Mercer v. Life Ins. Co. of N. Am.
| Decision Date | 18 June 2012 |
| Docket Number | Civil Action No. 11–0372. |
| Citation | 874 F.Supp.2d 610 |
| Parties | Alfred MERCER v. LIFE INSURANCE COMPANY OF NORTH AMERICA. |
| Court | U.S. District Court — Western District of Louisiana |
OPINION TEXT STARTS HERE
James A. Rountree, Rountree Law Offices, Monroe, LA, for Alfred Mercer.
Christopher Glenn Morris, Daniel P. Guillory, Baker Donelson et al., Baton Rouge, LA, for Life Insurance Company of North America.
The Report and Recommendation [Doc. No. 34] of the Magistrate Judge having been considered, together with Defendant's Objection [Doc. No. 35], Plaintiff's Response [Doc. No. 36], and Defendant's Reply [Doc. No. 37,] thereto filed with this Court, and, after a de novo review of the record, finding that the Magistrate Judge's Report and Recommendation is correct and that judgment as recommended therein is warranted,
IT IS ORDERED that the Motion for Summary Judgment [Doc. No. 28] filed by Defendant Life Insurance Company of North America is hereby DENIED.
IT IS FURTHER ORDERED that the Motion for Summary Judgment [Doc. No. 24] filed by Plaintiff Alfred Mercer is DENIED, insofar as it seeks to re-visit the standard of review to be applied in this case.
IT IS FURTHER ORDERED, ADJUDGED, and DECREED that the Motion for Summary Judgment [Doc. No. 24] filed by Plaintiff Alfred Mercer is otherwise GRANTED, and that judgment is hereby entered in favor of Plaintiff Alfred Mercer ordering Defendant Life Insurance of North America to pay Plaintiff long term disability benefits retroactive to his alleged disability onset date of December 17, 2009, through and until the entry of judgment, subject to such elimination period and offsets permitted under the Plan.
IT IS FURTHER ORDERED that Defendant Life Insurance of North America continue to make long term disability benefit payments, from the entry of this judgment, in the monthly amount specified in the Plan, subject to such offsets as are permitted in the Plan, until such time, if there comes such a time, that Life Insurance of North America makes an adverse determination, consistent with ERISA and the Plan terms, that Plaintiff is no longer entitled to benefits.
IT IS FURTHER ORDERED that attorney's fees are awarded in favor of Plaintiff in an amount to be jointly stipulated by the parties, or via contested motion, if, despite all reasonable and diligent efforts, the parties remain unable to agree upon a reasonable figure.
IT IS FURTHER ORDERED that defendant bear all assessable court costs.
Before the undersigned magistrate judge, on reference from the district court, are cross-motions for summary judgment filed by plaintiff Alfred Mercer [doc. # 24] and defendant Life Insurance Company of North America (“LINA”) [doc. # 28]. For reasons explained below, it is recommended that LINA's motion be denied, and that plaintiff's motion be denied in part and granted in part.
On March 8, 2011, Alfred Mercer filed the instant complaint under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001, et seq., against LINA, the designated plan fiduciary for the employee welfare benefit plan (“the Plan”) sponsored by Mercer's former employer, Lakeland Holdings, LLC, d/b/a WorldStrides. See Compl.; Amend. Rider; Admin. Record, Bates Labeled MERCER00240–241. Plaintiff contends that LINA wrongfully denied him disability benefits under the Plan. (Compl.). Accordingly, he seeks a judgment ordering LINA to pay him disability benefits under the Plan, plus attorney's fees. Id.
Following the resolution of cross-motions for summary judgment regarding the standard of review to be applied in this case,1 the court set a briefing schedule for submission of the matter for decision on the administrative record, as supplemented. (Sept. 22, 2011, ERISA Briefing Order [doc. # 23] ). Instead, however, the parties submitted the matter for decision in the context of cross-motions for summary judgment [doc. # s 24 & 28], thereby effectively conceding that there are no genuine issues of material fact.2 Following delays for responsive briefs, the matter is now before the court.
Summary judgment is appropriate when the evidence before the court shows “that there is no genuine issue as to any material fact and the movant is entitled to judgment as a matter of law.” Fed R. Civ. P. 56(a). A fact is “material” if proof of its existence or nonexistence would affect the outcome of the lawsuit under applicable law in the case. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 2511, 91 L.Ed.2d 202 (1986). A dispute about a material fact is “genuine” if the evidence is such that a reasonable fact finder could render a verdict for the nonmoving party. Id.
“[A] party seeking summary judgment always bears the initial responsibility of informing the district court of the basis for its motion, and identifying those portions of ‘the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any,’ which it believes demonstrate the absence of a genuine issue of material fact.” Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986) (quoting Anderson, 477 U.S. at 247, 106 S.Ct. 2505). “The moving party may meet its burden to demonstrate the absence of a genuine issue of material fact by pointing out that the record contains no support for the non-moving party's claim.” Stahl v. Novartis Pharmaceuticals Corp., 283 F.3d 254, 263 (5th Cir.2002). Thereafter, if the nonmovant is unable to identify anything in the record to support its claim, summary judgment is appropriate. Id.
In evaluating the evidence tendered by the parties, the court must accept the evidence of the non-movant as credible and draw all justifiable inferences in its favor. Anderson, 477 U.S. at 255, 106 S.Ct. 2505. “The court need consider only the cited materials, but it may consider other materials in the record.” Fed.R.Civ.P. 56(c)(3) (emphasis added). While courts will “resolve factual controversies in favor of the nonmoving party,” an actual controversy exists only “when both parties have submitted evidence of contradictory facts.” Little v. Liquid Air. Corp., 37 F.3d 1069, 1075 (5th Cir.1994) (en banc). There can be no genuine issue as to a material fact when a party 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., 477 U.S. at 322–23, 106 S.Ct. 2548. This is true “since a complete failure of proof concerning an essential element of the nonmoving party's case necessarily renders all other facts immaterial.” Id. at 323, 106 S.Ct. 2548.
When a movant bears the burden of proof on an issue, it must establish “beyond peradventure 3 all of the essential elements of the claim ... to warrant judgment in [its] favor.” Fontenot v. Upjohn Co., 780 F.2d 1190, 1194 (5th Cir.1986). In other words, the movant must affirmatively establish its right to prevail as a matter of law. Universal Sav. Ass'n v. McConnell, 1993 WL 560271 (5th Cir. Dec. 29, 1993) (unpubl.).
LINA issued Group Policy Number LK–961394 (a/k/a the “Plan”) to Lakeland Tours, LLC d/b/a WorldStrides (“WorldStrides”), which provided WorldStrides' employees with long term disability insurance coverage.4 Through his employment as a programmer-analyst at WorldStrides, plaintiff Alfred Mercer was a Class 2 participant under the Policy. (MERCER00167). LINA administers claims under the Plan and pays those claims from its own funds. (Interr. Resp.; Pl. MSJ, Exh.).
Relevant Plan provisions include,
The Insurance Company will pay Disability Benefits if an Employee becomes Disabled while covered under this Policy. The Employee must satisfy the Elimination Period, be under the Appropriate Care of a Physician, and meet all the other terms and conditions of the Policy. He or she must provide the Insurance Company, at his or her own expense, satisfactory proof of Disability before benefits will be paid ...
The Elimination Period is the period of time an Employee must be continuously Disabled before Disability Benefits are payable. The Elimination Period is shown in the Schedule of Benefits ...
* * *
The Employee is considered Disabled if, solely because of Injury or Sickness, he or she is:
1. unable to perform the material duties of his or her Regular Occupation; and
2. unable to earn 80% or more of his or her Indexed Earnings from working in his or her Regular Occupation.
After Disability Benefits have been payable for 36 months, the Employee is considered Disabled if, solely due to Injury or Sickness, he or she is:
1. unable to perform the material duties of any occupation for which he or she is, or may reasonably become, qualified based on education, training or experience; and
2. unable to earn 80% or more of his or her Indexed Earnings ...
* * *
The Employee's ability to work is based on the following:
1. medical evidence submitted by the Employee;
2. Consultation with the Employee's Physician; and
3. evaluation of the Employee's ability to work by not more than three Independent Experts if required by the Insurance Company ...
The Independent Expert must be:
1. licensed, registered or certified as required by the laws of the state in which the evaluation is made; and
2. acting within the scope of that license, registration or certificate.
* * *
The occupation the Employee routinely performs at the time the Disability begins. In evaluating the Disability, the Insurance Company will consider the duties of the occupation as it is normally performed in the general labor market in the national economy. It is not work tasks that are performed for a specific employer or at a specific location.
* * *
To continue reading
Request your trial
-
Jones v. Metro. Life Ins. Co.
...court should, as a general rule, remand the matter to the plan administrator for further assessment."); Mercer v. Life Ins. Co. of N. Am., 874 F. Supp. 2d 610, 633 (W.D. La. 2012) (declining to remand when the plan administrator "already had the opportunity to consider the SSA decision, but......