Santana v. Deluxe Corp.

12 F. Supp. 2d 162, 1998 U.S. Dist. LEXIS 16813, 1998 WL 293752
CourtDistrict Court, D. Massachusetts
DecidedJune 4, 1998
DocketCIV.A. 94-30111-FHF
StatusPublished
Cited by14 cases

This text of 12 F. Supp. 2d 162 (Santana v. Deluxe Corp.) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Santana v. Deluxe Corp., 12 F. Supp. 2d 162, 1998 U.S. Dist. LEXIS 16813, 1998 WL 293752 (D. Mass. 1998).

Opinion

MEMORANDUM AND ORDER

FREEDMAN, Senior District Judge.

I. INTRODUCTION

Looking to compel his former employer to change its allegedly evil ways, plaintiff Mariano Santana (“Santana”) brought a nine-count complaint against defendants Deluxe Corporation (“Deluxe”) and John Hancock Mutual Life Insurance Company (“John Hancock”) claiming that Deluxe and John Hancock have denied certain health care benefits to participants of a Deluxe employee health insurance benefit .plan. Having granted summary judgment to John Hancock on all counts, see Santana v. Deluxe Corp., 920 F.Supp. 249 (D.Mass.1996), the Court now considers motions for summary judgment from both Santana and Deluxe.

II. FACTS

Santana was employed by Deluxe, a company in the business of printing checks and forms for financial institutions, between November 28,1977 and November 2,1988, at its facility in Springfield. Santana became disabled in an industrial accident in April 1988. Under Deluxe’s six-month salary continuation plan, he continued to receive weekly salary benefits until November 2,1988.

In October 1988, he received a letter from Deluxe explaining that he would be terminated if he could not return to work by November 2, 1988. Because Santana could not return, he- was terminated. ' In January 1989, Santana moved from Massachusetts to Puer-to Rico. After termination, Santana applied for disability benefits under Deluxe’s Long Term Disability (“LTD”) Plan. On April 11, 1990, Santana received notification that his disability benefits were approved retroactive to January 1, 1989. Accordingly, he received a lump sum payment covering that period, with no federal income tax withheld from'it. He has received health care benefits under the LTD Plan ever since, remitting a premium to Deluxe.

Deluxe requires participants in the LTD Plan to apply for Social Security Disability Benefits (“SSDI”) from the federal government to offset weekly salary plan benefits and LTD Plan benefits paid for the same period. In May 1991, the Social Security Administration awarded Santana SSDI benefits, retroactive to the date of his disability in October 1988. At the same time, he was notified that he was entitled to Medicare health insurance starting from October 1990, two years after the date he qualified for SSDI. As a Social Security recipient, Santana was automatically enrolled in Medicare Part A coverage, which provides insurance for hospital treatment, but not in Medicare Part B, which requires recipients to enroll and pay premiums for physician expenses.

When Santana began to collect benefits under the LTD Plan in April 1990, Deluxe notified him that he and his family were enrolled as participants in Deluxe’s John Hancock/HMO plan (“the Indemnity Plan” or “Plan”), a health benefit plan funded by employer and participant contributions and managed by John Hancock. In June 1991, Deluxe sent Santana a copy of its 1991 employee handbook, ’entitled “Checking In with Deluxe,” that described the terms ■ of the Indemnity Plan. The terms of the 1991 handbook form the basis of this dispute. Specifically, The handbook contained the following statement under the heading “Submitting a *166 Claim for a Deluxe Retiree Eligible for Medicare”:

NOTE: The benefits provided by the Deluxe Employee Health Care Plan shall be reduced by an amount equal to the benefits you are entitled to receive under the Medicare Program. As a retiree, when you qualify for Medicare, Medicare then becomes your first line of coverage. It pays first, and the Deluxe Employee Health Care Plan then considers the charges that Medicare didn’t cover. The Deluxe plan will pay the difference between what Medicare pays and what the Deluxe plan would have paid alone. So it is very important to enroll for Medicare coverage, both Part A, hospital, and Part B, supplemental, when you become eligible for it in order to have adequate medical coverage. This also applies to former Deluxe employees who become eligible for Medicare due to disability (after two years of disability).

Beginning in November 1991, Santana incurred medical expenses from treatment by physicians and other medical providers, amounting to roughly $l;600. Santana applied to Medicare to cover the expenses but was informed that he could not receive Medicare Part B benefits because he was not enrolled. Deluxe also denied his claim for the expenses under its Indemnity Plan because, according to its interpretation of the handbook language, it considered the services covered by Medicare Part B. Santana did not file a formal written appeal through the Indemnity Plan’s process.

In January 1992, Santana applied for Medicare Part B coverage, and became enrolled in July 1992. Deluxe has paid for all other expenses Santana incurred after October 1990 that were not covered by Medicare.

In February 1994, Santana’s counsel requested fi*om Deluxe its employee benefit plans in which Santana participated. In response, Deluxe sent plaintiffs counsel portions of its “Checking in with Deluxe” booklets from 1988 to 1993 describing the Indemnity Plan and LTD Plan.

In May 1994, Santana filed a nine-count complaint against Deluxe and John Hancock, alleging an improper denial of benefits (Count Two), failure to provide an adequate summary plan description (“SPD”) under 29 TJ.S.C. § 1022(b) (Count Three), breach of contract (Count Four), violation of the Medicare As Secondary Payer (“MSP”) statute, 42 U.S.C. § 1395y(b) (Counts Five and Six), and requesting certification of a class action (Count One), injunctive relief (Count Seven), attorney’s fees (Count Eight) and double damages (Count Nine).

In March 1996, the Court granted summary judgment to John Hancock on all counts. The Court now turns to the summary judgment motions before it.

III. STANDARD OF REVIEW

Under Rule 56 of the Federal Rules of Civil Procedure, the essential purpose of summary judgment is “to pierce the boilerplate of the pleadings” and appraise the proof to determine whether a trial is necessary. See Wynne v. Tufts Univ. Sch. of Med., 976 F.2d 791, 794 (1st Cir.1992), cert. denied, 507 U.S. 1030, 113 S.Ct. 1845, 123 L.Ed.2d 470 (1993). When summary judgment is at stake, the Court must scrutinize the record in the light most favorable to the nonmoving party, “indulging all reasonable inferences in that party’s favor,” Griggs-Ryan v. Smith, 904 F.2d 112, 115 (1st Cir.1990), yet disregarding unsupported allegations, unreasonable inferences, and concluso-ry speculation. See Smith v. F.W. Morse & Co., 76 F.3d 413, 428 (1st Cir.1996); Medinar-Munoz v. R.J. Reynolds Tobacco Co., 896 F.2d 5, 8 (1st Cir.1990). If no genuine issue of material fact percolates through the record and the movant is entitled to judgment as a matter of law, then summary judgment is proper because a trial would serve no useful purpose. See Fed.R.Civ.P.

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Bluebook (online)
12 F. Supp. 2d 162, 1998 U.S. Dist. LEXIS 16813, 1998 WL 293752, Counsel Stack Legal Research, https://law.counselstack.com/opinion/santana-v-deluxe-corp-mad-1998.