Raymond v. Unum Grp.
| Decision Date | 23 February 2021 |
| Docket Number | CIVIL ACTION NO. 20-352-BAJ-EWD |
| Parties | MINA RAYMOND, ET AL. v. UNUM GROUP, ET AL. |
| Court | U.S. District Court — Middle District of Louisiana |
Please take notice that the attached Magistrate Judge's Report and Recommendation has been filed with the Clerk of the U.S. District Court.
In accordance with 28 U.S.C. § 636(b)(1), you have 14 days after being served with the attached report to file written objections to the proposed findings of fact, conclusions of law, and recommendations set forth therein. Failure to file written objections to the proposed findings, conclusions and recommendations within 14 days after being served will bar you, except upon grounds of plain error, from attacking on appeal the unobjected-to proposed factual findings and legal conclusions accepted by the District Court.
ABSOLUTELY NO EXTENSION OF TIME SHALL BE GRANTED TO FILE WRITTEN OBJECTIONS TO THE MAGISTRATE JUDGE'S REPORT.
Signed in Baton Rouge, Louisiana, on February 23, 2021.
/s/_________
ERIN WILDER-DOOMES
UNITED STATES MAGISTRATE JUDGE
Before the Court is the Motion to Remand (the "Motion"), filed by Mina Raymond ("Mina") and Steven Raymond (collectively, "Plaintiffs").1 The Motion is opposed by Defendants Paul Revere Life Insurance Company ("Paul Revere"), New York Life Insurance Company ("New York Life"), and Unum Group and/or Unum, the Benefit Group (collectively, "Defendants").2 Plaintiff has filed a reply memorandum.3 As explained more fully below, Defendants have established that federal subject matter jurisdiction exists and none of Plaintiffs' arguments in support of remand are availing; therefore, the undersigned recommends4 that the Motion be denied and this matter referred to the magistrate judge for a scheduling conference.5
This matter involves a dispute between Plaintiffs and Defendants over disability benefits governed by a Premier Disability Insurance Policy ("Policy") issued to Mina on or about March 24, 1988 by New York Life, and subsequently administered by Paul Revere and Unum Group or Unum, the Benefit Group, as the alleged agent of Paul Revere.6
The pertinent facts for the purposes of the instant Motion are as follows: Plaintiffs allege that the Policy is an "own occupation policy," which provides for payment of monthly income benefits for total disability ("Total Disability Benefits"), and supplemental benefits called social insurance supplemental benefits ("SIS Benefits"), if there is a finding that an insured is totally disabled, i.e., the insured has a disability that prevents her from performing the substantial or material duties of her regular job. According to Mina, the Policy permits an insured to obtain other employment and earn other income in the event of disability without losing eligibility for Total Disability Benefits or SIS Benefits, so long as the other employment does not constitute the insured's regular job.7 Furthermore, Plaintiffs contend that the Policy essentially provides that, throughout the Benefit Term, which is initiated by the payment of benefits, Policy premiums are waived.8
On August 6, 1996, Mina was diagnosed with multiple sclerosis, a permanent neuromuscular condition, while employed at her regular job as a retail pharmacist. New York Life determined that Mina was incapable of returning to her regular job of retail pharmacist and was totally disabled under the Policy. Mina began receiving Total Disability Benefits and SIS Benefitsin January 1997.9 At some point in early 1997 (and continuing through the present), Mina resumed working as a pharmacist on a part-time basis while continuing to receive benefits, allegedly with the approval of New York Life.10 Plaintiffs contend that Defendants wrongfully ceased payment of Mina's SIS Benefits from July 2001 through January 2013, which Plaintiffs were not aware of at the time.11 Further, several times during the benefit term, Defendants requested information from Mina regarding her duties and her income and continued to approve payment of her benefits under the Policy.12 That changed on May 14, 2019, when, according to Plaintiffs, Defendants issued a reservation of rights letter advising that, as a result of Defendants' analysis of Mina's income, all past and future payments were conditional under the Policy.13 Defendants reviewed additional information from Mina's physicians and, in January 2020, Defendants advised Plaintiffs that their review indicated that Mina was performing her regular job because she had started working increased hours (albeit in a reduced capacity), and her tax returns indicated that her actual income over the prior five years was much higher than the income she had reported to Defendants. Thus, Mina appeared to be disqualified for benefits under the applicable terms of the Policy.14 In response, Plaintiffs' attorney sent a representation letter to Defendants seeking Mina's claims file.15 According to Plaintiffs, "On March 31, 2020, Defendants cancelled the Policy, and sought recovery of $225,578.91 in benefits paid to Plaintiff Mina Raymond between 2014 and February 2020, based solely on an evaluation on her income, despite clear evidence that she remained Totally Disabled on a permanent basis."16
On April 27, 2020, Plaintiffs filed their original Petition for Damages ("Petition") in the Nineteenth Judicial District Court for the Parish of East Baton Rouge alleging Defendants breached the terms of the Policy and their fiduciary duties, as well as engaged in bad faith conduct, in their wrongful determination that Mina was employed in her regular job and their wrongful failure to pay Mina benefits under the Policy, as well as in their wrongful attempts to recover past benefits paid from 2014 through 2020 and their wrongful failure to pay Mina for SIS Benefits from July 2001 through January 2013. Mina additionally alleged that Defendants harassed her, invaded her privacy, caused her emotional distress, and were unjustly enriched at her expense, all of which entitled to her damages, including penalties and attorney's fees pursuant to La. R.S. 22:1821.17
After the Petition was filed, Plaintiffs received seven premium notices from Defendants, seeking payment of $4,458.65 for past-due premiums owed for 2014 through 2020.18 On May 7, 2020, Mina responded to the premium notices, contending that the premiums were waived under the Policy due to Mina's continuing total disability.19 On May 13, 2020, Defendants stated that, based on their prior determination that Mina was performing her regular job and had not suffered the requisite loss of income under the Policy, Mina was not qualified for disability benefits under the Policy and was also not entitled to waiver of premiums as of 2014. Defendants advised Mina that, if she wanted to keep her Policy in force, all premiums were due by June 10, 2020.20 In response, Plaintiffs filed their First Supplemental and Amending Petition for Damages ("First Amended Petition") on May 21, 2020, newly asserting that Defendants wrongfully sought payment of these previously-waived premiums, which Plaintiffs contend remained waived under thePolicy.21 On June 9, 2020, Plaintiffs' filed a Motion to Deposit Funds into the Registry of the Court ("Motion to Deposit"), which was granted the same day. Based on that Order, Plaintiffs tendered $4,458.65 into the registry of the state court.22 The Motion to Deposit states, 23 Defendants sent a letter directly to Mina, also dated June 9, 2020, notifying her that her Policy lapsed, effective March 24, 2014, due to nonpayment of the premiums.24 Subsequent email correspondence between counsel for the parties indicates that Plaintiffs' counsel advised Defendants that the purpose of the tender of funds was Plaintiffs' attempt to prevent cancellation of the Policy due to non-payment of the premiums and to have the state court decide whether the premiums were owed.25 Defendants responded that the tender 26 Plaintiffs maintain, however, that the non-payment of premiums was not grounds for cancellation and Defendants' June 9, 2020 letter did not cancel the Policy; rather, "thenotice of cancellation [is] a pretext by Defendants to avoid liability for future benefits under the Policy."27
On June 10, 2020, Defendants removed the matter to this Court on the basis of diversity jurisdiction pursuant to 28 U.S.C. § 1332, (and ultimately, filed a counterclaim against Plaintiffs for return of the benefits paid).28 Nine days after that, Plaintiffs moved to deposit $4,458.56 into the registry of this Court: "[p]ursuant to 28 USC Sec 2041-2042, and Local Civil Rule 67."29 Like the Motion to Deposit filed in the state court, in this Court Plaintiffs disclaimed liability for any premiums, but sought to deposit the funds "out of an abundance of caution," so that this Court can determine whether any premiums were owed.30 Defendants did not oppose this motion.
Following removal, the parties filed a number of pleadings regarding a various procedural issues that were discussed and ruled upon during the July 24, 2020 telephone hearing and conference with the undersigned, all of which is discussed in detail in the Hearing Report and Order.31 Of...
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