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Faciane v. Sun Life Assurance Co. of Canada

United States District Court, E.D. Louisiana

June 12, 2018


         SECTION I



         Plaintiff Michael Faciane (“Faciane”) receives a monthly benefit for long-term disability pursuant to an ERISA-regulated group insurance policy covering employees of Capital One Financial Corporation (“the policy”). He alleges that the policy administrator, defendant Sun Life Assurance Company of Canada (“Sun Life”), has underpaid him since he began receiving the benefit due to a miscalculation of a key input in the formula used to determine one's benefit amount.

         Before the Court is Sun Life's motion[1] for summary judgment on the issue of timeliness. Faciane opposes[2] the motion.


         For purposes of the present motion, the following facts are not in genuine dispute:

         Faciane sustained a work-related injury in June 2006. He later filed a claim under the policy for a long-term disability benefit.

         Sun Life approved Faciane's claim in March 2008.[3] Sun Life determined that Faciane “ha[d] been unable to work due to [his] disability effective July 4, 2006, ” and that, under the terms of the policy, his benefits began on December 1, 2006.[4]

         Initially, Faciane was approved to receive “a gross benefit of $100.00 (minimum monthly benefit).”[5] In a March 31, 2008 letter informing Faciane of the approval of his claim, Sun Life explained to Faciane how it had calculated this benefit amount.[6] Faciane did not administratively challenge this calculation until June 26, 2017.[7] After this challenged failed, Faciane initiated this case on December 18, 2017.


         Summary judgment is proper when, after reviewing the pleadings, the discovery and disclosure materials on file, and any affidavits, the court determines that there is no genuine dispute of material fact. See Fed. R. Civ. P. 56. “[A] party seeking summary judgment alays bears the initial responsibility of informing the district court of the basis for its motion and identifying those portions of [the record] which it believes demonstrate the absence of a genuine issue of material fact.” Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). The moving party need not produce evidence negating the existence of material fact, but need only point out the absence of evidence supporting the other party's case. Id.; Fontenot v. Upjohn Co., 780 F.2d 1190, 1195 (5th Cir. 1986).

         Once the party seeking summary judgment carries its initial burden, the nonmoving party must come forward with specific facts showing that there is a genuine dispute of material fact for trial. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986). The showing of a genuine issue of material fact is not satisfied by creating “‘some metaphysical doubt as to the material facts, ' by ‘conclusory allegations, ' by ‘unsubstantiated assertions, ' or by only a ‘scintilla' of evidence.” Little v. Liquid Air Corp., 37 F.3d 1069, 1075 (5th Cir. 1994) (citations omitted). Instead, a genuine issue of material fact exists when the “evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986).

         The party responding to the motion for summary judgment may not rest upon the pleadings, but must identify specific facts that establish a genuine issue. Id. However, the nonmoving party's evidence “is to be believed, and all justifiable inferences are to be drawn in [the nonmoving party's] favor.” Id. at 255; see also Hunt v. Cromartie, 526 U.S. 541, 552 (1999).

         Moreover, “[a]lthough the substance or content of the evidence submitted to support or dispute a fact on summary judgment must be admissible . . ., the material may be presented in a form that would not, in itself, be admissible at trial.” Lee v. Offshore Logistical & Transp., LLC, 859 F.3d 353, 355 (5th Cir. 2017) (quoting 11 Moore's Federal Practice-Civil ¶ 56.91 (2017)). “This flexibility allows the court to consider the evidence that would likely be admitted at trial . . . without imposing on parties the time and expense it takes to authenticate everything in the record.” Maurer v. Independence Town, 870 F.3d 380, 384 (5th Cir. 2017).



         Sun Life argues that this case is untimely. It points out that the policy “contains a contractual limitations period requiring [Faciane to have] file[d] suit within three years of when ‘Proof of Claim is required.'”[8] According to Sun Life, “Proof of Claim was required by March 2, 2007, and, therefore, [Faciane] was required to [have] file[d] a lawsuit by March 2, 2010, to challenge the benefit calculation.”[9]Because Faciane did not do so, Sun Life maintains that Faciane has lost the right to bring his miscalculation claim in court.

         The policy provides, in a subsection titled “Legal Proceedings”:

         No legal action may start:

1. until 60 days after Proof of Claim has been given; nor
2. more than 3 years after the time Proof of Claim is required.[10]

         According to the policy, “Proof of Claim” for a long-term disability benefit had to “be given to Sun Life no later than 90 days after the end of the Elimination Period.”[11]“Elimination Period” is then defined as “a period of continuous days of [t]otal or [p]artial [d]isability for which no [long-term disability] [b]enefit is payable.”[12] This period “begins on the first day of [t]otal or [p]artial [d]isability.”[13] For purposes of long-term disability, the “Elimination Period” is 150 days.[14]

         It is not genuinely disputed that Sun Life determined that July 4, 2006 is the date on which Faciane became unable to work due to his disability.[15] Thus, the “Elimination Period” ended on November 30, 2006.[16] Under the terms of the policy, Faciane's “Proof of Claim” was required by early March 2007, and so the policy's bar on the initiation of a legal action “more than 3 years after the time Proof of Claim is required” took effect in early March 2010-years before Faciane initiated this case.


         “Absent a controlling statute to the contrary, a participant and a[n] [ERISA-regulated] plan may agree by contract to a particular limitations period, even one that starts to run before the cause of action accrues, as long as the period is reasonable.” Heimeshoff v. Hartford Life & Acc. Ins. Co., 571 U.S. 99, 105-06 (2013). Worded differently, courts “must give effect to [a plan's] limitations provision unless [the court] determine[s] either that the period is unreasonably short, or that a ‘controlling statute' prevents the limitations provision from taking effect.” Id. at 109.

         In this case, no party points to a “controlling statute” that would trump ...

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