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Gonser v. Continental Casualty Co.

September 27, 2007


The opinion of the court was delivered by: Wm. R. Wilson, Jr. United States District Judge


Pending is Plaintiff's Motion for an Award of Benefits and Penalty,*fn1 Separate Defendants Continental Casualty Company's, CNA Group Life Assurance Company's, and The Hartford's ("insurance defendants") Motion for Judgment on the Pleadings,*fn2 and Separate Defendant Vulcan Materials Company's ("Vulcan") Motion for Judgment on the Pleadings.*fn3 Each party filed responses.*fn4

This is an ERISA claim for benefits under 29 U.S.C. § 1132 (a), (e)(1), and (f), and for penalties under 29 U.S.C. § 1105(a) and (b). Vulcan is Plaintiff's employer and the plan administrator. The plan is insured by the insurance defendants.

Vulcan and the insurance defendants assert that Plaintiff's Amended Complaint*fn5 should be dismissed because her claims are barred by the statute of limitations. Vulcan asserts that its conduct does not warrant an imposition of penalties, and that it paid Plaintiff six months of short- term disability ("STD") benefits. The insurance defendants allege that they are not the plan administrator and are, therefore, not subject to penalties, and that they are not responsible for paying STD benefits.

Plaintiff asserts that she is entitled to penalties for Vulcan's failure to provide a plan summary. She further maintains that her claim for STD benefits is not time barred, and that any failure to timely file her complaint was caused by Vulcan's conduct. Plaintiff argues that she is owed unpaid STD benefits from June through September 2001, and that she also has the right to seek long-term disability ("LTD") benefits.

I. Background

Plaintiff began working for Vulcan in January 19, 1998. She had back surgery on March 9, 2001*fn6 and never returned to work. Her STD benefits began in March 2001, but the insurance defendants denied Plaintiff's disability beyond June 29, 2001.*fn7 According to Vulcan, despite the decision by the insurance defendants, it paid Plaintiff's STD through September 2001.*fn8

Plaintiff filed a claim for STD benefits on July 11, 2001.*fn9 On August 6, 2001 the insurance defendants sent Plaintiff a letter explaining that STD benefits were approved by them through June 29, 2001. The insurance defendants told Plaintiff that more medical information was needed to verify additional disability.*fn10 In other correspondence, the insurance defendants mentioned LTD benefits to Plaintiff, and she was told to contact their office if she had questions.*fn11

On September 4, 2001, Plaintiff received a letter explaining that additional STD benefits were not owed. On September 19, 2001, she appealed, and, on October 26, 2001, the insurance defendants affirmed their decision. Plaintiff was also notified that this was the final decision.*fn12

On December 10, 2001, Plaintiff's lawyer sent a letter asking for reconsideration of the decision to deny further benefits, and stating that he was prepared to file a federal lawsuit.*fn13 A second letter was sent by Plaintiff's lawyer on December 26, 2001, asking for the identity of the plan sponsor, and for copies of the summary plan description.*fn14 The insurance defendants responded in January 2002 and advised that Vulcan was the plan administrator.*fn15 According to Plaintiff's lawyer, he then sent a letter to Vulcan asking for a copy of the plan summary.*fn16

Under the plan, a participant is entitled to a maximum of six months STD benefits.*fn17

After that, he or she may apply for LTD benefits. The plan also states that no action for LTD benefits can be brought after three years from the date "written proof is required."*fn18

Three years passed before Plaintiff's lawyer contacted the insurance defendants again. On April 14, 2005 he sent a letter and stated that he had not received notice from the plan administrator or the plan sponsor.*fn19 The insurance defendants immediately responded on April 21, 2005, and informed him that the final appeal determination was made on October 26, 2001.*fn20

On October 5, 2006, Plaintiff filed a Complaint,*fn21 claiming disability benefits accruing after September 1, 2001; penalties for failing to provide a plan summary; and liability for breach of fiduciary duties. On April 25, 2007, Plaintiff filed an Amended Complaint*f ...

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