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Bjelopetrovich v. Unum life Insurance Company of America

United States District Court, N.D. Illinois, Eastern Division

May 17, 2017

Janice Bjelopetrovich, Plaintiff,
v.
UNUM life Insurance Company of America Defendant.

          MEMORANDUM OPINION AND ORDER

          Elaine E. Bucklo United States District Judge.

         In this action, plaintiff Janice Bjelopetrovich seeks ERISA review of defendant's denial of life insurance benefits to which she claims she is entitled under her deceased husband Bozidar's employer-sponsored benefits plan.[1] Before me are the parties' cross-motions for summary judgment, which turn, the parties agree, on the resolution of a single dispositive issue: whether the terms of the plan required Bozidar to submit for defendant's approval an "evidence of insurability" form to obtain the coverage promising the benefits plaintiff seeks. Because I conclude, in light of the undisputed facts, that the only reasonable construction of the plan compels an affirmative answer to that question, I resolve the motions in defendant's favor.

         I.

         Plaintiff is the widow of Bozidar Bjelopetrovich, who was employed by Specialty Promotions from October 21, 2013, until his death on July 18, 2015. As a Specialty employee, Bozidar was eligible for coverage under the "Select Group Insurance Trust Policy No. 292000" (the "Group Plan"), issued by defendant. AR 47, 193.

         The Group Plan encompasses, among other coverages, two distinct life insurance modalities, each of which is captioned "Life Insurance Plan." The terms and conditions of the first are set forth in a document titled Group Insurance Summary of Benefits Non-Participating (for ease of reference, the "Summary of Benefits") and identified by Identification Number 294386 001. See AR 47-94. The terms and conditions of the second are set forth in a separate document that is also titled Group Insurance Summary of Benefits Non-Participating (again, the "Summary of Benefits), but is identified by Identification Number 294387 001. See AR 192-256.[2] Defendant refers to the first component as the "Basic Life" policy and to the second as the "Voluntary Life" policy. Plaintiff disputes this nomenclature, noting that the terms "Basic Life" and "Voluntary Life" do not appear in either Summary of Benefits, and further observing that both components are part of a single policy: the Group Plan. Terminology aside, however, it is clear from the face of the documents that the Group Plan establishes two distinct "Life Insurance Plan" coverages, each with its own terms and conditions as summarized in their respective "Benefits at a Glance" sections.[3]

         The Benefits at a Glance section of the Basic Life component describes the terms of coverage for employees who satisfy a certain minimum hours threshold and have completed a 60-day waiting period. The employer pays the cost of this coverage, which promises a fixed benefit in the amount of $15, 000.[4] AR 49. The Benefits at a Glance section of the Voluntary Life component describes similar threshold eligibility criteria (i.e., a minimum hours requirement and 60-day waiting period), but sets forth significantly different terms and conditions for coverage. See AR 195-96. First, the employee-not the employer-pays for Voluntary Life coverage. Second, the benefit amount is variable, not fixed, and is defined as "[a]mounts in $10, 000 benefit units as applied for by you and approved by Unum. All amounts are rounded to the next higher multiple of $10, 000, if not already an exact multiple thereof." Id. at 196. Third, the employee can change the benefit amount at any time after the initial election.

         The Benefits at a Glance section further provides, "EVIDENCE OF INSURABILITY IS REQUIRED FOR THE AMOUNT OF YOUR INSURANCE OVER: $140, 000." The section captioned "When Does Your Life Insurance Coverage Begin?" reiterates that evidence of insurability is required for benefits that exceed that amount, and it further provides that when evidence of insurability is required, coverage begins only after defendant has approved the employee's evidence of insurability form:

This plan provides benefit units that you can choose. When you first become eligible for coverage, you may apply for any number of benefit units, however, you cannot be covered for more than the maximum benefit available under the plan.
Evidence of insurability is required for any amount of life insurance over the amount shown in the LIFE INSURANCE 'BENEFITS AT A GLANCE" page.
You pay 100% of the cost yourself for any benefit unit. You will be covered at 12:01 a.m. on the later of:
- the first of the month coincident with or next following the date you are eligible for coverage, if you apply for insurance on or before that date, for any amount of insurance that is not subject to evidence of insurability requirements; or
- the first of the month coincident with or next following the date you apply for insurance, if you apply within 31 days after your eligibility date, for any amount of insurance that is not subject to evidence of insurability requirements; and
- the first of the month coincident with or next following the date Unum approves your evidence of insurability form, if you apply for insurance on or before your eligibility date or within 31 days after your eligibility date, for any amount of insurance that is subject to evidence of insurability requirements.

AR 213. Immediately following these provisions is a section captioned "When Can You Apply for Life Insurance Coverage if You Apply More Than 31 Days After Your Eligibility Date?", which sets forth the specific coverage requirements ...


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