United States District Court, E.D. Louisiana
ORDER AND REASONS
M. AFRICK, UNITED STATES DISTRICT JUDGE
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.
the Court is Sun Life's motion for summary judgment on the
issue of timeliness. Faciane opposes the motion.
purposes of the present motion, the following facts are not
in genuine dispute:
sustained a work-related injury in June 2006. He later filed
a claim under the policy for a long-term disability benefit.
Life approved Faciane's claim in March
2008. 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,
Faciane was approved to receive “a gross benefit of
$100.00 (minimum monthly benefit).” 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. Faciane did not administratively challenge
this calculation until June 26, 2017. After this challenged
failed, Faciane initiated this case on December 18, 2017.
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).
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).
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).
“[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).
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.'” 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.”Because Faciane did not do so, Sun Life
maintains that Faciane has lost the right to bring his
miscalculation claim in court.
policy provides, in a subsection titled “Legal
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
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.”“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.” This period “begins on
the first day of [t]otal or [p]artial
[d]isability.” For purposes of long-term disability,
the “Elimination Period” is 150
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. Thus, the “Elimination
Period” ended on November 30, 2006. 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.
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.
case, no party points to a “controlling statute”
that would trump ...