U.S. Fifth Circuit Court of Appeals Judge Stephen A. Higginson
NEW ORLEANS – The U.S. Court of Appeals for the 5th Circuit affirmed summary judgment for Sun Life Assurance Co. in a case in which it was accused of miscalculating benefits on a work-related injury claim for more than a decade.
The July 25 ruling was written by Circuit Judge Stephen Higginson with Circuit Judges Priscilla Owen and Leslie Southwick affirming.
Plaintiff Michael Faciane had claimed Sun Life miscalculated his long term disability benefits since 2008. In response, Sun Life had argued that contractual limitations on his claims expired, and both the Eastern District of Louisiana and the appeals court backed that argument.
Faciane sued with claims that he should have received $960 a month for benefits instead of $100 a month. But he sued six years after his dispute was resolved, and Sun Life pointed to a three-year contractual limitations provision when it filed a motion to dismiss. Still, Faciane insisted that he didn’t receive notice of the percentage he would be getting. Sun Life sent the first letter in March 2008, according to background information in the ruling.
To prove that it sent the letter, Sun Life provided an affidavit from an administrative review official, but Faciane argued this didn’t prove the company sent the letter.
But Higginson wrote, “Accordingly, with substantial evidence buttressing the presumption of receipt and only ineffectual rebuttals from Faciane, we affirm the district court’s conclusion that no genuine issue of material fact exists as to Faciane’s receipt of the March 2008 letter. We also affirm the district court’s conclusion that the March 2008 letter contained enough information for Faciane’s miscalculation claim to accrue.”
Faciane said his issues started in 2006 after a work-related injury at Capital One Financial Corp. Sun Life administered the disability plan in 2008. Specifically, a letter from March 31, 2008 revealed Faciane was owed a benefit of half of his basic monthly earnings, stating he didn’t have enough information to participate in a buy-up plan that would have entitled him to 66.67 percent. Based on Sun Life’s calculations, Faciane’s basic monthly income was $5,134.16. His monthly net benefit was $100, which was the minimum amount offered on the plan. While Faciane acknowledged he received a letter detailing the plan, he said he lost it. The dispute was settled in April 2011.
Faciane didn’t take legal action until June 2017, when he said his monthly income was $8,118.52, not the $5,134.16 that Sun Life calculated. He said he should have received $960 a month and not $100 a month, but the appeals court said he failed to prove his claim in time.