Torello v. UNUM Life Insur. Co., 1999 U.S. App. LEXIS 32228 (6th Cir. December 3, 1999) (unpublished). This court affirmed the district court’s grant of summary judgment in favor of UNUM Life and G&J Pepsi-Cola Bottlers, Inc. Torello sued after UNUM denied his claim for long-term disability benefits. Mr. Torello suffered a work-related injury in November, 1994. From January to October of 1995, Mr. Torello was off work. During this time, he received workers' compensation benefits, but did not apply for long-term disability insurance benefits through UNUM.
On October 16, 1995, Torello's personal physician cleared Torello to return to work. Shortly afterwards, he suffered a second injury (unrelated to work), and remained on leave of absence into early 1996. By this time, he had used the maximum one-year of leave time, and G&J terminated his employment. Torello hired an attorney, who suggested to G&J that Torello might forgo claims of unlawful discharge based on age and disability if G & J Bottlers reinstated Torello to allow him to file with UNUM for long-term disability benefits. G & J agreed to temporarily reinstate Torello for this purpose in exchange for a release of all claims against G & J.
However, upon his reinstatement, UNUM promptly denied Torello’s application for long-term disability benefits as untimely. The plan required Torello to report a claim within 30 days of the disability. On administrative appeal, UNUM further argued that Torello's second disability was not compensable because he was not "actively employed" by G & J when he was injured the second time.
This court reviewed de novo (declining review under the "arbitrary and capricious" standard on the basis that requiring a claimant to submit proof of disability is not sufficient to reflect a clear grant of discretion). This court denied several of Torello’s challenges to the time limits. Equitable tolling was inapplicable due to Torello’s own lack of diligence. The time limit terms were unambiguous. The summary plan description adequately explained the consequences of a failure to comply with the time limits. Notice of injury to G & J could not be construed as notice to UNUM via agency laws; and no "prejudice" against the insurer was required under Ohio law. As for coverage for his second injury, this court agreed found that he met none of the exceptions to the "active employment" requirement, a prerequisite for coverage under the policy. As for Torello’s agreement to release claims against G & J, this court held that his claim for benefits would have been untimely, regardless of an alleged breach of fiduciary duty.
