Wile v. Paul Revere Life Insurance

410 F. Supp. 2d 1313, 2005 U.S. Dist. LEXIS 39333, 2005 WL 3642726
CourtDistrict Court, N.D. Georgia
DecidedAugust 4, 2005
Docket1:04 CV 2159 CC
StatusPublished

This text of 410 F. Supp. 2d 1313 (Wile v. Paul Revere Life Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wile v. Paul Revere Life Insurance, 410 F. Supp. 2d 1313, 2005 U.S. Dist. LEXIS 39333, 2005 WL 3642726 (N.D. Ga. 2005).

Opinion

ORDER

COOPER, District Judge.

Plaintiff Harold H. Wile (“Plaintiff’) brings the instant action against Defendants Paul Revere Life Insurance Company, UnumProvident Corporation, and the Kenzer Corporation Group Long Term Disability Plan (collectively referred to as “Defendants”) pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. (“ERISA”). Plaintiff seeks to recover long term disability benefits under 29 U.S.C. § 1132, the civil enforcement provision of ERISA. Defendants have filed a Counterclaim, seeking attorneys’ fees and expenses of litigation under 29 U.S.C. § 1132(g).

Presently pending before the Court are Defendants’ Motion for Summary Judgment [Doc. No. 13], 1 Defendants’ Motion to Stay Discovery [Doc. No. 16], Plaintiffs Motion to Conduct Discovery [Doc. No. 21], Plaintiffs Motion to Stay Further Briefing and to Stay the Court’s Consideration of Defendants’ Motion for Summary Judgment [Doc. No. 21], Plaintiffs Motion for Summary Judgment [Doc. No. 22], and Plaintiffs Motion to Strike Defendants’ Response to Plaintiffs Notice to Court of Recent Eleventh Circuit Authority [Doc. No. 29],

I. FACTS AND POSITIONS OF THE PARTIES

On August 25, 1991, Paul Revere Life Insurance Company (“Paul Revere”) delivered a group long term disability insurance policy (the “Policy”) to Kenzer Corporation (“Kenzer”). (Defendants’ Rule 56.1 Statement of Undisputed Facts (referred to herein as “DSUF”) ¶ 1.) In the Policy’s “Schedule of Benefits” section, the Policy provides, in pertinent part, the following:

Amount of Disability Income Benefit:

60% of Basic Monthly Earnings:
Maximum Benefit— $3500 per month
Minimum Benefit— 15% of basic monthly earnings, up to a maximum of $100.

(DSUF ¶ 3, Ex. A at 3.) Under a subsection of the “Long Term Disability Income Benefit” section entitled “What We Pay,” the Policy states, in pertinent part, “We pay monthly total disability benefits to an employee if he become totally disabled while insured due to injury or sickness. The employee must be under the care of a doctor while totally disabled. The maximum amount we pay is shown in the Schedule of Benefits.” (DSUF ¶ 3, Ex. A at 16.) That section further states, “Benefit payments may be reduced if the employee receives income from other sources. When and how this occurs is described in the section entitled Benefit Reductions.” (Id.) (emphasis added). Under the section of the policy entitled “Benefit Reductions,” the policy states, in pertinent part, the following:

While an employee is disabled, he may be eligible for benefits from other income sources. If so, we reduce our benefit by the amount of such other benefit paid or payable.
Listed below are other income sources which will reduce our benefit.
1. Social Security benefits, including Primary Social Security benefits and/or Family Social Security benefits received by an employee or an employee’s dependents on account of the employee’s disability or early or normal retirement. (If an employee fails to apply for Social Security benefits, we determine the *1316 amount he was eligible to receive, and, for the purposes of this insurance, he will be considered to receive that amount.)

(DSUF ¶ 6, Ex. A at 23) (emphasis added). Finally, in the section of the Policy entitled “Premiums,” the Policy provides that “[t]he initial premium rates are: .677% of the first $5833 of Basic Monthly Earnings.” (DSUF, Ex. A at 33.)

Plaintiff Harold H. Wile is a former employee of Kenzer, who participated in the Kenzer Corporation Group Long Term Disability Plan (the “Plan”) during his employment with Kenzer. He became eligible for long term disability benefits from Paul Revere from the 90th day following his onset of disability until the expiration of the period during which benefits were payable, which was to the age of 65. (DSUF ¶ 7.) The maximum benefit period expired on January 12, 2003. (Id.)

Plaintiffs “Basic Monthly Earnings” pri- or to the onset of his disabling condition were determined to be $8,671.77. (DSUF ¶ 8.) Applying the 60% formula set forth in the “Schedule of Benefits” to his monthly earnings, the result is $5,203.06. (DSUF ¶ 9.) Plaintiff also receives a Social Security disability income benefit in the amount of $1,285.00. (DSUF ¶ 11.)

Based on the Policy provisions mentioned above, Defendants take the position that although 60% of Plaintiffs monthly earnings was $5,203.06, the maximum benefit to which he is entitled is $3,500.00. Further, inasmuch as Plaintiff receives $1,285.00 in Social Security disability benefits, Defendants contend that the amount of $1,285.00 should be deducted from the maximum benefit amount, which results in Plaintiff receiving benefits from the Plan in the amount of $2,215.00.

Plaintiff takes the contrary position that rather than deducting his Social Security disability benefits from the maximum benefit amount, his Social Security disability benefits should be deducted from 60% of his monthly earnings, which would amount to $3,918.06 (i.e„ $5,203.06 — $1,285.00). Plaintiff then asserts that he would be entitled to benefits from the Plan in the amount of $3,500.00, the maximum benefit permitted. At a minimum, Plaintiff contends that the definition of the terms “benefit” and “our benefit” are ambiguous and that the Court should either construe the ambiguity in his favor, since he did not draft the contract provisions, or permit discovery and consider extrinsic evidence to resolve the ambiguity.

II. DISCOVERY MOTIONS

Defendants move the Court to stay discovery pending resolution of their summary judgment motion, while Plaintiff moves the Court to conduct discovery pri- or to the Court considering Defendants’ summary judgment motion and the cross summary judgment motion that Plaintiff subsequently filed. Whether Plaintiff should be permitted to take discovery pri- or to the Court resolving the summary judgment motions depends entirely on whether the Court finds an ambiguity in the Policy with respect to the definition of “benefit” and “our benefit,” as those terms are used in the “Long Term Disability Income Benefit” and “Benefits Reduction” sections of the Policy.

Where an ambiguity exists in an ERISA plan, the issue is one of contract interpretation and extrinsic evidence may be considered to resolve the ambiguity. See, e.g., Adams v. Thiokol Corp., 231 F.3d 837, 844 (11th Cir.2000); Stewart v. KHD Deutz of America Corp., 980 F.2d 698, 702 (11th Cir.1993); First Capital Life Ins. Company-In Conservation v. AAA Communications, 906 F.Supp. 1546, 1556 (N.D.Ga.1995).

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410 F. Supp. 2d 1313, 2005 U.S. Dist. LEXIS 39333, 2005 WL 3642726, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wile-v-paul-revere-life-insurance-gand-2005.