Pottayil v. Thyssenkrupp Elevator Corp.
| Decision Date | 12 October 2021 |
| Docket Number | CIVIL ACTION NO. 1:17-CV-4431-RWS |
| Citation | 574 F.Supp.3d 1282 |
| Parties | Faheem POTTAYIL and Farzana Shihabudheen, Individually and as Next Friend and Guardian of her minor child, Sameeh Pottayil, Plaintiffs, v. THYSSENKRUPP ELEVATOR CORPORATION and Hartford Life and Accident Insurance Company, Defendants. |
| Court | U.S. District Court — Northern District of Georgia |
Glenn R. Kantor, Pro Hac Vice, Kantor & Kantor, Northridge, CA, Richard J. Dreger, Richard J. Dreger, Attorney at Law, P.C., Roswell, GA, Jerry A. Lumley, Lumley & Harper, LLC, Macon, GA, for Plaintiffs.
David S. Fryman, Pro Hac Vice, Shaina E. Hicks, Ballard Spahr Andrews, LLP, Philadelphia, PA, Sarah Tope Reise, Troutman Pepper Hamilton Sanders LLP, Atlanta, GA, for Defendant Thyssenkrupp Elevator Corporation.
Elizabeth Johnson Bondurant, Nikole Marie Crow, Womble Bond Dickinson (US) LLP, Atlanta, GA, Sarah Tope Reise, Troutman Pepper Hamilton Sanders LLP, Atlanta, GA, for Defendant Hartford Life and Accident Company.
This case comes before the Court on Defendant Thyssenkrupp Elevator Corporation's Motion for Summary Judgment [Dkt. 89] and Defendant Hartford Life and Accident Insurance Company's Rule 52(a) Motion for Judgment [Dkt. 91]. The Court, after a careful review of the record, enters the following Opinion and Order.
In this lawsuit, Plaintiffs Faheem Pottayil and Farzana Shihabudheen, individually and as next friend and guardian of her minor child, Sameeh Pottayil, seek additional supplemental life insurance benefits offered by Defendant Thyssenkrupp Elevator Corporation ("TKE") to its employees through Defendant Hartford Life and Accident Insurance Company ("Hartford"). The benefits are under Group Policy No. GL-677112 ("the Group Policy"), which was issued to TKE to fund supplemental term life insurance and other benefits under an employee welfare benefit plan sponsored by TKE and governed by the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), 29 U.S.C. § 1001 et seq.
Beginning on or around February 2, 2009, and continuing until his death, Shihabudheen Pottayil ("Mr. Pottayil") was an employee of TKE. (Statement of Undisputed Material Facts of Def. TKE ["SUMF"], Dkt. [89-2], at ¶ 1.) Mr. Pottayil was the husband of Plaintiff Farzana and the father of Plaintiffs Faheem and Sameeh. ( Id. at ¶ 2.)
In March 2009, Mr. Pottayil enrolled in the Supplemental Group Life Insurance Plan ("the Plan"), an ERISA-qualified welfare benefit plan offered by TKE to its employees. ( Id. at ¶ 3.) The Plan is fully insured by the Hartford Life and Accident Insurance Company ("Hartford"), which also acts as the Plan's Claims Administrator. ( Id. ) Mr. Pottayil designated Plaintiffs as his beneficiaries under the Plan. ( Id. at ¶ 4.) TKE was the Plan Administrator. ( Id. at ¶ 5.)
Upon enrolling in the Plan, Mr. Pottayil initially elected Supplemental Life Insurance Coverage in an amount equal to his annual earnings (the "Guaranteed Issue Amount") to become effective March 4, 2009. ( See Dkt. [76] at ¶ 16; Dkt. [78] at ¶ 16.) During the 2013 open enrollment period, Mr. Pottayil elected to increase his Supplemental Life Insurance Coverage from the Guaranteed Issue Amount to an amount equal to give (5) times his annual earnings. ( See Dkt. [76] at ¶ 19; Dkt. [78] at ¶ 19.)
Upon the commencement of the 2013 Plan year and continuing until Mr. Pottayil's death more than three years later, TKE deducted premiums from Mr. Pottayil's salary every month for Supplemental Life Insurance Coverage for Mr. Pottayil in the amount sufficient to pay a monthly premium for life insurance coverage in an amount equal to five times Mr. Pottayil's annual earnings. ( See Dkt. [76] at ¶ 20; Dkt. [78] at ¶ 20.)
Mr. Pottayil died on April 5, 2016. (Dkt. [89-2] at ¶ 6.) Following Mr. Pottayil's death, Plaintiffs made a claim for the Supplemental Life Insurance Coverage benefit in the amount of $848,000, which was equal to five times Mr. Pottayil's annual earnings. ( See Dkt. [76] at ¶ 24; Dkt. [78] at ¶ 24.) On August 9, 2016, Hartford approved the portion of Plaintiffs’ claim equal to the Guaranteed Issue Amount of $170,000. ( See Dkt. [76] at ¶ 25; Dkt. [78] at ¶ 25.) On August 11, 2016, Hartford rejected Plaintiffs’ initial claim for the additional $678,000 in supplemental life insurance benefits.1 ( See Dkt. [76] at ¶ 26; Dkt. [78] at ¶ 26; Dkt. [89-2] at ¶ 7.)
On September 12, 2016, Plaintiffs, through former counsel, requested a copy of the claim file from Hartford, which Hartford provided on September 27, 2016. (Dkt. [89-2] at ¶ 8.) Also, on September 12, 2016, Plaintiffs, through former counsel, appealed Hartford's initial rejection of their claim. ( Id. at ¶ 9.) Hartford denied the appeal on September 29, 2016. ( Id. )
On or around March 30, 2017, Plaintiffs, through current counsel, sent TKE a letter requesting that TKE provide certain documentation and information regarding a claim for supplemental life insurance benefits Plaintiffs had made with Hartford that Hartford had rejected initially and again on appeal. ( Id. at ¶ 10.) The letter contained 23 separate requests for documents. ( Id. )
On June 26, 2017, TKE, through counsel, responded to Plaintiffs’ letter. ( Id. at ¶ 11.) TKE's June 26th letter responded to each of counsel for Plaintiffs’ 23 requests with either responsive documents or an explanation that any responsive documents would reside with Hartford and/or that it had no documents responsive to the request. ( Id. at ¶ 12.) TKE also explained that TKE does not determine whether to pay any claim for benefits under the Plan and does not maintain records of claims for life insurance benefits. ( Id. at ¶ 13.) Rather, TKE explained, Hartford serves as the Claims Administrator and administers and determines claims under the Plan. ( Id. at ¶ 14.) Therefore, Hartford maintained any materials related to claims for benefits, and TKE referred Plaintiffs to Hartford for many of the documents requested. ( Id. ) The documents TKE enclosed in its response included the relevant Plan documents, the 2013 Benefits Guide Corporate Salaried, a screenshot from TKE's open enrollment process showing the Evidence of Insurability ("EOI") requirement, the EOI Form, and communications between TKE and Hartford concerning Plaintiffs’ claim. ( Id. at ¶ 15.)
Plaintiffs’ counsel also addressed his March 30, 2017, request to Hartford. ( Id. at ¶ 16.) On or around April 13, 2017, less than 30 days later, Hartford replied, once against attaching Mr. Pottayil's entire claim file, which included, among other things, the Group Policy, the Summary Plan Description, and internal communications between TKE and Hartford.2 ( Id. at ¶ 17.)
On or around June 14, 2017, Plaintiffs, through counsel, sent a letter to Hartford regarding the denial of Plaintiffs’ request for additional supplemental life insurance benefits, which Hartford treated as a second appeal. ( Id. at ¶ 18.) All the documents that Plaintiffs quote and rely upon in connection with their second appeal, including the language of the Group Policy, internal communications between TKE and Hartford, and TKE's correspondence with Plaintiffs, were already in Plaintiffs’ possession before Plaintiffs sent their second appeal on June 14, 2017. ( Id. at ¶ 19.) On or around July 25, 2017, Hartford denied Plaintiffs’ second appeal of their claim for supplemental life insurance. ( Id. at ¶ 20.) Plaintiffs did not supplement their second appeal with documents or information that they received from TKE on or around June 26, 2017, even though Hartford had not yet rendered a decision on their second appeal at that time. ( Id. at ¶ 21.)
A copy of the Group Policy, with amendatory riders, is contained within the administrative record filed by Hartford on March 3, 2021. (Dkt. [84-1], 2-14). The Group Policy provides that the contract between Hartford and TKE consists of:
1) The Policy;
2) any Certificate(s) of Insurance incorporated and made a part of The Policy;
3) any riders issued in connection with such Certificate(s) of Insurance;
4) the Policyholder's application, if any, a copy of which is attached to and made part of the Policy when issued; and 5) any individual application submitted by the Employee and accepted by The Company in connection with The Policy.
( Id. at p. 8.) The Group Policy further provides:
Certificate(s) of Insurance
The Company will give individual Certificate(s) of Insurance to:
1) the Policyholder; or
2) any other person according to a mutual agreement among the other person, the Policyholder, and The Company; for delivery to persons covered under The Policy and which will explain the important features of The Policy.
( Id. at p. 9.)
Under the caption, "INCORPORATION PROVISION," the Group Policy lists "Certificate(s) of Insurance and Rider(s)" which "are attached to, incorporated in and made a part of, The Policy." ( Id. at p. 10.) One of the Certificate(s) of Insurance listed in the INCORPORATION PROVISION is "Form GBD-1100 (10/08). ( Id. )
The Certificate of Insurance for TKE's "Supplemental Dependent Life, Supplemental Term Life, Supplemental Accidental Death and Dismemberment" coverage under the Group Policy ("the Supplemental Life Certificate") is contained in the administrative record filed by Hartford on March 3, 2021. ( Id. at pp. 15-54.) The face page of the Supplemental Life Certificate indicates in the lower left-hand corner that the Certificate is "Form GBD-1100 (10/08)." ( Id. at p. 20.)
With respect to the Guaranteed Issue amount for supplemental life insurance, the Supplemental Life Certificate provides for "1 or 2 times Your annual Earnings, subject to a maximum of $750,000 rounded to the next higher $1,000 if not already a multiple of $1,000." ( Id. at p. 22.) In the section entitled "ELIGIBILITY AND ENROLLMENT," the Supplemental Life Certificate contains the following...
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