United States District Court, D. New Jersey
plaintiff, Leon McBurrows, asserts claims against Verizon
Employee Benefits Committee ("VEBC") and the
Verizon Claims Review Committee ("VCRC") (together,
the "Plan Committees") under the Employee
Retirement Income Security Act of 1974 ("ERISA"),
29 U.S.C. § 1001, et. seq., for the alleged wrongful
denial of disability benefits. Mr. McBurrows also asserts
claims against Verizon New Jersey, Inc.
("Verizon") under the New Jersey Law Against
Discrimination ("NJLAD"), N.J. Stat. Ann. §
before the Court is the motion of the Plan Committees for
summary judgment pursuant to Fed.R.Civ.P. 56. (DE
For the reasons expressed herein, I will grant the Plan
Committees' motion for summary judgment.
McBurrows originally filed this action in state court
against, among others, Verizon. The defendants removed the
case to federal court because claims based on the denial of
disability and health insurance benefits are preempted by
ERISA, see 29 U.S.C. §§ 1132 & 1144.
The defendants then moved to dismiss the complaint on the
grounds that it failed to state an ERISA claim. I filed a
short order noting that the plaintiff had neither ERISA nor
federal pleading standards in mind when he filed his
state-court complaint, dismissing the complaint without
prejudice, and granting leave to file an amended complaint.
(DE 15). The plaintiff then filed his First Amended
Complaint, which for the first time named the Plan Committees
as defendants. (DE 16).
then moved to dismiss the First Amended Complaint. (DE 21; DE
23). In an Opinion dated February 17, 2017, I dismissed
without prejudice the Count 1 NJLAD claim of disability
discrimination, asserted against Verizon, for failure to
state a claim. See Fed. R. Civ. P. 12(b)(6). (DE 33;
DE 34). McBurrows v. Verizon, No. 15-CV-6321 (KM),
2017 WL 1243145, at *1 (D.N.J. Feb. 17, 2017). With respect
to the ERISA claims, I denied the motion to dismiss, holding
that the asserted defenses "relie[d] on facts extrinsic
to the complaint" and were therefore "best
considered in connection with a motion for summary
Judge Dickson granted plaintiffs motion for leave to file a
Second Amended Complaint. (DE 52). Mr. McBurrows then filed
his Second Amended Complaint, which is the currently
operative pleading. (DE 53).Counts 3, 4, and 5 assert ERISA
claims against the Plan Committees. Now before the Court is
the motion of the Plan Committees for summary judgment
pursuant to Fed.R.Civ.P. 56. (DE 74).
approximately 1986 through June 2015, Mr. McBurrows was
employed by Verizon at various locations in New Jersey. (DE
79-2 at 4; DE 16-2 at 21). Mr. McBurrows seeks, as against
the Plan Committees, short term disability ("STD")
and long term disability ("LTD") benefits under
Verizon's Plan for Group Insurance (the
"Plan"). The parties do not dispute that the Plan
is an employee benefit welfare plan governed by ERISA and
that Mr. McBurrows was a participant in the Plan while
employed by Verizon.
Plan document is entitled "Your Disability Coverage
Verizon January 1, 2011." (DE 75 ¶ 2; DE
79-1 ¶ 2; DE 74-3 at 4). As to STD coverage, the Plan
explains that an eligible Verizon employee is
"automatically enrolled for STD coverage" on his or
her first day of work, but that one "must enroll for LTD
coverage." (DE 74-3 at 7, 12; DE 75 ¶ 7; DE 79-1
¶ 7). If one is enrolled and approved for LTD coverage,
LTD benefits are payable when STD benefits end, assuming one
meets the Plan's definition of totally disabled.
McBurrows suffered from certain medical ailments that
worsened in August 2013 and thereafter. (DE 79-2 at 4). Due
to those health complications, Mr. McBurrows went on short
term leave from Verizon in August 2013 and received STD
benefits under the Plan during that time. (DE 79-2 at 4). On
June 17, 2014, Verizon sent Mr. McBurrows a letter explaining
that his STD benefits expired on May 24, 2014, and that if he
did not return to work he would be deemed to be "on an
unauthorized absence." (DE 16-2 at 4, 27). After Mr.
McBurrows's counsel successfully appealed this STD
benefits determination, his STD benefits were extended to
August 12, 2014. (DE 16-2 at 33, 36).
on July 14, 2014, Mr. McBurrows returned to work at Verizon,
although at a different location in New Jersey. His job
duties changed, and instead of full time, he worked
"shortened days." (2AC 1 ¶ 7; DE 16-2 at 16).
Thereafter, on October 6, 2014, he was placed on unpaid
personal leave. (DE 16-2 at 17).
25, 2015, Verizon sent Mr. McBurrows a letter stating that
his unpaid leave of absence expired on June 5, 2015, and that
Verizon had been made aware that he was unable to return to
work following that date. (DE 16-2 at 21). The June 25, 2015
letter informed Mr. McBurrows that his request for an
extension of the unpaid leave was denied and that Verizon
considered Mr. McBurrows to have abandoned his position.
(Id.). Verizon officially terminated his employment
on June 25, 2015. (Id.).
McBurrows did not receive LTD benefits in the relevant period
described above. Mr. McBurrows did not submit a claim for LTD
benefits to the Plan Committees. Instead he filed the present
lawsuit as described in the procedural history above. (DE 75
¶ 14; DE 79-1 ¶ 14).
McBurrows's enrollment history for LTD benefits is as
follows. He had varying amounts of LTD coverage through
Verizon for each year from 2002 through the end of 2006. (DE
74-30 at 57-58; DE 79-2 at 8-9). A Verizon historical LTD
enrollment record shows that he did not elect to have any LTD
coverage for the years 2001, 2007, 2008, 2009, 2010, 2011,
and 2012. (Id.). That enrollment record is silent as
to the years before 2001 and after 2012. (Id.).
Annual Enrollment Confirmation Statement, documenting Mr.
McBurrows's coverage elections as of November 2013,
indicates that he did not have any LTD coverage in 2013. (DE
74-12 at 76; DE 75 ¶ 21; DE 79-1 ¶ 21). That
document shows that in November 2013, Mr. McBurrows did elect
to enroll in LTD coverage for the following year, but that
such 2014 LTD coverage was "(p]ending [e]vidence of
1, 2015, MetLife sent a letter to Mr. McBurrows that noted
his STD benefits exhausted on August 12, 2014. That letter
referred to a recent notice sent to Mr. McBurrows confirming
that he was not currently enrolled for LTD coverage. (DE
74-26 at 40). On June 5, 2015, Verizon also sent Mr.
McBurrows a letter which referred to MetLife's recent
notice confirming that he was not enrolled in LTD coverage
with Verizon. (DE 74-29 at 42; DE 75 ¶ 13; DE79-1 ¶
June 5, 2015 letter from Verizon additionally noted that
MetLife's records indicated that any LTD coverage Mr.
McBurrows previously had with Verizon expired around January
2011. (Id.). The Plan Committees contend that this
is was an error; Mr. McBurrows, they say, was not enrolled
for LTD coverage at any time subsequent to 2006. (DE 75
August 2, 2017, Verizon sent a letter to Mr. McBurrows's
counsel explaining that VCRU issued a claim determination
that Mr. McBurrows "sought enrollment for LTD coverage
on October 31, 2013, via the Benefits Connection website when
making 2014 calendar year annual enrollment elections."
(DE 74-8 at 13; DE 75 ¶ 22). Overall, VCRU concluded
that Mr. McBurrows "was not enrolled for or eligible to
participate in the LTD coverage under the Plan" and that
he "had not been enrolled for LTD coverage since 2006
when coverage became subject to employee-paid premiums."
August 2, 2017 letter, Verizon also noted that in October
2013, while Mr. McBurrows was receiving STD benefits, he
attempted to enroll in LTD coverage. (Id.). VCRU
explained the reasons why it believed Mr. McBurrows was not
entitled to LTD under those circumstances:
[E]nrollment for LTD coverage under the Plan is predicated on
submission of evidence of insurability to MetLife, acceptance
of evidence of insurability by MetLife, payment of required
premiums and return to active employment for a minimum of 90
days after STD.
Benefits Center records indicate that Mr. McBurrows never
submitted the required evidence of insurability. As a result,
evidence of insurability was never accepted by MetLife and he
was not enrolled for LTD coverage under the Plan. Moreover,
he did not pay premiums for LTD coverage. Additionally, he
did not return to active employment for a period of 90
consecutive days after his return from STD.
Despite the fact that Mr. McBurrows failed to satisfy the
requirements for enrollment for LTD coverage as noted above,
the Verizon Claims Review Unit consulted with MetLife to
determine whether a submission of evidence of insurability by
Mr. McBurrows would have been accepted by MetLife as required
under the Plan.
Evidence of insurability requires the submission of the
enclosed Statement of Health Form. MetLife has determined
that if Mr. McBurrows had completed the Statement of Health
Form, yes answers would have been required to items 1 lb., 1
Ik., and 1 It [relating to whether a pre- existing medical
condition exists]. MetLife has indicated that yes responses
to these items would have resulted in MetLife's
determination that the evidence of insurability was
unacceptable (a copy of that opinion is also enclosed). As a
result, coverage and enrollment would also have been denied
on the basis of insurability.
(DE 74-8 at 15-16; DE 75 ¶ 22; DE 79-1 ¶ 22).
January 24, 2018, Mr. McBurrows appealed the LTD claim
determination to the VCRC. (DE 75 ¶ 23; DE 79-1 ¶
23). Kevin Cammarata, the Chairperson of the VCRC, considered
the appeal and whether Mr. McBurrows was eligible for LTD
coverage under the Plan. (DE 75 ¶ 24; DE 79-1 ¶
24). The VCRC issued a final determination on April 30, 2018,
and concluded that Mr. McBurrows was ineligible for LTD
coverage because (1) he did not submit evidence of
insurability to MetLife; (2) he did not pay the required
premiums for LTD coverage; and (3) he did not return to
full-time employment for a minimum of 90 days following
receipt of his STD benefits. (DE 74-27 at 62-66; DE 75 ¶
25; DE 79-1 ¶ 25), Moreover, even if MetLife had
received his evidence of insurability, that evidence would
have established that he was not eligible for coverage,
because he had a pre-existing medical condition.
LTD Coverage under the Plan
Plan sets forth the following applicable provisions with
respect to enrolling for LTD coverage:
You must enroll in the LTD plan in order to be eligible for
You can enroll for LTD coverage within 31 days of your hire
date. If you enroll for LTD coverage during the initial
31-day period, you will not need to provide evidence of
insurability for coverage to take effect. Evidence of
insurability is a statement of your medical health that
MetLife will use to determine if you are approved for LTD
During the year
You can enroll for LTD coverage at any time during the year,
including during annual enrollment. However, you will need to
provide evidence of insurability to MetLife, and that
evidence must be accepted, before coverage can take effect.
If you do not enroll
You will receive "no coverage" for LTD if you do
Paying for coverage
You pay the cost of LTD coverage through after-tax payroll
deductions, which provides the advantage of tax-free LTD
benefits. Your contributions for coverage are based upon your
annual benefits compensation as of July 1 of the previous
calendar year and the LTD coverage option you choose. If you
are on an ...