Schnabel v. Philadelphia American Life Insurance

795 F. Supp. 816, 15 Employee Benefits Cas. (BNA) 1574, 1992 U.S. Dist. LEXIS 7448, 1992 WL 117253
CourtDistrict Court, S.D. Texas
DecidedApril 3, 1992
DocketCiv. A. H-90-3948
StatusPublished
Cited by5 cases

This text of 795 F. Supp. 816 (Schnabel v. Philadelphia American Life Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Schnabel v. Philadelphia American Life Insurance, 795 F. Supp. 816, 15 Employee Benefits Cas. (BNA) 1574, 1992 U.S. Dist. LEXIS 7448, 1992 WL 117253 (S.D. Tex. 1992).

Opinion

MEMORANDUM AND ORDER

LAKE, District Judge.

Plaintiff, Bruce Schnabel, seeks declaratory judgment that defendant, Philadelphia American Life Insurance Company (PALI-CO), wrongfully denied insurance coverage to which he was entitled under a conversion privilege in the Group Accident and Health Insurance Contract issued by PALICO to Schnabel’s former employer, Schneider Construction Company. Pending before the Court are Defendant’s Motion for Summary Judgment (Docket Entry No. 18) and Plaintiff’s Motion for Partial Summary Judgment for Declaration Enforcing Benefits Due (Docket Entry No. 31). For the reasons discussed below, the Court will deny defendant’s motion and grant plaintiff’s motion.

I. Background

While employed with Schneider, plaintiff was covered under Schneider’s June 1, *818 1986, Group Accident and Health Contract with PALICO (the “Group Policy”). 1 The Group Policy provided maximum lifetime benefits of $1,000,000 for each covered person. 2 Texas law requires group insurers to provide employees covered by their employers’ group policies the option of either continuing their group coverage or converting it to individual coverage if their eligibility for group coverage terminates. Texas Insurance Code Ann. art. 3.51-6, § 1(d)(3) (Vernon’s Supp.1992). In the “Conversion Privilege” of Schneider’s Group Policy PALICO agreed to “issue an individual contract, in a form customarily issued by it, with benefits not greater than the benefits provided by this Contract” to any employee who became ineligible for group coverage. 3 The conversion privilege does not further define the individual contact to be issued, either by reference to a particular contract form or by an attachment to the Group Policy.

In June of 1986 PALICO introduced an Individual Accident and Health Contract, form 6119, which provided maximum lifetime benefits of $250,000. 4 On July 16, 1986, PALICO notified Schneider that the State of Texas had approved this new “medical conversion policy,” that Schneider should replace its present supply of conversion application forms with the new attached application forms, and that if any employees wished to convert their insurance, they should complete one of the new application forms and submit it along with the premium payment prescribed in the form within 31 days of the expiration of their group coverage. 5 In 1987 PALICO sought and received approval from the Texas Board of Insurance to increase premium rates for employees who had converted their group coverage to individual coverage under policy form 6119. 6 PALICO informed the Texas Board of Insurance that policy form 6119 would not be available to persons whose group coverage terminated after October 31, 1987, and that the rate increases would apply only to persons who had converted their coverage before October 31, 1987. 7 Although PALICO notified everyone who had already converted from group coverage to individual coverage under policy form 6119 of the rate increases, PALICO failed to notify Schneider that it would not accept applications for policy form 6119 after October 31, 1987, or that Schneider should replace its applications for policy form 6119 with another conversion policy application form. 8

Because of a terminal illness, plaintiff’s employment with Schneider ended on December 8, 1989, although his coverage under Schneider’s Group Policy continued through January 30, 1990. 9 Wishing to convert his group coverage to individual coverage, plaintiff completed the conversion application for policy 6119 on file with Schneider and hand delivered it to PALICO on February 28, 1990, together with a check for the premium required for $250,-000 in maximum lifetime benefits shown on the form. 10 In response, PALICO sent plaintiff a letter dated February 28, 1990, *819 stating that the conversion application he had submitted was an old one, and that to convert his group coverage to individual coverage he would have to complete a new application form. 11 The policy to which PALICO alleges plaintiff was entitled to convert (form 974) only provided for maximum lifetime benefits of $7,500. 12 Because plaintiff did not return an application for policy form 974 to PALICO, PALICO denied plaintiff’s application for conversion coverage. 13

On November 13,1990, plaintiff filed suit in state court seeking declaratory judgment that he was entitled to an individual insurance policy providing maximum lifetime benefits of $250,000 in accordance with the application form that he submitted to PALICO. 14 On December 20, 1990, PALICO removed the suit to this Court alleging that plaintiffs claim was one for benefits under an ERISA plan. 15 In his First Amended Original Complaint (Docket Entry No. 25) plaintiff alleged causes of action for failure to disclose a material modification of the conversion benefits of the Group Policy, wrongful denial of benefits, failure to provide proper denial notices, failure to provide sufficient coverage pursuant to the Texas Insurance Code, Article 3.51-6, and arbitrary and capricious conduct. In addition to attorneys’ fees and costs, the relief sought by plaintiff under all causes of action was payment of the benefits he would have been due under the conversion policy for which he applied on February 28, 1990, and for “such other and further relief to which he may be justly entitled.”

II. Pending Motions for Summary Judgment

Summary judgment is authorized if the movant establishes that there is no genuine dispute about any material fact and the law entitles the movant to judgment. Fed. R.Civ.P. 56(c); Thomas v. Harris County, 784 F.2d 648, 651 (5th Cir.1986). The Supreme Court has interpreted the plain language of Rule 56(c) to mandate “the entry of summary judgment, after adequate time for discovery and upon motion, against a party who fails to make a showing sufficient to establish the existence of an element essential to that party’s case, and on which that party will bear the burden of proof at trial.” Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986).

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795 F. Supp. 816, 15 Employee Benefits Cas. (BNA) 1574, 1992 U.S. Dist. LEXIS 7448, 1992 WL 117253, Counsel Stack Legal Research, https://law.counselstack.com/opinion/schnabel-v-philadelphia-american-life-insurance-txsd-1992.