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Cox v. Graphic Communications Conference of the International Brotherhood of Teamsters

March 25, 2009

MADELINE M. COX, PLAINTIFF,
v.
GRAPHIC COMMUNICATIONS CONFERENCE OF THE INTERNATIONAL BROTHERHOOD OF TEAMSTERS, ET AL. DEFENDANTS.



The opinion of the court was delivered by: Colleen Kollar-kotelly United States District Judge

MEMORANDUM OPINION

Plaintiff Madeline M. Cox brings the above-captioned action to challenge the denial of her health care benefits from the Graphic Communications National Health and Welfare Fund (the "Fund"), following her retirement from Graphic Communications Conference of the International Brotherhood of Teamsters (her "Employer"). Plaintiff's three-count Complaint alleges that the denial of her benefits constituted a breach of contract and a violation of Section 502(a)(1)(B) of the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1132(a)(1)(B), and that the actions of George Tedeschi, President of her Employer, constituted an interference with her right to benefits in violation of Section 510 of ERISA, 29 U.S.C. § 1140. Plaintiff has asserted these claims against her Employer, Mr. Tedeschi (in his individual and official capacities), the Fund, and the Fund's Board of Trustees.

Defendants have responded with a Motion to Dismiss, or in the alternative, Motion for Summary Judgment, which the Court shall construe as one for summary judgment. Both parties have attached to their filings various declarations and exhibits outside the scope of the Complaint and have submitted statements of material fact pursuant to Local Civil Rule 7(h)(1) ("[e]ach motion for summary judgment shall be accompanied by a statement of material facts" and "[a]n opposition to such a motion shall be accompanied by a separate concise statement").*fn1 After thoroughly reviewing the parties' submissions in connection with Defendants' Motion for Summary Judgment, including the attachments thereto, and all relevant case law and applicable statutory authority, the Court shall GRANT Defendants' [7] Motion for Summary Judgment, for the reasons that follow.

I. BACKGROUND

Plaintiff worked at her Employer*fn2 for over thirty-two years as an Executive Secretary to the President and Executive Assistant to the President.*fn3 Defs.' Stmt. ¶ 1. The Employer participated in an employee benefits plan administered by the Fund and provided eligible retirees with Employer-paid health insurance until age sixty-five. Defs.' Stmt. ¶¶ 5, 8. On March 6, 2006, Plaintiff informed Mr. Tedeschi, President of the Employer, that she intended to retire as of March 31, 2006, and expected the Employer to continue paying for her health insurance. Id. ¶ 3. Mr. Tedeschi explained that the Employer would not pay for Plaintiff's health insurance because she was retiring at fifty-five years old, id. ¶ 2, and "it was the policy of the Employer that health care premiums would not be paid on behalf of employees who left employment prior to age [sixty] . . . ."*fn4 Id. ¶ 4.

Plaintiff retired on March 31, 2006. Defs.' Stmt. ¶ 1. Consistent with Mr. Tedeschi's representations to Plaintiff, the Employer submitted a "Termination and Change Form" to the Fund indicating that Plaintiff retired on March 31, 2006, and advising that her coverage should terminate effective April 1, 2006.*fn5 Id. ¶ 27. On April 7, 2006, the Fund sent Plaintiff a "Termination of Health Insurance Coverage" notice informing her that "[she] and [her] spouse/dependents [were] no longer eligible to be covered under the [Fund]" as of April 1, 2006. Defs.' Mot., Ex. B-8 at 1 (4/7/06 Termination of Coverage Notice).

Of central significance to this case is a document called the Summary Plan Description ("SPD"), which the Fund distributes to its participants and which Plaintiff received. Defs.' Stmt. ¶¶ 21, 22. The SPD describes specific procedures available to challenge a partial or complete denial of coverage, which require a plan participant to (1) submit a claim for coverage within one year of incurred expenses, and if the claim is denied, (2) file an appeal to the Fund's Board of Trustees within 120 days of the denial:

Time Limit for Filing Claims

All claims must be submitted to the Plan within one year following the date on which the expenses were incurred. No Plan Benefits will be paid for any claim not submitted within this period.

Review Procedure if Your Claim Is Denied

The Administrator will notify you in writing within 90 days of receipt of the claim if payment of your claim is denied in whole or in part. It will explain the reasons why, with reference to the Plan provisions on which the denial was based . . .

You will be told what steps you may take to submit your claim for review and reconsideration.

Your request for review or reconsideration must be made in writing to [the Fund], within 120 days after you receive notice of denial.

Defs.' Mot., Ex. B-2 at 46-47 (SPD) (emphasis in original omitted). Although the Fund also provides participants with a "Plan Document" containing a description of these procedures, Defs.' Stmt. ¶ 13, Plaintiff did not receive a copy of that document.*fn6 See Pl.'s Resp. Stmt. ¶ 11; Defs.' Resp. Stmt. ¶ 11.

On April 2, 2007 (i.e., more than 120 days but less than one year after Plaintiff's health insurance was terminated), Plaintiff's attorney submitted a "Notice of Claim of Plan Benefits" to the Fund asking that the Fund to reinstate Plaintiff's insurance coverage. Pl.'s Opp'n, Ex. B-9 at 1 (4/2/07 Letter from G. Bohn to the Fund). The Fund responded on April 17, 2007, indicating that Plaintiff was ineligible for coverage under the plan:

[a]s of April 2006, [Plaintiff] was dropped from the eligibility report provided to the Plan by her [Employer]. The [Employer] further notified the Plan that under the plan of benefits negotiated between the [Employer] and the collective bargaining representative, [Plaintiff] was not entitled to health care benefits following her termination of employment. Further, no premium payments have been received on her behalf since that date.

Pl.'s Opp'n, Ex. A-11 at 2 (4/17/07 Letter from M. Ganzglass to G. Bohn). The letter also stated that the Fund forwarded Plaintiff's notice "to the [Employer] with a request for an explanation of the determination that [Plaintiff] was no longer eligible for coverage under the Plan," and that once the Fund received a response, it would "respond to [the] April 2nd letter [sent by Plaintiff's attorney]." Id.

The Fund did not respond further. On June 8, 2007, Plaintiff's attorney sent the Fund a letter explaining that two months had elapsed and the Fund had not provided a further explanation. Id., Ex. A-12 at 1 (6/8/07 Letter from G. Bohn to the Fund). Plaintiff's attorney advised the Fund that "[i]n the event no explanation is received in the next sixty (60) days, or if [Plaintiff's] health benefits are not reinstated, then [Plaintiff] has no alternative but to pursue other available remedies." Id. The Fund did not respond to this letter and Plaintiff took no further action. Pl.'s Resp. Stmt. ¶ 40.

On January 3, 2008, a medical provider submitted a claim for payment to the Fund in connection with an office visit by Plaintiff's spouse. See Defs.' Reply, Ex. B-1 at 1 (1/22/08 Explanation of Benefits notice). On January 22, 2008, an Explanation of Benefits notice was sent on behalf of the Fund to Plaintiff denying the claim because--as explained previously--she was no longer eligible for health benefits:

At the time these services were rendered, this member's coverage was no longer in effect. Therefore, we are unable to ...


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