Unum Life Insurance Co. of America v. Epes

715 F. Supp. 2d 837, 2010 U.S. Dist. LEXIS 41283, 2010 WL 1729707
CourtDistrict Court, E.D. Arkansas
DecidedApril 27, 2010
Docket4:09CV00244-WRW
StatusPublished
Cited by2 cases

This text of 715 F. Supp. 2d 837 (Unum Life Insurance Co. of America v. Epes) is published on Counsel Stack Legal Research, covering District Court, E.D. Arkansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Unum Life Insurance Co. of America v. Epes, 715 F. Supp. 2d 837, 2010 U.S. Dist. LEXIS 41283, 2010 WL 1729707 (E.D. Ark. 2010).

Opinion

ORDER

WM. R. WILSON, JR., District Judge.

In this ERISA 1 case, Plaintiff Unum Life Insurance Company of America (“Unum”) seeks to recover alleged over-payments made to Defendant Wooten Epes (“Epes”). 2 Epes counterclaims for reinstatement of his benefits, and for back payments. 3 Pending are cross-Motions for Summary Judgment (Doc. Nos. 18, 22). 4

Unum’s Motion for Summary Judgment is GRANTED IN PART (because Unum properly terminated Epes’s benefits) and DENIED IN PART (because Unum cannot recover the overpayments).

Epes’s Motion for Summary Judgment is GRANTED IN PART (because Epes is entitled to keep all payments made by Unum), and DENIED IN PART (because Epes is not entitled to reinstatement or back benefits).

As a result, both the Claim and Counterclaim are DISMISSED with prejudice.

I. BACKGROUND

The following facts are undisputed. 5 Epes was a partner in the law firm Kutak Rock, LLP (“Kutak”). Kutak had a long-term disability benefits policy (“the Policy”) issued by Unum. On or about September 16, 2004, Unum began paying benefits to Epes after he suffered a back injury. The Policy includes a benefits termination provision that reads: “[disability benefits will cease on ... the date the insured’s current earnings exceed 80% of his indexed pre-disability earnings.” 6 The crux *840 of this case is whether Epes began “earning” more than 80% of his pre-disability earnings when he began participating in various business ventures while receiving disability payments.

Unum required continuing proof of disability. The Policy states that “[p]roof of the insured’s monthly earnings must be given to [Unum] on a quarterly basis,” and that “[b]enefit payments will be adjusted upon receipt of this proof of earnings.” In the course of conversations between Unum and Epes regarding proof of continuing disability, Epes disclosed, in or about 2004, that he was a partner in Edgewater Affordable Housing Limited Partnership (“EAH”). At that time, Epes said his business was earning some money. Epes claimed, however, that there was no net gain. Epes also said that at the end of four years he expected to earn what he had earned before making his disability claim.

On November 24, 2004, Epes provided Unum with a job description regarding EAH. Epes described the nature of the business as “real estate development” and listed himself as “co-owner.” He described his duties as: “communicate via telephone and computer with partner and two employees about multifamily housing rental property acquisitions and sales.” Epes indicated that he had not received any income from EAH.

As the result of this and other communications between Epes and Unum regarding EAH, Unum sent a field representative to interview Epes in person on June 26, 2005. During this interview, Epes represented that he had no earnings from his business. He said he hoped to work up to an annual profit of $250,000-$300,000 in the next five years. Following the field interview, over the next two months, Unum approved two more benefits payments to Epes.

The following month, on September 19, 2005, Epes submitted a Supplemental Claimant’s Statement affirming that he was engaged in work activity for payment, which consisted of part-time work from his home in a real estate investment and development business.

On June 7, 2006, Epes submitted an updated Supplemental Claimant’s Statement in which he reversed his previous statement, answering “no” to the question of whether he had been engaged in work activity for a profit. He wrote that he was “self employed — real estate investment business. I do not receive paychecks regularly. Do not expect to return to work.”

Later, Epes provided Unum with his tax returns for 2004 and 2005. Unum argues that the 2004 return reflected a loss in “earnings” of — $158,481, and that the 2005 return reflected “earnings” of $221,373. Epes argues that the returns do not show “earnings,” but instead show “income and losses calculated by defendant’s CPA and according to the rules and regulations of the Internal Revenue Service.” 7

In July, 2007, Epes provided copies of his 2002 and 2003 tax returns. The returns were analyzed by a Unum financial consultant, who concluded that Epes would “likely” have an overpayment for the year 2006, and that 2007 “will be similar.” A Unum representative called Epes on September 11, 2007, and the call notes from that conversation read:

Noted to the claimant that we have reviewed the available financial records and note that it appears that the 2006 year will result in an overpayment. The claimant notes that to date, his 2006 taxes have not been completed but his extension is coming due soon. The claimant is going to forward these rec *841 ords to us when they become available. Reviewed that based on our initial calculations, we are going to begin offsetting his LTD benefits in the amount of $6700/mo. The claimant confirms his understanding and this will begin with the current month’s benefit.

Epes now disputes that he was informed that the $6,700 per month offset was the result of overpayment.

Unum scheduled another in-home interview with Epes, which occurred on September 13, 2007. The interviewer’s report from that meeting indicates that Epes advised Unum’s representative that he had “made a lot of money” in 2006, and that he would forward his 2006 tax return when it was available.

On October 2, 2007, Unum produced a financial analysis based on Epes’s 2002 through 2005 tax returns and information that Epes had provided. Unum’s representative observed that “the Insured’s duties and responsibilities within this business is one of real estate investor who oversees the development (rehabilitation) of the property.” Based on that information, and on the information in Mr. Epes’s tax returns, Unum concluded that, “it appears that the Insured is earning substantial income and the earnings are not passive. This may be earnings as defined in the contract.”

On October 14, 2007, Epes sent Unum his 2006 tax return. Epes’s return reported a total of $881,041 in “non-passive income.” The 2006 tax return stated EAH had non-passive income of $785,563. Unum concluded that this non-passive income meant Epes was actively involved in running the business and that this income counted as “earnings” under the Policy.

Based on the information contained in Epes’s 2006 tax return, Unum determined that Epes’s earnings exceeded 80% of his pre-disability earnings no later than January 1, 2006. Additionally, Unum calculated overpayment of benefits in the amount of $253,050.83. Epes was informed of Unum’s denial of benefits and the overpayment by letter dated December 14, 2007. In response to this letter, Epes sent Unum a letter requesting an explanation of the overpayment calculations.

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715 F. Supp. 2d 837, 2010 U.S. Dist. LEXIS 41283, 2010 WL 1729707, Counsel Stack Legal Research, https://law.counselstack.com/opinion/unum-life-insurance-co-of-america-v-epes-ared-2010.