Gentle v. Kohler Co.
| Decision Date | 16 August 2013 |
| Docket Number | Civil Action No. 12–S–586–NE. |
| Citation | 966 F.Supp.2d 1276 |
| Parties | Karen GENTLE, Plaintiff, v. KOHLER CO. and Kohler Co. Group Insurance Plans for Factory Associates at Huntsville, Defendants. |
| Court | U.S. District Court — Northern District of Alabama |
OPINION TEXT STARTS HERE
Jay E. Emerson, Jr., Higgs and Emerson, Huntsville, AL, for Plaintiff.
Gregory H. Revera, Leo Law LLC, Huntsville, AL, Kevin J. Kinney, Mark A. Johnson, Krukowski & Costello SC, Milwaukee, WI, for Defendants.
Plaintiff, Karen Gentle, a former employee of defendant, Kohler Company (“Kohler”), seeks short- and long-term disability benefits through Kohler's employee benefits plan.1 Plaintiff asserts claims under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq.2 This action is before the court on the parties' cross-motions for summary judgment.3 Upon consideration of the pleadings, evidentiary submissions, and briefs, the court concludes that plaintiff is entitled to short-term disability benefits, but not to long-term benefits.
Federal Rule of Civil Procedure 56 states that “[t]he 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 judgment as a matter of law.” Fed.R.Civ.P. 56(a) (alteration supplied). Thus, “the plain language of [that rule] mandates the entry of summary judgment, after adequate time for discovery and upon motion, against a party who fails to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial.” Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986) (alteration supplied).
In making this determination, the court must review all evidence and make all reasonable inferences in favor of the party opposing summary judgment.
[However,] [t]he mere existence of some factual dispute will not defeat summary judgment unless that factual dispute is material to an issue affecting the outcome of the case. The relevant rules of substantive law dictate the materiality of a disputed fact. A genuine issue of material fact does not exist unless there is sufficient evidence favoring the nonmoving party for a reasonable [factfinder] to return a verdict in its favor.
Chapman v. AI Transport, 229 F.3d 1012, 1023 (11th Cir.2000) (en banc) (internal citations omitted, alterations and emphasis supplied).
When presented cross motions for summary judgment, “[t]he court must rule on each party's motion on an individual and separate basis, determining, for each side, whether a judgment may be entered in accordance with the Rule 56 standard.” 10A Wright, Miller & Kane, Federal Practice and Procedure: Civil 3d § 2720, at 335–36 (1998) (footnote omitted, alteration supplied). As another court within this Circuit has observed:
“Cross motions for summary judgment do not change the standard.” Latin Am. Music Co. v. Archdiocese of San Juan of the Roman Catholic & Apostolic Church, 499 F.3d 32, 38 (1st Cir.2007). “Cross motions for summary judgment are to be treated separately; the denial of one does not require the grant of another.” Christian Heritage Acad. v. Okla. Secondary Sch. Activities Ass'n, 483 F.3d 1025, 1030 (10th Cir.2007) (quoting Buell Cabinet Co. v. Sudduth, 608 F.2d 431, 433 (10th Cir.1979)). “Even where parties file cross motions pursuant to Rule 56, summary judgment is inappropriate if disputes remain as to material facts.” Id.; accord Monumental Paving & Excavating, Inc. v. Pa. Mfrs.' Ass'n Ins. Co., 176 F.3d 794, 797 (4th Cir.1999) ( ) (citations omitted).
Ernie Haire Ford, Inc. v. Universal Underwriters Insurance Co., 541 F.Supp.2d 1295, 1297–98 (M.D.Fla.2008) (alteration in original). See also American Bankers Insurance Group v. United States, 408 F.3d 1328, 1331 (11th Cir.2005) ().
The “Summary Plan Description” of Kohler's employee benefits plan (the “Plan”) states that Kohler, as the Administrator of the Plan, “has the exclusive right to determine eligibility for benefits and to interpret the provisions of the benefit plan, so the decision by the Plan Administrator shall be conclusive and binding.” 4 The Plan's description states that 5
In a section entitled “Highlights of Your Pay Protection Program,” the Summary Plan Description states that: 6 A subsequent section, entitled “Your Short–Term Benefit,” notably omits the reference to “total disability” and, instead, speaks only of becoming “disabled”: i.e., “ If you become disabled by accidental injury or illness, are unable to work at your job, and are under a doctor's care, you will be eligible for a weekly benefit from this plan.” 7
The Plan's description of long-term disability benefits also contains a similar contradiction. In the section entitled “Highlights of Your Pay Protection Program,” the Plan states: “Long-term disability benefits begin after you have been disabled for 26 weeks.” 8 Note again that the term “disabled” is not qualified by the adjective “total.” Conversely, the section entitled “Long–Term Disability Benefits” resurrects the “total disability” requirement when it states that: “Benefits begin after you have received 26 weeks of Short–Term Disability providing you remain totally disabled.” 9
The term “total disability” is defined in only one place: a section entitled “When Long–Term Disability Benefits Are Paid.” 10 That part of the Plan states:
When Long–Term Disability Benefits Are Paid
Long–Term Disability benefits begin after you've been totally disabled for 26 weeks.
• During the first 36 months of disability you must be totally disabled from performing any and every duty of your occupation or similar job.
• After 36 months you must be totally disabled from performing any occupation or employment.
At all times, you must be under the care of a licensed physician. Before your Long–Term Disability benefit payments can begin, your disability will need to be medically verified and satisfactory to the company.11
If an employee's initial claim for short-term disability benefits is denied, he or she may file an appeal.12 The appeals process allows the employee to obtain “a full review” of the disability claim.13 Specifically, the Summary Plan Description states:
If A Claim Is Denied If a claim is denied, either totally or partially, you or your beneficiary will receive a written notice within 90 days after you first filed the claim. The notice will explain the reason for the denial, refer to the specific plan provision or provisions on which the denial is based, describe any additional information which is necessary to process your claim and explain why such information is necessary, and describe the steps to be taken if you wish to submit your claim for review.
If a claim is denied, you may appeal the denial within 65 days to the Plan Administrator and subsequently through ERISA. If you have a dispute on the application of negotiated benefit levels, it may be referred to the grievance procedure within 30 days of the final ERISA decision.
....
If you or your beneficiary disagree with the denial decision, you, your beneficiary, or an authorized representative can make a written request within 65 days to the plan administrator for a review of the claim. Pertinent documents may be reviewed, and issues and comments may be submitted in writing.
Within 60 days after a request for a review is received, you or your beneficiary will receive a written notice of the final decision or the reasons for the delay in reaching a final decision, if special circumstances require an extension of time.
In any event, a final decision will be reached, and you will be notified within 120 days after a request for a review is received. The final decision will be in writing and will include the specific reasons for the decision as well as references to the specific plan provision on which the decision is based.
The Plan Administrator has the exclusive right to determine eligibility for benefits and to interpret the provisions of the benefit plan, so the decision by the Plan Administrator shall be conclusive and binding.14
Plaintiff was employed by Kohler at its Huntsville, Alabama factory for more than ten years, from April 1, 1999 until September 23, 2009.15 During the course of her employment, plaintiff mainly worked as a “Molder Operator,” but occasionally in several other positions as necessary.16 Her duties required medium to heavy physical exertion, and the positions occupied were classified by the Dictionary of Occupational Titles as “unskilled” to lower “semi-skilled” jobs.17 Plaintiff's primary position (that of Molder Operator) required her to lift and manipulate fifty-pound fiberglass “charges,” while simultaneously operating two industrial presses.18 In...
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