Whitlinger v. Continental Casualty Co.

129 F. Supp. 2d 924, 2001 WL 85836
CourtDistrict Court, E.D. Virginia
DecidedJanuary 22, 2001
DocketCiv.A. 2:00CV579
StatusPublished
Cited by2 cases

This text of 129 F. Supp. 2d 924 (Whitlinger v. Continental Casualty Co.) is published on Counsel Stack Legal Research, covering District Court, E.D. Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Whitlinger v. Continental Casualty Co., 129 F. Supp. 2d 924, 2001 WL 85836 (E.D. Va. 2001).

Opinion

OPINION & ORDER

DOUMAR, District Judge.

This matter is before the Court on Defendant Continental Casualty Company’s (“Continental”) Motion to Dismiss Count Two of Amended Complaint. For the reasons that follow, the Motion to Dismiss Count Two of Amended Complaint is GRANTED.

I. Factual Background

Plaintiff Roberta Whitlinger brings this action to redress an alleged wrongful denial of long-term disability benefits under a disability insurance contract between her former employer, Sentara Health Systems (“Sentara”), and Continental.

Whitlinger became a Sentara employee on August 8, 1988. See Am.Compl. ¶ 6. As such, Whitlinger was qualified and vested to participate in the long-term disability benefits program provided for Sentara employees under the disability insurance contract between Continental and Sentara. See id. ¶ 5.

In June 1993, Whitlinger was diagnosed with Systemic Lupus Erythematous (“lupus”). See id. ¶ 7. The lupus gradually restricted Whitlinger’s ability to continue working as a Utilization Review Coordinator, and Whitlinger finally stopped working at Sentara in November 1995. See id. ¶ 7. Pursuant to the terms of the disability policy between Sentara and Continental, Continental began paying Whitlinger short-term disability benefits in January 1996. See id. ¶ 8. In May 1996, in response to Continental’s investigation of Whitlinger’s eligibility for long-term disability benefits, Whitlinger’s doctor, Garret M. Kelly, D.O., indicated to Continental that Whitlinger was totally disabled and would never be able to resume work. See id. ¶ 9. Based on its investigation, Continental began paying long-term disability benefits to Whitlinger in May 1996. See id. ¶ 10. Whitlinger also filed an application for Social Security disability benefits on March 13,1996. See Pl.Ex. C.

*926 In connection with Whitlinger’s application for Social Security benefits, the disability insurance contract between Continental and Sentara states, inter alia, that

[t]he Monthly Benefit under this Policy shall be reduced by:
1. Disability benefits paid, payable, or for which there is a right under:
a: The Social Security Act, excluding any amounts for which the Insured Employee’s dependents may qualify because of the Insured Employee’s Disability,
b: Any Worker’s Compensation or Occupational Disease Act or Law, or any other law which provides compensation for an occupational injury or sickness, or
c: Any State Disability . Benefit Law....

See Addendum 2, Def.Ex. 1. This portion of the disability policy was explained in a letter dated October 21, 1996 from Continental to Whitlinger. That letter states that “[y]our Long-Term Disability benefits are reduced by any benefits that are paid or payable under the Social Security Act.” See Pl.Ex. C. On October 24, 1996, Whit-linger executed an election form that requested Continental to pay full long-term disability benefits until Whitlinger received an award of Social Security benefits, with Whitlinger agreeing to reimburse Continental for any overpayment that would occur as a result of such an award. See id. Alternatively, Whitlinger could have elected to have Continental deduct her estimated Social Security award from Continental’s monthly long-term disability payment, which would have resulted in a reduced monthly benefit initially, while preventing or reducing the potential for a large overpayment upon receipt of any lump-sum Social Security award for prior disability benefits. See id. In addition to that election form, Whitlinger executed an acknowledgment form on October 30, 1996 that said:

I, Roberta Whitlinger, acknowledge that my Long Term Disability (LTD) vion Continental Casualty Company, hereafter referred to as the Company, thru my employer, allows the Company to reduce the benefits payable to me by certain amounts paid or payable under the disability or retirement provisions of the Social Security Act (including any payments for eligible dependents), any Worker’s Compensation, or any Occupational Disease Act or Law, any State Compulsory Disability Benefit Law, and any disability, retirement or other income benefits provided by or through my employer.
However, I also acknowledge the advantage of having the Company advance the full monthly benefit until I receive any of the benefits described above. I also realize that when I receive any of these benefits- an overpayment will occur on my claim. I agree, in consideration of this advance, to repay the Company the full amount of these benefits paid during the time the full monthly benefit is paid under my LTD plan.
I understand, and agree, that repayment of monies advanced will be made in one (1) lump-sum upon receipt of such other benefits as described. I also acknowledge the right of the Company, upon my failure to repay in one (1) lump-sum, to withhold my monthly benefit until the overpayment is satisfied.
I also acknowledge and agree that in the event of my failure to deliver payment of any overpaid balance to the Company within sixty (60) days of demand for such overpaid balance, the Company may assess interest on such overpaid balance. The applicable interest rate will be the Prime Interest Rate in effect on the date of demand. Interest will be charged from the date of the overpayment through the final date of resolution. I understand that if I deliver payment to the Company within sixty (60) days of demand, no interest will be due. I agree to reimburse the Company for all attorneys’ fees and other expenses incurred as a result of my failure to *927 make reimbursement as described above. My acceptance of an advance, along with my signature below, is my acceptance of the terms of this agreement.
/S/ Roberta N. Whitlinger, November 30,1996

Pl.Ex. C.

While Whitlinger’s Social Security case was proceeding, Continental continued to pay Whitlinger full long-term disability benefits. In July 1997, Dr. Kelly again stated that Whitlinger was continuously disabled from November 1995 through July 1997, with the prognosis that Whit-linger would never be able to return to work. See Am.Compl. ¶ 12. Whitlinger alleges that in August 1997, based on the medical records of Dr. Kelly, Whitlinger’s prior medical records, and the apparent review of Continental’s medical consultant, Continental informed Whitlinger that she had “the capacity to perform the substantial and material duties of [her] occupation” and therefore Continental was denying further benefits beyond September 19, 1997. See id. ¶ 18. Whitlinger appealed that determination to Continental’s Appeals Committee, and in December 1997, the Appeals Committee informed Whitlinger that “the denial of benefits was correct and proper based on the evidence.” See id. ¶ 17.

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Cite This Page — Counsel Stack

Bluebook (online)
129 F. Supp. 2d 924, 2001 WL 85836, Counsel Stack Legal Research, https://law.counselstack.com/opinion/whitlinger-v-continental-casualty-co-vaed-2001.