Young v. Reliance Standard Life Insurance Company

CourtDistrict Court, W.D. Texas
DecidedApril 13, 2022
Docket1:20-cv-00739
StatusUnknown

This text of Young v. Reliance Standard Life Insurance Company (Young v. Reliance Standard Life Insurance Company) is published on Counsel Stack Legal Research, covering District Court, W.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Young v. Reliance Standard Life Insurance Company, (W.D. Tex. 2022).

Opinion

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF TEXAS AUSTIN DIVISION

JASON THOMAS YOUNG, § Plaintiff § v. § § RELIANCE STANDARD LIFE § CIVIL NO. 1:20-CV-739-LY-SH INSURANCE COMPANY and § MATRIX ABSENCE § MANAGEMENT, INC., § Defendants

REPORT AND RECOMMENDATION OF THE UNITED STATES MAGISTRATE JUDGE

TO: THE HONORABLE LEE YEAKEL UNITED STATES DISTRICT JUDGE Before the Court are Defendants’ Motion for Summary Judgment (Dkt. 30), filed January 28, 2022; Plaintiff’s Response (Dkt. 34), filed March 12, 2022; and Defendants’ Reply (Dkt. 37), filed April 1, 2022. On October 27, 2020, the District Court referred all pending and future non- dispositive and dispositive motions to the undersigned Magistrate Judge for resolution and Report and Recommendation, respectively, pursuant to 28 U.S.C. § 636(b)(1), Federal Rule of Civil Procedure 72, and Rule 1 of Appendix C of the Local Rules of the United States District Court for the Western District of Texas. I. General Background In January 2019, Plaintiff Jason Thomas Young worked as a truck driver for Pilot Travel Centers, L.L.C., and participated in a long-term disability benefits plan governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001-1461 (the “Plan” or “Policy”). Reliance Standard Life Insurance Company (“Reliance”) is the Plan’s insurer; Matrix Absence Management, Inc. (“Matrix”) is the administrator. The Plan provided that Plaintiff would receive a “Monthly Benefit” if Plaintiff became totally disabled. First Am. Compl. (Dkt. 7) ¶ 14. The Plan also stated that “Other Income Benefits1 are to be deducted from the Monthly Benefit.” Id. On January 2, 2019, Plaintiff sustained “permanent and disabling injuries” in a car collision. Id. ¶ 6. After the collision, Plaintiff submitted to Reliance a claim for long-term disability (“LTD”) benefits under the Plan. Reliance agreed that Plaintiff was totally disabled and agreed to pay him

a monthly benefit of $3,150.76. After Plaintiff received $153,774.14 from a settlement with the third party who caused the accident, however, Reliance notified Plaintiff on January 17, 2020, that it would offset his benefits by the settlement amount (“Settlement Offset”) because it considered the settlement to be “Other Income Benefits” under the Plan. Id. ¶ 17. Accordingly, Reliance immediately reduced Plaintiff’s monthly benefits by $2,562.90, to $587.86. On March 17, 2020, Plaintiff appealed Reliance’s decision, arguing that the settlement of a third-party tort liability suit and payment of underinsured motorist benefits were not included in Other Income Benefits under the Plan. On June 5, 2020, Reliance affirmed its original decision that it was entitled to the Settlement Offset.

On July 10, 2020, Plaintiff filed this lawsuit pursuant to 29 U.S.C. § 1132(a)(1)(B) against Defendants Reliance and Matrix, asserting that “there is no basis in the policy for any offset or reduction based on the third party settlement that Plaintiff made.” Original Complaint (Dkt. 1) ¶ 26. Plaintiff sues “to recover benefits due to him, to enforce his rights to benefits under the terms

1 Plaintiff alleges that under the Plan, “Other Income Benefits” includes: all benefits (except medical or death benefits) including any settlement made in place of such benefits (whether or not liability is admitted) an Insured is eligible to receive because of his/her Total Disability under: (a) Workers’ Compensation Laws; (b) occupational disease law; (c) any other laws of like intent as (a) or (b) above; and (d) any compulsory benefit law. Dkt. 7 ¶ 15. of the Reliance policy, and to clarify his future rights to benefits under the terms of the Reliance policy.” Id. ¶ 26. Plaintiff sought an injunction prohibiting Defendants from interpreting the “Other Income Benefits” language as including settlements of liability claims for personal injuries or underinsured motorist claims. Id. ¶ 34. Plaintiff also sought attorney’s fees, pre-judgment and post- judgment interest, and “further relief as the court deems equitable, just and proper.” Id. ¶ 39.

Eighteen days after Plaintiff filed suit, on July 28, 2020, Reliance sent Plaintiff an email notifying him that: Upon review and discussion, at this time we will be terminating the offset in the amount of $2[,]562.90 (monthly), and will refund Mr. Young the monies that have been offset to date. It appears this offset began as of January, 2020. Mr. Young can expect his benefits to resume to the pre-offset amount in the next benefit payment.

However, under the policy, any monies paid under a compulsory benefit law, such as PIP coverage (i.e. wage loss), are to be offset. Therefore, it is imperative that we receive a “distribution breakdown” of this settlement to determine if any portion is considered Other Income Benefits as defined by the policy.

Dkt. 30-1 at 218. Reliance asked Plaintiff to dismiss the lawsuit, but Plaintiff refused. On September 24, 2020, Defendants filed a motion to dismiss, asserting lack of subject matter jurisdiction under Rule 12(b)(1) and failure to state a claim under Rule 12(b)(6). Dkt. 2. On October 26, 2020, Plaintiff filed an Amended Complaint, in which he again contends that “[t]here is no basis in the policy for any offset or reduction based on the settlement with Plaintiff’s underinsured motorist coverage.” Dkt. 7 ¶ 32. Plaintiff also added a new claim, alleging that there was no basis in the Policy for offset based on any payment of PIP benefits he had received. Id. ¶ 33. Plaintiff further alleges that “[t]here has been no formal or informal acknowledgment that the interpretation formerly relied upon by Matrix and Reliance was incorrect, nor any decision that they will not rely upon it again, with regard to the payments or settlements Mr. Young has already received or that he may receive in the future.” Id. ¶ 27. In his Amended Complaint, Plaintiff seeks the disability benefits due under the Policy; a declaration that Defendants violated the Policy; an injunction prohibiting Defendants from interpreting the “Other Income Benefits” language as including settlements of liability claims for bodily injuries, underinsured motorist claims for bodily injuries, or PIP benefits paid for medical expenses; and pre-judgment interest, attorneys’ fees, and

costs. Id. ¶¶ 37-46. In light of the Amended Complaint, the undersigned Magistrate Judge dismissed as moot Defendants’ first motion to dismiss on November 18, 2020. On November 3, 2020, Defendants filed a second motion to dismiss, again arguing that Plaintiff’s lawsuit should be dismissed under Rule 12(b)(1) for lack of jurisdiction because there was no longer a live case or controversy. Dkt. 11. Specifically, Defendants argued that Plaintiff lacked standing to pursue this litigation because Reliance reinstated his benefits. Alternatively, Defendants argued that Matrix is not a proper ERISA defendant, and that Plaintiff’s newly asserted claim regarding PIP benefits should be dismissed for failure to exhaust under Rule 12(b)(6).

On February 2, 2021, the Court issued a Report and Recommendation that the District Court deny Defendants’ motion to dismiss except as to Plaintiff’s claim regarding an offset for PIP benefits. Dkt. 21 at 15. The Court found that Defendants’ argument that Plaintiff lacks standing because Reliance terminated the Settlement Offset after he filed suit relies on the wrong jurisdictional doctrine: this argument concerns mootness, not standing. See Already, LLC v. Nike, Inc., 568 U.S.

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Young v. Reliance Standard Life Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/young-v-reliance-standard-life-insurance-company-txwd-2022.