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UNUM Life Insurance Co. of America v. Grourke

December 20, 2005

UNUM LIFE INSURANCE COMPANY OF AMERICA, PLAINTIFF,
v.
MICHAEL J. GROURKE, JR., DEFENDANT.



The opinion of the court was delivered by: Judge Caputo

MEMORANDUM

Presently before the Court is Plaintiff UNUM Life Insurance Company of America's Motion For Summary Judgment (Doc. 13).For the reasons set forth below, the Court will deny UNUM's motion. The Court has jurisdiction over this matter pursuant to 29 U.S.C. § 1132(e) and 28 U.S.C. § 1331.

BACKGROUND

The facts in the present case are relatively undisputed. Michael J. Grourke, Jr. began employment with Honeywell, Inc. on January 29, 1962. On or about January 1, 1995, Mr. Grourke became a participant in a fully-insured employee benefit welfare plan under Group Long-Term Disability Insurance Policy No. 392237 ("Plan") issued to Honeywell, Inc. by UNUM Life Insurance Company of America ("UNUM"). The Plan is subject to the provisions of the Employee Retirement Income Security Act, 29 U.S.C. §§ 1001, et seq. ("ERISA").

On November 14, 1997, Mr. Grourke ceased working due to injuries affecting his knee and back. He submitted a claim for long-term disability benefits to UNUM under the Plan on or about April 14, 1998. Mr. Grourke's claim was approved, and he began receiving monthly disability benefits retroactive to May 14, 1998. Under the Plan, any long-term disability benefits paid out are to be offset by other benefits received by the insured. Specifically, the Plan provides that UNUM will "subtract from [the insured's] gross disability payment . . . the amount that [the insured is] entitled to receive as disability payments . . . under the United States Social Security Act." (Doc. 13, Ex. A at LTD-BEN-3.) Further, the Plan provides that once it is determined that the insured may qualify for Social Security benefits, UNUM "will estimate [the insured's] entitlement to these benefits . . ." unless the insured ". . . sign[s] . . .[a] payment option form . . . stating that [the insured] promise[s] to pay any overpayment caused by an award." Id. at LTDBEN-5. Mr. Grourke does not deny signing the Payment Option Form ("POF"), but states that he did not designate either of the two payment options in the POF. Mr. Grourke asserts that, furthermore, he was not requested to sign the POF until May of 1999, and that he was told his disability benefits from UNUM would immediately cease if he failed to sign the form.

Then, on or about September 19, 2000, UNUM ceased making disability payments to Mr. Grourke on the basis that he was no longer disabled. At that point, Mr. Grourke had received a total of $64, 896.20 in benefits from UNUM between May 14, 1998 and September 18, 2000; without a reduction in monthly payments based upon Mr. Grourke's potential Social Security benefits. Thereafter, Mr. Grourke retroactively received $48,700.17 in benefits from Social Security for his period of disability between May 14, 1998 to September 18, 2000. Mr. Grourke admits that he has never paid UNUM any portion of the alleged overpayment of disability benefits.

UNUM filed suit to recover the alleged overpayment of disability benefits on July 26, 2004. (Doc. 1.) On May 25, 2005, UNUM filed the present motion for summary judgment. (Doc. 13.) This motion is fully briefed and ripe for disposition.

LEGAL STANDARD

Summary judgment is appropriate if "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." FED. R. CIV. P. 56(c). A fact is material if proof of its existence or nonexistence might affect the outcome of the suit under the applicable substantive law. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986).

Where there is no material fact in dispute, the moving party need only establish that it is entitled to judgment as a matter of law. Where, however, there is a disputed issue of material fact, summary judgment is appropriate only if the factual dispute is not a genuine one. See id. at 248. An issue of material fact is genuine if "a reasonable jury could return a verdict for the nonmoving party." Id.

Where there is a material fact in dispute, the moving party has the initial burden of proving that: (1) there is no genuine issue of material fact; and (2) the moving party is entitled to judgment as a matter of law. See CHARLES ALAN WRIGHT & ARTHURR. MILLER, FEDERALPRACTICE AND PROCEDURE: CIVIL 2D § 2727 (2d ed. 1983). The moving party may present its own evidence or, where the nonmoving party has the burden of proof, simply point out to the Court that "the nonmoving party has failed to make a sufficient showing of an essential element of her case." Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986).

All doubts as to the existence of a genuine issue of material fact must be resolved against the moving party, and the entire record must be examined in the light most favorable to the nonmoving party. See White v. Westinghouse Elec. Co., 862 F.2d 56, 59 (3d Cir. 1988). Once the moving party has satisfied its initial burden, the burden shifts to the nonmoving party to either present affirmative evidence supporting its version of the material facts or to refute the moving party's contention that the facts entitle it to judgment as a matter of law. See Anderson, 477 U.S. at 256-257.

The Court need not accept mere conclusory allegations, whether they are made in the complaint or a sworn statement. Lujan v. Nat'l Wildlife Fed'n, 497 U.S. 871, 888 (1990). In deciding a motion for summary judgment, "the judge's function is not himself to weigh the evidence and determine the truth of the matter but to determine whether there is a genuine issue for trial." Anderson, 477 U.S. at 249.

DISCUSSION

1. "Equitable Relief" Under 29 U.S.C. ยง ...


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