Silva v. Metropolitan Life Ins.

912 F. Supp. 2d 781, 54 Employee Benefits Cas. (BNA) 2373, 2012 WL 6115063, 2012 U.S. Dist. LEXIS 174410
CourtDistrict Court, E.D. Missouri
DecidedDecember 10, 2012
DocketCase No. 4:11cv0337 TCM
StatusPublished
Cited by2 cases

This text of 912 F. Supp. 2d 781 (Silva v. Metropolitan Life Ins.) is published on Counsel Stack Legal Research, covering District Court, E.D. Missouri primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Silva v. Metropolitan Life Ins., 912 F. Supp. 2d 781, 54 Employee Benefits Cas. (BNA) 2373, 2012 WL 6115063, 2012 U.S. Dist. LEXIS 174410 (E.D. Mo. 2012).

Opinion

MEMORANDUM AND ORDER

THOMAS C. MUMMERT, III, United States Magistrate Judge.

In the remaining count of his two-count First Amended Complaint,1 Salvador Silva (“Plaintiff’) seeks to hold defendants, Metropolitan Life Insurance Company (“Met-Life”) and Savvis Communications Corporation (“Savvis”), liable for the amount of life insurance coverage his son signed up for before his death.2 The life insurance [783]*783benefits are part of an employee benefits plan offered by Sawis to its employees. Sawis and MetLife argue they are entitled to summary judgment because Plaintiffs did not take the necessary steps to effectuate his enrollment. Plaintiff argues he is entitled to summary judgment on the question of liability because any omission by his son is either the fault of Defendants or was waived by them.

Background

This dispute has its origins in the untimely death of Plaintiffs son, Abel Silva (Abel), on June 27, 2010. (PL Am. Compl. ¶ 1,3 ECF No. 314; Defs. Mot. Ex. at 27,5 ECF No. 73.) Abel was then, and had been since September 27, 2004, an employee of Sawis. (Defs. Stat.6 ¶¶ 1, 10, ECF No. 75.) At the time of his hiring, Abel declined enrollment in Sawis’ Group Supplemental Life Insurance plan. (Id. ¶ 11.) He did so by marking a box by the sentence “I elect to decline the Supplemental Life plan.” (Defs. Mot. Ex. at 15.) This box was in the section of the enrollment form labeled “Supplemental Life Insurance — Employee.” (Id.) Also in this section was a paragraph explaining the options for electing supplemental life insurance. (Id.) The explanation included the following caution: “If you elect an amount that exceeds the lesser of 3 times your salary or the guaranteed issue amount of $250,000, you will need to provide evidence of good health that is satisfactory to Hartford Life7 before the excess can become effective.” • (Id. (footnote added)) In the section of the enrollment form labeled “Employee Confirmation,” the first two sentences read: “I have been given the opportunity to . enroll in [Sawis’] Group Supplemental Life Insurance plans. I understand that 'if I decline now, but later decide to enroll, I will be required to provide evidence of good.health that is satisfactory to Hartford Life and understand my request for coverage may be denied.” (Id. at 16.)

Under the Group Life and Supplemental Life Plan for Sawis employees (“the Plan”), Abel later could, during an annual enrollment period as determined by Savvis, “enroll for insurance for which [he] [was] eligible or choose a different option than the one for which [he] [was] currently enrolled.” (Id. at 88.8) The provisions for subsequent enrollment included the following:

The insurance enrolled for or changes to Your [the employee’s] insurance made during an annual enrollment period will take effect as follows:
• for any amount for which You are • required to give evidence of Your insur[784]*784ability and We determine that You are insurable, such insurance will take effect on the date We state in Writing, if You are Actively at Work on that date....

m

A separate section of the Plan,' titled “EVIDENCE OF INSURABILITY” (EOI), provided, in relevant part:

5. If You make a request during an annual enrollment period to increase the amount of Your Supplemental Life Insurance to an option which is more than one level above Your current amount of Supplemental Life Insurance.
If You do not give Us evidence of insurability or the evidence of insurability is not accepted by Us as satisfactory, the amount of Your Supplemental Life Insurance will not be increased.
9. If You make a late request for Supplemental Life Insurance. A late request is one made more than 31 days after You become eligible.
If You do not give Us evidence of insurability or the evidence of insurability is not acceptable by Us as satisfactory, You will not be covered for Supplemental Life Insurance.

(Id. at 104-05.)

“You and Your mean an. employee who is insured under the Group Policy for the insurance described in [the] certificate.” (Id. at 85.) “We, Us, and Our mean Met-Life.” (Id.) Under the heading “ERISA INFORMATION,” Sawis is listed in the Plan as both the employer and the Plan administrator. (Id. at 131.) MetLife insures the benefits provided under the Plan, including supplemental life insurance benefits. (Id.) MetLife' also reviews a claim for benefits and decides whether to approve or deny the claim. (Id. at 132.) If MetLife denies the claim, MetLife reviews' any appeal of its denial. (Id. at 133.)

The Plan further provides that:-

In carrying out their respective responsibilities under the Plan, the Plan administrator and other Plan fiduciaries shall have discretionary authority to interpret the terms of the Plan and to determine eligibility for and entitlement to Plan benefits in accordance with the terms of the Plan. Any interpretation or determi- , nation made pursuant to such discretionary authority shall be given full force and effect, unless it can be shown that the interpretation or determination was arbitrary and capricious.

(Id. at 135.)

Several years later, on an online enrollment' form, Abel requested supplemental life insurance with a coverage level of five times his salary. .(Defs. Stat. ¶ 13.) Plaintiff was the sole beneficiary of this coverage, $429,000. (Id.; Defs. Mot. Ex. at 08-09.) The cost,was $10.73 bi-monthly. (Id. at 08.) Abel also added his domestic partner, Jill Bitter, on his health insurance plan, (Id. at 12.)

After Abel’s death, Plaintiff made a claim against Sawis and MetLife for supplemental life insurance benefits under the Plan: (Id. at 02-03.) Subsequently, Savvis’ representative, Terry Flynn, faxed MetLife a- “Life Insurance Claim Form: Employer’s Statement” listing Basic Life benefits of $172,000 and supplemental life insurance benefits of $429,000. (Id. at 07.) The former had an effective date of January 1, 2005; the latter had an effective date of January 1, 2010.(/d) Plaintiffs claim for supplemental life insurance benefits was denied by MetLife. (Defs. Stat. ¶ 17.) The November 2010 letter explaining the denial quoted paragraphs five and nine of the EOI provisions, see pages 3 to 5, supra, and read, in relevant part:

Based on the documentation in our file, [Abel] was hired on September 27, 2004 and as such, eligible for coverage under the SAWIS Supplemental Life Plan at that time. In September 2004, he de[785]*785dined coverage under the SAWIS Supplemental .Life Plan. However, he did elect coverage for the first time under the Supplemental Life Plan in the amount of 5 times his BAE [base annual earnings] to become effective on January 1, 2010. According to the. Plan provisions noted above, since he made a “late request for Supplemental Life Insurance” evidence of insxxrability is required.

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912 F. Supp. 2d 781, 54 Employee Benefits Cas. (BNA) 2373, 2012 WL 6115063, 2012 U.S. Dist. LEXIS 174410, Counsel Stack Legal Research, https://law.counselstack.com/opinion/silva-v-metropolitan-life-ins-moed-2012.