Spalding v. Reliance Standard Life Insurance

835 F. Supp. 23, 27 Fed. R. Serv. 3d 1621, 1993 U.S. Dist. LEXIS 14251, 1993 WL 421754
CourtDistrict Court, D. Massachusetts
DecidedSeptember 21, 1993
DocketCiv. A. 92-12463-GN
StatusPublished
Cited by5 cases

This text of 835 F. Supp. 23 (Spalding v. Reliance Standard Life Insurance) 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
Spalding v. Reliance Standard Life Insurance, 835 F. Supp. 23, 27 Fed. R. Serv. 3d 1621, 1993 U.S. Dist. LEXIS 14251, 1993 WL 421754 (D. Mass. 1993).

Opinion

GORTON, District Judge.

Report and Recommendation accepted and adopted. •

REPORT AND RECOMMENDATION RE: DEFENDANT’S MOTION FOR SUMMARY JUDGMENT (DOCKET ENTRY # 9)

ORDER RE: PLAINTIFF, BARBARA F. SPALDING’S MOTION TO AMEND THE COMPLAINT (DOCKET ENTRY #14)

BOWLER, United States Magistrate Judge.

Pending before this court are two motions, one for summary judgment (Docket Entry # 9) and one to amend the amended complaint (Docket Entry # 14). On June 21, 1993, this court held a hearing and took the motions (Docket Entry ## 9 & 14) under advisement.

BACKGROUND

The instant litigation arises out of a denial of benefits to plaintiff Barbara F. Spalding (“plaintiff’), the beneficiary of a group life insurance policy issued by defendant Reliance Standard Life Insurance Company (“defendant”) on the life of her deceased husband, Richard L. Spalding (“decedent”). Defendant issued the group policy to decedent former’s employer, Merchants Bank of Boston (“the bank”). Decedent, a former bank employee, left the bank’s employ because of a disability in November 1989 and died in August 1990. 1

In the amended complaint, plaintiff brings the following counts: estoppel; breach of good faith and fair dealing; negligent misrepresentation; and violation of Massachusetts Laws chapter 93A, section 9 (“Chapter 93A”), grounded on an alleged violation of Massachusetts General Laws chapter 176D, sections 2 and 3. (Docket Entry #8). In plaintiffs proposed amended complaint, she seeks leave to bring a fifth count for violation of the Employee Retirement Income Security Act, 29 U.S.C. §§ 1001 et seq. (“ERISA”). (Docket Entry # 14).

I. DEFENDANT’S MOTION FOR SUMMARY JUDGMENT (DOCKET ENTRY #9)

Defendant moves for summary judgment on the basis that plaintiffs four counts are preempted by ERISA. Aternatively, defendant argues that it acted in accordance with the terms of the policy. (Docket Entry # 10). For purposes of summary judgment, this court finds the following facts.

At the time of his employment, decedent was covered under the policy noted supra. According to Carmine Pallotta (“Pallotta”), Senior Vice President of Merchants Bank of Boston, the bank provided all employees with a summary plan description of the policy. (Docket Entry # 12, Ex. A, pp. 35-36). The *27 bank additionally provided all employees with a booklet describing the life and group disability insurance policy underwritten by defendant. (Docket Entry # 12, Ex. A, Pallotta, p. 35). According to William W. Wade (“Wade”), Secretary of Claims and Claim Litigation for defendant, defendant terminated the bank’s coverage under the policy because of nonpayment of premiums on June 1, 1990. 2 (Docket Entry # 11).

According to the booklet, 3 the policy provided a life insurance benefit in the amount of three times an employee’s annual salary, subject to a maximum amount of $330,000. 4 (Docket Entry # 11). The policy also contained a conversion privilege permitting eligible employees, upon termination of the policy, to convert the policy to an individual life insurance policy. The individual insurance policy provided for a life insurance benefit of “the lesser of’ $5,000 or the amount as calculated under the group policy. (Docket Entry # 11, p. 00082).

The policy also allowed a totally disabled, eligible employee to apply for a waiver of premium. Under this provision, the amount of life insurance was the amount “in force at the time that total disability began.” (Docket Entry # 11, p. 00084). This provision stated that defendant would extend the amount of insurance for a one year period after proof of total disability if, among other requirements, “you [the employee] become totally disabled prior to age 60.” (Docket Entry # 11, p. 00084).

Plaintiff admits in her complaint that decedent was 63 on November 10, 1989, the day he apparently ceased working at the Bank because of his disability. There is no evidence in the record that decedent was under the age of 60 at the time he became disabled. 5

Prior to the May 1990 bank insolvency and the June 1990 termination of the policy, Pallotta telephoned Frank McCarthy (“McCarthy”), an independent insurance broker handling the policy for the bank, and inquired about the continuation of life insurance benefits for disabled employees. After speaking with McCarthy, Pallotta discussed with decedent his coverage under the group policy. Pallotta testified that he spoke with decedent about the policy and the age limitation contained in the waiver of premium provision before decedent left the bank’s employ. 6

Thereafter, in the winter and spring of 1990, Pallota had additional conversations ■ with McCarthy about the effect of the policy and the need to preserve the benefits of the three disabled bank employees. (Docket Entry # 12, Ex. A, Pallotta, pp. 70-72 & 74-75). From speaking with McCarthy, Pallotta understood that decedent would be eligible to apply for the waiver of premium.

McCarthy, an independent broker, spoke several times with Swain during the winter *28 and spring of 1990 about decedent and two other, disabled bank employees. According to McCarthy, Swain told him not to worry about the three employees and that they would be covered by the waiver of premium provision. McCarthy and Swain did not discuss the effect of the age limitation as it applied to decedent. Rather, the two discussed the three disabled employees collectively as a group. (Docket Entry # 12, Ex. A, McCarthy; Docket Entry # 17, Ex. C). According to Swain, he remembers speaking with McCarthy about the waiver of premium provision with respect to the three disabled employees. He does not recall the specifics of the conversations. (Docket Entry # 12, Ex. A, Swain).

By letter dated June 29, 1990, McCarthy submitted the completed waiver of premium applications for the three disabled employees to Swain. By letter dated July 27, 1990, Bobbie Barone (“Barone”), a claims examiner for defendant, informed decedent that his application was approved. By letter dated July 30, 1990, Barone told decedent the July 27 letter was in error and that his application was denied inasmuch as he had not been totally disabled before reaching the age of 60. (Docket Entry # 12, Ex. C & D; Docket Entry # 17, Ex. D). Plaintiff testified that she could not understand why an insurance company would send one letter allowing a waiver and another letter rescinding the waiver. (Docket Entry # 17, Ex. A).

In the July 30, 1990 letter, Barone additionally noted that decedent had certain conversion privileges and, if interested, should apply to convert his certificate. (Docket Entry # 12, Ex. D; Docket Entry # 12, Ex. D).

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Bluebook (online)
835 F. Supp. 23, 27 Fed. R. Serv. 3d 1621, 1993 U.S. Dist. LEXIS 14251, 1993 WL 421754, Counsel Stack Legal Research, https://law.counselstack.com/opinion/spalding-v-reliance-standard-life-insurance-mad-1993.