302 F.3d 576 (6th Cir. 2002), 00-5983, Caffey v. Unum Life Ins. Co.
| Citation | 302 F.3d 576 |
| Party Name | Rosalyn CAFFEY, Plaintiff-Appellant, v. UNUM LIFE INSURANCE CO., Defendant-Appellee. |
| Case Date | September 03, 2002 |
| Court | United States Courts of Appeals, U.S. Court of Appeals — Sixth Circuit |
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Submitted: June 12, 2002.
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[Copyrighted Material Omitted]
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Rosalyn Caffey (briefed), Morrow, GA, pro se.
John M. Scannapieco (briefed), Boult, Cummings, Conners & Berry PLC, Nashville, TN, for Defendant-Appellee.
Before BOGGS, SILER, and MOORE, Circuit Judges.
OPINION
MOORE, Circuit Judge.
In this pro se appeal, the plaintiff Rosalyn Caffey challenges a number of rulings by the district court in her suit to recover long-term disability benefits under an employee welfare plan. The defendant UNUM Life Insurance Company ("UNUM"), which administers claims for the plaintiffs long-term disability insurance plan, initially denied Caffey's disability claim. Caffey filed suit against UNUM under the Employee Retirement Income Security Act ("ERISA") to compel payment of benefits. The district court granted summary judgment to UNUM, but the Sixth Circuit reversed. On remand, the district court granted summary judgment to Caffey on her claim to recover benefits. On appeal, Caffey argues: (1) that the district court erred in ruling that her state-law claims were preempted by ERISA; (2) that the district court erred in finding that she was not entitled to certain equitable relief; (3) that the district court erred in failing to impose a statutory penalty for UNUM'S failure to supply certain plan information on request; (4) that the district court erred in its calculation of prejudgment interest; (5) that the district court erred in' declining to award postjudgment interest on its award of legal fees and prejudgment interest; (6) that the district court's findings of fact concerning UNUM's bad faith were in error; and (7) that the district court omitted one month's payment of disability benefits in calculating its award. After reviewing the briefs and the record of the proceedings below, we determine that the district court erred only in failing to order payment of postjudgment interest on its prejudgment interest and attorney fees awards. We therefore AFFIRM IN PART, REVERSE IN PART, and REMAND to the district court solely for the purpose of entering an appropriate award for postjudgment interest.
I. FACTS AND PROCEDURE
A. Factual Background
The facts giving rise to the instant dispute are fully set forth in a prior opinion of this court, Caffey v. UNUM Life Ins. Co., 1997 WL 49128 (6th Cir.). The relevant facts are summarized below.
Caffey worked as a financial analyst for the Mansur Financial Group, Inc. ("Mansur") from September 11, 1989, until June 29, 1990. As a Mansur employee, Caffey participated in the company's long-term disability benefits plan (the "Plan"). UNUM was responsible for claims administration under the Plan. The Plan contained a provision excluding benefits for certain pre-existing conditions. The preexisting conditions provision stated:
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This policy will not cover any disability:
1. caused by, contributed to by, or resulting from a pre-existing condition; and
2. which begins in the first 12 months after an insured's effective date.
A "pre-existing condition" means a sickness or injury for which the insured received medical treatment, consultation, care or services, including diagnostic measures, or had taken prescribed drugs or medicines in the three months prior to the insured's effective date.
Plan at L-BEN-5.
Caffey's "effective date," after which she was eligible for benefits under the Plan, was October 12, 1989. Caffey applied for long-term disability benefits on July 14, 1990, citing severe headaches and vision problems. UNUM reviewed Caffey's medical records and discovered that Caffey had received treatment for similar symptoms on August 23, 1989. In fact, Caffey's medical records revealed that she had been receiving treatment for hormone-related headaches and visual anomalies for many years. Physicians who examined Caffey at the time of her initial claim, including Dr. Valerie Purvin, believed that Caffey's symptoms were attributable to her long-standing history of migraine. Caffey, 1997 WL 49128, at *1.
Caffey's condition failed to improve and she began to experience new symptoms such as memory loss and motion sickness. On March 27, 1991, Caffey was diagnosed with lupus erythematosus on the basis of a positive test for a DNA antibody characteristic of the disease. Based upon this new information, Dr. Purvin reassessed her previous determination that Caffey's symptoms were due to migraine, and wrote a letter stating that "the headaches for which [Caffey] was treated in July and August of 1990 must have been a manifestation of her lupus rather than a flare-up of her previous migraine." Dr. Purvin Letter, August 6, 1992. Dr. Jose Tord, another physician who treated Caffey, also wrote a letter distinguishing Caffey's previous history of migraine from the onset of lupus in June of 1990.
A UNUM staff physician reviewed Caffey's medical history and determined that her lupus was a pre-existing condition, because the migraines and visual anomalies experienced in the summer of 1990 were identical to symptoms reported in August of 1989. Accordingly, UNUM denied Caffey's request for benefits in a letter dated May 22, 1991. Caffey appealed UNUM's decision. Caffey supplied UNUM with letters from Dr. Tord and Dr. Purvin, which fixed the onset of lupus in the summer of 1990. After additional review of Caffey's medical records, UNUM's staff physician concluded that the diagnosis of lupus was incorrect; and alternatively, if Caffey did have lupus, that it was impossible to determine retroactively the date of onset of the disease to be in the summer of 1990.
B. Procedural History
Following UNUM's denial of benefits, Caffey filed suit in the United States District Court for the Middle District of Tennessee on June 8, 1993. Caffey filed an amended complaint on January 12, 1995, alleging thirteen claims for relief. The claims are summarized as follows:
Count One sought recovery of long-term disability benefits under ERISA.
Count Two alleged breach of fiduciary duties under ERISA, violations of Indiana state insurance law, and common-law fraud arising from UNUM's processing of her benefits claim.
Count Three alleged that UNUM failed to comply with plaintiffs requests for plan information in violation of 29 U.S.C. § 1024(b).
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Count Five1 sought to remove UNUM as fiduciary of the Plan pursuant to 29 U.S.C. § 1109(a).
Count Six claimed that UNUM should be equitably estopped from offsetting any recovery by the amount of Social Security payments received by plaintiff.
Count Seven sought an injunction requiring UNUM to pay disability benefits in full.
Count Eight sought prejudgment interest on all past due disability benefits.
Count Nine sought payment of legal fees.
Count Ten asserted a claim for "Damages for Vexation," seeking recovery of certain money damages under ERISA, 29 U.S.C. § 1132(g), and Indiana state law.
Counts Eleven through Fourteen asserted various claims arising under common law doctrines of fraud, bad faith, negligence, and duress arising from UNUM'S handling of plaintiffs benefits claim.
The parties filed cross-motions for summary judgment. The district court ruled in favor of UNUM. The court found that Caffey's various state-law claims were preempted by ERISA. The district court then determined that plaintiff could not show that her lupus was not a pre-existing condition within the meaning of the Plan. Caffey filed a pro se appeal.
We reversed the district court's grant of summary judgment to UNUM. Caffey, 1997 WL 49128, at *3. We noted that the district court improperly placed the burden of proof on Caffey, whereas ERISA places the burden of proving an exclusion from coverage in an ERISA-regulated welfare plan on the plan administrator. Id. We further concluded that genuine issues of material fact existed as to whether the similarity between the symptoms reported by Caffey in August 1989 and those reported in the summer of 1990 established that Caffey's lupus was a pre-existing condition. We explained:
Such facts include evidence that Caffey functioned ably with her hormone-related migraine for more than twenty years prior to the summer of 1990, when her headaches and visual problems so affected her that she was unable to work. Simultaneously, she began to experience unusual symptoms, such as motion sickness and memory loss. In explaining the nature of her condition, letters from two of Caffey's treating physicians support the argument that Caffey suffered from two distinct illnesses and that one of her maladies, lupus, did not set in until the summer of 1990.
Id. We remanded the case to the district court for further proceedings.
After the remand, UNUM requested that the district court remand to the plan administrator for reconsideration of Caffey's claim. The district court granted this motion. Upon reconsideration, UNUM determined that Caffey was eligible for long-term disability benefits and was not barred by the pre-existing condition provision of the Plan. Accordingly, UNUM mailed plaintiff three checks totaling $91,592, which represented UNUM'S determination of the total amount of past-due disability benefits for the period beginning July 30, 1990, and ending January 29, 1999, reduced by the total amount of Social Security benefits received by Caffey during that period. UNUM began making regular monthly disability payments to the plaintiff at that time.
Caffey subsequently filed a motion for summary judgment in the district court
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requesting that the court enter judgment on the claims asserted in her amended complaint. In an order dated March 2, 2000, the district court granted plaintiffs motion in part and denied it in...
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