The opinion of the court was delivered by: COLLEEN KOTELLY, District Judge
Plaintiff brings suit under the Employee Retirement Income
Security Act of 1974, 29 U.S.C. §§ 1001 et. seq. ("ERISA").
Plaintiff seeks an Order clarifying his rights as a plan
beneficiary to past and future benefits under the terms of an
employee welfare plan. Compl. ¶ 2. Specifically, Plaintiff seeks
an order declaring that: (1) no deference be granted to the
decision of Defendant to terminate benefits; (2) Plaintiff is
entitled to long-term disability payments under his long-term
disability policy; (3) Plaintiff is entitled to payment of past
and future long-term disability benefits; (4) Plaintiff is
entitled to payment of pre- and post-judgment interest; and (5)
Plaintiff is entitled to payment of attorney's fees and costs.
Id. at 4.
Pending before the Court are the parties' cross motions for
summary judgment and supporting documents. After carefully
considering the pleadings, the relevant case law and the entire
record, the Court will grant Defendant's Motion for Summary
Judgment and deny Plaintiff's motion. I: FACTUAL BACKGROUND
The Court begins its discussion of the facts by noting that
this Court strictly adheres to the text of Local Civil Rule 56.1.
As such, in resolving the present summary judgment motions, the
Court "assumes that facts identified by the moving party in its
statement of material facts are admitted, unless such a fact is
controverted in the statement of genuine issues filed in
opposition to the motion." LCvR 56.1. Thus, in most instances the
Court cites to Defendant's Statement of Material Facts As To
Which There is No Genuine Issue ("Def.'s Stmt.") unless such
statement is contradicted by Plaintiff in her Statement of
Genuine Issues ("Pl.'s Stmt.").*fn1 The Court also cites
directly to the record, where appropriate, to provide additional
information not covered in either of the parties' statements.
Having set forth these preliminaries, the Court moves to a
discussion of the material facts not genuinely in dispute.
Plaintiff is a former employee of the Washington Post (the
"Post").*fn2 Pl.'s Stmt. for Pl.'s Mot. ¶ 1. He worked in the Post's mailroom for twenty five years,
beginning at age 16.*fn3 Id. In July 1995, Plaintiff was
injured in a non-work related automobile accident in which he
suffered multiple leg fractures. Id. ¶ 3. Plaintiff stopped
working for the Post in January 2000 and filed an application for
long-term disability benefits under the Washington Post Long-Term
Disability Plan ("LTD Plan"). Def.'s Stmt. for Pl.'s Mot. ¶ 4.
The Post established the LTD Plan on June 1, 1983 to provide
benefits to employees of the Post and its subsidiaries
(collectively referred to as the "Post") who became disabled
during their period of employment. Def.'s Stmt for Def.'s Mot. ¶
1. The LTD Plan is subject to the provisions of ERISA. Id. The
Post provides several employee welfare plans to its employees.
Id. ¶ 2. These welfare benefit plans are summarized in various
summary plan descriptions ("SPDs") that are provided to
participants as required by ERISA. Id. The SPDs typically
describe a benefits program that consists of all the welfare
benefits available to a particular group of employees. Id.
Since 1983, the LTD Plan has been summarized in various SPDs,
including the Multi-Option Benefits Program SPD, effective
January 1, 1999 (the "1999 SPD"). Id.
The 1999 SPD granted the Post, as Plan Administrator,
discretionary authority to determine participants' eligibility
for benefits and interpret provisions for the LTD Plan. Id. ¶
3. The Post delegated this discretionary authority to The
Prudential Insurance Company of America ("Prudential"). Id. ¶ 4.*fn4
On May, 28, 1998, the Post mailed a letter to all mailroom
employees announcing the availability of two new benefit options
including an increased payment option for the Accident and
Sickness Insurance Plan ("A & S Plan") and the LTD Plan. Id. ¶
8. The letter announced a special enrollment period from June 1,
1998 to June 19, 1998, during which eligible employees could
enroll in the two new benefit options. Id. The letter described
the LTD Plan, stating that the "LTD [Plan] enables you to receive
part of your income while you are totally disabled." Id. The
letter also defined "total disability:"
For up to two years, total disability means that you
are wholly and continuously unable to perform the
duties of the job you held when you became disabled.
You must be under the regular care and attendance of
a legally qualified physician. You will not be
considered totally disabled if you engage in any
occupation or perform any work for compensation or
profit. ("own-occupation" standard)
After two years, you are considered totally disabled
if you are unable to engage in any kind of work for
which you are, or reasonably could become, qualified
by your education, training or experience.
("any-occupation" standard) Id.*fn5 Attached to the letter was a form
entitled "Special 1998 Enrollment Form," which
eligible employees could use to select coverage under
the LTD Plan and authorize the Post to deduct the
necessary contributions from their salary for the
Plaintiff testified that he did not remember receiving the
letter, but there is no dispute that he executed the special 1998
enrollment form on June 4, 1998, and elected coverage under the
LTD Plan. Pl.'s Stmt. for Def.'s Mot. ¶ 9. Plaintiff's benefits
coverage was consolidated in the Multi-Option Benefits Program.
Def.'s Stmt. for Def.'s Mot. ¶ 10. The Multi-Option Benefits
Program offered participation in a number of component plans for
certain groups of employees at the Post, including the A & S,
LTD, and Business Travel Accident Plans. Id. The coverages
available were described in the 1999 SPD. Id.
The two-part definition of total disability (the own
occupation-standard followed after two years by the
any-occupation standard) was omitted from the 1999 SPD. Id. ¶
11. According to Section Seven, the section of the 1999 SPD
entitled "Long Term Disability Plan," the LTD Plan "pays benefits
in the form of monthly income payments to covered employees after
a defined period of total disability." (emphasis in original).
1999 SPD at 7-1; Administrative R.("AR") at 63. The bold type
indicates that the term "total disability" should have been
defined in the 1999 SPD's glossary, but it is not there in the
context of the LTD Plan. 1999 SPD at 1, 14-1-6; AR at 12, 93-98.
The two-part definition for total disability does, however appear
in the original LTD Plan document, and since the LTD Plan's
inception in 1983, has been consistently applied to claims for
covered employees of the Post under the LTD Plan. Def.'s Stmt.
for Def.'s Mot. ¶ 11.
The 1999 SPD did include a definition of total disability, but
only for purposes of the Business Travel Accident Plan. Id. ¶
12. In the 1999 SPD, total disability for the Business Travel
Accident Plan was defined under the any-occupation standard.
Id. Plaintiff does not dispute this. According to the 1999 SPD,
medical disability claims used the own-occupation standard. 1999
SPD at 14-5; AR at 97. Plaintiff argues that in the absence of a
definition for total disability in the 1999 SPD, that the
definition of "medical disability" which is included in the SPD
for the A & S Plan and uses the own-occupation standard, applies
to his LTD Plan claim. Pl.'s Stmt. for Def.'s Mot. ¶ 12; 1999 SPD
at 14-5; AR at 97. This is a legal, not factual dispute, and will
be discussed below.
On May 8, 2000, Plaintiff filed a claim for long-term
disability benefits under the LTD Plan. Def.'s Stmt. for Def.'s
Mot. ¶ 13. On July 17, 2000, Prudential denied Plaintiff's claim
because he did not satisfy the own-occupation standard. Id. ¶
14. In this, and all subsequent correspondence regarding
Plaintiff's claim, Prudential recited the LTD Plan's two-part
definition of total disability. Id. Following appeals,
Prudential approved Plaintiff's claim on March 19, 2001,
retroactive to July 17, 2000. Id. ¶ 15. On February 4, 2002,
Prudential notified Plaintiff of the impending change from the
own-occupation to the any-occupation standard which would occur
after two years. Id. ¶ 16.
Prudential then requested that Plaintiff complete forms for
evaluation of his total disability under the any-occupation
standard. Id. Plaintiff signed the forms on February 26, 2002
and returned them to Prudential. Id. In a letter dated May 1,
2002, Prudential notified Plaintiff that his benefits would be
terminated on July 16, 2002 because he did not satisfy the any-occupation standard, applicable after the expiration of the
initial two years. Id. ¶ 17. Plaintiff appealed that decision
in a May 7, 2002 letter. Id. ¶ 18. In that letter, Plaintiff
did not challenge Prudential's application of the any-occupation
standard to his claim. Id. Rather, Plaintiff contested
Prudential's conclusion that he did not satisfy that standard.
Id. Prudential denied Plaintiff's appeal. Id. Plaintiff
responded to this denial with a letter dated August 3, 2002, in
which he asserted, for the first time, that the any-occupation
standard did not apply to his claim under the LTD Plan because it
was not included in the 1999 SPD. Id.
Following subsequent appeals, Prudential issued its final
decision in an August 20, 2003 letter in which it affirmed that
it had applied, and would apply, the any-occupation standard to
Plaintiff's claim for continuing long-term disability benefits.
Id. ¶ 19. In that letter, Prudential provided ASA No. 39922,
the agreement between the Post and Prudential effective June 1,
1983. Id. Prudential marked with a yellow tab the definition of
disability it was using from the original LTD Plan. Id. That
definition uses the two-part definition of total disability,
meaning that after the initial two-year period of disability (in
Plaintiff's case, this would have begun on July 17, 2000) the
participant must be "unable to engage in any gainful occupation
for which he or she is reasonably suited by training, education,
or experience," in order to receive benefits under the LTD Plan.
Id. (quoting Def.'s Mot. for Summ. J. Ex. D (Moran Aff.) ¶ 6.).
Because the Post had not provided this definition in the plan
documents it had previously provided to Plaintiff, Prudential
extended Plaintiff's benefits through October 2003, an additional
fifteen months beyond the initial twenty-four month period. Id.
Prudential also reiterated to Plaintiff that the any-occupation
standard would be used to evaluate future eligibility benefits
beyond October 2003. Id. In a letter dated November 14, 2003,
Plaintiff, through counsel, informed Prudential that he took the August 20, 2003 letter as a
final denial of his claim and asserted that he was entitled to
long-term disability benefits under the own-occupation standard
until he reached age 65. Id. ¶ 20. In the same ...