Tucci v. First Unum Life Insurance

446 F. Supp. 2d 473, 2006 WL 2389590
CourtDistrict Court, D. South Carolina
DecidedAugust 13, 2006
DocketC.A. 2:05-1580-PMD
StatusPublished
Cited by6 cases

This text of 446 F. Supp. 2d 473 (Tucci v. First Unum Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. South Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Tucci v. First Unum Life Insurance, 446 F. Supp. 2d 473, 2006 WL 2389590 (D.S.C. 2006).

Opinion

ORDER

PATRICK MICHAEL DUFFY, District Judge.

This matter is before the court upon the following motions: (1) Defendant First Unum Life Insurance Company’s (“First Unum”) motion for summary judgment; and (2) Defendant First Unum’s motion to strike all references to evidence outside of the administrative record. For the reasons set forth herein, the court grants Defendant’s motion for summary judgment, thereby rendering moot Defendant’s motion to strike.

BACKGROUND

I. Procedural History

On May 18, 2005, Plaintiff Linda M. Tucci, f/k/a Linda M. Purdy, (“Tucci” or “Plaintiff’) brought this action in the Court of Common Pleas for Charleston County, South Carolina, seeking to recover continuing benefits under a long term disability insurance plan. Specifically, Plaintiffs Complaint seeks a declaratory judgment and asserts causes of action for breach of contract, bad faith denial of an insurance claim, breach of fiduciary duty, and violation of the South Carolina Unfair Trade Practices Act. However, on June 3, 2005, Defendant First Unum removed the case to this court, asserting jurisdiction under the Employee Retirement Income Security Act, 29 U.S.C. § 1001 et seq. (“ERISA”) or alternatively under 28 U.S.C. § 1331.

On December 13, 2005, Defendant First Unum filed a motion for summary judgment, alleging that ERISA preempts Plaintiffs state law causes of action and that First Unum did not abuse its discretion in denying Plaintiffs claim for continuing disability benefits under the long term disability plan. Plaintiff filed a memorandum in opposition to Defendant’s motion, asserting that Defendant has failed to meet its burden of establishing that an ERISA plan exists. Alternatively, if the court determines that Defendant has established that an ERISA plan exists, Plaintiff argues both that a de novo standard of review applies and that Defendant has the burden of establishing that Tucci could return to her regular occupation.

Lastly, on February 9, 2006, Defendant First Unum filed a motion to strike all references to evidence outside the administrative record, specifically, Plaintiffs argument on page three of her memorandum and accompanying exhibits A and B.

II. Factual Background

Plaintiff Tucci was employed by Ham-bre, Inc. (“Hambre”) as an account manager, and Hambre maintained long term disability coverage with First Unum as part of its employee welfare benefit plan. In 2001, Tucci filed a claim with First Unum for long term disability benefits, alleging that she was “diagnosed with viral pneumonia followed by chronic fatigue syndrome causing extreme tiredness and shortness of breath- — difficulty in talking,” and that she had been unable to work since February 7, 2001, because of this condition. (Admin. Record at 1564.)

*477 Initially, on or about August 20, 2001, First Unum denied Plaintiffs claim for long term disability benefits. However, Plaintiff appealed this denial and submitted additional medical information. Subsequently, on or about May 1, 2002, First Unum reversed the denial of Plaintiffs claim and approved her benefits. (Admin. Record at 1371-73.) However, approximately 18 months later, on December 19, 2003, First Unum notified Plaintiff that it was denying her claim for continuing benefits, finding that Tueci no longer qualified for benefits. (Admin. Record at 235-38.) Plaintiff appealed this decision, and First Unum conducted a medical review of Plaintiffs appeal. On July 26, 2004, First Unum notified Plaintiffs counsel that it was upholding the denial of her claim. (Admin. Record at 739-42.) Plaintiff again appealed, but on December 28, 2004, First Unum again wrote Plaintiffs counsel that it was upholding the denial of Plaintiffs benefits. (Admin. Record at 755.)

STANDARD OF REVIEW

To grant a motion for summary judgment, the court must find that “there is no genuine issue as to any material fact.” Fed.R.Civ.P. 56(c). The judge is not to weigh the evidence but rather must determine if there is a genuine issue for trial. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). All evidence should be viewed in the light most favorable to the nonmoving party. Perini Corp. v. Perini Constr., Inc., 915 F.2d 121, 123-24 (4th Cir.1990). “[W]here the record taken as a whole could not lead a rational trier of fact to find for the nonmoving party, disposition by summary judgment is appropriate.” Teamsters Joint Council No. 83 v. Centra, Inc., 947 F.2d 115, 119 (4th Cir.1991). “[T]he plain language of Rule 56(c) mandates the entry of summary judgment, after adequate time for discovery and upon motion, against a party who fails to make a showing sufficient to establish the existence of an element essential to that party’s case, and on which that party will bear the burden of proof at trial.” Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). The “obligation of the nonmoving party is ‘particularly strong when the nonmoving party bears the burden of proof.’ ” Hughes v. Bedsole, 48 F.3d 1376, 1381 (4th Cir.1995) (quoting Pachaly v. City of Lynchburg, 897 F.2d 723, 725 (4th Cir.1990)). Summary judgment is not “a disfavored procedural shortcut,” but an important mechanism for weeding out “claims and defenses [that] have no factual bases.” Celotex, 477 U.S. at 327, 106 S.Ct. 2548.

DISCUSSION

I. Defendant’s Motion for Summary Judgment

In its motion for summary judgment, Defendant First Unum asserts that Plaintiffs state law claims are preempted by ERISA. Moreover, Defendant asserts that it did not abuse its discretion in denying Plaintiffs continuing claim for disability benefits. Defendant states: “Because the policy grants discretionary authority to First Unum, the proper standard of review for the Court to employ in reviewing First Unum’s benefit determination is an abuse of discretion standard.” (Def. Mot. at 24.) In response, however, Plaintiff disagrees and first argues that First Unum has failed to meet its burden that an ERISA plan exists. Second, Plaintiff argues that a de novo standard of review applies to the decision to deny Plaintiffs claim for continuing benefits because the plan administrator is also the plan’s insurer. (PI. Opp. at 5.) In its Reply, Defendant steadfastly argues that a de novo standard of review does not apply, but rather, that a modified *478

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

Related

Smith v. Michelin Tire Corporation
D. South Carolina, 2021
Golden v. Barnett
N.D. West Virginia, 2018
Hendrix v. Resource Real Estate Management, Inc.
170 F. Supp. 3d 879 (D. South Carolina, 2016)
Campbell v. Hartford Life & Accident Insurance
766 F. Supp. 2d 661 (D. South Carolina, 2011)

Cite This Page — Counsel Stack

Bluebook (online)
446 F. Supp. 2d 473, 2006 WL 2389590, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tucci-v-first-unum-life-insurance-scd-2006.