Silva v. Fortis Benefits Insurance

437 F. Supp. 2d 819, 2006 U.S. Dist. LEXIS 47296, 2006 WL 1928692
CourtDistrict Court, N.D. Illinois
DecidedJuly 12, 2006
Docket05 C 3340
StatusPublished
Cited by3 cases

This text of 437 F. Supp. 2d 819 (Silva v. Fortis Benefits Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Silva v. Fortis Benefits Insurance, 437 F. Supp. 2d 819, 2006 U.S. Dist. LEXIS 47296, 2006 WL 1928692 (N.D. Ill. 2006).

Opinion

MEMORANDUM OPINION AND ORDER

JEFFREY COLE, United States Magistrate Judge.

INTRODUCTION AND BACKGROUND OF THE LITIGATION

Union Security Insurance Company (“USIC”), formerly known as Fortis Benefits Insurance Company (“Fortis”), moves for a protective order pursuant to Rule 26(c)(1), Federal Rules of Civil Procedure, precluding plaintiffs discovery requests for the production of documents, interrogatories, request for admission of facts and genuineness of documents, and notice of deposition of Tracie Hoffman (“the Discovery Requests”). For the reasons discussed below, the motion is granted.

Plaintiff filed a complaint on April 27, 2005, in the Circuit Court of Cook County, Illinois, alleging breach of contract and estoppel and seeking declaratory judgment. The complaint alleged that Fortis had wrongly refused to pay her $500,000 in additional life insurance benefits under a group life insurance policy issued by Fortis to her deceased husband, Edward Silva, through his former employer. The complaint charged that the carrier was es-topped to deny coverage by virtue of two minimal payroll deductions by Mr. Silva’s employer in January 2003 and a letter from a Fortis disability analyst (in response to an inquiry from a financial planner for the plaintiffs husband) stating that Mr. Silva had “elected” additional coverage. Although the letter did not say that Fortis had agreed to this election, the complaint alleged that it “clearly and unambiguously provided that a contract for additional life insurance existed by and between” Fortis and Mr. Silva. The requi *821 site allegations of reasonable and detrimental reliance by Mr. Silva were conspicuous by their absence from the estoppel count.

Because the group life insurance policy under which plaintiff sought benefits was an “employee benefit plan” as defined by the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1002(1), For-tis removed this case to federal district court pursuant to 28 U.S.C. § 1441.

The plaintiff served the Discovery Requests on January 26, 2006. By agreement of the parties, USIC’s time to respond to the Discovery Request was tolled pending settlement discussions between the parties, which have recently concluded without success. USIC argues that the discovery sought is improper because in an ERISA case, the court’s review is limited to the administrative record. USIC has already provided that record to plaintiff and the court, and as a result, seeks a protective order that the “discovery not be had” under Rule 26(c)(1), Federal Rules of Civil Procedure.

The lengthy administrative record tells a melancholy story: faced with a severe and ultimately terminal illness, Mr. Silva applied for an additional $119,000 in life insurance coverage in early 2002. A review of his medical records by Fortis predictably led to a denial of his application pursuant to a provision in the group policy which required proof of good health satisfactory to Fortis. Mr. Silva was informed that although he could reapply he would have to show proof of good health. By December 2002, Mr. Silva’s condition had worsened considerably. He was uninsura-ble by any standards. Nonetheless, he made an online application to his employer for $500,000 in additional coverage. He was sent a paper application and a health questionnaire, which he never returned. He became disabled from his cancer in 2003 and died on October 6, 2004.

A.

Mr. Silva’s Employee Life Insurance

Mr. Silva began working for Kuehne & Nagel, Inc., on October 16, 2000. (Administrative Record (“AR”) at 34). Shortly thereafter, Fortis issued a certificate of group life insurance to Kuehne & Nagel, which became effective on April 1, 2001. (AR at 3). At that time, all employees received the benefit of a base life insurance policy, apparently in the amount of two times their yearly salary. Mr. Silva’s policy was worth $247,500.92, and the plaintiff received a check in that amount upon Mr. Silva’s death. (Complaint for Declaratory Judgment and Related Relief, ¶ 16). All employees were also eligible to apply for any amount of voluntary life insurance coverage. If they did so within the first 31 days of eligibility, they would not need to complete a questionnaire regarding their health. (Id.).

Mr. Silva applied for $119,000 of voluntary life insurance by application dated December 31, 2001. The application was received about a week later, long after the 31-day unconditional enrollment period had expired. (AR at 104). The initial attempt to acquire additional life insurance appears to have been in response to concerns about persistent abdominal pains that began in July, 2001 and became “severe” by about late October, 2001. These pains became so severe that Mr. Silva had a CT scan on December 5, 2001. The scan revealed a differential diagnosis of lymphoma of the small bowel or metastases to the small bowel. (AR at 30-3; 114). In his December 31st application, however, Mr. Silva stated that the results of his CT scan were normal, even though scans taken on September 26 and December 6, 2001 were not. (AR at 114, 119). On December 12th, Mrs. Silva was notified of the test results. (AR 109).

On March 14, 2002, Fortis acknowledged receipt of Mr. Silva’s application for addi *822 tional life insurance coverage and informed him that “[ujnder the terms of the group contract you are required to submit proof of good health before your application can be approved.” (AR at 128). He was also informed that “[vjoluntary Life insurance coverage will not become effective until satisfactory evidence has been received,” including a new CT scan. Id. Based upon the medical information obtained by USIC’s Medical Underwriting Department over the course of the next few months, Fortis denied Mr. Silva’s application, and he was informed of the denial in a letter dated May 15, 2002. In that letter, Mr. Silva was also informed that he could reapply for coverage only if he provided a current medical examination, follow-up tests regarding his abdominal pain, and a current CT scan. (AR at 100; 4).

In the meanwhile, Mr. Silva was forced to deal with increasingly alarming medical news. In April 2002, he was diagnosed with diffuse malignant mesothelioma. The symptoms had been present since July 2001, becoming severe later in the year. (AR 30-31, 55,74-83). This led to a summer of tests, treatments, and clinical trials conducted by a series of specialists both locally and in Washington, D.C., culminating in a diagnosis of primary peritoneal mesothelioma. (AR at 30-32; 52-82; 77). Mrs. Silva was aware of the seriousness of her husband’s condition. (AR at 82). Sadly, by November 14, 2002, one of Mr. Silva’s treating physicians counseled him to think realistically about his overall prognosis and its implications for his family. (AR at 64). 1

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Miller v. Ameritech Long Term Disability Plan
584 F. Supp. 2d 1106 (C.D. Illinois, 2008)
Molina v. First Line Solutions LLC
566 F. Supp. 2d 770 (N.D. Illinois, 2007)
Cotter v. Prudential Financial
238 F.R.D. 567 (N.D. West Virginia, 2006)

Cite This Page — Counsel Stack

Bluebook (online)
437 F. Supp. 2d 819, 2006 U.S. Dist. LEXIS 47296, 2006 WL 1928692, Counsel Stack Legal Research, https://law.counselstack.com/opinion/silva-v-fortis-benefits-insurance-ilnd-2006.