![]() Plaintiff s last payment was returned to him, and he filed two appeals regarding the termination of his benefits.2 Unsuccessful in his appeals, plaintiff filed the instant suit against UPS and 2 Despite the termination of his LTD benefits under the Plan, Aetna mistakenly continued to send plaintiff LTD benefit checks for seven months. Crossing in the mail, UPS sent plaintiff an Octoletter informing him that his LTD benefits were terminated because of nonpayment of premiums. He mailed a $128.96 check to UPS dated October 1, 2008, which was received and deposited on October 9, 2008. Plaintiff claims that he did not receive the Septembilling notice until around September 23, 2008. Once terminated, THIS IS YOUR FINAL NOTICE FOR THE Your current balance is due on 10-01- 2008. It stated, Coverage will be terminated effective 8-31-2008 unless your unpaid previous balance of $64.48 is received by 9-30-2008. The Septemstatement showed an outstanding unpaid balance of $64.48 for the September premium, and billed $64.48 for the October premium. It is unclear whether plaintiff received the August statement, but plaintiff did not make this payment, as reflected by the next month s billing notice. 3 statement stated, Full payment is due on 9-01-2008. 1 This Plaintiff claims that he tried to set up an automatic debit card arrangement, but was told that UPS would only accept a check sent through the mail. The Augbilling notice noted plaintiff s $260.07 payment, and billed for September s $64.48 LTD premium. Plaintiff submitted a check for the entire $260.07 balance by a check dated July 15, 2008, which was received by UPS on July 28, 2008. The statement did not provide a specific date that the unpaid balance or August premium was due. THIS The July statement also notified plaintiff that his premium for August in the amount of $64.48 was due. IS YOUR FINAL NOTICE FOR THE UNPAID PREVIOUS BALANCE. Once terminated, coverage cannot be reinstated. The bill stated, Coverage will be terminated effective 4-29-2008 unless your unpaid previous balance of $195.59 is received. The Jstatement informed plaintiff that his coverage would be terminated unless he satisfied an unpaid balance. Whatever the reason, it is undisputed that plaintiff was late in making his LTD premium payments. According to plaintiff, while he was on STD he had difficulty obtaining his LTD billing notices from UPS in order to pay his LTD premiums, and he contacted customer service about this issue.1 UPS disputes this. 2 When he began STD, however, plaintiff was then required to write a check and mail his LTD premium payments to UPS directly in order to maintain eligibility for LTD benefits. ![]() Under the terms of the Plan, plaintiff was responsible for paying monthly LTD premiums, which were automatically deducted from his paycheck prior to his injury. Plaintiff then filed a claim for long-term disability ( LTD ) benefits in order to continue his disability leave after November 12, 2008. On Octohe was informed that his STD benefits would expire on November 12, 2008. Initially, Plaintiff received short-term disability ( STD ) coverage under the UPS Health & Welfare Plan. BACKGROUND On April 30, 2008, plaintiff, an airplane mechanic at UPS, began disability leave due to a workplace injury. JURISDICTION Plaintiff brought his claims pursuant to ERISA and this Court has jurisdiction over his claims under 28 U.S.C. For the reasons expressed below, the Court will grant plaintiff s motion, deny defendants motion, and order the submission of supplemental materials on damages and fees. Both plaintiff and defendants have moved for summary judgment in their favor. The Court is called upon to determine whether the termination of plaintiff s long term disability benefits was arbitrary and capricious, and, therefore, unlawful pursuant to 29 U.S.C. The long term disability plan at issue is an employee welfare benefit plan governed by the Employee Retirement Income Security Act (hereinafter ERISA ), 29 U.S.C. 10-5791 (NLH)(AMD) OPINION APPEARANCES: THOMAS JOSEPH HAGNER HAGNER & ZOHLMAN, LLC 57 KRESSON ROAD CHERRY HILL, NJ 08034 Attorney for plaintiff EDWARD P LYNCH HEATHER WEINE BROCHIN DAY PITNEY LLP ONE JEFFERSON ROAD PARSIPPANY, NJ 07054-2891 Attorneys for defendants HILLMAN, District Judge Plaintiff, Frank Molinaro, seeks reimbursement of benefits due to him under his long term disability policy with defendant, The UPS Health & Welfare Package, which is administered by defendant Aetna Life Insurance Company. THE UPS HEALTH & WELFARE PACKAGE AETNA LIFE INSURANCE COMPANY, Defendants. UNITED STATES DISTRICT COURT DISTRICT OF NEW JERSEY FRANK MOLINARO, Plaintiff, v.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |