Eusebio Cotto Villegas v. Federal Express Corp.

• Decision Date: 20 December 2006
• Docket Number: No. CIV. 00-1969(PG).,CIV. 00-1969(PG).
• Citation: 468 F.Supp.2d 293
• Parties: EUSEBIO COTTO VILLEGAS; et al., Plaintiffs, v. FEDERAL EXPRESS CORPORATION; et al., Defendants.
• Court: U.S. District Court — District of Puerto Rico

468 F.Supp.2d 293

EUSEBIO COTTO VILLEGAS; et al., Plaintiffs, v. FEDERAL EXPRESS CORPORATION; et al., Defendants.

No. CIV. 00-1969(PG).

United States District Court, D. Puerto Rico.

December 20, 2006.

Appeal from the District Court, Aida M. Delgado-Colon, United States Magistrate Judge, 2005 WL 5028076

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Vilma M. Dapena-Rodriguez, Vilma Maria Dapena Law Office, Bayamon, PR, for Plaintiffs.

Carl E. Schuster, Mariela Rexach-Rexach, Lourdes C. Hernandez-Venegas, Schuster Usera & Aguilo LLP, San Juan, PR, for Defendants.

OPINION AND ORDER

PEREZ-GIMENEZ, District Judge.

Plaintiffs Eusebio Cotto-Villegas ("Cotto"), his wife Ana Santana-Concepcion, and their Conjugal Partnership (collectively referred to as "plaintiffs") filed the above-styled and captioned suit pursuant to the Employment Retirement Income Security Act of 1974 ("ERISA"), as amended, 29 U.S.C. § 1001 et seq. Their main allegation is that Cotto, who is a participant in a short term disability benefit plan ("STD") administered by defendant Federal Express Corporation ("FedEx" or "defendant") was arbitrarily denied STD benefits. Also, Cotto alleges that upon his retirement he was issued a defective notice under the Consolidated Omnibus Budget Reconciliation Act ("COBRA") and was denied the opportunity to elect the same health care coverage as FedEx's employees hired before January 1988. Plaintiffs also bring supplemental state claims alleging violations of the state anti-discrimination and tort law.

Before the Court is Magistrate Judge Aida M. Delgado's¹ Report and Recommendation ("R & R") (Docket No. 101) regarding defendant's Motion for Summary Judgment (Docket No. 66). For the following reasons, the Court grants in part and denies in part defendant's motion.

FACTUAL AND PROCEDURAL BACKGROUND²

Cotto was an employee of Flying Tiger Line (hereafter "FTL") from September 16, 1981 to August 6, 1989. On August 7, 1989, FTL merged with FedEx. Cotto was classified as a Customer Service Agent for Puerto Rico. At the time of the merger, FedEx devised a system of assigning seniority for former FTL employees who had years of service with FTL. This calculation resulted in Cotto being assigned a hire date of June 24, 1986.

As a FedEx employee, Cotto had coverage under a STD Plan and a Group Health Plan. In 1998 and 1999 the Plan Administrator for both plans was Group Health Federal Express Corporation. Also, in 1998 the STD Plan was a General Asset Plan and was paid for by Federal Express Corporation directly from its general assets. In 1998, the paying administrator for the STD Plan was Unicare. Thereafter, and pursuant to the 1999 Supplement to Employee Benefits, the paying administrator changed to Kemper National Services (hereinafter "Kemper"). The Court is unaware of the specific date for the change, however, a letter delivered to Cotto indicates that as of at least September 25, 1998, the claims paying administrator was no longer Unicare but Kemper.

The request for STD benefits

On February 27, 1998, Cotto sustained a work related injury and reported to the State Insurance Fund (hereafter "SIF") on March 3, 1998. The SIF verified that on March 6, 1998, Cotto had requested a medical statement or certificate for submission to his company's disability insurance plan.

On March 11, 1998, Carlos Dueño (hereafter "Dueño"), FedEx's Human Capital Management Program Manager, informed Cotto by letter the benefits available to him during his medical leave of absence. This letter is identified as the "Medical Leave of Absence Information and Requirement letter." It advised Cotto that he was "solely responsible for reporting" his STD claim to the claim paying administrator, Unicare, and provided its telephone number. The letter also warned that failure to respond promptly to requests from the SIF and Unicare could result in the delay, suspension or denial of his Workers' Compensation or Disability Plan benefits and the termination of his. employment. Lastly, the letter requested that Cotto contact Dueño on a weekly basis.

Cotto testified during his deposition that he actually called Unicare on March 16, 1998, to report his claim. He does not know, however, the name of the person with whom he spoke. Cotto testified that he believed he had filed his claim with Unicare when he called on March 16, 1998. It is Cotto's position that his phone call to Unicare tolled the 60-day period to submit his claim. He further testified that he explained to Unicare that he could not secure a doctor's certificate because his records were misplaced at the SIF. Cotto narrated having been told that Unicare would send him a package to complete, and that once he received the medical report he had to send it and open the case or claim. At that time, Unicare advised him that a medical certificate was required and that without it a claim could not be officially opened.

Cotto advised Dueño of his conversation with Unicare representatives sometime during March and April. Cotto testified that when he first spoke with Dueño he advised him that Unicare had requested medical information. Cotto did not speak to Dueño again until he received the medical certificate that had been requested. Cotto testified that he tried to get the medical certificate, and relied upon what he had been told by Unicare to the effect that he could not go forward with his claim until he obtained the medical certificate.

By April of 1998, Cotto had not received the certificate so he contacted the SIF's office to inquire and determine the status of his request. On April 14, Dueño authored a letter to the SIF requesting medical information for three FedEx employees, including Cotto. In the letter, Dueño explained that FedEx provides their employees monetary benefits during the time an employee is incapacitated but that it could not provide the benefits until it received SIF's medical certificate inasmuch as it was required before benefits could be afforded. Within the letter, Cotto is asked to have the medical information delivered to Unicare "as soon as possible."

Dueño explained during his deposition that he included Cotto's name in the letter to enable him to obtain and submit his medical record and information as soon as possible. Contrary to Cotto's testimony, Dueño testified that he was unaware that Cotto had not received a medical certificate from the SIF or that he was having problems because his medical record had been lost or misplaced at the SIF. Dueño testified that at the time he sent the letter to the SIF he had no idea of the status of Cotto's claim before Unicare. Furthermore, he testified that he was unaware if Cotto had or had not filed his claim. Nonetheless, Dueño testified that once he received the medical information he automatically forwarded it to Unicare for the approval or denial of the claim as determined by Unicare.

On May 12, 1998, Dueño sent to Karen Hines, Unicare's Claims Administrator, the medical information he received from the SIF for Cotto's injury. The cover memo states, "Please advise by email if this information is sufficient to approve the claim," making reference to Cotto's claim with Unicare. Dueño testified that after he sent the memo, Karen Hines informed him that Unicare had not received any telephone calls or claims from Cotto, and that the last telephone call recorded from Cotto was in 1994 when he was on a leave of absence.

On June 13, 1998, Cotto sent a letter to Dueño enclosing a medical certificate that he had finally obtained from the SIF. The letter refers to his claim with Unicare by stating "the information is provided in order to expedite the handling of my claim through Unicare." Twelve days later, Nelly Concepcion, FedEx's District. Personnel Manager, sent a letter to Cotto indicating that its records revealed that as of that date Cotto had not complied with the instructions set forth in the March 11 letter from Dueño. The letter states: "as per policy, you only had 60 days from the injury date to file a claim with Unicare. Upon verification with Unicare, as of today you have not filed your claim with them." This June 25 letter indicates that the SIF would only provide FedEx with information regarding Cotto's leave status and release date, but would never provide medical information to FedEx. This contradicts, however, Dueño's May 12 memo acknowledging having received medical records from either the employee or the SIF and his previous request to the SIF for Cotto's records The next day, June 26, 1998, Dueño sent a memorandum to Cotto advising as follows:

You failed to follow the requirement instructions because as of today (over 90 days after your injury date) you have not opened the claim with Unicare. As per the program guideline, you had only 60 days from the date of the injury to open the claim. Therefore, all benefits under STD/LTD program is [sic] denied due to your failure in complying with the basic requirements.

On July 3, 1998, Cotto wrote a letter of protest arguing that neither Unicare nor FedEx would accept a claim without the medical certificate from the SIF. Over a month and one-half later, on August 19, 1998, Dueño sent a letter to Cotto confirming a telephone conversation had on the same day, and explaining that Cotto's claim for STD benefits had been denied due to his failure to follow the procedures as explained in the Medical Leave of Absence Information and Requirement letter (the March 11 letter). Dueño also indicated that it was Cotto's responsibility to call Unicare and initiate a claim, which Cotto had 60 days from the date of injury to do so, and that he had failed to do so. In the letter, Dueño explained the appeal process and advised Cotto that he had 10 days to request a review with the Federal Express Corporation. For such purposes, Dueño provided Cotto with an address in Memphis, Tennessee.

The record reflects that the ten-day period to seek review as explained by...