United States District Court, D. Utah, Central Division
ORDER AND MEMORANDUM OF DECISION
CAMPBELL, U.S. DISTRICT COURT JUDGE
Don Foust filed this action against Defendant Lincoln
National Life Insurance Company (“Lincoln”),
challenging Lincoln's denial of his claim for long-term
benefits (“LTD benefits”) and its denial of his
claim for certain life insurance benefits (“LWOP
benefits”). On September 24, 2019, the court granted
Mr. Foust's motion for summary judgment. See Foust v.
Lincoln Nat'l Life Ins. Co., No. 2:17-cv-01208-TC,
2019 WL 4645416 (D. Utah Sept. 24, 2019).
court concluded that Mr. Foust was “totally
disabled” within the meaning of his insurance policies
from August 12, 2014, to October 4, 2015; that he was
“partially disabled” from October 5, 2015, to
July 2016; and that he was again totally disabled from July
2016 to the date of the order. Id. at *7-8, 10.
Because of these findings, the claims were mostly resolved in
Mr. Foust's favor. But two issues remained outstanding.
based on the above, the court held that Mr. Foust was
entitled to LWOP benefits between August 12, 2014, and
October 4, 2015 (a period of total disability), and was not
entitled to those benefits from October 5, 2015, to July 2016
(a period of partial disability). But the court noted that
the parties had not briefed whether Mr. Foust was entitled to
further LWOP benefits beginning in July 2016, when he again
became totally disabled. Absent such briefing, the court
declined to resolve the issue. Id. at *8 n.5.
the court held that Lincoln had wrongfully denied Mr.
Foust's claim for LTD benefits. But in ordering Lincoln
to pay such benefits, the court noted that there was an
unresolved question regarding whether the amount of the award
should be reduced because of a previous overpayment of
benefits. The court instructed the parties to try and settle
the matter but authorized them to file a motion if they were
“unable to resolve this dispute without court
intervention.” Id. at *12.
October 24, 2019, Lincoln filed this motion for entry of
judgment. (ECF No. 55.) According to both the motion and Mr.
Foust's opposition (see ECF No. 62), the parties
have stipulated to the total amount of LTD benefits Lincoln
owes to Mr. Foust, so the second issue has been resolved. But
the first issue remains disputed. Lincoln asks the court to
address the matter here and then enter judgment consistent
with its findings.
reviewed the parties' briefing, the court concludes Mr.
Foust is not entitled to any LWOP benefits after July 2016.
Foust's life insurance policy states that LWOP benefits
“will terminate automatically on . . . the day the
Insured Person ceases to be Totally Disabled.”
(Administrative Record (“AR”) 1333; see
also AR 2372.) It further states that “[i]f Total
Disability ends, and the Insured Person does not return to a
class eligible for Policy coverage[, ] then he or she may
exercise the Conversion Privilege.” (AR 1333; AR 2374.)
To be part of a “class eligible for Policy coverage,
” an individual must be an actively working, full-time
employee. (AR 1322, 1324, 1327; AR 2368-70.) The Conversion
Privilege allows a former employee to apply for an individual
life insurance policy to replace the group life insurance
policy he had during employment. (AR 1337; AR
court's view, these provisions apply directly to Mr.
Foust's situation. He was totally disabled until October
4, 2015. During that time, his LWOP benefits preserved his
life insurance coverage, even though he no longer made
premium payments. By October 5, 2015, he was no longer
totally disabled, so this benefit automatically ended. But
because Mr. Foust did not return to full-time work, he
“[did] not return to a class eligible for Policy
coverage, ” so his coverage under the policy was
terminated. At that point, the only option available to him
was to convert his group policy to an individual policy.
Nothing in the language of his insurance policies supports
the conclusion that, when he again became totally disabled
eight months later, his original coverage was resurrected.
Foust does not directly address any of this language from the
policy in his opposition to Lincoln's motion. Instead, he
cites case law requiring that ambiguous terms in insurance
contracts be construed against the insurer. See, e.g.,
LaAsmar v. Phelps Dodge Corp. Life, AD&D and Dependent
Life Ins. Plan, 605 F.3d 789 (10th Cir. 2010). But Mr.
Foust has not shown that any of the above provisions are
ambiguous. Instead, the provisions straightforwardly explain
why Mr. Foust is no longer covered under the policy.
the court concludes Mr. Foust is not entitled to an extension
of his LWOP benefits beyond October 4, 2015. Instead, Mr.
Foust, if he so desires, may invoke the conversion privilege
available under the policy.
resolved the only remaining outstanding issue, Lincoln's
motion for entry of final judgment (ECF No. 55) is GRANTED.
The court now enters final judgment as follows:
1. Mr. Foust is entitled to past due LTD benefits in the
amount of $67, 256.58, which will bring Plaintiffs LTD
benefit payments ...