Brenner v. Metro. Life Ins. Co.

• Decision Date: 03 March 2015
• Docket Number: CIVIL ACTION NO. 11-12096-GAO
• Parties: LYNN BRENNER, Plaintiff, v. METROPOLITAN LIFE INSURANCE COMPANY and SOUTHBORO MEDICAL GROUP, INC., Defendants.
• Court: U.S. District Court — District of Massachusetts

LYNN BRENNER, Plaintiff,
v.
METROPOLITAN LIFE INSURANCE COMPANY and SOUTHBORO MEDICAL GROUP, INC., Defendants.

CIVIL ACTION NO. 11-12096-GAO

UNITED STATES DISTRICT COURT DISTRICT OF MASSACHUSETTS

March 3, 2015

REPORT AND RECOMMENDATION ON MOTIONS FOR SUMMARY JUDGMENT (#50, #52).

KELLEY, U.S.M.J.

Plaintiff Lynn Brenner brought this action against Defendants Metropolitan Life Insurance Company ("MetLife") and Southboro Medical Group, Inc. ("SMG") for damages arising out of a life insurance plan that was issued to her husband, Alan Brenner. The only count at issue here is Count VI of the amended complaint, a claim for equitable relief for breach of fiduciary duties under § 502(a)(3) of the Employment Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1132(a)(3). Defendants filed motions for summary judgment (SMG's motion, #50; MetLife's motion, #52); Plaintiff responded in opposition (#56, #59); and MetLife filed a reply (#62). For the reasons that follow, I recommend that MetLife's motion for summary judgment be ALLOWED, and that SMG's motion for summary judgment be DENIED.

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I. BACKGROUND

Except where otherwise noted, the parties have agreed on the following facts. In June 2004, Dr. Alan Brenner, a rheumatologist, was hired by Southboro Medical Group. (#54 at 1.) Dr. Brenner participated in an employee benefit plan administered by SMG that provided group life insurance coverage. (Id.) The plan is an "employee welfare benefit plan" as defined by ERISA. (#53-2 at 54-59.) Dr. Brenner named his wife, Lynn Brenner, as beneficiary of the policy. (Id. at 2.) MetLife provided the life insurance; SMG paid premiums to MetLife on behalf of its employees on a monthly basis. (Id. at 2-3.)

When MetLife issued the policy, it granted SMG access to an online administrative manual and provided copies of documents for SMG to distribute to plan participants. (#54 at 2.) According to SMG, these documents, (called the "Plan Documents" or "the SMG Plan"), included the MetLife Certificate of Insurance, which contains the terms and provisions of the group policy, and information relevant to ERISA. (See #55 at 1.) Defendants claim that SMG provided Dr. Brenner and his wife with the Plan Documents on multiple occasions. (#54 at 2; #55 at 3, 5.) Plaintiff asserts that there are substantial issues of fact about whether Dr. Brenner or Lynn Brenner ever received copies of these documents. (#58 at 2, 3; #61 at 5, 7-8.) Plaintiff further asserts that even if Dr. Brenner was provided with the documents, from the time he became sick until his death, he was "medically incapable of reviewing the SMG Plan even if it was in his possession," and that SMG was aware of his condition. (#58 at 2.)

The Plan Documents provide that, in order to remain eligible for coverage under the policy, an employee must be actively at work, that is, performing all usual duties of his job on a full-time basis, which is defined as thirty or more hours per week. (#54 at 3.) A plan participant's coverage

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may end on the last day of the month in which he ceases active work, or, a participant's life insurance policy may remain in effect for nine months after he ceases active work if (i) he stopped work because of an injury, illness, or disease, and (ii) SMG continues to pay premiums for the coverage. (Id. at 3-4.) The administrative manual provides that if there are changes in an employee's status that may affect his life insurance coverage, it is SMG's responsibility to inform MetLife by completing a form. (Id. at 3.)

The Plan Documents provide for a "Conversion Option," allowing a qualified plan participant to convert to an individual policy upon the expiration of his participation in the group policy. (Id. at 4.) A participant in group coverage must submit an application if he wishes to convert to an individual policy. (Id.) The application period cannot exceed 91 days from the date that the group insurance ends. (Id. at 5.)

In 2009, Dr. Brenner began suffering from Guillain-Barre Syndrome, "a neurological autoimmune disease" that left him "paralyzed, unresponsive, and unable to speak or write." (#57 at 2.) As a result of his illness, Dr. Brenner stopped working in March 2009. (#54 at 5.) Because he stopped working due to illness and SMG continued to pay premiums, his life insurance coverage was continued for an additional nine months, through December 31, 2009. (Id. at 6.) As Dr. Brenner never submitted an application for the Conversion Option, his employee-sponsored life insurance coverage ended after December 31, 2009, nine months after he ceased active employment. (Id.)

Dr. Brenner never returned to work. (Id.) Lynn Brenner claims that neither he nor she was informed that the group policy coverage would end on December 31, 2009, nor did they ever receive notice of the right to convert to an individual policy. (Amended Complaint, #16 at 4.) She alleges,

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however, that from the outset of her husband's illness, she regularly informed Kathryn Tomashunas, SMG's Human Resources Director, about Dr. Brenner's condition and made inquiries about the status of his benefits. (#60 at 2-4, 7.) For instance, in May, 2009, she emailed Tomashunas to ask if her checks for benefits were being received and "to be sure everything is still in place." (#58 at 7.) Tomashunas reponded by asking Jaimee Lazano, a benefits coordinator who worked under her, to "confirm with Lynn Brenner that we have our check and everything is ok." (Id.)

Plaintiff also claims that, without her knowledge, in August 2009, Tomashunas checked with the SMG insurance broker, Robert Muenzburg, to get "advice about the best way to proceed" with Dr. Brenner's life insurance. (#60 at 2-3; see Tomashunas Deposition, #58-1, at 21, 67.) Tomashunas's purpose in speaking to Muenzberg was to ensure that Dr. Brenner would remain covered under his life insurance policy. (#58 at 8.) Plaintiff states that, based on those conversations, Tomashunas "decided to keep [Dr. Brenner] on the SMG Plan and continue paying his benefits." (#60 at 2-3.)

Tomashunas testified at a deposition that she knew that Dr. Brenner could convert to an individual policy, but she decided not to send the conversion notice or otherwise pursue conversion because she felt that it might be too expensive for him to do so.¹ (#58 at 10.) Tomashunas and Lozano believed that Dr. Brenner would continue to be covered under the policy as long as SMG

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continued to "keep him on the SMG Plan," and did not realize that his enrollment would automatically be terminated nine months after he stopped working. (#55 at 4.)

In January 2010, after Dr. Brenner's coverage had been terminated, Plaintiff asked Tomashunas how much she owed for the life insurance premium for the new year; Tomashunas replied that the premium was $51.56 per month. (Id. at 4; emails, #58-3, at 6.) She continued to make premium payments. (#54 at 7.) On Monday, March 29, 2010, Ms. Brenner emailed Tomashunas, explaining that Dr. Brenner was about to die and asking about the status of his life and health insurance. Tomashunas responded by informing her that the life insurance policy was through MetLife in the amount of three times his annual salary, up to $500,000. (Id. at 9.)

Dr. Brenner passed away on March 31, 2010. (#54 at 6.) On April 13, 2010, Lynn Brenner made a claim for life insurance benefits. (Id. at 7.) On May 13, 2010, and again on July 26, 2010, MetLife sent letters to Plaintiff advising her that benefits were not payable because her husband was not covered by the policy at the time of his death. (Id.) In June 2010, SMG returned the premium payments that Plaintiff had paid since the coverage expired. (Id.)

Plaintiff alleges that Defendants failed to exercise reasonable care or competence in obtaining or communicating information about the life insurance policy to Plaintiff. (#16 at 8.) Ms. Brenner claims that although Tomashunas knew that Dr. Brenner was incapacitated and was "physically unable to consult the SMG plan," she failed to take steps or precautions to make sure his interests were addressed. Tomashunas admitted in a deposition that SMG has no policy for dealing with a situation where a plan participant is incapacitated and cannot consult the SMG plan. (#60 at 3.)

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On November 28, 2011, Plaintiff filed a complaint against MetLife and SMG. In her amended complaint, she brought claims for misrepresentation, promissory estoppel, breach of contract, breach of the implied covenant of good faith and fair dealing, breach of contract under ERISA, breach of fiduciary duty under ERISA, unfair claims settlement practices in violation of Massachusetts law, and unfair or deceptive practices in violation of Massachusetts law. (#16 at 6-14.) On Defendants' motions, the Court dismissed all of Plaintiff's state law claims as preempted by ERISA, and her ERISA breach of contract claim as falling outside of the types of claims permitted under that statute. (#32, #35.) Consequently, the only claim that remains in this case is Count VI of the amended complaint, for breach of fiduciary duty under ERISA. See 29 U.S.C. § 1132(a)(3).

II. STANDARD OF REVIEW

The purpose of summary judgment is "to pierce the boilerplate of the pleadings and assay the parties' proof in order to determine whether trial is actually required." Rojas-Ithier v. Sociedad Espanola de Auxilio Mutuo y Beneficiencia de Puerto Rico, 394 F.3d 40, 42 (1st Cir. 2005) (internal quotation marks and citation omitted). When considering a motion for summary judgment, "a court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to a judgment as a matter of law." Fed. R. Civ. P. 56(a). The moving party bears the initial burden of asserting the absence of a genuine issue of material fact and "support[ing] that assertion by affidavits, admissions, or other materials of evidentiary quality." Mulvihill v. Top-Flite Golf Co., 335 F.3d 15, 19 (1st Cir....