Provident Life & Accident Insurance Company v. Melvyn Cohen, Provident Life & Accident Insurance Company v. Melvyn Cohen

423 F.3d 413, 35 Employee Benefits Cas. (BNA) 2063, 2005 U.S. App. LEXIS 18587, 2005 WL 2063854
CourtCourt of Appeals for the Fourth Circuit
DecidedAugust 29, 2005
Docket04-1270, 04-1386
StatusPublished
Cited by15 cases

This text of 423 F.3d 413 (Provident Life & Accident Insurance Company v. Melvyn Cohen, Provident Life & Accident Insurance Company v. Melvyn Cohen) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Provident Life & Accident Insurance Company v. Melvyn Cohen, Provident Life & Accident Insurance Company v. Melvyn Cohen, 423 F.3d 413, 35 Employee Benefits Cas. (BNA) 2063, 2005 U.S. App. LEXIS 18587, 2005 WL 2063854 (4th Cir. 2005).

Opinion

Affirmed in part and reversed in part by published opinion. Judge TRAXLER wrote the opinion, in which Chief Judge WILKINS and Judge WIDENER Joined.

OPINION

TRAXLER, Circuit Judge.

Provident Life & Accident Insurance Company (Provident) brought this suit against Melvyn Cohen under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C.A. § 1101 et seq. (West 1999 & Supp.2004), seeking recovery of the “total disability” benefits paid to Cohen under a disability income policy (the Policy) and requesting that the district court declare the Policy null and void. Cohen counterclaimed, seeking reinstatement of benefits. After a bench trial, the district court denied Cohen’s counterclaim, denied Provident’s claim seeking recovery of the benefits paid to Cohen, and granted Provident’s request for declaratory relief. Cohen then filed a motion to alter or amend the judgment pursuant to Rule 59(e) of the Federal Rules of Civil Procedure, asking that the district court address Cohen’s entitlement to “residual disability” benefits under the Policy. The district court denied Cohen’s motion.

Cohen appeals from both rulings and raises three issues. Cohen first claims that he satisfies the definition of “totally disabled” under the Policy and is entitled to reinstatement of his benefits. Cohen next argues that, if he is not totally disabled, then he is “residually disabled” under the Policy. Finally, Cohen maintains that the district court should not have declared the Policy null and void. Provident cross-appeals, arguing that the district court should have awarded it a recovery of the benefits paid to Cohen under the Policy. We affirm in part and reverse in part.

*417 I.

After a nine-day bench trial, the district court made the following findings of fact. Cohen was the president and head salesperson at Colonial Distributors (Colonial), a business that sold and distributed cabinets and countertops for kitchens and baths. With approximately 30 years of experience in this business in the greater Washington, D.C. metropolitan area, Cohen had developed a large network of business contacts which allowed him to succeed in this line of work. Cohen worked primarily on “ship and bill direct” jobs for new apartments or hotels. Ship and bill direct means that the makers of the cabinets or countertops ship the product directly to the construction site, where the contractor is responsible for unloading and installing the cabinets and countertops.

A typical job for Cohen involved the following tasks: learning about a construction project from publicly available sources or from contacts in the construction industry, obtaining the blueprint for the construction project, drawing the styles of kitchen or bathroom cabinets or counter-tops needed for the project, obtaining price information from manufacturers, and bidding for the project. If Cohen’s bid was accepted, then he also attended weekly meetings at the job site to track the construction progress; measured the kitchens and bathrooms in advance of the delivery date so that, if necessary, the manufacturer could modify the product before the delivery deadline; and finally, arranged for the product’s arrival in time to permit the contractor to unload and install the product. Successful completion of these tasks involved considerable attention to detail, and Cohen normally worked on several projects at once. As president and head salesman of Colonial, Cohen also handled the firing and hiring of employees, worked on accounts receivable, and trained new salespeople.

After suffering a heart attack in November 1995, Cohen, on the advice of his physician, spent time recuperating, assisting in the completion of numerous projects at Colonial, and closing the sale of his business interest in Colonial in June 1997. Cohen also applied for and received total disability benefits from Provident under the Policy. From March 1996 through June 1999, Cohen received approximately $238,000 in total disability benefits. Provident terminated Cohen’s benefits on June 21, 1999, however, because an investigation revealed that Cohen’s medical condition had improved and that Cohen was engaging in his prior occupational activities, despite statements he made to the contrary on his monthly supplemental statement of claim forms.

Specifically, Provident demonstrated at trial that, in July 1997, Cohen began working without compensation for his sons’ new kitchen and bath business named Montgomery Kitchen and Bath (“MKB”), and recruited a salesperson from Colonial, Robert Cutler, to join MKB. Cohen worked the pricing part of the ship and bill direct jobs, and Cutler completed the field work. This arrangement increased the volume of work that MKB could manage, and several of Colonial’s large customers switched suppliers in 1997 when MKB opened for business.

In his work for MKB, Cohen handled the stress of meeting deadlines and dealing with customers, trained his sons in the business, and supervised Cutler’s work. Cohen also held himself out as being in charge of MKB’s business. For example, Kevin MacClary of Fougler-Pratt Contracting, for whom MKB did several projects during 1997-1999, testified that he dealt almost exclusively with Cohen, believed Cohen was “the principal” at MKB, *418 and, if there were any problems with the project, turned to Cohen for assistance. J.A. 662-63.

Finally, the medical evidence revealed that Cohen’s physical capacity had substantially improved since his heart attack. In January 1997, Cohen was able to engage in physical activity requiring an oxygen intake of nine metabolic equivalents (“METs”). In February 2000, Cohen exercised at a level of ten METs. 1

Despite all this work activity, Cohen submitted a supplemental statement of claim form to Provident every month from the time MKB began its business. When asked what activities he engaged in, Cohen responded that he was exercising, participating in a cardiovascular treatment program, and doing chores and volunteer work. These supplemental statement of claim forms also requested that Cohen describe which of the duties of his former position he was unable to do. Every month, Cohen replied, “all duties.” J.A. 3507-52.

Based on this evidence, the district court denied Cohen’s counterclaim for reinstatement of his benefits, ruling that Cohen was not totally disabled as defined by the Policy. The Court also denied Provident’s federal common law unjust enrichment claim, reasoning that such claim failed under our decision in Provident Life & Accident Insurance Co. v. Waller, 906 F.2d 985 (4th Cir.1990), and was inconsistent with the Supreme Court’s decision in Great-West Life & Annuity Insurance Co. v. Knudson, 534 U.S. 204, 122 S.Ct. 708, 151 L.Ed.2d 635 (2002). The district court granted Provident’s request for declaratory relief, however, declaring the Policy null and void under 29 U.S.C.A. § 1132(a)(3)(B) (West 1999).

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423 F.3d 413, 35 Employee Benefits Cas. (BNA) 2063, 2005 U.S. App. LEXIS 18587, 2005 WL 2063854, Counsel Stack Legal Research, https://law.counselstack.com/opinion/provident-life-accident-insurance-company-v-melvyn-cohen-provident-life-ca4-2005.