Sosinski v. Unum Life Insurance Co. of America

15 F. Supp. 3d 723, 94 Fed. R. Serv. 272, 2014 U.S. Dist. LEXIS 56762, 2014 WL 1624176
CourtDistrict Court, E.D. Michigan
DecidedApril 23, 2014
DocketCase No. 13-13576
StatusPublished
Cited by6 cases

This text of 15 F. Supp. 3d 723 (Sosinski v. Unum Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sosinski v. Unum Life Insurance Co. of America, 15 F. Supp. 3d 723, 94 Fed. R. Serv. 272, 2014 U.S. Dist. LEXIS 56762, 2014 WL 1624176 (E.D. Mich. 2014).

Opinion

MEMORANDUM AND ORDER DENYING PLAINTIFF’S MOTION FOR JUDGMENT ON THE ADMINISTRATIVE RECORD (Doc. 14) AND GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT (Doc. 15)

AVERN COHN, District Judge.

I. Introduction

This is a case under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1001 et seq. Plaintiff Michael Lee Sosinski (Sosinski) appeals from the final determination of defendant Unum Life Insurance Company (UNUM) that he is not entitled to disability benefits. As [726]*726will be explained, Sosinski applied for and received disability benefits from UNUM as a result of injuries sustained in a car accident. Upon later learning that Sosinski was convicted of operating while impaired as a result of the accident, UNUM stopped paying benefits on the grounds that the policy excludes benefits under these circumstances. UNUM has filed a counterclaim seeking to recoup a portion of the benefits it says it overpaid.

Before the Court is Sosinski’s motion for judgment on the administrative record seeking to reverse UNUM’s decision. Also before the Court is UNUM’s motion for summary judgment on its counterclaim seeking a money judgment against Sosin-ski in the amount of $22,589.52.1 For the reasons that follow, Sosinski’s motion will be denied and UNUM’s motion will be granted. A judgment will enter in favor of UNUM in the amount of $22,589.52.

II. Sosinski’s Motion for Judgment on the Administrative Record

A. Legal Standard — Motion for Entry of Judgment

In Wilkins v. Baptist Healthcare System, Inc., 150 F.3d 609 (6th Cir.1998), the Court of Appeals for the Sixth Circuit held that summary judgment procedures are not appropriate in the Sixth Circuit in denial of benefits actions under ERISA. Rather, a district court should adjudicate an ERISA action as if it were conducting a standard bench trial and, therefore, determining whether there is a genuine issue of fact for trial would make little sense. Wilkins, 150 F.3d at 618-19 (Gilman, J., concurring in part and setting out the judgment of the court of appeals on the issue regarding the summary judgment standard).

Accordingly, the Court will decide this matter under the guidelines set forth in Wilkins2 by rendering findings of fact and conclusions of law based solely upon the administrative record. See Eriksen v. Metro. Life Ins. Co., 39 F.Supp.2d 864 (E.D.Mich.1999).

B. Standard of Review

The parties have not articulated the standard of review of UNUM’s decision to stop paying Sosinski’s benefits. The policy contains the following language:

The Plan, acting through the Plan Administrator, delegates to UNUM and its affiliate Unum Group discretionary authority to make benefit determinations under the Plan_ Benefit determina[727]*727tions include determining eligibility for benefits and the amount of benefits, resolving factual disputes, and interpreting and enforcing the provisions of the Plan. All benefit determinates must be reasonable and based on the terms of the Plan and the facts and circumstances of each claim.

This language invokes the arbitrary and capricious standard of review as it confirms that UNUM has discretionary authority to construe and interpret the provisions of the Plan. See Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989); Miller v. Metro. Life Ins. Co., 925 F.2d 979, 983 (6th Cir.1991). This standard is the “least demanding form of judicial review.” Admin. Comm. of the Sea Ray Employees Stock Ownership and Profit Sharing Plan v. Robinson, 164 F.3d 981, 989 (6th Cir.1999). This requires “review of the quality and quantity of the medical evidence and the opinions on both sides of the issues.” McDonald v. W.-& Life Ins. Co., 347 F.3d 161, 172 (6th Cir.2003). The plan administrator’s decision should be upheld if it is “the result of a deliberate, principled reasoning process” and “supported by substantial evidence.” Glenn v. MetLife, 461 F.3d 660, 666 (6th Cir.2006), aff'd, Met. Life Ins. Co. v. Glenn, 554 U.S. 105, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008). The standard, although deferential, is not “inconsequential.” Moon v. Unum Provident Corp., 405 F.3d 373, 379 (6th Cir.2005). ‘While a benefits plan may vest discretion in the plan administrator, the federal courts do not sit in review of the administrator’s decisions only for the purpose of rubber stamping those decisions.” Id.

The Court makes the findings of fact and conclusions of law based on the administrative record.3

C. Findings of Fact

1. Relevant Plan Provision

The Plan contains the following exclusion:

WHAT DISABILITIES ARE NOT COVERED UNDER YOUR PLAN? Your plan does not cover any disabilities caused by, contributed to by, or resulting from your:
— intentionally self-inflicted injuries.
— active participation in a riot.
— loss of a professional license, occupational license or certification.
— commission of a crime for which you have been convicted.
— pre-existing condition.
2. Sosinski’s Claim

On March 22, 2009, Sosinski was involved in a single car accident when he hit á tree. At the time of the accident, Sosin-ski was speeding in excess of 90 miles per hour. Sosinski was ejected from the car and suffered a closed head and other injuries. A crash report shows the presence of alcohol and drugs based on the results of a blood test.

At the time of the accident, Sosinski was a participant in the Plan through his employer, Hascall Steel & Supply. UNUM is the plan administrator. After his accident, Sosinski filed an application for long term disability benefits with UNUM. UNUM approved his claim and began paying benefits beginning on June 20, 2009. His benefits were $941.23 per month.

At some point thereafter, UNUM became aware that Sosinski had plead no contest to a charge of operating while impaired. The administrative record shows Sosinski was charged on June 19, 2009. [728]*728He was sentenced in January 2010, following his plea, to 12 months probation.

On July 9, 2013, UNUM wrote to Sosin-ski, explaining that his benefits have been terminated. The letter states in pertinent part:

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15 F. Supp. 3d 723, 94 Fed. R. Serv. 272, 2014 U.S. Dist. LEXIS 56762, 2014 WL 1624176, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sosinski-v-unum-life-insurance-co-of-america-mied-2014.