Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Groux v. Liberty Life Assurance Company of Boston

September 26, 2008

CLAUDIA GROUX, PLAINTIFF,
v.
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON, DEFENDANT.



The opinion of the court was delivered by: Scullin, Senior Judge

MEMORANDUM-DECISION AND ORDER

I. INTRODUCTION

Currently before the Court are Defendant's motion for summary judgment and Plaintiff's cross-motions for summary judgment, declaratory judgment, attorney's fees and to amend the complaint. Plaintiff asserts claims under the Employee Retirement Income Security Act ("ERISA") against Defendant for wrongful termination of disability benefits.*fn1

II. BACKGROUND

A. Factual History

Plaintiff, a telemarketer for Taconic Plastics, experienced an inferior wall myocardial infarction in January of 1997. Defendant received Plaintiff's claim for long-term disability benefits in June of 1997. On August 5, 1997, Defendant sent Plaintiff a letter stating that Plaintiff's claim for "Long Term Disability (LTD) benefits ha[d] been approved, based on [her] inability to perform the duties of [her] occupation." See Declaration of C. Meyerson, Esq. dated August 8, 2006 ("Meyerson Decl."), Exhibit "J," at CL0308. The letter also stated the following: "Thank you for notifying us of your return to work on a part-time basis. You fall under the 'Partial Disability' provision of your Long Term Disability policy . . . ." See id., Exhibit "J," at CL0309.*fn2

On November 12, 2001, Defendant told Plaintiff via telephone that her benefits had been terminated and that she had a right to request a review of the claim. See Memorandum-Decision and Order dated March 28, 2005, at 4. On November 16, 2001, Defendant sent Plaintiff a letter informing her that she was not entitled to benefits, explaining the denial and noting her right to seek an appeal. See Meyerson Decl., Exhibit "J," at CL0119-22, Letter from M. Bruneau to C. Groux dated November 16, 2001. This letter cites a definition for "'Disability' or 'Disabled'" that does not appear in the policy and is similar to the definition of "Total Disability" in the controlling policy. See id. at CL0119.

On January 15, 2002, Plaintiff, through her attorney, sent a letter as Notice of Appeal and Appeal of the decision to terminate benefits. See Meyerson Decl., Exhibit "J," at CL0057-60, Letter from C. Meyerson, Esq. to M. Cook dated January 15, 2002. In the letter, Mr. Meyerson stated: "It must be noted that Ms. Groux is not claiming under 'Total Disability' or 'Totally Disabled'. Ms. Groux is claiming under 'Partial Disability' or 'Partially Disabled'."*fn3 See id. at CL0059.

On March 8, 2002, Defendant sent Plaintiff a letter upholding its previous denial of benefits. See Meyerson Decl., Exhibit "J," at CL0046-49, Letter from S. Colinet to C. Meyerson, Esq. dated March 8, 2002. In its letter, Defendant cited the correct Partial Disability provisions from the controlling policy, see id. at CL0046, and the letter consistently referred to the terminated benefits as benefits for partial disability, see id. passim.

B. Long Term Disability Policy

The policy includes the following provisions pertinent to the discussion below:

SECTION II - DEFINITIONS

PARTIAL DISABILITY or PARTIALLY DISABLED means as a result of the sickness or injury which caused total disability, the insured is:

(1) able to perform one or more, but not all, of the material and substantial duties of his own or any other occupation on a full-time or a part-time basis; or

(2) able to perform all of the material and substantial duties of his own or any other occupation on a part-time basis.

To qualify for a partial disability benefit the insured must be earning less than 80% of his predisability income at the time partial disability employment begins.

TOTAL DISABILITY or TOTALLY DISABLED means during the elimination period and the next 24 months of disability the insured is:

(1) unable to perform all of the material and substantial duties of his occupation on a full-time basis because of a disability:

(a) caused by injury or sickness;

(b) that started while insured under this coverage; and

(2) after 24 months of benefits have been paid, the insured is unable to perform with reasonable continuity all of the material and substantial duties of his own or any other occupation for which he is or becomes reasonably fitted by ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.