The opinion of the court was delivered by: SUSAN ILLSTON, District Judge
On May 24, 2005, the Court filed its Order granting summary
judgment in favor of plaintiff. The Court directed the parties to
provide the Court with a proposed order that included the
appropriate payment of back benefits and clarification of future
benefits. Plaintiff submitted such an order on June 17, 2005, but
defendant did not agree with the analysis in the order or the
award requested by plaintiff and on June 21, 2005 submitted its
own analysis. Plaintiff's letter stated that he would file a
response to defendant's objections, but he has not done so. Thus,
to date, no judgment has been entered.
The parties agree that the Gross Monthly Benefit ("GMB") is
$3,745.35. The parties also agree that the amount provided under
the plan should be reduced by any Social Security benefits or
state disability benefits received by plaintiff. The parties
agree that the state disability payments total $2,123.33 a month.
However, plaintiff asserts that he received state disability
benefits from June 1, 2002 until November 30, 2002. Defendant
argues that state disability benefits are paid for one year, and
if plaintiff's state disability benefits were discontinued, it
means that he was no longer disabled. Therefore, the Court will
reduce plaintiff's award by $2,123.33 a month for twelve months
beginning on June 1, 2002, unless plaintiff 1) produces evidence
that his state disability benefits were discontinued 2) for
reasons other than a change in whether he was disabled, as
defined by the state. Additionally, if defendant's assertion that
state disability benefits are paid for 12 months is incorrect,
plaintiff should notify the Court and it would then be entitled
to have the reduction withdrawn. The parties disagree on the amount of Social Security Benefits
received. Plaintiff states that the monthly payment is $1,314.
Defendant states that the payment is $1,333. Neither party has
presented any evidence in support of their assertion. Therefore,
unless plaintiff presents evidence to the contrary, his award
should be reduced by $1,333 a month.
The remaining issue is whether plaintiff is entitled to recover
benefits from June 1, 2002 until the present. Plaintiff asks the
Court to award benefits "for as long as plaintiff remains
disabled under the terms of the plan or until plaintiff reaches
the age of 65 years as provided in the plan documents." See
Proposed Order at 2. Defendant argues that the policy limits
benefits to 24 months for disabilities "caused by or contributed
by mental or nervous disorders including depressive disorders."
Letter Brief at 2. See AR at 18. Additionally, after receiving
benefits for 36 months, an individual can only receive benefits
if "totally disabled from any occupation." Id. See AR at 8.
Because plaintiff's diagnosis by his doctor that he was
disabled was based, at least in part, on his depression, the
Court finds that plaintiff is entitled to benefits for at least
24 months beginning from June 1, 2002. It is clear from the
administrative record that plaintiff had physical limitations.
However, plaintiff's doctor specifically included depression in
his diagnosis. See AR at 191. Therefore, the current record
does not allow determination whether, after receiving coverage
for 24 months, plaintiff's disability was not "contributed by
mental or nervous disorders" as provided in the policy. See AR
at 18. Hence, the matter should be remanded to determine whether
plaintiff was entitled to coverage under the policy after 24
Accordingly, the Court orders plaintiff to prepare a form
of judgment providing for the proper payment of back benefits,
taking into consideration this Order, and submit it to the Court
by no later than September 23, 2005. Thereupon, the matter will
be remanded for further consideration by the plan administrator
concerning coverage after 24 months and/or into the future.
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