Furleigh v. Allied Group Inc.
| Decision Date | 08 September 2003 |
| Docket Number | No. C02-3069-MWB.,C02-3069-MWB. |
| Citation | 281 F.Supp.2d 952 |
| Parties | John P. FURLEIGH, Plaintiff, v. ALLIED GROUP INC. and Continental Casualty Company, Defendants. |
| Court | U.S. District Court — Northern District of Iowa |
James M Stanton, Stanton & Sorensen, Clear Lake, IA, for Plaintiff.
Michael W. Thrall, John B. Tuffnell, Nyemaster, Goode, Voigts, West, Hansell & O'Brien, PC, Des Moines, IA, for Defendant.
TABLE OF CONTENTS
I. INTRODUCTION ..................................................................... 955
A. Procedural Background ........................................................ 955
B. Findings of Fact ............................................................. 956
1. Allied's long term disability plan ....................................... 956
2. Plaintiff Furleigh's retirement .......................................... 957
3. Medical records .......................................................... 958
II. LEGAL ANALYSIS ................................................................... 962
A. Standards For Summary Judgment ............................................... 962
B. Timeliness of the Action ..................................................... 963
1. Most analogous statute of limitations .................................... 963
a. Generally ............................................................ 964
b. Where the applicable plan contains a contractual period of
limitations ......................................................... 964
i. Where the contractual period of limitations is expressly
authorized by state statute .................................... 965
ii. Where the contractual limitations period in the plan is
not expressly authorized by state statute ...................... 967
2. Accrual of plaintiff Furleigh's cause of action .......................... 969
C. Timeliness Of Written Proof Of Loss .......................................... 972
D. Was Plaintiff Totally Disabled At The Time Of His Retirement? ................ 974
1. Standard of Review ....................................................... 974
2. Total disability as defined by the Plan .................................. 974
3. Evidence of total disability ............................................. 975
a. Continuously unable to perform substantial and material
duties of his occupation ............................................ 975
i. Incidents occurring during plaintiff Furleigh's employment ...... 976
ii. Medical records ................................................. 976
b. Under the regular care of a licensed physician ....................... 978
c. Not employed in any occupation ....................................... 978
III. CONCLUSION ....................................................................... 979
On August 9, 2002, plaintiff John P. Furleigh ("Furleigh") filed a petition in the Iowa District Court for Cerro Gordo County against defendants Allied Group, Inc. ("Allied") and Continental Casualty Company ("CNA") to recover long term disability ("LTD") benefits under Allied's long term disability plan ("Plan"), which was funded by a group term disability policy issued by CNA ("Policy"). Specifically, plaintiff Furleigh asserts Iowa common law claims for breach of contract and a declaratory judgment that Allied and CNA are in breach of contract. Defendants Allied and CNA removed the case to this court on September 10, 2002, pursuant to 28 U.S.C. § 1441, correctly asserting that Furleigh's claim was governed exclusively by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. ("ERISA"). (Doc. No. 1). On November 12, 2002, Defendants Allied and CNA filed their answer. (Doc. No. 5). Defendants Allied and CNA filed a motion for summary judgment on June 27, 2003, asserting that there is no genuine issue of any material fact that Furleigh's claim is barred as untimely under the terms of the Policy, and that plaintiff was not disabled at any time during his employment with Allied. (Doc. No. 15). Furleigh filed a timely resistance to defendants' motion for summary judgment on July 22, 2003 (Doc. No. 16). On July 23, 2003, this court granted the defendants' motion for extended time to reply to the plaintiff's resistance, and according to the terms of that order defendants Allied and CNA timely filed a reply on August 5, 2003 (Doc. No. 22). The court turns first to a discussion of the undisputed facts as shown by the record and the parties' submissions, then to consideration of whether the defendants are entitled to summary judgment.
Plaintiff John P. Furleigh1 was employed by Allied Group, Inc. as a full-time claims supervisor from June 2, 1975 until July 7, 1995.2 At the time of his retirement, Furleigh was sixty years old. As an employee of Allied, Furleigh participated in Allied's long term disability plan ("Plan"), an employee welfare benefit plan as defined by ERISA. This Plan was funded by a group term disability policy issued by CNA ("Policy"), which became effective on March 1, 1992. Defendants' Appendix in Support of Summary Judgment ("Defendants' Appendix"), Doc. No. 15 at 0087.3 The Policy was effective through June 30, 1998. Furleigh was furnished with a copy of the summary plan description ("SPD") on September 12, 1992, which described, among other things, eligibility requirements for long term disability ("LTD") benefits under the Plan. Defendants' Appendix, Doc. No. 15 at 0026. The SPD's definition of "total disability" is as follows:
"Total Disability" means that, during the Elimination Period and Your Occupation Period, You, because of Injury or Sickness, are:
1. continuously unable to perform the substantial and material duties of Your regular occupation;
2. under the regular care of a licensed physician other than Yourself; and 3. not gainfully employed in any occupation for which You are or become qualified by education, training, or experience.
Defendants' Appendix, Doc. No. 15 at 0015. "Elimination Period" is defined further as "the length of time you must be disabled before you are eligible to begin receiving [benefits]." Defendants' Appendix, Doc. No. 15 at 0008. The SPD provides for an Elimination Period of 180 days, and an Occupation Period of 24 months. Defendants' Appendix, Doc. No. 15 at 0011. Under the terms of the SPD, benefits under the Plan terminate on the earliest of the following dates:
1. the date the policy is terminated;
2. the premium due date if ALLIED fails to pay the required premium for you, except for an inadvertent error; or
3. the date You
a. are no longer a member of a class eligible for this insurance;
b. withdraw from the program;
c. are retired or pensioned; or
d. cease work because of a leave of absence, furlough, layoff, or temporary work stoppage due to a labor dispute, unless We and ALLIED have agreed in writing to continue insurance during such period.
Termination will not affect a covered loss which began before the date of termination.
Defendants' Appendix, Doc. No. 15 at 0017 (emphasis added). The SPD also includes important provisions covering notice, proof of loss, and limitation on legal actions:
NOTICE OF CLAIM. Written notice of claim must be given to Continental Casualty Company within 30 days after the loss begins or as soon as reasonably possible.
The notice will suffice if it identifies You and the policy. ALLIED will send it to Continental Casualty Company ...
* * * * * *
WRITTEN PROOF OF LOSS. Written proof of loss must be furnished within 90 days after the end of a period for which we are liable. If it is not possible to give the proof within 90 days, the claim is not affected if the proof is given as soon as reasonably possible. Unless You are legally incapacitated, written proof must be given within 1 year of the time it is otherwise due.
* * * * * *
LEGAL ACTIONS. No action at law or in equity can be brought until after 60 days following the date proof of loss was given. No action can be brought after 3 years (Kansas 5 years, South Carolina 6 years) from the date written proof of loss is required.
Furleigh announced his retirement from Allied in a letter dated June 9, 1995, in which he declared July 7, 1995 as his last day of work. Prior to Furleigh's announcement, presumably in response to an inquiry by the plaintiff, an interoffice memorandum, dated October 8, 1994, was prepared by co-employee Nancy Hutchins describing the benefits Furleigh was entitled to upon his retirement from Allied. The following language regarding LTD benefits was contained in that memorandum: "Your long term disability coverage with the company ceases on the last day of your full time employment." Defendants' Appendix, Doc. No. 15 at 0027. Subsequent to announcing his retirement, another memorandum, dated June 13, 1995, discussing Furleigh's benefits upon retirement was generated. This memorandum contained the following language regarding LTD benefits: "Your long term disability coverage with the company ceases the last day of your full time employment." Defendants' Appendix, Doc. No. 15 at 0032. On June 16, 1995, Furleigh was subjected to a retirement interview in which various topics were discussed. A checklist memorializing the topics covered in this interview was generated, and the final document was signed by the plaintiff. On this checklist is a space for filling in the...
To continue reading
Request your trial
-
Gaines v. Sargent Fletcher, Inc. Group Life Ins.
...ill and working part-time from home); Lauder v. First UNUM Life Ins. Co., 284 F.3d 375, 380-81 (2d Cir.2002); Furleigh v. Allied Group Inc., 281 F.Supp.2d 952, 973 (N.D.Iowa 2003). Waiver is the voluntary or intentional relinquishment of a known right. Rhorer, 181 F.3d at 645 (quoting Pitts......
-
Holcomb Condo. Homeowners' Ass'n, Inc. v. Stewart Venture, LLC
...that requires the plaintiff to bring an action before any loss can be ascertained is per se unreasonable.” 3Furleigh v. Allied Group Inc., 281 F.Supp.2d 952, 968 (N.D.Iowa 2003). In this case, the district court dismissed HCHA's asserted claims for negligence, negligence per se, negligent m......
-
Knoepfler v. Guardian Life Ins. Co. of America, 05-1186.
...e.g., Hofkin, 81 F.3d at 374; Clark v. Massachusetts Mut. Life Ins. Co., 749 F.2d 504, 507 (8th Cir.1984); Furleigh v. Allied Group Inc., 281 F.Supp.2d 952, 971-72 (N.D.Iowa 2003); Oglesby v. Penn Mut. Life Ins. Co., 877 F.Supp. 872, 886-87 (D.Del. 1994); Liberto v. Mutual Benefit Health & ......
-
Sigai v. Metro. Life Ins. Co.
...was unable to work first examined the claimant more than two years after her resignation from employment); Furleigh v. Allied Group, Inc., 281 F. Supp. 2d 952, 976-79 (N.D. Iowa 2003) (concluding the record did not support claimant's allegation he was disabled during his employment because ......