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Nozal v. Allina Health Systems Long-Term Disability Benefit Plan

United States District Court, D. Minnesota

August 15, 2014

Kristina Nozal, Plaintiff,
v.
Allina Health Systems Long-Term Disability Benefit Plan; and Life Insurance Company of North America, a CIGNA Group Company, Defendants.

Matthew B. Newman, Esq., Matthew B. Newman, P.A., Eagan, MN, on behalf of Plaintiff.

Daniel K. Ryan, Esq., Hinshaw & Culbertson LLP, Chicago, IL; and Michael T. Berger, Hinshaw & Culbertson LLP, Minneapolis, MN, on behalf of Defendants.

FINDINGS OF FACT AND CONCLUSIONS OF LAW

ANN D. MONTGOMERY, District Judge.

I. INTRODUCTION

This matter came before the undersigned United States District Court Judge for findings of fact and conclusions of law as to Plaintiff Kristina Nozal's ("Nozal") claim for attorney's fees. The parties successfully settled the underlying litigation at a Court-ordered settlement conference before Magistrate Judge Tony Leung but did not reach an agreement on the award of attorney's fees. Nozal and Defendants Allina Health Systems Long-Term Disability Benefit Plan ("Allina") and Life Insurance Company of North America ("LINA") agreed to submit this issue to the Court for resolution.

Thus, the Findings of Fact and Conclusions of Law herein address only the issue of Nozal's claim for attorney's fees. The findings are based on the briefing of the parties, the exhibits submitted to the Court, and the parties' declarations.[1]

II. FINDINGS OF FACT

1. Nozal was injured in a car accident. Am. Compl. [Docket No. 5] ¶ 12. After initially paying Long Term Disability (LTD) benefits to Nozal, LINA discontinued those payments. Id . ¶ 13. In December 2012, Nozal appealed LINA's decision to discontinue her benefits. Id . ¶ 14.

2. On January 16, 2013, LINA acknowledged receipt of Nozal's appeal and stated that it "require[d] an extension of up to 45 days to make a decision." Id . ¶ 15.

3. On February 15, 2013, LINA wrote Nozal's attorney and stated that "we require an extension of up to 45 days to make a decision on the Appeal." Id . ¶ 16.

4. On March 14, 2013, LINA wrote Nozal's attorney and stated that "we require an extension of up to 45 days to make a decision on the Appeal." Id . ¶ 17.

5. On April 9, 2013, Nozal's attorney wrote LINA to inform it that the Social Security Administration awarded Nozal Social Security Disability Income benefits ("SSDI"). Id . ¶ 18. In this April 9, 2013 letter to LINA, Nozal's attorney stated, "I note from the record that [LINA] is not in compliance with ERISA's[2] administrative claim and appeal regulations, which affords Plan Administrators in disability benefit appeals a single 45 day period for extensions on appeal. LINA has taken two such extensions." Id . ¶¶ 18-19.

6. LINA did not respond to Nozal's attorney regarding the allegations that LINA was in violation of ERISA's appeals process regulations. Id . ¶ 20

7. On April 12, 2013, LINA wrote Nozal's attorney and stated that given Nozal's award of SSDI benefits, "we would like to give you the opportunity to submit a complete copy of the medical records evaluated by the SSA-if they differ from the medical records contained in Ms. Nozal's LTD claim file.... If the information is not available or beneficial for the appeal review, please let us know by April 26, 2013 and we will move forward with our review based on the information contained in the claim.... The time it takes to submit additional information is TOLLED until you contact ...


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