Opinion
No. CV07-5003534S
May 18, 2009
MEMORANDUM OF DECISION
This matter is before the court on the parties' motions for summary judgment wherein both the plaintiff and defendant claim that there is no genuine issue of material fact that remains and both of the parties are entitled to judgment as a matter of law. For the following reasons, the court grants the plaintiff's motion for summary judgment and denies the defendant's motion for summary judgment.
FACTS
On December 29, 2006, the plaintiff, David Rivard, commenced this action by service of process on the defendant, the Town of Wolcott Board of Education. This action arises out of the defendant's denial of the plaintiff's claim for disability benefits pursuant to a group annuity policy. In a one-count complaint, the plaintiff alleges a breach of contract claim.
The facts, as jointly stipulated to by the parties on December 2, 2008, are as follows. The plaintiff was employed by the defendant as a custodian in 1983. At all times relevant to this matter, the defendant had a collective bargaining agreement with the Wolcott Custodians, a union of which the plaintiff was a member. In addition, the Wolcott Custodians and the defendant entered into a Connecticut Retirement Annuity Plan, which became effective September 1, 1962. Under the terms of that plan, a member of the union becomes a participant after he has completed one year of continuous service to the defendant, is a full-time regular employee who works forty hours or more per week and has attained the age of twenty-one. Additionally, this plan provides for disability benefits to a participant if the following requirements are satisfied: "1) He must have been an active participant on the date he became disabled; 2) He must have been totally and permanently disabled after medical examination administered by a licensed medical doctor selected by the Employer; 3) He must have attained his forty-fifth birthday; and 4) He must have completed at least eight years of service."
On August 30, 1998, the plaintiff sustained an employment-related injury to his right knee and both parties to this action agreed at that time that this injury was compensable under the applicable provisions of the Connecticut Workers' Compensation Act. The plaintiff, however, additionally sought workers' compensation for injuries to his left ankle and foot, as well as for an ongoing psychiatric condition, claiming that his knee injury was a substantial causative factor. The defendant objected to this characterization and these claims were adjudicated before Workers' Compensation Commissioner Ernie Walker in case number 601019827. On November 2, 2007, the commissioner found that the plaintiff's knee injury did not have a material or substantial impact on his additional injuries, and therefore, denied the plaintiff's claim. The plaintiff did not appeal this decision.
Upon the finding and dismissal of the plaintiff's workers' compensation claims, the plaintiff's employment relationship with the defendant ceased. Until that time, as required by the laws of Connecticut, the defendant continued to provide the plaintiff with medical benefits.
Throughout the course of his various treatments, the plaintiff was examined by several doctors and shared their reports with the defendant. Specifically, Peter R. Barnett, an orthopaedic surgeon, reported that, "[f]rom an objective standpoint, I can see no reason why [the plaintiff] cannot return to some form of gainful employment. Based on the object assessment performed, this gentleman should certainly be capable of sedentary work with limited periods of standing and walking." Similarly, J. Kevin Lynch, M.D., an orthopaedic knee surgeon, Raymond J. Sullivan, an orthopaedic surgeon, Enzo Sella, M.D., an orthopaedic surgeon and Donald R. Grayson, M.D., a psychiatrist, have all evaluated the plaintiff and determined that the defendant has some work capacity. All seemingly agree, however, that the work must be of a sedentary nature.
Between 1998 and 2007, the plaintiff returned to work several times in his capacity as a custodian, only to re-injure his knee. The plaintiff has made several requests for the disability retirement benefit pursuant to the Connecticut Retirement Annuity Plan. The defendant, however, has repeatedly denied these requests on the sole ground that the plaintiff is not "totally and permanently disabled" from working based on the aforementioned doctors' reports. The Connecticut Retirement Annuity Plan does not contain a definition of "totally and permanently disabled," although it does contain a provision that seemingly gives the exclusive right of interpretation to the defendant, in its capacity as the plan administrator.
On January 20, 2009, both the plaintiff and the defendant filed a motion for summary judgment on the sole count of his complaint. The plaintiff moves on the ground that no genuine issue of material fact remains and that he is entitled to summary judgment as a matter of law because he is "totally and permanently disabled" under the terms of the Connecticut Retirement Annuity Plan. The defendant agrees that no genuine issue of material fact remains, but contends that, as a matter of law, it is entitled to summary judgment because the plaintiff is not "totally and permanently disabled" under the terms of the Connecticut Retirement Annuity Plan. The matter was heard at short calendar on February 9, 2009.
DISCUSSION
Summary judgment "shall be rendered forthwith if the pleadings, affidavits and any other proof submitted show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." Practice Book § 17-49. "[I]n seeking summary judgment, it is the movant who has the burden of showing the nonexistence of any issue of fact. The courts are in entire agreement that the moving party for summary judgment has the burden of showing the absence of any genuine issue as to all the material facts, which, under applicable principles of substantive law, [entitle] him to a judgment as a matter of law. The courts hold the movant to a strict standard. To satisfy his burden, the movant must make a showing that it is quite clear what the truth is, and that excludes any real doubt as to the existence of any genuine issue of material fact . . . As the burden of proof is on the movant, the evidence must be viewed in the light most favorable to the opponent." (Internal quotation marks omitted.) Socha v. Bordeau, 277 Conn. 579, 585-86, 893 A.2d 422 (2006).
"A material fact is a fact that will make a difference in the outcome of the case." (Internal quotation marks omitted.) Lombard v. Edward J. Peters, Jr., P.C., 79 Conn.App. 290, 294, 830 A.2d 346 (2003). "Once the moving party has met its burden . . . the opposing party must present evidence that demonstrates the existence of some disputed factual issue . . . It is not enough, however, for the opposing party merely to assert the existence of a disputed issue. Mere assertions of fact . . . are insufficient to establish the existence of a material fact and, therefore, cannot refute evidence properly presented to the court under Practice Book § [17-45]." (Internal quotation marks omitted.) Ramirez v. Health Net of the Northeast, Inc., 285 Conn. 1, 11, 938 A.2d 576 (2008). In this case, however, the parties have submitted a joint stipulation of the material facts. Furthermore, both parties agree "that the Court must resolve the single narrow legal issue of whether the Board violated an alleged contractual obligation to Rivard when it denied his request for disability pension benefits under the Plan."
Regarding the standard of which to review the Board of Education's denial of disability benefits to the plaintiff under the contract, the court notes that the Supreme Court has "previously employed the standard governing review of administrative agencies to municipal boards carrying out similar functions." O'Connor v. Waterbury, 286 Conn. 732, 741 n. 10, 945 A.2d 936 (2008). Specifically, the Supreme Court has previously "followed established principals of administrative law" to review a board of education's decision to terminate a tenured teacher's employment contract. Rogers v. Board of Education, 252 Conn. 753, 761, 749 A.2d 1173 (2000). "[R]eview of an administrative agency decision requires a court to determine whether there is substantial evidence in the administrative record to support the agency's findings of basic fact and whether the conclusions drawn from those facts are reasonable . . . [No court] may retry the case or substitute its own judgment for that of the administrative agency on the weight of the evidence or questions of fact . . . [The court's] ultimate duty is to determine, in view of all of the evidence, whether the agency, in issuing its order, acted unreasonably, arbitrarily, illegally or in abuse of its discretion . . .
"The substantial evidence rule governs judicial review of administrative fact-finding . . . An administrative finding is supported by substantial evidence if the record affords a substantial basis of fact from which the fact in issue can be reasonably inferred . . . The substantial evidence rule imposes an important limitation on the power of the courts to overturn a decision of an administrative agency . . . It is fundamental that a plaintiff has the burden of proving that the [municipal board], on the facts before [it], acted contrary to law and in abuse of [its] discretion . . . The law is also well established that if the decision of the [municipal board] is reasonably supported by the evidence it must be sustained . . . This substantial evidence standard is highly deferential and permits less judicial scrutiny than a clearly erroneous or weight of the evidence standard of review . . . Where, however, the [municipal board] has made a legal determination, the scope of review ordinarily is plenary." (Citations omitted; emphasis added; internal quotation marks omitted.) O'Connor v. Waterbury, supra, 286 Conn. 741-42.
The court acknowledges that by alleging a breach of contract, the plaintiff essentially challenges the defendant's legal determination that he is not eligible to receive disability benefits under article one, section seven of the Connecticut Retirement Annuity Plan. This claim, however, is not based on an allegation of an improper factual determination by the defendant. Rather, the question in this appeal is a legal issue of contract interpretation, namely whether the defendant's definition of the term "totally and permanently disabled" was proper under the contractual language. "Although ordinarily the question of contract interpretation, being a question of the parties' intent, is a question of fact . . . [w]here there is definitive contract language, the determination of what the parties intended by their contractual commitments is a question of law." (Internal quotation marks omitted.) Poole v. Waterbury, 266 Conn. 68, 88, 831 A.2d 211 (2003). Accordingly, the court's review of this must be plenary because the defendant made a legal determination as to the meaning of "totally and permanently disabled."
Next, the court must consider a claim made by the defendant in its motion for summary judgment, as well as in its reply memorandum to the plaintiff's motion for summary judgment. In those memorandums, the defendant contends that, "[u]nder applicable law and pursuant to the terms of the pension, the competing interpretations of the pension document advanced by the parties here are not equally favored. Rather, the plan, by its term is to be interpreted by the Plan Administrator in all situations other than amendment." In support of this proposition, the defendant cites Firestone Tire Rubber Co. v. Bruch, 489 U.S. 101, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). The defendant, however, fails to recognize a key distinction between Firestone Tire Rubber Co. and the case at hand. In Firestone Tire Rubber Co., the contract qualified as an employee benefit plan under the Employee Retirement Income Security Act, more commonly referred to as ERISA. Although the Connecticut Retirement Annuity Plan may seem similar to an employee benefit plan under ERISA, the Supreme Court has made it clear that "ERISA does not apply to government sponsored benefit plans" and although the law that has developed under ERISA may be helpful, it is not binding. Poole v. Waterbury, supra, 266 Conn. 83. Furthermore, in Firestone Tire Rubber Co., the Supreme Court of the United States reasoned that the "federal common law of rights and obligations under ERISA-regulated plans" was heavily reliant on trust law, and therefore, the discretion afforded to trustees should be extended to plan administrators. Id., 110-15 ("ERISA abounds with the language and terminology of trust law . . . Consistent with established principles of trust law, we hold that a denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan"). In contrast, the law of trusts has seemingly never been adopted in Connecticut to aid it in determining the legal rights and obligations regarding a government sponsored benefit plan. The holding of Firestone Tire Rubber Co., therefore, has no application to the facts of this case.
Article one, section sixteen of the Connecticut Retirement Annuity Plan provides in relevant part: "The Plan Administrator shall from time to time establish rules for the administration of the Plan. Except as herein otherwise expressly provided, the Plan Administrators shall have the exclusive right to interpret the Plan and to decide any matters arising thereunder in connection with the administration of the Plan. They shall make all such determinations in a consistent and non-discriminatory manner. All such determinations shall be conclusive for the purposes of the Plan . . ."
Upon considering the disability benefits provision of the Connecticut Retirement Annuity Plan, it is clear to the court that this type of contract provision is regarded as a form of disability insurance. See 1 E. Holmes, Appleman on Insurance (2d Ed. 1996) § 1.27, p. 138-40; Downey v. Retirement Board, 22 Conn.App. 172, 174, 576 A.2d 582, cert. denied, 216 Conn. 811, 580 A.2d 56 (1990) (noting that a government sponsored retirement benefit plan is a life insurance policy). Due to this classification, the Supreme Court has repeatedly used the principles of contract interpretation, rather than the law of trusts, when adjudicating allegations regarding these agreements. See O'Connor v. Waterbury, supra, 286 Conn. 743; Poole v. Waterbury, supra, 266 Conn. 87. The court, therefore, will follow the Supreme Court's approach and use the law of contracts to determine what is meant by the phrase "totally and permanently disabled" in the policy.
"The law governing the construction of contracts is well settled. When a party asserts a claim that challenges the . . . construction of a contract, [a court] must first ascertain whether the relevant language in the agreement is ambiguous . . . A contract is ambiguous if the intent of the parties is not clear and certain from the language of the contract itself . . . Accordingly, any ambiguity in a contract must emanate from the language used in the contract rather than from one party's subjective perception of the terms . . . When the language of a contract is ambiguous, the determination of the parties' intent is a question of fact . . . Moreover, in constructing contracts, we give effect to all the language included therein, as the law of contract interpretation . . . militates against interpreting a contract in a way that renders a provision superfluous . . . If a contract is unambiguous within its four corners, intent of the parties is a question of law requiring plenary review . . . Where the language of the contract is clear and unambiguous, the contract is to be given effect according to its terms. A court will not torture words to import ambiguity where the ordinary meaning leaves no room for ambiguity." (Citations omitted; internal quotation mark omitted.) O'Connor v. Waterbury, supra, 286 Conn. 743-44.
"To ascertain the commonly approved usage of a word, it is appropriate to look to the dictionary definition of the term." (Internal quotation marks omitted.) Buell Industries, Inc. v. Greater New York Mutual Ins. Co., 259 Conn. 527, 539, 791 A.2d 489 (2002). The court, therefore, starts its ambiguity inquiry with the language of the key phrase "totally and permanently disabled." The word "totally" is an adverb that means "[e]ntirely; wholly; completely." American Heritage Dictionary (New College Ed. 1976). The word "whole," as a noun, is defined as, "1. [a]ll of the component parts or elements of a thing; 2. [a] complete entity or system." Id. Thus, the word "totally" requires additional terms to clarify what thing, entity or system it is referring to. In this case, the contract only provides the additional word "disabled," which means "[t]o weaken or destroy the normal physical or mental abilities of." Id. The word "destroy," defined as "[t]o ruin completely," however, has a vastly different meaning than "weaken," which means "[l]acking the capacity to function well or in a normal manner." (Emphasis added.) Id.; see also Black's Law Dictionary (Abridged 5th Ed. 1983) ("[d]isability may be either general or special; the former when it incapacitates the person for the performance of all legal acts of a general class, or giving to them their ordinary legal effect; the latter when it debars him from one specific act").
"Disability clauses in sickness and accident policies or in life insurance sometimes are phrased to require only that the insured be prevented from performing the duties pertaining to his particular profession. These are called occupational disability clauses. Other such provisions provide benefits for disability from performing any work or follow any occupation for compensation, and are known as general disability clauses . . . The policy here in issue does not specify either, and the consequent narrowing of the question to be decided eliminates from consideration the plethora of cases involving such specific phraseology." (Citation omitted; internal quotation marks omitted.) Ratchford v. Mutual Benefit Health Accident Ass'n., 23 Conn.Sup. 51, 55, 176 A.2d 589 (1961).
"[Defining] the insured event is usually the most difficult and important task of those who draft insurance policy language." 1 E. Holmes, supra, p. 140. Typically, insurers provide additional terms to assist the court in interpreting whether the scope of the qualifying disability is intended to be general or occupational. Id. Without such additional language, as the United States District Court for the Eastern District of New York has provided, the phrase "totally and permanently disabled" is "somewhat vague and ambiguous." Rooney v. Apfel, 160 F.Sup.2d 454, 466 (E.D.N.Y. 2001). In Connecticut, the language following the phrase "totally and permanently disabled" has proved crucial to courts when interpreting the meaning of similar provisions. See O'Donnell v. Waterbury, 111 Conn.App. 1, 8, 958 A.2d 163, cert. denied, 289 Conn. 959, 961 A.2d 422 (2008); O'Connor v. Waterbury, supra, 286 Conn. 744; Reardon v. Waterbury, Superior Court, judicial district of Waterbury, Docket No. CV 04 4001783S (April 28, 2006, Moraghan, J.T.R.)
"Construction placed upon this disability clause and others containing substantially equivalent language, such as total disability, permanently disabled, and the like, has divided into three principal categories. The first holds that an insured is not totally disabled unless he cannot engage in any occupation whatever, the so-called strict view. The middle ground is that the insured need be disabled not only from engaging in his usual business or occupation but also from any comparable employment for which he is fitted by education, experience, background and physical condition. The third or liberal view holds that total disability occurs if the insured becomes unable to perform the duties of his particular occupation." (Internal quotation marks omitted.) Ratchford v. Mutual Benefit Health Accident Assn, supra, 23 Conn.Sup. 56-57.
In light of this case law, therefore, the court recognizes that if the language of a contract does not put the word "disabled" into either a general or an occupational context, it could lawfully have either of the understandings purported by the parties in this case. The court, therefore, finds that an antiquity emanates from the contractual language.
"Thus, having concluded that the relevant policy language is ambiguous, [the court] ordinarily would be free to consider extrinsic evidence, although [i]f the extrinsic evidence presents issues of credibility or a choice among reasonable inferences, the decision on the intent of the parties is a job for the trier of fact . . . The present case is, however, before . . . this court on a statement of stipulated facts, and, accordingly, the language falls into the category of ambiguities that cannot be resolved by examining the parties' intentions . . . [The court,] therefore, conclude[s] that the ambiguous language should be construed in accordance with the reasonable expectations of the insured when he entered into the contract . . . Courts in such situations often apply the contra proferentem rule and interpret a policy against the insurer . . . Indeed, our interpretation of ambiguous policy language in favor of coverage under the doctrine of contra proferentem has become near axiomatic in insurance coverage disputes." (Citations omitted; internal quotation marks omitted.) Connecticut Ins. Guaranty Assn. v. Fontaine, 278 Conn. 779, 788-89, 900 A.2d 18 (2006).
The defendant contends that it is not the drafter of this contract, and therefore, the contra proferentem rule should not apply in this case. The court sees "no reason to distinguish between the rule's application as to an insurance company that drafted the policy . . . and its application as to another entity that assumes the drafter's responsibilities, in other words, that stands in the shoes of the drafter. Thus, [the court reads] the ambiguous language in favor of extending insurance coverage . . ." Connecticut Ins. Guaranty Assn. v. Fontaine, supra, 278 Conn. 789.
Thus, the court interprets the ambiguous phrase "totally and permanently disabled" to be an occupational disabilityclause that includes the knee injuries sustained by the plaintiff. The court, therefore, finds that pursuant to article one, section three, subsection (d) of the Connecticut Retirement Annuity Plan, the plaintiff satisfies the express criteria required to be eligible for disability benefits. Ergo, the defendant's denial of disability benefits to the plaintiff constituted a breach of contract. Accordingly, the plaintiff's motion for summary judgment is granted and the defendant's motion for summary judgment is denied.