booklet dated September 1993 was not distributed to DNLP employees covered by the DNLP Benefits Program. The parties also agree that no subsequent draft of the Benefits Booklet (there were several generated between September, 1993, and November, 1996) was distributed to eligible DNLP employees. (Rumeld Aff., Exh. D, Wooley Dep. at 64; Rado Aff. at ¶¶ 8-10.)

In July, 1997, Prudential and DNLP executed Group Contract No. GW-22581. (Prudential’s Rule 56.1 Statement, Exh. J.) The Group Contract is dated and expressly takes effect on January 8, 1993, and specifically incorporates by reference draft of the Benefits Booklet dated October 6, 1995 (hereinafter, the “Contract Benefits Booklet”), setting forth the terms of the different kinds of coverage available under the Contract, through the DNLP Benefits Program. (Id. at PRU, 00003, 00016, 00055, 00061.) The Contract Benefits Booklet provides that long-term disability coverage is to be made available to eligible participants in the Program in amounts equal to the difference between 60 percent of the covered employee’s pre-disability monthly salary, and the total of certain “Periodic Benefits.” (Id. at 00071-72, 00078-80.) These “Periodic Benefits” are defined under the Contract as including benefits received under any Workers’ Compensation law, and the United States Social Security Act, among other sources. (Id. at 00079.) The Contract Benefits Booklet also contains language identical to that just quoted concerning the role of the “Reimbursement Agreement” in the determination of long-term disability benefits under the Plan. (Id.)

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74 F. Supp. 2d 240, 23 Employee Benefits Cas. (BNA) 3003, 1999 U.S. Dist. LEXIS 17471, 1999 WL 1029653, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pocchia-v-prudential-insurance-nyed-1999.