Taaffe v. Life Insurance Co. of North America

769 F. Supp. 2d 530, 2011 U.S. Dist. LEXIS 20539, 2011 WL 723586
CourtDistrict Court, S.D. New York
DecidedFebruary 23, 2011
Docket09 Civ. 6710(FM)
StatusPublished
Cited by18 cases

This text of 769 F. Supp. 2d 530 (Taaffe v. Life Insurance Co. of North America) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Taaffe v. Life Insurance Co. of North America, 769 F. Supp. 2d 530, 2011 U.S. Dist. LEXIS 20539, 2011 WL 723586 (S.D.N.Y. 2011).

Opinion

DECISION AND ORDER

FRANK MAAS, United States Magistrate Judge.

Plaintiff Carolyn Taaffe (“Taaffe”) commenced this action against defendant Life Insurance Company of North America (“LINA”) under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001, et seq. Taaffe now seeks to recover prejudgment interest on $165,000 in long term disability benefits paid by LINA on April 20, 2010, as well as the attorneys’ fees and costs that she incurred in prosecuting this case.

For the reasons set forth below, the Court awards Taaffe $66,062.26, consisting of $12,244.68 in prejudgment interest, *534 $53,305.88 in attorneys’ fees, and $511.70 in costs.

I. Background

A. Tagffe’s Disability Coverage

Taaffe worked at UBS Financial Services Inc. (“UBS”) as a Senior Trading Assistant and General Securities Principal. (Compl. (ECF No. 1) ¶8). As a UBS employee, Taaffe had both short term disability (“STD”) and long term disability (“LTD”) insurance coverage. (See Reply Affirm, of Scott M. Riemer, Esq., dated June 21, 2010 (ECF No. 24) (“Reply Affirm.”), Ex. H at 1141-45 (“STD Plan”), 1146-60 (“LTD Plan”)). 1

Under the STD Plan, UBS employees are eligible to receive STD benefits if they meet the STD Plan’s definition of “having a disability” or “being disabled.” (STD Plan at 1142). To qualify for benefits, an employee therefore must be “unable to perform all the material and substantial duties of [his or her] occupation on an active employee basis because of an illness or sickness.” (Id.). Pursuant to an administrative services agreement with UBS, LINA is responsible for administering claims for STD benefits by UBS employees. (Aff. of Richard Lodi, sworn to June 10, 2010 (ECF No. 20) (“Lodi Aff.”), ¶ 3). UBS, in turn, is responsible for the payment of STD benefits. (Id.; STD Plan at 1142). The STD Plan provides, however, that UBS will pay STD benefits only for a period of 180 days after the employee’s STD claim is approved. (STD Plan at 1142).

The LTD Plan states that if it becomes apparent that an employee seeking or receiving STD benefits will be unable to return to work before the expiration of the 180-day STD benefits period, LINA “will begin to transition [the] claim to a [LINA] LTD Case manager.” 2 (LTD Plan at 1159). LINA’s own claims manual, known internally as the “Book of Knowledge,” similarly provides that a “claim should be escalated to the LTD Case Manager when it becomes clear that a return to work may not or will not occur prior to the STD Termination Date.” (Reply Affirm. Ex. G (“Book of Knowledge”) at 1020). Additionally, the LTD Plan states under the heading “Filing a Claim” that LINA and another carrier, Unum Provident (“Unum”), will “send [an employee] any notice of claim forms to begin processing [his or her] LTD claim.” (LTD Plan at 1159). According to LINA, to file a claim for LTD benefits successfully, an employee “must submit a long term disability claim form with proof of loss to LINA.” (Lodi Aff. ¶ 9).

The LTD Plan’s definition of “disability” differs from that of the STD Plan. Under the LTD Plan, an employee is considered “disabled” if “because of injury or sickness, [the employee is] unable to perform all the material duties of [his or her] regular occupation or, solely due to injury or sickness, [the employee is] unable to earn more than 80% of [his or her] indexed covered earnings.” (LTD Plan at 1151). Employees must be disabled within the meaning of the LTD Plan for 180 days before they may begin receiving LTD benefits. (Id. at 1152). The period between the determination of disability and the receipt of benefits is known as the “benefit waiting period.” (Id.).

In addition to her LINA LTD group coverage, Taaffe had an individual LTD policy issued by Unum. (Lodi Aff. ¶ 10). *535 The Unum policy was intended to cover salary amounts above the maximum covered under the LTD Plan. (Id.). LINA contends that claims “made under this policy are administered and paid by Unum” with no input from LINA. (Id.). LINA also alleges that its “standard procedure” is to approve a UBS employee’s claim for LTD benefits under the LTD Plan when it receives notification that Unum has approved such a claim under its LTD policy. (Id. ¶ 13).

B. Procedural History

On February 27, 2008, Taaffe stopped working at UBS due to severe pain in her neck and shoulder. (Affirm, of Scott M. Riemer, Esq., dated May 28, 2010 (ECF No. 19) (“Riemer Affirm.”-), Ex. A at 33, 60). On or about March 17, 2008, she submitted a claim to LINA for STD benefits. (Compl. ¶ 10). LINA denied that claim on June 6, 2008. (Riemer Affirm. Ex. A at 271-73).

By letter dated November 11, 2008, Taaffe sought certain documents and informed LINA that she intended to appeal its decision. (Reply Affirm. Ex. I at 878). Although Taaffe had not filed a formal claim for LTD benefits, her letter stated that she planned to appeal LINA’s “June 6, 2008 denial of long term disability benefits.” (Id.) (emphasis added). In her appeal letter dated March 3, 2009, however, Taaffe appealed from LINA’s “June 6, 2008 denial of short and long term disability benefits.” (Id. at 723). In response, by letter dated May 1, 2009, LINA affirmed its previous denial of STD benefits, but failed to address the topic of LTD benefits. (Riemer Affirm. Ex. A at 256-58).

Taaffe then commenced this suit on July 29, 2009. In her complaint, Taaffe demanded “the amount of all long term disability benefits due under the terms of the [LTD] Plan that have not been paid, together with the interest thereon,” as well as attorneys’ fees and costs. (Compl. at 5).

After the filing of her suit, Taaffe submitted a claim to Unum for LTD benefits. (Lodi Aff. ¶ 11). On March 24, 2010, Unum approved that claim and also notified LINA of its decision. (Id. ¶¶ 11-12). That same day, purportedly following its “standard procedure” upon receiving notification of Unum’s approval of a claim for LTD benefits, LINA sent Taaffe’s counsel a letter stating that her “claim for long term disability benefits has been approved.” (Affirm, of Emily Hayes, Esq., in Opp’n to Mot. for Prejudgment Interest, Attorney’s Fees and Costs, dated June 14, 2010 (ECF No. 21), Ex. 3 (“Mar. 24 Letter”) at 1); Lodi Aff. ¶ 13 (“LINA’s standard procedure upon receiving such a notification from Unum is to also approve long term disability benefits under the LINA policy.”). Insofar as relevant, the letter stated: “[Taaffe’s] date of disability is February 27, 2008. Benefits commence on August 27, 2008 following a benefit waiting period of 26 weeks.” (Mar. 24 Letter at 1). On April 20, 2010, LINA paid Taaffe $165,000 in benefits for the period from August 27, 2008, to April 26, 2010. (Lodi Aff. ¶ 16).

This case initially was referred to me for settlement purposes. (ECF No. 8).

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769 F. Supp. 2d 530, 2011 U.S. Dist. LEXIS 20539, 2011 WL 723586, Counsel Stack Legal Research, https://law.counselstack.com/opinion/taaffe-v-life-insurance-co-of-north-america-nysd-2011.