In 2013, plaintiff’s husband attempted to enroll in a supplemental life insurance plan through his employer, NOV. Unum provided coverage to NOV’s employees through issuance of a Summary of Benefits. Mr. Talasek received a Benefits Confirmation Statement from Unum, reflecting his new elections, which were to begin in 2014, but the statement noted that “any coverage listed as suspended requires approval”, while indicating that several of his elections were “suspended”, because Unum required completion an Evidence of Insurability form before coverage could begin.
Mr. Talasek submitted the form on January 2, 2014, and, later that month, was diagnosed with pancreatic cancer. He and Unum began corresponding more frequently about his benefits, and, on January 18, 2014, Unum sent Mr. Talasek a letter informing him that it had identified an error in his application, and that more information was needed. The plaintiff’s husband corrected the error and re-submitted the form, but was told that, as part of the review process, he would be required to provide blood and urine samples, which he did on March 3, 2014. Because of the abnormal lab results, Unum sent Mr. Talasek a letter, dated March 6, 2014, which explained that it was not able to approve the supplemental insurance coverage.
However, the plaintiffs continued to receive statements from the NOV Benefits Service Center, reflecting the same elections he made in 2013 and showing that NOV was deducting funds from Mr. Talasek’s paycheck for the coverage. Absent from these statements were any “suspended” notations.
Mr. Talasek died in December of 2017, and his widow submitted a claim under the group life insurance policy, which Unum both approved and denied. In denying Talasek’s claim for the supplemental benefits, Unum indicated that it had rejected Mr. Talasek’s application in March of 2014. After the plaintiff unsuccessfully appealed this decision, she filed suit against both Unum and NOV, alleging estoppel, negligence, and violations of ERISA. After summary judgment was granted in favor of defendants, Mrs. Talasek appealed, challenging only the district court’s grant of summary judgment in favor of her husband’s employer, NOV, on her estoppel claim.
The Court of Appeal agreed with the appellant that the employer’s actions were misleading, but nevertheless affirmed the dismissal of plaintiff’s estoppel claims, because the plaintiff and her husband could not have reasonably relied on the employer’s actions or representations.
“The provision of the group life insurance policy that required Ben Talasek to complete an Evidence of Insurability form before coverage could begin was unambiguous. The Summary of Benefits, provided by Unum, is the governing document. It states, in no uncertain terms, that evidence of insurability is required for any amount of life insurance. Ben Talasek was on notice that coverage applied for during an annual enrollment period began at midnight following the later of two conditions: (1) the first day of the next plan year; and (2) the date Unum approved his evidence of insurability form. The Summary of Benefits made clear that this was also the case for changes in coverage.
“Furthermore, the Summary of Benefits also made clear that NOV’s representations were not Unum’s. And, perhaps most significant, it delineated when and by whom changes could be made to the terms — restricting those instances to narrow circumstances. Talasek does not argue that she and her husband relied on NOV’s representations to help them interpret an ambiguous or unclear term in the Summary of Benefits. Rather, she contends that it was reasonable to rely on NOV’s representations rather than the unambiguous group policy language. Against this backdrop, we cannot say that Talasek’s reliance on NOV’s statements and deductions was reasonable — no matter how frustrating those misrepresentations were in reality. Thus, Talasek cannot establish the second element of her claim.”
Talasek v. National Oilwell Varco, No.21-20069, 2021 WL 4860133 (5th Cir. Oct. 19, 2021).