Opinion
Civil Action No. 00-2308, Section: E/2.
February 22, 2001.
ORDER AND REASONS
Defendant United States Life Insurance Company ("USLIC") has filed a motion for summary judgment on the claim of plaintiff Carl M. Sutherland, II, M.D. ("Dr. Sutherland"). Dr. Sutherland opposes the motion. The parties requested oral argument on this motion, and oral argument was heard.
This is a claim by the plaintiff, Dr. Carl M. Sutherland, II, for disability benefits under a disability policy of defendant United States Life Insurance Company. USLIC has filed the instant motion for summary judgment seeking judgment dismissing the plaintiff's claim for disability benefits on the grounds that it is an ERISA claim, USLIC is the Plan Administrator and it did not abuse is discretion in denying disability benefits on the basis that (1) plaintiff is not disabled under the policy; (2) the claim was not filed timely under the policy; and (3) any other claims brought under state law are preempted by ERISA and must be dismissed.
Dr. Sutherland opposes the motion for summary judgment, contending (1) it is not an ERISA claim, but one under Louisiana law which regulates insurance; (2) plaintiff has submitted satisfactory proof of disability from his treating psychiatrist and defendant has abused its discretion in determining that he is not disabled; and (3) defendant cannot show any prejudice in the notice provisions of the policy, assuming that there was late notice.
USLIC issued a denial of the claim due to late filing, and then agreed to reconsider it on the basis that the plaintiff was seeking total disability from 1999, and only partial benefits from 1996 to 1999. This in essence appears to be two separate claims, one for partial benefits from 1996 to 1999, and one for benefits for total disability from 1999. USLIC again denied the claim. Shortly before the oral argument, on February 17, 2001, plaintiff appealed the denial of USLIC. The defendant, in its post-hearing supplemental memoranda, urged the Court to stay the proceedings or dismiss plaintiff's suit without prejudice so that plaintiff may pursue the appeal.
The Court does not find that dismissal of the suit is appropriate. However, in its present posture, the motion for summary judgment is premature as plaintiff's appeal of the denial is still pending and if ERISA is applicable to this claim, the administrative record is incomplete.
Because the matter is being stayed while the administrative appeal is pending, the court will not determine whether, in fact, ERISA governs this claim. Should the motion be refiled, additional briefing, with factual supplementation, on the subject would be required.
At this time, the Court finds that the motion for summary judgment should be dismissed as premature, with right to refile it after the administrative appeal has been decided. This action will be stayed and closed administratively, with right of plaintiff to reopen the matter by motion filed within 10 days of the determination of the appeal.
Accordingly, for the above and foregoing reasons,
IT IS ORDERED that the motion of defendant USLIC for summary judgment be and is hereby DENIED AT THIS TIME as premature, with right to refile at the conclusion of the appeal.
IT IS FURTHER ORDERED that this case be and is hereby STAYED until the administrative appeal of the denial of Dr. Sutherland's claim for disability benefits has been concluded, and CLOSED for statistical purposes. This matter will be reopened upon motion of any party within 10 days of the conclusion of the administrative appeal. This Court will retain jurisdiction of this matter.