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.

Tulino v. United of Omaha Life Insurance Co.

United States District Court, S.D. New York

January 26, 2017

PASQUALE TULINO, Plaintiff,
v.
UNITED OF OMAHA LIFE INSURANCE COMPANY, Defendant.

          Attorney for Plaintiff MICHAEL SWAALEY, ATTORNEY AT LAW By: Michael Swaaley, Esq.

          Attorneys for Defendant GOLDBERG SEGALLA, LLP By: Fallyn B. Cavalieri, Esq. GOLDBERG SEGALLA, LLP By: Alex J. Yastrow, Esq.

          OPINION

          ROBERT W. SWEET U.S.D.J.

         This is an action arising from an alleged wrongful denial of long-term disability benefits under an employee benefits plan subject to the requirements of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. ("ERISA"). Plaintiff Pasquale Tulino ("Tulino" or the "Plaintiff") has moved for a judgment on the administrative record and Defendant United of Omaha Life Insurance Company ("United" or the "Defendant") has cross-moved for the same. Based on the facts and conclusions set forth below, the motion of the Plaintiff is denied, and the cross-motion of the Defendant is granted.

         I. Prior Proceedings and Facts

         The facts are set forth in Plaintiff's Statement of Material Facts Pursuant to Local Civil Rule 56.1, Defendant's Response and Counter-Statement of Additional Undisputed Facts, and Plaintiff's Response and Counter-Statement of Additional Undisputed Facts, and are not in dispute except as noted below.

         Pasquale Tulino, the Plaintiff, is a professional engineer who was employed by HDR, Inc., as a Senior Vice President-Civil Section Manager. As part of his compensation package, Tulino's employer provided Long Term Disability (LTD) insurance. United of Omaha Life Insurance Company, the Defendant, issued the disability plan to HDR, Inc., under policy number GLTD-13J8, effective January 1, 2007 (the "Plan"). See Plaintiff's Statement of Undisputed Material Facts Pursuant to Local Civil Rule 56.1 ("PL's 56.1 Stmt.") ¶¶ 1-2; Defendant's Response to Defendant's 56.1 Statement and Counter-Statement of Additional Undisputed Material Facts Pursuant to Local Civil Rule 56.1 ("Def.'s Resp. 56.1 Stmt.", collectively with PL's 56.1 Stmt., the "56.1 Stmts.") ¶¶ 1-2, 44. The plan is an employee welfare benefit plan governed by ERISA. See Def.'s Resp. 56.1 Stmt. ¶ 45.

         The plan provides LTD benefits in the event of a covered claim under the terms and conditions of the plan. Specifically, the plan provides:

LONG-TERM DISABILITY BENEFITS
Benefits
If, while insured under this provision, You become Disabled due to Injury or Sickness, We will pay the Monthly Benefit shown in the Schedule. Benefits will begin after You satisfy the Elimination Period shown in the Schedule.

Id. ¶ 46.

         The plan contains language which confers United with discretionary authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the policy. Specifically, the plan provides:

RIDER
This rider is made a part of Group Policy GL TD-13J8 This rider is effective January 1, 2014.
In the event of a conflict between this Rider and any other provision of the Policy, including the Certificate, this Rider shall control.
The following is made a part of the Policy.
Authority To Interpret Policy
The Policyholder has delegated to Us the discretion to determine eligibility for benefits and to construe and interpret all terms and provisions of the Policy. Benefits under the Policy will be paid only if We decide, after exercising Our discretion, that the Insured Person is entitled to them. In making any decision, We may rely on the accuracy and completeness of any information furnished by the Policyholder, an Insured Person or any other third parties.
The Insured Person has the right to request a review of Our decision. If, after exercising the Policy's review procedures, the Insured Person's claim for benefits is denied or ignored, in whole or in part, the Insured Person may file suit and a court will review the Insured Person's eligibility or entitlement to benefits under the Policy.
* * *
PAYMENT OF CLAIMS
* * *
Authority to Interpret Policy
Policy benefits will be paid only if We determine, in Our discretion, that the claimant is entitled to benefits under the terms of the Policy (see the Authority to Interpret Policy provision in the ERISA Summary Plan Description information included with the Certificate).

Id. ¶ 47.

         The plan contains the following relevant definitions:

LONG-TERM DISABILITY DEFINITIONS
* * *
Disability and Disabled means that because of Injury or Sickness, a significant change in Your mental or physical functional capacity has occurred in which You are:
a) prevented from performing at least one of the Material Duties of Your Regular Occupation on a part-time or full-time basis: and b) unable to generate Current Earnings which exceed 99% of Your Basic ...

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.