IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT,

IN AND FOR PALM BEACH COUNTY, FLORIDA.

CIRCUIT CIVIL

KRISTA ROSENBERG, M.D., CASE NO.: 

Plaintiff,

vs. 

RELIANCE STANDARD 

INSURANCE COMPANY,

Defendant.

 /

COMPLAINT

Plaintiff, KRISTA ROSENBERG, M.D., by and through undersigned counsel, hereby 

files this her Complaint against Defendant, RELIANCE STANDARD INSURANCE 

COMPANY, and says:

1. This is an action for damages in excess of Thirty Thousand Dollars 

($30,000.00).

2. The Plaintiff, KRISTA ROSENBERG, M.D. (hereinafter “ROSENBERG” or 

“Plaintiff”), is a resident of Boca Raton, Palm Beach, County, Florida and is, in all respects, 

sui juris.

3. Defendant, RELIANCE STANDARD INSURANCE COMPANY, (hereinafter 

“RELIANCE” or “Defendant”), is a foreign corporation doing business in Florida and can 

be found in Florida.

4. RELIANCE issued and delivered a Group Long Term Disability Policy 

(#LTD124706) (hereinafter as “Disability Policy” or “Policy”) to Retina Vitreous 

Consultants, LLP d/b/a Retina Group of Florida (hereinafter “The Retina Group” or 

Filing # 155835197 E-Filed 08/22/2022 04:13:26 PM Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 1 of 70
ROSENBERG v RELIANCE

COMPLAINT

Page 2 of 7

“Group”), in the State of Florida, effective December 1, 2013. (The Disability Policy is 

attached hereto as Exhibit “A.”).

5. ROSENBERG, a former full-time Owner/Physician of The Retina Group, is an 

insured person under the policy.

6. Neither the Disability Policy nor these claims are subject to the Employment 

Retirement Income Security Act (“ERISA”) 29 U.S.C. §1001 et, seq. in that the policy was not 

issued as part of an employee welfare benefit plan and are thus exempt from ERISA.

7. The purpose of the Disability Policy was to provide ROSENBERG a monthly 

loss of income benefit in the event that she became totally disabled, defined as:

Totally Disabled” and “Total Disability” as defined by the 

Policy means that as a result of injury or sickness, during the 

Elimination Period and thereafter you cannot perform the 

substantial and material duties of your regular occupation.1

(See Exhibit A, Page 2.2.)

8. ROSENBERG suffers from, among other things, continuing symptomatology 

from a collapsed lung/pneumothorax, including fatigue, shortness of breath and pain.

9. As of November 19, 2020, ROSENBERG has been unable to perform the 

substantial and material duties of her regular occupation as a vitreoretinal surgeon due to 

her disabling condition. ROSENBERG is clearly totally disabled under the terms of the 

Disability Policy.

1

“Regular Occupation” means the occupation you are routinely performing when Total Disability begins. We will look 

at your occupation as it is normally performed in the national economy, and not the unique duties performed for a 

specific employer or in a specific locale.

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 2 of 70
ROSENBERG v RELIANCE

COMPLAINT

Page 3 of 7

10. On or about May 20, 2021, ROSENBERG notified Defendant that she was 

totally disabled.

11. By letter dated September 30, 2021, RELIANCE denied coverage for Plaintiff’s 

claim asserting that because Plaintiff’s employer (The Retina Group) paid the Plaintiff her 

earnings to her pass-through Subchapter S Corporation rather than to her directly, “there 

are no eligible earnings upon which to base a benefit in accordance with your group’s LTD 

(Long Term Disability) Policy definition of Covered Monthly Earnings.” (RELIANCE’S 

September 30, 2021, denial letter is attached hereto as Exhibit “B.”).

12. By letter dated March 3, 2022, ROSENBERG, through counsel, appealed 

Defendant’s improper denial of coverage. (Counsel’s March 3, 2022, letter is attached hereto 

as Exhibit “C.”). The appeal letter explains that Defendant’s interpretation of the definition 

of “Covered Monthly Earnings”2 to deny benefits to Plaintiff merely because her income 

from the group practice passed through her Subchapter S Corporation is contrary to the 

Policy and Florida law.

13. The letter further explains that Defendant denied coverage even though the 

definition of Covered Monthly Earnings includes an insureds’ “basic monthly salary” and 

2

“Covered Monthly Earnings” means your basic monthly salary received from the Policyholder on the day just before 

the date of Total Disability, prior to any deductions to a 401(k) and Section 125 plan. Covered Monthly Earnings does 

not include commissions, overtime pay, incentive pay, or any other special compensation not received as Covered 

Monthly Earnings. However, “Covered Monthly Earnings” will include bonuses received from the Policyholder averaged 

over the lesser of: (1) the number of months worked; or (2) the 36 months; just prior to the date Total Disability began. 

and “Covered Monthly Earnings” means your compensation from the partnership averaged over the lesser of: (1) the 

number of months worked; or (2) the 36 months; in the calendar year(s) prior to the date Total Disability began, as 

reported on the partnership federal income tax return (Ki) as “net earnings (loss) from self-employment”.

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 3 of 70
ROSENBERG v RELIANCE

COMPLAINT

Page 4 of 7

the absence of any policy provision which either excludes pass-through income to a 

Subchapter S Corporation or limits “basic monthly salary” to W-2 wages.

14. Finally, the letter explains that the Policy was sold to The Retina Group by a 

licensed and appointed agent of RELIANCE, and that RELIANCE’s agent knew at the time 

of application for the Policy that ROSENBERG and each of the other co-owner physicians of 

the group had established their own Subchapter S Corporation as a pass-through entity.

15. Defendant did not respond to counsel’s March 3, 2022, letter of appeal.

16. Although Defendant has since agreed to amend the Policy to clarify that 

Plaintiff, and the Subchapter S-Corporations of the other physician owners in the Group are 

indeed insureds, Defendant continues to deny Plaintiff’s claim for total disability benefits.

17. ROSENBERG has exhausted all the administrative remedies under the Policy, 

or they have been waived or excused.

18. ROSENBERG has complied with all conditions precedent to this action, or 

they have been excused or waived.

19. ROSENBERG has been forced to retain the services of undersigned counsel in 

order to prosecute this action and is obligated to pay attorneys’ fees on a contingent fee 

basis.

COUNT I

DECLARATORY RELIEF

Plaintiff, KRISTA ROSENBERG, M.D., hereby adopts, realleges and reaffirms each 

and every allegation contained in paragraphs 1 through 19 of this Complaint as though fully 

alleged herein and further alleges:

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 4 of 70
ROSENBERG v RELIANCE

COMPLAINT

Page 5 of 7

20. This is an action for Declaratory Relief pursuant to Chapter 86 of the Florida 

Statutes.

21. RELIANCE has denied coverage to ROSENBERG on the basis that 

ROSENBERG had no eligible earnings upon which to base a benefit as her earnings first 

passed through her Subchapter S Corporation.

22. ROSENBERG contends that the policy provides coverage, notwithstanding 

the manner in which her earnings were paid. 

23. On the facts of this case, the Plaintiff, ROSENBERG, is in doubt as to her rights 

under the terms and provisions of the subject insurance policy and Florida law.

24. The parties have an actual, present and bona fide dispute as to whether the 

policy provides coverage for ROSENBERG’s claim.

WHEREFORE, KRISTA ROSENBERG, M.D. respectfully requests that this Court:

A. Take jurisdiction over this matter for the purposes of rendering a 

declaratory decree;

B. Having taken jurisdiction, enter an Order declaring that the subject 

insurance policy provides coverage for ROSENBERG’s claim.

C. Require RELIANCE to indemnify ROSENBERG for any and all benefits 

due and owing under the policy; 

D. Grant such other relief as the Court deems proper; and 

E. Retain jurisdiction over the parties and the subject matter to assess 

reasonable attorneys’ fees and costs to ROSENBERG’s counsel and assess 

any and all penalties this Court deems meet and just.

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 5 of 70
ROSENBERG v RELIANCE

COMPLAINT

Page 6 of 7

WHEREFORE, Plaintiff, KRISTA ROSENBERG, M.D., respectfully requests this 

Honorable Court to enter declaratory judgment in its favor and against RELIANCE 

STANDARD INSURANCE COMPANY, and award damages, costs, and attorneys’ fees 

pursuant to Florida Statute §627.428 and/or §627.6698, pre-judgment interest on all 

liquidated sums, and demands a trial by jury of all issues so triable.

COUNT II

BREACH OF CONTRACT – DISABILITY POLICY

Plaintiff, KRISTA ROSENBERG, M.D., incorporates the allegations contained in 

Paragraphs 1 through 19 as if fully stated herein and says further the following:

25. Based on the foregoing, Defendant has breached the contract of insurance and 

Plaintiff is entitled to the Disability Policy benefits consisting of past long-term disability 

benefits including prejudgment interest, retroactive to the day benefits were denied.

26. As a direct and proximate result, Plaintiff is entitled to the benefits identified 

herein because:

a. The benefits are permitted benefits under the Disability Policy;

b. Plaintiff has satisfied all conditions to be eligible to receive the benefits; 

and

c. Plaintiff has not waived or otherwise relinquished her entitlement to the 

benefits.

WHEREFORE, Plaintiff, KRISTA ROSENBERG, M.D., prays for judgment for 

damages against Defendant, RELIANCE STANDARD INSURANCE COMPANY, together 

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 6 of 70
ROSENBERG v RELIANCE

COMPLAINT

Page 7 of 7

with prejudgment interest, costs and attorneys’ fees pursuant to F.S. §627.428 and/or 

§627.6698, and demands a trial by jury as to all issue so triable.

Respectfully submitted this 22nd day of August, 2022.

BENRUBI LAW, P.A.

6501 Congress Avenue, Suite 118

Boca Raton, FL 33487

Office: (561) 910-8650

Email: Rbenrubi@benrubilaw.com

Secondary: cgarcia@benrubilaw.com

Counsel for Plaintiff

By: /s/ Richard M. Benrubi .

 RICHARD M. BENRUBI, ESQ.

 Florida Bar No.: 796573

LIGGIO & CORNELL, P.A.

1615 Forum Place, Suite 3B

West Palm Beach, FL 33401

Office: (561) 616-3333

Fax: (561) 616-3266

Email: jliggio@liggiolaw.com

Co-Counsel for Plaintiff

By: /s/ Jeffrey M. Liggio .

 JEFFREY M. LIGGIO, ESQ.

 Florida Bar No.: 357741

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 7 of 70
1 

From: 

Sent: 

To: 

Subject: 

Attachments: 

Here is the reliance policy 

Thanks 

Krista Rosenberg 

Krista < prosen2908@aol.com > 

April 19, 2021 2:03 PM 

Rubin, Amy S.; Burack, Seth B. 

[EXT) Fw: Reliance insurance 

Reliance Standard Life (Doctors policy).pdf 

Sent from the all new AOL app for iOS 

On Tuesday, April 13, 2021, 12:20 PM, 

Hi Dr. Rosenberg, 

Please see attached LTD policy. 

Thank you. 

Kind regards, 

0 Retina Group 

of Florida� 

EXHIBIT "A"

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 8 of 70
From: Krista <prosen2908@aol.com> 

Sent: Tuesday, April 13, 2021 10:43 AM 

To: 

Subject: Reliance insurance 

[EXTERNAL] Caution: This email originated from outside of the organization. 

Can you please send me our full contract and policy with reliance disability insurance? 

Thank you 

Krista 

Sent from the all new AOL app for iOS 

2 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 9 of 70
)0 

._ ‘

GROUP LONG TERM DISABILIT 

INSURANCE PROGRAM 

Retina Vitreous Consultants, LLP dba 

Retina Group of Florida 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 10 of 70
QuAotet Pzt)tu(,,a_. 

RELIANCE STANDARD LIFE 

INSURANCE COMPANY 

Home Ofice: Chicago, Illinois 

Administrative Office: Philadelphia, Pennsylvania 

CERTIFICATE OF INSURANCE 

We certify that the Person whose name appears on the enrollment card 

attached to this Certificate is insured for the benefits which apply to 

his/her class, under Group Policy No. LTD 124706 issued to Retina 

Vitreous Consultants, LLP dba Retina Group of Florida, the Policyholder. 

This Certificate is not a contract of insurance. It contains only the major 

terms of insurance coverage and payment of benefits under the Policy. It 

replaces all certificates that may have been issued to you earlier. 

eflJL�� 

Secretary President 

GROUP LONG TERM DISABILITY INSURANCE CERTIFICATE 

If you have any questions about your insurance, or 

need assistance, please call (877) 268-7606. 

LRS-6570 Ed. 2/83 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 11 of 70
TABLE OF CONTENTS 

Page 

SCHEDULE OF BENEFITS ................................................................... 1.0 

DEFINITIONS ........................................................................................ 2.0 

TRANSFER OF INSURANCE COVERAGE .......................................... 3.0 

GENERAL PROVISIONS ...................................................................... 4.0 

CLAIMS PROVISIONS .......................................................................... 5.0 

ELIGIBILITY, EFFECTIVE DATE AND TERMINATION ....................... 6.0 

BENEFIT PROVISIONS ........................................................................ 7.0 

EXCLUSIONS ........................................................................................ 8.0 

LIMITATIONS ........................................................................................ 9.0 

SPECIFIC INDEMNITY BENEFIT ....................................................... 10.0 

SURVIVOR BENEFIT - LUMP SUM ................................................... 11.0 

WORK INCENTIVE AND CHILD CARE BENEFITS ........................... 12.0 

EXTENSION OF COVERAGE UNDER THE FAMILY AND 

MEDICAL LEAVE ACT AND UNIFORMED SERVICES 

EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT (USERRA) .. 13.0 

REHABILITATION BENEFIT ............................................................... 14.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 12 of 70
SCHEDULE OF BENEFITS 

EFFECTIVE DATE: December 1, 2013 

ELIGIBLE CLASSES: Each active, Full-time Owner/ Physican, except 

any person employed on a temporary or seasonal basis, who: 

(1) is engaged in a non-hazardous occupation; and

(2) functions primarily in an office environment.

WAITING PERIOD: 90 days of continuous employment. 

YOUR EFFECTIVE DATE: The first of the month coinciding with or next 

following completion of the Waiting Period. 

INDIVIDUAL REINSTATEMENT: 6 months 

LONG TERM DISABILITY BENEFIT 

ELIMINATION PERIOD: 90 consecutive days of Total Disability. 

MONTHLY BENEFIT: The Monthly Benefit is an amount equal to 60% 

of Covered Monthly Earnings. 

To figure this benefit amount payable: 

(1) multiply your Covered Monthly Earnings by the benefit

percentage(s) shown above;

(2) take the lesser of the amount:

(a) of step (1) above; or

(b) the Maximum Monthly Benefit shown below; and

(3) subtract Other Income Benefits, as shown below, from step (2),

above.

We will pay at least the Minimum Monthly Benefit as follows. 

OTHER INCOME BENEFITS: Other Income Benefits are: 

(1) disability income benefits you receive because of your Total

Disability under any group insurance plan(s);

(2) disability income benefits you are eligible to receive because

of your Total Disability under any governmental retirement

system, except benefits payable under a federal government

employee pension benefit;

(3) all benefits (except medical or death benefits) including any

settlement made in place of such benefits (whether or not

liability is admitted) you are eligible to receive because of your

Total disability under:

(a) Workers' Compensation Laws;

(b) occupational disease law;

LRS-6570-1-0704-FL Page 1.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 13 of 70
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(c) any other laws of like intent as (a) or (b) above; and

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(4) any of the following that you are entitled to receive:

(a) wages, salary or other compensation, excluding the

amount allowable when engaged in Rehabilitative

Employment; and

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vested renewal commissions, but, excluding commissions

or monies that you earned prior to Total Disability which

are paid after Total Disability has begun;

(5) that part of disability benefits paid for by the Policyholder which

you are eligible to receive because of your Total disability

under a group retirement plan; and

(6) that part of Retirement Benefits paid for by the Policyholder

which you are eligible to receive under a group retirement

plan; and

(7) disability or Retirement Benefits under the United States Social

Security Act, the Canadian pension plans, or any other

government plan for which:

(a) you are eligible to receive because of your Total Disability

or eligibility for Retirement Benefits; and

(b) your dependents are eligible to receive due to (a) above.

Disability and early Retirement Benefits will be offset only if such benefits 

are elected by you or if election would not reduce the amount of your 

accrued normal Retirement Benefits then funded. 

Retirement Benefits under number (7) above will not apply to disabilities 

which begin after age 70 if you are already receiving Social Security 

Retirement Benefits while continuing to work beyond age 70. 

MINIMUM MONTHLY BENEFIT: In no event will the Monthly Benefit 

payable to you be less than $100. 

MAIMUM MONTHLY BENEFIT: $10,000 (this is equal to a maximum 

Covered Monthly Earnings of $16,667). 

LRS-6570-1-0704-FL Page 1.1 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 14 of 70
67 

MAIMUM DURATION OF BENEFITS: Benefits will not accrue beyond 

the longer of: the Duration of Benefits; or Normal Retirement Age; 

specified below: 

Age at Disablement 

61 or less 

62 

63 

64 

65 

66 

67 

68 

69 or more 

OR 

Duration of Benefits (in years) 

To Age 65 

31⁄2 

3 

21⁄2 

2 

13⁄4 

11⁄2 

11⁄4 

1 

Normal Retirement Age as defined by the 1983 Amendments to the 

United States Social Security Act and determined by your year of birth, 

as follows: 

Year of Birth 

1937 or before 

1938 

1939 

1940 

1941 

1942 

1943 thru 1954 

1955 

1956 

1957 

1958 

1959 

1960 and after 

Normal Retirement Age 

65 years 

65 years and 2 months 

65 years and 4 months 

65 years and 6 months 

65 years and 8 months 

65 years and 1 0 months 

66 years 

66 years and 2 months 

66 years and 4 months 

66 years and 6 months 

66 years and 8 months 

66 years and 1 0 months 

67 years 

CHANGES IN MONTHLY BENEFIT: Increases in the Monthly Benefit 

are effective on the date of the change, provided you are Actively at 

Work on the effective date of the change. If you are not Actively at Work 

on that date, the effective date of the increase in the benefit amount will 

be deferred until the date you return to Active Work. Decreases in the 

Monthly Benefit are effective on the date the change occurs. 

LRS-6570-1-0704-FL Page 1.2 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 15 of 70
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CONTRIBUTIONS: You are not required to contribute toward the cost of 

this insurance. 

Premium contributions will not be included in your gross income. 

For purposes of filing your Federal Income Tax Return, this means that 

under the law as of the date the Policy was issued, your Monthly Benefit 

might be treated as taxable. It is recommended that you contact your 

personal tax advisor. 

LRS-6570-1-0704-FL Page 1.3 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 16 of 70
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DEFINITIONS 

"You", "your" and "yours" means a person who meets the Eligibility 

Requirements of the Policy and is enrolled for this insurance. 

"We", "us" and "our" means Reliance Standard Life Insurance Company. 

"Actively at Work" and "Active Work" mean actually performing on a Fulltime basis the material duties pertaining to your job in the place where 

and the manner in which the job is normally performed. This includes 

approved time off such as vacation, jury duty and funeral leave, but does 

not include time off as a result of an Injury or Sickness. 

"Claimant" means you made a claim for benefits under the Policy for a 

loss covered by the Policy as a result of your Injury or Sickness. 

"Covered Monthly Earnings" means your basic monthly salary received 

from the Policyholder on the day just before the date of Total Disability, 

prior to any deductions to a 401 (k) and Section 125 plan. Covered 

Monthly Earnings does not include commissions, overtime pay, incentive 

pay or any other special compensation not received as Covered Monthly 

Earnings. However, "Covered Monthly Earnings" will include bonuses 

received from the Policyholder averaged over the lesser of: 

(1) the number of months worked; or

(2) the 36 months;

just prior to the date Total Disability began. 

and 

"Covered Monthly Earnings" means your compensation from the 

partnership averaged over the lesser of: 

(1) the number of months worked; or

(2) the 36 months;

in the calendar year(s) prior to the date Total Disability began, as 

reported on the partnership federal income tax return (K1) as "net 

earnings (loss) from self-employment". 

If you were not a partner during the calendar year prior to the date Total 

Disability began, "Covered Monthly Earnings" means your average 

monthly compensation (excluding dividends, capital gains and return of 

capital) from the partnership prior to the date Total Disability began, 

determined in accordance with the terms of your partnership agreement. 

"Elimination Period" means a period of consecutive days of Total 

Disability, as shown on the Schedule of Benefits page, for which no 

LRS-6570-2-0704 Page 2.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 17 of 70
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benefit is payable. It begins on the first day of Total Disability. 

Interruption Period: If, during the Elimination Period, you return to Active 

Work for less than 30 days, then the same or related Total Disability will 

be treated as continuous. Days that you are Actively at Work during this 

interruption period will not count towards the Elimination Period. This 

interruption of the Elimination Period will not apply to you if you become 

eligible under any other group long term disability insurance plan. 

"Full-time" means working for the Policyholder for a minimum of 40 hours 

during your regular work week. 

"Hospital" or "Institution" means a facility licensed to provide care and 

Treatment for the condition causing your Total Disability. 

"Injury" means bodily Injury resulting directly from an accident, 

independent of all other causes. The Injury must cause Total Disability 

which begins while your insurance coverage is in effect. 

"Physician" means a duly licensed practitioner who is recognized by the 

law of the state in which treatment is received as qualified to treat the 

type of Injury or Sickness for which a claim is made. The Physician may 

not be you or a member of your immediate family. 

"Pre-existing Condition" means any Sickness or Injury for which you 

received medical treatment, consultation, care or services, including 

diagnostic procedures, or took prescribed drugs or medicines, during the 

three (3) months immediately prior to your effective date of insurance. 

"Regular Occupation" means the occupation you are routinely performing 

when Total Disability begins. We will look at your occupation as it is 

normally performed in the national economy, and not the unique duties 

performed for a specific employer or in a specific locale. 

"Retirement Benefits" mean money which you are entitled to receive 

upon early or normal retirement or disability retirement under: 

(1

) any plan of a state, county or municipal retirement system, if

such pension benefits include any credit for employment with the

Policyholder;

(2) Retirement Benefits under the United States Social Security Act

of 1935, as amended, or under any similar plan or act; or

(3) an employer's retirement plan where payments are made in a

lump sum or periodically and do not represent contributions

made by you.

LRS-6570-2-0704 Page 2.1 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 18 of 70
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Retirement Benefits do not include: 

(1) a federal government employee pension benefit;

(2) a thrift plan;

(3) a deferred compensation plan;

(4) an individual retirement account (IRA);

(5) a tax sheltered annuity (TSA);

(6) a stock ownership plan; or

(7) a profit sharing plan.

"Sickness" means illness or disease causing Total Disability which 

begins while your insurance coverage is in effect. Sickness includes 

pregnancy, childbirth, miscarriage or abortion, or any complications 

therefrom. 

"Totally Disabled" and "Total Disability" mean, that as a result of an Injury 

or Sickness, during the Elimination Period and thereafter you cannot 

perform the substantial and material duties of your Regular Occupation; 

(1) "Partially Disabled" and "Partial Disability" mean that as a result

of an Injury or Sickness you are capable of performing the

substantial and material duties of your Regular Occupation on a

part-time basis or some of the substantial and material duties on

a full-time basis. If you are Partially Disabled you will be

considered Totally Disabled, except during the Elimination

Period; and

(2) "Residual Disability" means being Partially Disabled during the

Elimination Period. Residual Disability will be considered Total

Disability.

If you are employed by the Policyholder and require a license for such 

occupation, the loss of such license for any reason does not in and of 

itself constitute "Total Disability". 

LRS-6570-2-0704 Page 2.2 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 19 of 70
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• ' w ITRANSFER OF INSURANCE COVERAGE 

If you were covered under any group long term disability insurance plan 

maintained by the Policyholder prior to the Policy's Effective Date, you 

will be insured under the Policy, provided that you are Actively At Work 

and meet all of the requirements for being an Eligible Person under the 

Policy on its Effective Date. 

If you were covered under the prior group long term disability plan 

maintained by the Policyholder prior to the Policy's Effective Date, but 

were not Actively at Work due to Injury or Sickness on the Effective Date 

of the Policy and would otherwise qualify as an Eligible Person, coverage 

will be allowed under the following conditions: 

(1) You must have been insured with the prior carrier on the date of the

transfer; and

(2) Premiums must be paid; and

(3) Total Disability must begin on or after the Policy's Effective Date.

If you are receiving long term disability benefits, become eligible for 

coverage under another group long term disability insurance plan, or 

have a period of recurrent disability under the prior group long term 

disability insurance plan, you will not be covered under the Policy. If 

premiums have been paid on your behalf under the Policy, those 

premiums will be refunded. 

Pre-existing Conditions Limitation Credit 

If you are an Eligible Person on the Effective Date of the Policy, any time 

used to satisfy the Pre-existing Conditions Limitation of the prior group 

long term disability insurance plan will be credited towards the 

satisfaction of the Pre-existing Conditions Limitation of the Policy. 

Waiting Period Credit 

If you are an Eligible Person on the Effective Date of the Policy, any time 

used to satisfy any Waiting Period of the prior group long term disability 

insurance plan will be credited towards the satisfaction of the Waiting 

Period of the Policy. 

LRS-6570-113-0800 Page3.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 20 of 70
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GENERAL PROVISIONS 

TIME LIMIT ON CERTAIN DEFENSES: After the Policy has been in 

force for two (2) years from its Effective Date, no statement made by you 

on a written application for insurance shall be used to reduce or deny a 

claim after your insurance coverage, with respect to which claim has 

been made, has been in effect for two (2) years. 

CLERICAL ERROR: Clerical errors in connection with the Policy or 

delays in keeping records for the Policy, whether by the Policyholder, the 

Plan Administrator, or us: 

(1) will not terminate insurance that would otherwise have been

effective; and

(2) will not continue insurance that would otherwise have ceased or

should not have been in effect.

If appropriate, a fair adjustment of premium will be made to correct a 

clerical error. 

NOT IN LIEU OF WORKERS' COMPENSATION: The Policy is not a 

Workers' Compensation Policy. It does not provide Workers' 

Compensation benefits. 

WAIVER OF PREMIUM: No premium is due us while you are receiving 

Monthly Benefits from us. Once Monthly Benefits cease due to the end 

of your Total Disability, premium payments must begin again if insurance 

is to continue. 

LRS-6570-3-0394 Page4.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 21 of 70
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CLAIMS PROVISIONS 

NOTICE OF CLAIM: Written notice must be given to us within thirty-one 

(31) days after a Total Disability covered by the Policy occurs, or as soon

as reasonably possible. The notice should be sent to us at our

Administrative Office or to our authorized agent. The notice should

include your name, the Policyholder's name and the Policy Number.

CLAIM FORMS: When we receive the notice of claim, we will send you 

the claim forms to file with us. We will send them within fifteen (15) days 

after we receive notice. If we do not, then the proof of Total Disability will 

be met by giving us a written statement of the type and extent of the 

Total Disability. The statement must be sent within ninety (90) days after 

the loss began. 

WRITEN PROOF OF TOTAL DISABILITY: For any Total Disability 

covered by the Policy, written proof must be sent to us within ninety (90) 

days after the Total Disability occurs. If written proof is not given in that 

time, the claim will not be invalidated nor reduced if it is shown that 

written proof was given as soon as was reasonably possible. In any 

event, proof must be given within one (1) year after the Total Disability 

occurs, unless you are legally incapable of doing so. 

TIME OF PAYMENT OF CLAIMS: After receiving written proof of loss, 

we will pay monthly all benefits then due because of your Total Disability. 

Benefits for any other loss covered by the Policy will be paid as soon as 

we receive written proof. 

We will either pay the claim or notify you in writing that the claim has 

been denied within forty-five (45) days after receipt of written proof of 

Total Disability. If additional information is required in order to review the 

claim, we will pay or deny such claim within sixty (60) days after receipt 

of the additional information. In any case, we will either pay or deny any 

claim not later than one hundred twenty (120) days after receiving written 

proof of Total Disability. Any overdue payments will include interest at a 

rate of ten (10%) percent per annum. 

PAYMENT OF CLAIMS: When we receive written proof of Total 

Disability covered by the Policy, we will pay any benefits due. Benefits 

that provide for periodic payment will be paid for each period as we 

become liable. 

We will pay benefits to you, if living, or else to your estate. 

If you died and we have not paid all benefits due, we may pay up to 

$3,000 to any relative by blood or marriage, or to the executor or 

administrator of your estate. The payment will only be made to persons 

entitled to it. An expense incurred as a result of your last illness, death 

LRS-6570-36-0394 Page 5.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 22 of 70
or burial will entitle a person to this payment. The payments will cease 

when a valid claim is made for the benefit. We will not be liable for any 

payment we have made in good faith. 

Reliance Standard Life Insurance Company shall serve as the claims 

review fiduciary with respect to the insurance certificate and the Plan. 

The claims review fiduciary has the discretionary authority to interpret the 

Plan and the insurance certificate and to determine eligibility for benefits. 

Decisions by the claims review fiduciary shall be complete, final and 

binding on all parties. 

ARBITRATION OF CLAIMS: Any claim or dispute arising from or 

relating to our determination regarding your Total Disability may be 

settled by arbitration when agreed to by you and us in accordance with 

the Rules for Health and Accident Claims of the American Arbitration 

Association or by any other method agreeable to you and us. In the 

case of a claim under an Employee Retirement Income Security Act 

(hereinafter referred to as ERISA) Plan, your ERISA claim appeal 

remedies, if applicable, must be exhausted before the claim may be 

submitted to arbitration. Judgment upon the award rendered by the 

arbitrators may be entered in any court having jurisdiction over such 

awards. 

Unless otherwise agreed to by you and us, any such award will be 

binding on you and us for a period of twelve (12) months after it is 

rendered assuming that the award is not based on fraudulent information 

and you continue to be Totally Disabled. At the end of such twelve (12) 

month period, the issue of Total Disability may again be submitted to 

arbitration in accordance with this provision. 

Any costs of said arbitration proceedings levied by the American 

Arbitration Association or the organization or person(s) conducting the 

proceedings will be paid by us. 

PHYSICAL EXAMINAION AND AUTOPSY: We will, at our expense, 

have the right to have you interviewed and/or examined: 

(1) physically;

(2) psychologically; and/or

(3) psychiatrically;

to determine the existence of any Total Disability which is the basis for a 

claim. This right may be used as often as it is reasonably required while 

a claim is pending. 

We can have an autopsy made unless prohibited by law. 

LEGAL ATIONS: No legal action may be brought against us to recover 

on the Policy within sixty (60) days after written proof of loss has been 

given as required by the Policy. No action may be brought afer the 

LRS-6570-36-0394 Page 5.1 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 23 of 70
expiration of the applicable statute of limitations from the time written 

proof of loss is required to be given. 

LRS-6570-36-0394 Page5.2 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 24 of 70
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ELIGIBILIT, EFFECTIVE DATE AND TERMINATION 

ELIGIBILIT REQUIREMENTS: You are eligible for insurance under 

the Policy if you: 

(1) are a member of an Eligible Class, as shown on the Schedule of

Benefits page; and

(2) have completed the Waiting Period, as shown on the Schedule

of Benefits page.

WAITING PERIOD: If you are continuously employed on a Full-time 

basis with the Policyholder for the period specified on the Schedule of 

Benefits page, then you have satisfied the Waiting Period. 

EFFECTIVE DATE OF YOUR INSURANCE: If the Policyholder pays 

the entire Premium due for you, your insurance will go into effect on Your 

Effective Date, as shown on the Schedule of Benefits page. 

If you pay a part of the Premium, you must apply in writing for the 

insurance to go into effect. You will become insured on the latest of: 

(1) Your Effective Date, as shown on the Schedule of Benefits page,

if you apply on or before that date;

(2) on the first of the month coinciding with or next following the date

you apply, if you apply within thirty-one (31) days from the date

you first met the Eligibility Requirements; or

(3) on the first of the month coinciding with or next following the date

we approve any required proof of health acceptable to us. We

require this proof if you apply:

(a) after thirty-one (31) days from the date you first met the

Eligibility Requirements; or

(b) after you terminated this insurance but remained in an

Eligible Class, as shown on the Schedule of Benefits page.

The insurance for you will not go into effect on a date you are not 

Actively at Work because of a Sickness or Injury. The insurance will go 

into effect after you are Actively at Work for one (1) full day in an Eligible 

Class, as shown on the Schedule of Benefits page. 

TERMINATION OF YOUR INSURANCE: Your insurance will terminate 

on the first of the following to occur: 

(1) the date the Policy terminates;

(2) the date you cease to meet the Eligibility Requirements;

(3) the end of the period for which Premium has been paid for you;

or

(4) the date you enter military service (not including Reserve or

National Guard).

LRS-6570-32 Ed. 2/83 Page 6.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 25 of 70
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YOUR REINSTATEMENT: If you are terminated, your insurance may be 

reinstated if you return to Active Work with the Policyholder within the 

period of time as shown on the Schedule of Benefits page. You must 

also be a member of an Eligible Class, as shown on the Schedule of 

Benefits page, and have been: 

(1) on a leave of absence approved by the Policyholder; or

(2) on temporary lay-off.

You will not be required to fulfill the Eligibility Requirements of the Policy 

again. The insurance will go into effect after you return to Active Work 

for one (1) full day. If you return after having resigned or having been 

discharged, you will be required to fulfill the Eligibility Requirements of 

the Policy again. If you return after terminating insurance at your request 

or for failure to pay Premium when due, proof of health acceptable to us 

must be submitted before you may be reinstated. 

EXTENSION OF BENEFITS: Termination of the Policy will not affect 

any claim which was covered prior to termination, subject to the terms 

and conditions of the Policy. 

LRS-6570-32 Ed. 2/83 Page 6.1 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 26 of 70
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BENEFIT PROVISIONS 

INSURING CLAUSE: We will pay a Monthly Benefit if you: 

(1) are Totally Disabled as the result of a Sickness or Injury covered

by the Policy;

(2) are under the regular care of a Physician;

(3) have completed the Elimination Period; and

(4) submit satisfactory proof of Total Disability to us.

Please refer to the Schedule of Benefits for the MONTHLY BENEFIT and 

OTHER INCOME BENEFITS. 

Benefits you are entitled to receive under OTHER INCOME BENEFITS 

will be estimated if the benefits: 

(1) have not been applied for; or

(2) have been applied for and a decision is pending; or

(3) have been denied and the denial may be appealed.

The Monthly Benefit will be reduced by the estimated amount. If benefits 

have been estimated, the Monthly Benefit will be adjusted when we 

receive proof: 

(1) of the amount awarded; or

(2) that benefits have been denied and the denial cannot be further

appealed.

If we have underpaid the Monthly Benefit for any reason, we will make a 

lump sum payment. If we have overpaid the Monthly Benefit for any 

reason, the overpayment must be repaid to us. At our option, we may 

reduce the Monthly Benefit or ask for a lump sum refund. If we reduce 

the Monthly Benefit, the Minimum Monthly Benefit, if any, as shown on 

the Schedule of Benefits page, would not apply. 

For each day of a period of Total Disability less than a full month, the 

amount payable will be 1/30th of the Monthly Benefit. 

COST OF LIVING FREEZE: After the initial deduction for any Other 

Income Benefits, the Monthly Benefit will not be further reduced due to 

any cost of living increases payable under these Other Income Benefits. 

LUMP SUM PAYMENTS: If Other Income Benefits are paid in a lump 

sum, the sum will be prorated over the period of time to which the Other 

Income benefits apply. If no period of time is given, the sum will be 

prorated over sixty (60) months. 

TERMINATION OF MONTHLY BENEFIT: The Monthly Benefit will stop 

on the earliest of: 

LRS-6570-6-0704 Page 7.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 27 of 70
.. 

(1) the date you cease to be Totally Disabled;

(2) the date you die;

(3) the Maximum Duration of Benefits, as shown on the Schedule of

Benefits page, has ended; or

(4) the date you fail to furnish the required proof of Total Disability.

RECURRENT DISABILITY: If, after a period of Total Disability for which 

benefits are payable, you return to Active Work for at least six (6) 

consecutive months, any recurrent Total Disability for the same or 

related cause will be part of a new period of Total Disability. A new 

Elimination Period must be completed before any further Monthly 

Benefits are payable. 

If you return to Active Work for less than six (6) months, a recurrent Total 

Disability for the same or related cause will be part of the same Total 

Disability. A new Elimination Period is not required. Our liability for the 

entire period will be subject to the terms of the Policy for the original 

period of Total Disability. 

If you become eligible for insurance coverage under any other group 

long term disability insurance plan, then this recurrent disability section 

will not apply to you. 

LRS-6570-6-0704 Page 7.1 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 28 of 70
EXCLUSIONS 

We will not pay a Monthly Benefit for any Total Disability caused by: 

(1) an act of war, declared or undeclared; or

(2) an intentionally self-inflicted Injury; or

(3) the Insured committing a felony; or

(4) an Injury or Sickness that occurs while the Insured is confined in

any penal or correctional institution.

LRS-6570-33-1189 Page 8.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 29 of 70
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LIMITATIONS 

MENTAL OR NERVOUS DISORDERS: Monthly Benefits for Total 

Disability caused by or contributed to by mental or nervous disorders will 

not be payable beyond an aggregate lifetime maximum duration of 

twenty-four (24} months unless you are in a Hospital or Institution at the 

end of the twenty-four (24} month period. The Monthly Benefit will be 

payable while so confined, but not beyond the Maximum Duration of 

Benefits. 

If you were confined in a Hospital or Institution and: 

(1) Total Disability continues beyond discharge;

(2) the confinement was during a period of Total Disability; and

(3) the period of confinement was for at least fourteen (14)

consecutive days;

then upon discharge, Monthly Benefits will be payable for the greater of: 

(1) the unused portion of the twenty-four (24) month period; or

(2) ninety (90) days;

but in no event beyond the Maximum Duration of Benefits, as shown on 

the Schedule of Benefits page. 

Mental or Nervous Disorders are defined to include disorders which are 

diagnosed to include a condition such as: 

(1) bipolar disorder (manic depressive syndrome);

(2) schizophrenia;

(3) delusional (paranoid) disorders;

(4) psychotic disorders;

(5) depressive disorders;

(6) anxiety disorders;

(7) somatoform disorders (psychosomatic illness);

(8) eating disorders; or

(9) mental illness.

SUBSTANCE ABUSE: Monthly Benefits for Total Disability due to 

alcoholism or drug addiction will be payable while you are a participant in 

a Substance Abuse Rehabilitation Program. The Monthly Benefit will not 

be payable beyond twenty-four (24) months. 

LRS-6570-85-0994 Page9.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 30 of 70
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If, during a period of Total Disability due to Substance Abuse for which a 

Monthly Benefit is payable, you are able to perform Rehabilitative 

Employment, the Monthly Benefit, less 50% of any of the money 

received from this Rehabilitative Employment will be paid until: (1) you 

are performing all the material duties of your Regular Occupation on a 

full-time basis; or (2) the end of twenty-four (24) consecutive months 

from the date that the Elimination Period is satisfied, whichever is earlier. 

All terms and conditions of the Rehabilitation Benefit will apply to 

Rehabilitative Employment due to Substance Abuse. 

"Substance Abuse" means the pattern of pathological use of a 

Substance which is characterized by: 

(1) impairments in social and/or occupational functioning;

(2) debilitating physical condition;

(3) inability to abstain from or reduce consumption of the Substance;

or

(4) the need for daily Substance use for adequate functioning.

"Substance" means alcohol and those drugs included on the Department 

of Health, Retardation and Hospitals' Substance Abuse list of addictive 

drugs, except tobacco and caffeine are excluded. 

A Substance Abuse Rehabilitation Program means a program 

supervised by a Physician or a licensed rehabilitation specialist approved 

by us. 

PRE-EXISTING CONDITIONS: Benefits will not be paid for a Total 

Disability: 

(1) caused by;

(2) contributed to by; or

(3) resulting from;

a Pre-existing Condition unless you have been Actively at Work for one 

(1) full day following the end of twelve (12) consecutive months from the

date you became insured.

LRS-6570-85-0994 Page 9.1 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 31 of 70
SPECIFIC INDEMNIT BENEFIT 

If you suffer any one of the Losses listed below from an accident 

resulting in an Injury, we will pay a guaranteed minimum number of 

Monthly Benefit payments, as shown below. However: 

(1) the Loss must occur within one hundred and eighty (180) days;

and

(2) you must live past the Elimination Period.

For Loss of: Number of Monthly 

Benefit Payments: 

Both Hands ................................................................................ .46 Months 

Both Feet .................................................................................. .46 Months 

Entire Sight in Both Eyes .......................................................... .46 Months 

Hearing in Both Ears ................................................................... 46 Months 

Speech ....................................................................................... 46 Months 

One Hand and One Foot .......................................................... .46 Months 

One Hand and Entire Sight in One Eye .................................... .46 Months 

One Foot and Entire Sight in One Eye ..................................... .46 Months 

One Arm .................................................................................... 35 Months 

One Leg ..................................................................................... 35 Months 

One Hand .................................................................................. 23 Months 

One Foot .................................................................................... 23 Months 

Entire Sight in One Eye ............................................................. 15 Months 

Hearing in One Ear .................................................................... 15 Months 

"Loss(es)" with respect to: 

(1) hand or foot, means the complete severance through or above

the wrist or ankle joint;

(2) arm or leg, means the complete severance through or above the

elbow or knee joint; or

(3) sight, speech or hearing, means total and irrecoverable Loss

thereof.

If more than one (1

) Loss results from any one accident, payment will be 

made for the Loss for which the greatest number of Monthly Benefit 

payments is provided. 

The amount payable is the Monthly Benefit, as shown on the Schedule of 

Benefits page, with no reduction from Other Income Benefits. The 

number of Monthly Benefit payments will not cease if you return to Active 

Work. If death occurs after we begin paying Monthly Benefits, but before 

the Specific Indemnity Benefit has been paid according to the above 

schedule, the balance remaining at time of death will be paid to your 

LRS-6570-9 Ed. 2

/83 Page 10.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 32 of 70
estate, unless a beneficiary is on record with us under the Policy. 

Benefits may be payable longer than shown above as long as you are 

still Totally Disabled, subject to the Maximum Duration of Benefits, as 

shown on the Schedule of Benefits page. 

LRS-6570-9 Ed. 2/83 Page 10.1 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 33 of 70
SURVIVOR BENEFIT - LUMP SUM 

We will pay a benefit to your Survivor when we receive proof that you 

died while: 

(1) you were receiving Monthly Benefits from us; and

(2) you were Totally Disabled for at least one hundred and eighty

(180) consecutive days.

The benefit will be an amount equal to 3 times your last Monthly Benefit. 

The last Monthly Benefit is the benefit you were eligible to receive right 

before your death. It is not reduced by wages earned while in 

Rehabilitative Employment. 

A benefit payable to a minor may be paid to the minor's legally appointed 

guardian. If there is no guardian, at our option, we may pay the benefit 

to an adult that has, in our opinion, assumed the custody and main 

support of the minor. We will not be liable for any payment we have 

made in good faith. 

"Survivor" means your spouse. If the spouse dies before you or if you 

were legally separated, then your natural, legally adopted or stepchildren, who are under age twenty-five (25) will be the Survivors. If 

there are no eligible Survivors, payment will be made to your estate, 

unless a beneficiary is on record with us under the Policy. 

LRS-6570-10 Ed. 1/00 Page 11.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 34 of 70
WORK INCENTIVE AND CHILD CARE BENEFITS 

WORK INCENTIVE BENEFIT 

During the first twelve (12) months of Rehabilitative Employment during 

which a Monthly Benefit is payable, we will not offset earnings from such 

Rehabilitative Employment until the sum of: 

(1) the Monthly Benefit prior to offsets with Other Income Benefits;

and

(2) earnings from Rehabilitative Employment;

exceed 100% of your Covered Monthly Earnings. If the sum above 

exceeds 100% of Covered Monthly Earnings, our Benefit Amount will be 

reduced by such excess amount until the sum of (1) and (2) above 

equals 100%. 

CHILD CARE BENEFIT 

We will allow a Child Care Benefit if: 

(1) you are receiving benefits under the Work Incentive Benefit;

(2) your Child(ren) is (are) under 14 years of age;

(3) the child care is provided by a non-relative; and

(4) the charges for child care are documented by a receipt from the

caregiver, including social security number or taxpayer

identification number.

During the twelve (12) month period in which you are eligible for the 

Work Incentive Benefit, an amount equal to actual expenses incurred for 

child care, up to a maximum of $250 per month, will be added to your 

Covered Monthly Earnings when calculating the Benefit Amount under 

the Work Incentive Benefit. 

Child(ren) means: your unmarried child(ren), including any foster child, 

adopted child or step child who resides in your home and is financially 

dependent on you for support and maintenance. 

LRS-6570-59-0406 Page 12.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 35 of 70
EXTENSION OF COVERAGE UNDER THE FAMILY AND MEDICAL 

LEAE ACT AND UNIFORMED SERVICES 

EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT (USERRA) 

Family and Medical Leave of Absence: 

We will continue your coverage in accordance with the Policyholder's 

policies regarding leave under the Family and Medical Leave Act of 

1993, as amended, or any similar state law, as amended, if: 

(1) the premium for you continues to be paid during the leave; and

(2) the Policyholder has approved your leave in writing and provides a

copy of such approval within thirty-one (31) days of our request.

As long as the above requirements are satisfied, we will continue 

coverage until the later of: 

(1) the end of the leave period required by the Family and Medical

Leave Act of 1993, as amended; or

(2) the end of the leave period required by any similar state law, as

amended.

Military Serices Leave of Absence: 

We will continue your coverage in accordance with the Policyholder's 

policies regarding Military Services Leave of Absence under USERRA if 

the premium for you continues to be paid during the leave. 

As long as the above requirement is satisfied, we will continue coverage 

until the end of the period required by USERRA. 

The Policy, while coverage is being continued under the Military Services 

Leave of Absence extension, does not cover any loss which occurs while 

on active duty in the military if such loss is caused by or arises out of 

such military service, including but not limited to war or any act of war, 

whether declared or undeclared. 

While you are on a Family and Medical Leave of Absence for any reason 

other than your own illness, injury or disability or Military Services Leave 

of Absence you will be considered Actively at Work. Any changes such 

as revisions to coverage due to age, class or salary changes, as 

applicable, will apply during the leave except that increases in the 

amount of insurance, whether automatic or subject to election, will not be 

effective if you are not considered Actively at Work until you have 

returned to Active Work for one (1) full day. 

LRS-6570-7 4-0708 Page 13.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 36 of 70
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A leave of absence taken in accordance with the Family and Medical 

Leave Act of 1993 or USERRA will run concurrently with any other 

applicable continuation of insurance provision in the Policy. 

Your coverage will cease under this extension on the earliest of: 

(1) the date the Policy terminates; or

(2) the end of the period for which premium has been paid for you; or

(3) the date such leave should end in accordance with the

Policyholder's policies regarding Family and Medical Leave of

Absence and Military Services Leave of Absence in compliance

with the Family and Medical Leave Act of 1993, as amended and

USERRA. Coverage will not be terminated if you become Totally

Disabled during the period of the leave and are eligible for benefits

according to the terms of the Policy. Any Monthly Benefit which

becomes payable will be based on your Covered Monthly Earnings

immediately prior to the date of Total Disability.

Should the Policyholder choose not to continue your coverage during a 

Family and Medical Leave of Absence and/or Military Services Leave of 

Absence, your coverage will be reinstated. 

LRS-6570-7 4-0708 Page 13.1 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 37 of 70
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REHABILITATION BENEFIT 

"Rehabilitative Employment" means work in any gainful occupation for 

which your training, education or experience will reasonably allow. The 

work must be approved by a Physician or a licensed or certified 

rehabilitation specialist approved by us. Rehabilitative Employment 

includes work performed while Partially Disabled, but does not include 

performing all the material duties of your Regular Occupation on a fulltime basis. 

If you are receiving a Monthly Benefit because you are considered 

Totally Disabled under the terms of the Policy and are able to perform 

Rehabilitative Employment, we will continue to pay the Monthly Benefit 

less an amount equal to 50% of earnings received through such 

Rehabilitative Employment. 

If you are able to perform Rehabilitative Employment when Totally 

Disabled due to Substance Abuse, we will continue to pay the Monthly 

Benefit less an amount equal to 50% of earnings received through such 

Rehabilitative Employment. This Monthly Benefit is payable for a 

maximum of twenty-four (24) consecutive months from the date the 

Elimination Period is satisfied. 

You will be considered able to perform Rehabilitative Employment if a 

Physician or licensed or certified rehabilitation specialist approved by us 

determines that you can perform such employment. If you refuse such 

Rehabilitative Employment, or have been performing Rehabilitative 

Employment and refuse to continue such employment, even though a 

Physician or licensed or certified rehabilitation specialist approved by us 

has determined that you are able to perform Rehabilitative Employment, 

the Monthly Benefit will be reduced by 50%, without regard to the 

Minimum Monthly Benefit. 

LRS-6570-82-0994 Page 14.0 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 38 of 70
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RELIANCE STANDARD LIFE INSURANCE COMPANY 

AMENDATORY RIDER 

It is hereby understood and agreed that the Certificate to which this 

Rider is attached shall be amended by the addition of the following: 

Applicable to Vermont Residents Only 

The following sections/provisions of the Certificate are amended to 

comply with Vermont law: 

1. Schedule of Benefits section, Elimination Period provision.

The Elimination Period will be the lesser of the number of days

shown on the Schedule of Benefits in the certificate or:

For Benefit Periods 2 years and greater: 365 days.

For Benefit Periods greater than 1 year but less than 2 years:

180 days.

2. Definitions section, definition of Full-Time, if such definition

is included in the Certificate is replaced with:

"Full-time" means working for the Policyholder for a minimum of

17.5 hours during your regular work week.

3. Limitations section, Mental or Nervous Disorders and/or

Substance Abuse, if such limitations are included in the

Certificate.

If the Certificate contains limitations in coverage for mental or

nervous disorders and/or substance abuse, such limitations will

not apply to Vermont residents. Coverage for these conditions

will be treated the same as other conditions that may entitle you

to full benefits.

4. Limitations section, Pre-existing Conditions, if such

limitation is included in the Certificate.

LRS-8352-01-0887 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 39 of 70
ea,Q, .-

The pre-existing condition provision time period in.the definition 

of Pre-existing Condition shall be the lesser of the time period 

shown on the Limitations form in the Certificate or twelve (12) 

months. 

The period of time during which you become Totally Disabled 

due to a Pre-existing Condition and a benefit is not payable for 

such Total Disability is the lesser of the time period as shown in 

the certificate or twelve ( 12) months. 

All other terms and conditions remain unchanged. 

LRS-8352-01-0887 

RELIANCE STANDARD LIFE INSURANCE 

COMPANY 

Secretary 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 40 of 70
Claim Procedures and 

ERISA Statement of Rights 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 41 of 70
CLAIM PROCEDURES FOR CLAIMS FILED WITH 

RELIANCE STANDARD LIFE INSURANCE COMPANY 

ON OR AFTER JANUARY 1, 2002 

CLAIMS FOR BENEFITS 

Claims may be submitted by mailing the completed form along with any 

requested information to: 

Reliance Standard Life Insurance Company 

Claims Department 

P.O. Box 8330 

Philadelphia, PA 19101-8330 

Claim forms are available from your benefits representative or may be 

requested by writing to the above address or by calling 1-800-644-1103. 

TIMING OF NOTIFICATION OF BENEFIT DETERMINAION 

Non-Disability Benefit Claims 

If a non-disability claim is wholly or partially denied, the claimant shall be 

notified of the adverse benefit determination within a reasonable period of 

time, but not later than 90 days after our receipt of the claim, unless it is 

determined that special circumstances require an extension of time for 

processing the claim. If it is determined that an extension of time for 

processing is required, written notice of the extension shall be furnished 

to the claimant prior to the termination of the initial 90-day period. In no 

event shall such extension exceed a period of 90 days from the end of 

such initial period. The extension notice shall indicate the special 

circumstances requiring an extension of time and the date by which the 

benefit determination is expected to be rendered. 

Calculating time periods. The period of time within which a benefit 

determination is required to be made shall begin at the time a claim is 

filed, without regard to whether all the information necessary to make a 

benefit determination accompanies the filing. 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 42 of 70
Disability Benefit Claims 

In the case of a claim for disability benefits, the claimant shall be notified 

of the adverse benefit determination within a reasonable period of time, 

but not later than 45 days after our receipt of the claim. This period may 

be extended for up to 30 days, provided that it is determined that such 

an extension is necessary due to matters beyond our control and that 

notification is provided to the claimant, prior to the expiration of the initial 

45-day period, of the circumstances requiring the extension of time and

the date by which a decision is expected to be rendered. If, prior to the

end of the first 30-day extension period, it is determined that, due to

matters beyond our control, a decision cannot be rendered within that

extension period, the period for making the determination may be

extended for up to an additional 30 days, provided that the claimant is

notified, prior to the expiration of the first 30-day extension period, of the

circumstances requiring the extension and the date by which a decision

is expected to be rendered. In the case of any such extension, the

notice of extension shall specifically explain the standards on which

entitlement to a benefit is based, the unresolved issues that prevent a

decision on the claim, and the additional information needed to resolve

those issues, and the claimant shall be afforded at least 45 days within

which to provide the specified information.

Calculating time periods. The period of time within which a benefit 

determination is required to be made shall begin at the time a claim is 

filed, without regard to whether all the information necessary to make a 

benefit determination accompanies the filing. In the event that a period 

of time is extended due to a claimant's failure to submit information 

necessary to decide a claim, the period for making the benefit 

determination shall be tolled from the date on which the notification of 

the extension is sent to the claimant until the date on which the claimant 

responds to the request for additional information. 

MANNER AND CONTENT OF NOTIFICATION OF BENEFIT 

DETERMINATION 

Non-Disability Benefit Claims 

A Claimant shall be provided with written notification of any adverse 

benefit determination. The notification shall set forth, in a manner 

calculated to be understood by the claimant, the following: 

1. The specific reason or reasons for the adverse determination;

2. Reference to the specific plan/policy provisions on which the

determination is based;

3. A description of any additional material or information necessary for

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 43 of 70
the claimant to perfect the claim and an explanation of why such 

material or information is necessary; and 

4. A description of the review procedures and the time limits applicable

to such procedures, including a statement of the claimant's right to

bring a civil action under section 502(a) of the Employee Retirement

Income Security Act of 1974 as amended ("ERISA") (where

applicable), following an adverse benefit determination on review.

Disability Benefit Claims 

A claimant shall be provided with written notification of any adverse 

benefit determination. The notification shall be set forth, in a manner 

calculated to be understood by the claimant, the following: 

1. The specific reason or reasons for the adverse determination;

2. Reference to the specific plan/policy provisions on which the

determination is based;

3. A description of any additional material or information necessary for

the claimant to perfect the claim and an explanation of why such

material or information is necessary;

4. A description of the review procedures and the time limits applicable

to such procedures, including a statement of the claimant's right to

bring a civil action under section 502(a) of the Employee Retirement

Income Security Act of 1974 as amended ("ERISA") (where

applicable), following an adverse benefit determination on review;

and

5. If an internal rule, guideline, protocol, or other similar criterion was

relied upon in making the adverse determination, either the specific

rule, guideline, protocol, or other similar criterion; or a statement that

such a rule, guideline, protocol, or other similar criterion was relied

upon in making the adverse determination and that a copy of such

rule, guideline, protocol, or other criterion will be provided free of

charge to the claimant upon request.

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 44 of 70
The term "Reliance Standard Life Insurance Company" means Reliance 

Standard Life Insurance Company and/or its authorized claim 

administrators. 

ERISA STATEMENT OF RIGHTS 

As a participant in the Group Insurance Plan, you may be entitled to 

certain rights and protections in the event that the Employee Retirement 

Income Security Act of 1974 (ERISA) applies. ERISA provides that all 

Plan Participants shall be entitled to: 

Receive Information About Your Plan and Benefits 

Examine, without charge, at the Plan Administrator's office and at other 

specified locations, such as worksites and union halls, all documents 

governing the Plan, including insurance contracts and collective 

bargaining agreements, and a copy of the latest annual report (Form 

5500 Series) filed by the Plan with the U.S. Department of Labor and 

available at the Public Disclosure Room of the Employee Benefits 

Security Administration. 

Obtain, upon written request to the Plan Administrator, copies of 

documents governing the operation of the Plan, including insurance 

contracts and collective bargaining agreements, and copies of the latest 

annual report (Form 5500 Series) and updated summary plan 

description. The Administrator may make a reasonable charge for the 

copies. 

Receive a summary of the Plan's annual financial report. The Plan 

Administrator is required by law to furnish each participant with a copy of 

this summary annual report. 

Prudent Actions by Plan Fiduciaries 

In addition to creating rights for Plan Participants, ERISA imposes duties 

upon the people who are responsible for the operation of the employee 

benefits plan. The people who operate your Plan, called "fiduciaries" of 

the Plan, have a duty to do so prudently and in the interests of you and 

other Plan Participants and Beneficiaries. No one, including your 

employer, your union, or any other person, may fire you or otherwise 

discriminate against you in any way to prevent you from obtaining a 

benefit or exercising your rights under ERISA. 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 45 of 70
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- L I. • - t 

Reliance Standard Life Insurance Company shall serve as the claims 

review fiduciary with respect to the insurance policy and the Plan. The 

claims review fiduciary has the discretionary authority to interpret the 

Plan and the insurance policy and to determine eligibility for benefits. 

Decisions by the claims review fiduciary shall be complete, final and 

binding on all parties. 

Enforce Your Rights 

If your claim for a benefit is denied or ignored, in whole or in part, you 

have a right to know why this was done, to obtain copies of documents 

relating to the decision without charge, and to appeal any denial, all 

within certain time schedules. 

Under ERISA, there are steps you can take to enforce the above rights. 

For instance, if you request a copy of the Plan documents or the latest 

annual report from the Plan and do not receive them within 30 days, you 

may file suit in a Federal court. In such a case, the court may require the 

Plan Administrator to provide the materials and pay you up to $110 a day 

until you receive the materials, unless the materials were not sent 

because of reasons beyond the control of the Administrator. If you have 

a claim for benefits which is denied or ignored, in whole or part, you may 

file suit in a state or Federal court. In addition, if you disagree with the 

Plan's decision or lack thereof concerning the qualified status of a 

domestic relations order or a medical child support order, you may file 

suit in Federal Court. If it should happen that Plan Fiduciaries misuse 

the Plan's money, or if you are discriminated against for asserting your 

rights, you may seek assistance from the U.S. Department of Labor, or 

you may file suit in a Federal court. The court will decide who should 

pay court costs and legal fees. If you are successful, the court may 

order the person you have sued to pay these costs and fees. If you lose, 

the court may order you to pay these costs and fees, for example, if it 

finds your claim is frivolous. 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 46 of 70
Assistance with Your Questions 

If you have any questions about your Plan, you should contact the Plan 

Administrator. If you have any questions about this statement or about 

your rights under ERISA, or if you need assistance in obtaining 

documents from the Plan Administrator, you should contact the nearest 

Office of the Employee Benefits Security Administration, U.S. 

Department of Labor, listed in your telephone directory or the Division of 

Technical Assistance and Inquiries, Employee Benefits Security 

Administration, U.S. Department of Labor, 200 Constitution Avenue, 

N.W., Washington, D.C. 20210. You may also obtain certain 

publications about your rights and responsibilities under ERISA by calling 

the publications hotline of the Employee Benefits Security Administration. 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 47 of 70
I

RELIANCE STANDARD 

LIFI; INSURANCI; COMPANY 

, MEMSER O• 'HI TOKIO t.lltU CROUP 

Home Office: Chicago, Illinois 

Administrative Office: Philadelphia, Pennsylvania 

LTD 124706 

Ed. 12/2013 

CLASS 1 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 48 of 70
other information relevant to the claimant's claim for benefits; 

4. The review on (timely) appeal shall take into account all comments,

documents, records, and other information submitted by the claimant

relating to the claim, without regard to whether such information was

submitted or considered in the initial benefit determination;

5. No deference to the initial adverse benefit determination shall be

afforded upon appeal;

6. The appeal shall be conducted by an individual who is neither the

individual who made the (underlying) adverse benefit determination

that is the subject of the appeal, nor the subordinate of such

individual;

7. Any medical or vocational expert(s) whose advice was obtained in

connection with a claimant's adverse benefit determination shall be

identified, without regard to whether the advice was relied upon in

making the benefit determination; and

8. In deciding the appeal of any adverse benefit determination that is

based in whole or in part on a medical judgment, the individual

conducting the appeal shall consult with a health care professional:

(a) who has appropriate training and experience in the field of

medicine involved in the medical judgment; and

(b) who is neither an individual who was consulted in connection with

the adverse benefit determination that is the subject of the

appeal; nor the subordinate of any such individual.

TIMING OF NOTIFICAION OF BENEFIT DETERMINATION ON 

REVIEW 

Non-Disability Benefit Claims 

The claimant (or their authorized representative) shall be notified of the 

benefit determination on review within a reasonable period of time, but 

not later than 60 days after receipt of the claimant's timely request for 

review, unless it is determined that special circumstances require an 

extension of time for processing the appeal. If it is determined that an 

extension of time for processing is required, written notice of the 

extension shall be furnished to the claimant prior to the termination of the 

initial 60-day period. In no event shall such extension exceed a period of 

60 days from the end of the initial period. The extension notice shall 

indicate the special circumstances requiring an extension of time and the 

date by which the determination on review is expected to be rendered. 

Calculating time periods. The period of time within which a benefit 

determination on review is required to be made shall begin at the time an 

appeal is timely filed, without regard to whether all the information 

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 49 of 70
2. 

2. 

APPEALS OF ADVERSE BENEFIT DETERMINATIONS 

Appeals of adverse benefit determinations may be submitted in 

accordance with the following procedures to: 

Reliance Standard Life Insurance Company 

Quality Review Unit 

P.O. Box 8330 

Philadelphia, PA 19101-8330 

Non-Disability Benefit Claims 

1. Claimants (or their authorized representatives) must appeal within 60

days following their receipt of a notification of an adverse benefit

determination, and only one appeal is allowed;

2. Claimants shall be provided with the opportunity to submit written

comments, documents, records, and/or other information relating to

the claim for benefits in conjunction with their timely appeal;

3. Claimants shall be provided, upon request and free of charge,

reasonable access to, and copies of, all documents, records, and

other information relevant to the claimant's claim for benefits;

4. The review on (timely) appeal shall take into account all comments,

documents, records, and other information submitted by the claimant

relating to the claim, without regard to whether such information was

submitted or considered in the initial benefit determination;

5. No deference to the initial adverse benefit determination shall be

afforded upon appeal;

6. The appeal shall be conducted by an individual who is neither the

individual who made the (underlying) adverse benefit determination

that is the subject of the appeal, nor the subordinate of such

individual; and

7. Any medical or vocational expert(s) whose advice was obtained in

connection with a claimant's adverse benefit determination shall be

identified, without regard to whether the advice was relied upon in

making the benefit determination.

Disability Benefit Claims 

1. Claimants (or their authorized representatives) must appeal within

180 days following their receipt of a notification of an adverse benefit

determination, and only one appeal is allowed;

2. Claimants shall be provided with the opportunity to submit written

comments, documents, records, and/or other information relating to

the claim for benefits in conjunction with their timely appeal;

3. Claimants shall be provided, upon request and free of charge,

reasonable access to, and copies of, all documents, records, and

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 50 of 70
necessary to make a benefit determination on review accompanies the 

filing. In the event that a period of time is extended as above due to a 

claimant's failure to submit information necessary to decide a claim, the 

period for making the benefit determination on review shall be tolled from 

the date on which the notification of the extension is sent to the claimant 

until the date on which the claimant responds to the request for additional 

information. 

Disability Benefit Claims 

The claimant (or their authorized representative) shall be notified of the 

benefit determination on review within a reasonable period of time, but 

not later than 45 days after receipt of the claimant's timely request for 

review, unless it is determined that special circumstances require an 

extension of time for processing the appeal. If it is determined that an 

extension of time for processing is required, written notice of the 

extension shall be furnished to the claimant prior to the termination of the 

initial 45-day period. In no event shall such extension exceed a period of 

45 days from the end of the initial period. The extension notice shall 

indicate the special circumstances requiring an extension of time and the 

date by which the determination on review is expected to be rendered. 

Calculating time periods. The period of time within which a benefit 

determination on review is required to be made shall begin at the time an 

appeal is timely filed, without regard to whether all the information 

necessary to make a benefit determination on review accompanies the 

filing. In the event that a period of time is extended as above due to a 

claimant's failure to submit information necessary to decide a claim, the 

period for making the benefit determination on review shall be tolled from 

the date on which the notification of the extension is sent to the claimant 

until the date on which the claimant responds to the request for additional 

information. 

MANNER AND CONTENT OF NOTIFICATION OF BENEFIT 

DETERMINATION ON REVIEW 

Non-Disability Benefit Claims 

A claimant shall be provided with written notification of the benefit 

determination on review. In the case of an adverse benefit determination 

on review, the notification shall set forth, in a manner calculated to be 

understood by the claimant, the following: 

1. The specific reason or reasons for the adverse determination;

2. Reference to the specific plan/policy provisions on which the

determination is based;

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 51 of 70
3. A statement that the claimant is entitled to receive, upon request and

free of charge, reasonable access to, and copies of, all documents,

records, and other information relevant to the claimant's claim for

benefits; and

4. A statement of the claimant's right to bring an action under section

502(a) of ERISA (where applicable).

Disability Benefit Claims 

A claimant must be provided with written notification of the determination 

on review. In the case of adverse benefit determination on review, the 

notification shall set forth, in a manner calculated to be understood by the 

claimant, the following: 

1. The specific reason or reasons for the adverse determination;

2. Reference to the specific plan/policy provisions on which the

determination is based;

3. A statement that the claimant is entitled to receive, upon request and

free of charge, reasonable access to, and copies of, all documents,

records, and other information relevant to the claimant's claim for

benefits;

4. A statement of the claimant's right to bring an action under section

502(a) of ERISA (where applicable);

5. If an internal rule, guideline, protocol, or other similar criterion was

relied upon in making the adverse determination, either the specific

rule, guideline, protocol, or other similar criterion; or a statement that

such a rule, guideline, protocol, or other similar criterion was relied

upon in making the adverse determination and that a copy of such

rule, guideline, protocol, or other criterion will be provided free of

charge to the claimant upon request; and

6. The following statement: "You and your plan may have other

voluntary alternative dispute resolution options, such as mediation.

One way to find out what may be available is to contact your local

U.S. Department of Labor Office and your State insurance regulatory

agency (where applicable)."

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 52 of 70
DEFINITIONS 

The term "adverse benefit determination" means any of the following: a 

denial, reduction, or termination of, or a failure to provide or make 

payment (in whole or in part} for, a benefit, including any such denial, 

reduction, termination, or failure to provide or make payment that is 

based on a determination of a participant's or beneficiary's eligibility to 

participate in a plan. 

The term "us" or "our" refers to Reliance Standard Life Insurance 

Company. 

The term "relevant" means: 

A document, record, or other information shall be considered relevant to 

a claimant's claim if such document, record or other information: 

• Was relied upon in making the benefit determination;

• Was submitted, considered, or generated in the course of making the

benefit determination, without regard to whether such document,

record or other information was relied upon in making the benefit

determination;

• Demonstrates compliance with administrative processes and

safeguards designed to ensure and to verify that benefit claim

determinations are made in accordance with governing plan

documents and that, where appropriate, the plan provisions have

been applied consistently with respect to similarly situated claimants;

or

• In the case of a plan providing disability benefits, constitutes a

statement of policy or guidance with respect to the plan concerning

the denied benefit of the claimant's diagnosis, without regard to

whether such advice or statement was relied upon in making the

benefit determination.

EXHIBIT "A"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 53 of 70
'

RELIANCE STANDARD

LIFE INSURANCE COMPANY 

A MEMBER OF THE TOKIO MARI HE GROUP 

September 30, 2021 

Krista Rosenberg 

I 02 NE 2nd St #305 

Boca Raton, FL 33432 

Re: Claimant: 

Policy No: 

Claim No: 

Krista Rosenberg 

LTD 124706 

2021-04-29-0227-LTD-0 I 

P.O. Box 8330 

Philadelphia, PA 19101-8330 

(800) 351-7500

Fax (267) 256-4262 

Policyholder: Retina Vitreous Consultants, LLP dba Retina Group of Florida 

Dear Krista Rosenberg: 

We would like to express our appreciation for your patience and cooperation during the review 

of your claim for Long Tenn Disability (LTD) benefits. We have now completed our 

determination regarding your eligibility for benefits under the above group LTD policy. 

The group policy states: 

ELIGIBLE CLASSES: Each active, Full-time employee, except any person employed on a 

temporary or seasonal basis, according to the following classifications: 

CLASS 1: Owner/ Physician who: 

(]) is engaged in a non-hazardous occupation; and 

(2) functions primarily in an office environment. 

CLASS 2: Manager and Administrator 

EXHIBIT "B"

EXHIBIT "B"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 54 of 70
CLASS 1: "Covered Monthly Earnings" means the Insured's monthly salary received from you 

on the day just before the date of Total Disability, prior to any deductions to a 401 (k) and 

Section 125 plan. Covered Monthly Earnings does not include commissions, overtime pay, 

incentive pay or any other special compensation not received as Covered Monthly Earnings. 

However, "Covered Monthly Earnings" will include bonuses received Ji-om you averaged over 

the lesser of 

(J) the number of months worked; or 

(2) the 36 months; 

Just prior to the date Total Disability began. 

AND 

With respect to a Partner, "Covered Monthly Earnings" means the Insured's compensationfi·om 

the partnership averaged over the lesser of 

(1) the number of months worked; or

(2) the 36 months;

in the calendar year(s) prior to the date Total Disability began, as reported on the partnership 

federal income tax return as "self-employment earnings (loss)" per Schedule Kl, Federal Form 

1065 (box 14). 

If the Insured was not a partner during the calendar year prior to the date Total Disability 

began, "Covered Monthly Earnings" means the Insured's average monthly compensation 

(excluding dividends, capital gains and return of capital) from the partnership prior to the date 

Total Disability began, determined in accordance with the terms of the Insured's partnership 

agreement. 

MONTHLY BENEFIT: The Monthly Benefit is an amount equal to 60% of Covered Monthly 

Earnings, payable in accordance with the section entitled Benefit Amount. 

In order to calculate the Covered Monthly Earnings ( defined above), we reviewed your Schedule 

Kl Federal Form 1065 for the 36 months (2018, 2019 and 2020) prior to your disability date of 

February 24, 2021. In review of the Schedule Kl, for each of the 3 years, there is no reported 

income in Box 14 as self-employment earnings (loss). As it appears, in review of your tax 

returns, that your employer is paying your corporation and not you directly, there are no eligible 

earnings upon which to base a benefit in accordance with your group's LTD policy definition of 

Covered Monthly Earnings. 

We regret our decision could not be more favorable. Our determination has been based on the 

information contained in your file and the policy provisions applicable to your claim. 

You may request a review of this determination by submitting your request in writing to: 

Reliance Standard Life Insurance Company 

Quality Review Unit 

P.O. Box 8330 

Philadelphia, PA 19101-8330 

EXHIBIT "B"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 55 of 70
6,vit,/berzef ?. c7.42.42e,a 

This written request for review must be submitted within 180 days of your receipt of this letter. 

Your request should state any reasons why you feel this determination is incorrect, and should 

include any written comments, documents, records, or other information relating to your claim 

for benefits, including but not limited to any information submitted in conjunction with any 

claim for Social Security disability or other benefits which you would like us to consider. Only 

one review will be allowed, and your request must be submitted within 180 days of your receipt 

of this letter to be considered. 

Any such review will be conducted by an individual who is neither the individual who made the 

underlying detennination that is the subject of the review, nor the subordinate of such individual. 

Under normal circumstances, you will be notified in writing of the final determination within 45 

days of the date we receive your request for review. Ifwe detennine that special circumstances 

require an extension of time for processing, you will ordinarily be notified of the decision no 

later than 90 days from the date we receive your request for review. 

We will, upon specific request and free of charge, provide copies of all documents, records, 

and/or other information relevant to your claim for benefits. We will also, upon specific request 

and free of charge, provide copies of any internal rule, guideline, protocol or other similar 

criterion (if any) relied upon in making this detennination. 

In the event that your claim is subject to the Employee Retirement Income Security Act of 197 4 

("the Act"), you have the right to bring a civil action under section 502(a) of the Act following an 

adverse benefit determination on review. Your failure to request a review within 180 days of 

your receipt of this letter may constitute a failure to exhaust the administrative remedies 

available under the Act, and affect your ability to bring civil action under the Act. 

Nothing in this letter should be construed as a waiver of any of Reliance Standard Life Insurance 

Company's rights and defenses under the above policy, and all these rights and defenses are 

reserved to the Company, whether or not specifically mentioned herein. 

If you have any questions regarding this matter, please feel free to contact us at 1-800-351-7500. 

Sincerely, 

Courtney Holmes for Lorrie Dobson 

LTD Claims Department 

EXHIBIT "B"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 56 of 70
NOTICE OF LNGUAGE ASSISTANCE SERVICES 

J!�#}i!;/JJl�Hi� (Chinese) 

SAAD BEE AKA E'EYEED NIHA HOLQ (Navajo) 

AVISO SOBRE LOS SERVICIOS DE ASISTENCIA LINGUISTICA {Spanish) 

ABISO SA MGA SERBISYO NG TU LONG SA WIKA (Tagalog) 

If you need language assistance in translating this letter, language interpretation during phone calls, or 

language assistance fr any other matters relating to your claim, please call. 

:ilu*12ltEIJ'l"¥Jls:Ei§ ff �if �m-Jl/J, tE:i/!h!Wl l'iiJ \�if � P w, !%Jm�� 12;:FJlJilil'ff :1 ioJAB '.;'. 

�i�-�#), -i!.i, (Chinese) 

Haada yit'eego di naaltsoos nich'i' alyaaigii t'aa shizaad k' ehji shich'i' yid6olah ninzingo d66 t'aa 

shizaad k'ehjf choo'i dooleel nfnfzingo t'aa ha'at'fhf da kwe'e bfdeet'i'fgii biniiye koj[' hodiilnih.

(Navao) 

Si necesita asistencia lingufstica para traducir esta carta, servicios de interpretaci6n durante llamadas 

telefnicas o asistencia con cualquier otro asunto relacionado con su reclamo, llamenos. (Spanish) 

Kung kailangan mo ng tu long sa wika sa pagsasalin sa liham na ito, pasalitang pagsasalin sa wika sa 

panahon ng mga tawag sa telepono, o tu long sa wika sa anumang ibang mga usapin sa iyong 

paghahabol, pakitawagan ang. (Tagalog) 

EXHIBIT "B"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 57 of 70
LIGGIO 

CORNELL 

ATTORNEYS AT LAW 

*+Jeffrey M. Liggio

L. Jason Cornell

*National Board Certified

 Civil Trial Advocate

+Florida Board Certified

 Civil Trial Lawyer

 Paralegal:

◊ Kathy G. Harmon

◊ Florida Registered Paralegal

 Barristers Building

 Suite 3-B

1615 Forum Place 

 West Palm Beach 

 Florida 33401

Phone: 561-616-3333

 Fax: 561-616-3266

E-mail: info@liggiolaw.com

www.liggiocornell.com

March 3, 2022

Reliance Standard Life Insurance Company Lorrie Dobson

Quality Review Unit Reliance Standard Life Ins. Co.

P.O. Box 8330 2001 Market Street, Suite 1500

Philadelphia, PA 19101-8330 Philadelphia, PA 19103

Re: Claimant: Krista Rosenberg

Policy No: LTD 124706

Claim No: 2021-04-29-0227-LTD-01

Policyholder: Retina Vitreous Consultants, LLP dba Retina 

Group of Florida

Dear Ms. Dobson,

I have reviewed Reliance Standard’s repeated denials of Dr. Rosenberg’s 

disability claim.

The instant policy, was sold to Dr. Rosenberg and her co-owners of Retina 

Vitreous Consultants, LLP d/b/a Retina Group of Florida back in 2013, by a 

licensed and appointed Reliance Standard Agent, Baruch Levi:

https://licenseesearch.fldfs.com/Licensee/185483

Indeed, in 2013, through the present time, the Retina Group partners, 

including Dr. Rosenberg, each had established Subchapter S corporations and 

their income from the Retina Group simply passed through to them from the 

Retina Group.

Mr. Levi (and therefore Reliance Standard) knew this when the instant 

policy was bound and issued in 2013.

This policy is governed by Florida Law. 

It is long-standing Florida Law that knowledge of the insurance agent is 

always imputed to the insurer which he represents. Almerico v. RLI Ins. Co., 

716 So.2d 774, 776 (Fla. 1998); Desantolo v. John Alden Life Insurance Co., 

744 So.2d 1123 (Fla. 4th DCA 1999); Straw v. Associated, 728 So.2d 354 (Fla. 

5

th DCA 1999); Gaskin v. General Insurance Company of Florida, 397 So.2d 

729 (Fla. 1st DCA 1981). See also: Essex Ins. Co. v. Zota, 985 So.2d 1036, 

1046 (Fla. 2008)

While I am not sure what transpired between Mr. Levi and Reliance 

Standard when the instant policy was initially bound back in 2013, I do 

understand that since Reliance Standard has denied Dr. Rosenberg’s claim, 

that the local Reliance Standard agents and Reliance Standard have agreed 

to amend the instant policy to clarify that Dr. Rosenberg and the other Retina 

EXHIBIT "C"

EXHIBIT "C"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 58 of 70
Group principals’ Subchapter-S Corporations were and are indeed covered individuals.

Even without an amendment to the instant policy, Reliance Standard’s interpretation of 

the policy language to deny benefits to Dr. Rosenberg because her income from Retina 

Associates passes through her subchapter – S corporation and is not a W-2 wage, is also 

contrary to Florida Law. 

Here is the “Covered Monthly Earnings” definition within the instant policy:

“Covered Monthly Earnings” means your basic monthly salary 

received from the Policyholder on the day just before the date of 

Total Disability, prior to any deductions to a 401(k) and Section 

125 plan. Covered Monthly Earnings does not include 

commissions, overtime pay, incentive pay or any other special 

compensation not received as Covered Monthly Earnings. 

However, “Covered Monthly Earnings” will include bonuses

received from the Policyholder averaged over the lesser of:

(1) the number of months worked; or

(2) the 36 months;

just prior to the date Total Disability began.

And

“Covered Monthly Earnings’ means your compensation from the

partnership averaged over the lesser of:

(1) the number of months worked; or

(2) the 36 months;

in the calendar year(s) prior to the date Total Disability began, 

as reported on the partnership federal income tax return (K1) as 

“net earnings (loss) from self-employment”.

 Even though that definition includes the phrase “basic monthly salary” there is no 

verbiage within the policy that excludes pass-through income to a Subchapter – S 

corporation, and no verbiage that limits “basic monthly salary” to W-2 wages.

There are very strict rules of insurance policy interpretation in Florida that Reliance 

Standard’s denial of benefits to Dr. Rosenberg simply ignore. Rather than recount them in 

this letter, I direct your attention to several Florida cases: Travelers Indemnity Co. v. PCR 

Inc., 889 So. 2d 779, 785 (Fla. 2004); Washington Nat. Ins. Corp. v. Ruderman, 117 So. 3d 

943, 948 (Fla. 2013); Robles v. United Auto. Ins. Co., 2021 WL 1743606 (Fla. 1st DCA 2021).

Finally, a cursory bit of legal research reveals that a Federal Court in an ERISA matter in 

California, (the instant policy is not governed by ERISA) more than a decade ago, rejected 

EXHIBIT "C"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 59 of 70
tk 

Reliance Standard’s improper interpretation of “Covered Monthly Earnings” as it has towards 

Dr. Rosenberg. 

I’ve enclosed a copy of that opinion, Joas, MD. V. Reliance Standard Life Insurance 

Company, 621 F.Supp.2d 1001 (S.D. Cal 2007) for your consideration.

Dr. Rosenberg has fully complied with each and every obligation she has, under the 

instant policy, and had complied with every request by Reliance in regard to her claim.

I strongly urge you to reconsider your position forthwith, and:

1) Approve Dr. Rosenberg’s claim;

2) Pay Dr. Rosenberg all unpaid back benefits with interest, and;

3) Place her on claim going forward.

I can’t imagine that it will take more than 30 days to reconsider, pay the back benefits with 

interest, and place Dr. Rosenberg on claim going forward. Therefore, I’ll expect to hear from 

you no later than 30 days after your receipt of this letter.

Sincerely, 

Jeffrey M. Liggio, Esq.

EXHIBIT "C"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 60 of 70
621 F.Supp.2d 1001 (2007)

Thomas A. JOAS, M.D., Plaintiff,

v.

RELIANCE STANDARD LIFE INSURANCE COMPANY, Defendant.

Case No. 03CV850 WQH (AJB).

December 11, 2007.

 Month Amount

United States District Court, S.D. California.

1002 *1002 David Blair Sharp, Law Offices of David B. Sharp, San Diego, CA, for Plaintiff.

Kevin P. McNamara, Harrington, Foxx, Dubrow and Canter, Los Angeles, CA, for Defendant.

ORDER GRANTING PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT AND

DENYING DEFENDANT'S MOTION FOR SUMMARY JUDGMENT

HAYES, District Judge.

Pending before the Court are cross-motions for summary judgment following remand from the Court of Appeal for the Ninth

Circuit. (Docs. # 57, 59). On September 24, 2007, the Court heard oral argument on these matters. (Doc. # 67).

PROCEDURAL BACKGROUND

On or about April 4, 2003, Plaintiff Thomas A. Joas, M.D. filed the Complaint in this matter against Defendant Reliance

Standard Life Insurance Company in the California State Superior Court in San Diego. (Doc. # 1). Plaintiff alleged that

Defendant improperly calculated Plaintiff's disability benefits in violation of various state laws. (Doc. # 1). On May 19, 2003,

Defendant Reliance Standard Life Insurance Company removed the case to this Court on the grounds that the dispute was

governed by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001, et seq., and presented a

federal question. (Doc. # 1). Plaintiff did not challenge the removal.

On March 25, 2004, the parties filed cross-motions for summary judgment. (Docs. # 16-17, 22-23). Thereafter, on April 29,

2004, the Court granted Defendant's motion for summary judgment and denied Plaintiff's motion for summary judgment.

(Doc. # 34). On May 21, 2004, Plaintiff filed a notice of appeal. (Doc. # 36).

On January 3, 2007, the Court of Appeal for the Ninth Circuit vacated this Court's Order of April 29, 2004, and remanded

the case back to this Court for reconsideration in light of Abatie v. Alta Health & Life Insurance Co., 458 F.3d 955 (9th

Cir.2006) (en banc), an intervening Circuit decision which altered the standard of review for a district court in ERISA cases.

(Doc. # 69). On July 25, 2007, the parties filed the pending cross-motions for summary judgment. (Docs. # 57, 59).

1003 *1003 FACTS

Plaintiff is a medical doctor licensed to practice medicine in the State of California, with a specialty in anesthesiology.

Declaration of Thomas A. Joas (Joas Decl.) (Doc. # 61), ¶ 2. On July 1, 1971, Plaintiff became a shareholder and employee

of Anesthesia Service Medical Group, Inc. (ASMG), a California corporation. Joas Decl., ¶ 3. As an employee of ASMG,

Plaintiff received monthly compensation which fluctuated depending on (1) "the amount billed and collected by ASMG for

the professional service that [Plaintiff] rendered on ASMG's behalf," and (2) the administrative fee charged by ASMG. Joas

Decl., ¶¶ 4, 6. Between November, 1999, and November, 2001, Plaintiff received the following monthly compensation:

EXHIBIT "C"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 61 of 70
 11/99 $15,126.17

 12/99 $17,116.13

 1/00 $21,714.77

 2/00 $12,203.08

 3/00 $ 9,640.12

 4/00 $21,917.05

 5/00 $14,039.76

 6/00 $ 8,851.30

 7/00 $20,037.03

 8/00 $21,575.97

 9/00 $22,799.05

 10/00 $ 8,617.60

 11/00 $15,109.80

 12/00 $20,204.94

 1/01 $ 8,063.91

 2/01 $ 4,915.79

 3/01 $12,950.39

 4/01 $12,749.14

 5/01 $ 7,266.23

 6/01 $12,635.32

 7/01 $11,009.22

 8/01 $18,715.38

 9/01 $19,492.20

 10/01 $10,509.75

 11/01 $ 8,578.41

Joas Decl., ¶¶ 6, 10

ASMG contracted with Defendant Reliance Standard Insurance Company to provide disability insurance benefits to ASMG

shareholders and employees. Joas Decl., ¶ 8; Declaration of Glen Buberl (Buberl Decl.) (Doc. # 19), ¶¶ 8-11. ASMG

employees were required to participate in "the group longterm disability insurance program," and ASMG paid Defendant

premiums for long term disability insurance for the years 2000 and 2001. Buberl Decl., ¶ 10. Each ASMG employee and

shareholder is an anesthesiologist. Buberl Decl., ¶ 5.

The insurance policy entered into between ASMG and Defendant provided monthly disability benefits to ASMG employees

if, among other things, one of the employees "is Totally Disabled as a result of a Sickness or Injury covered by this Policy."

Declaration of David B. Sharp (Sharp Decl.) (Doc. # 63), Ex. 1 at 18. To determine the amount of monthly benefits a totally

disabled person would be entitled to under the policy, the policy provided in relevant part:

BENEFIT AMOUNT: To figure the benefit amount payable:

(1) multiply an Insured's Covered Monthly Earnings by the benefit percentage(s), as shown on the Schedule

of Benefits page;

(2) take the lesser of the amount:

(a) of step (1) above; or

(b) the Maximum Monthly Benefit, as shown on the Schedule of Benefits page; and

(3) subtract Other Income Benefits, as shown below, from step (2) above.

Sharp Decl., Ex. 1 at 18. The policy defined "Covered Monthly Earnings" as:

"Covered Monthly Earnings" means the insured's monthly salary received from you on the day just before

the date of Total Disability, prior to any deductions to a 401(k) plan. Covered Monthly Earnings do not include

commissions, overtime pay, bonuses or any other special compensation not received as Covered Monthly

EXHIBIT "C"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 62 of 70
 Monthly Eligible Salary @

 60% [60% of $8,578.41] $5,147.05

 Less Retirement Pension $1,500.00

 Less CA State Disability $2,123.33

 _________

 Monthly Benefit $1,523.72

Earnings. However, for a *1004 salesperson, "Covered Monthly Earnings" will include commissions received

from you averaged over the lesser of:

1004

(1) the number of months worked; or

(2) the 24 months just prior to the date Total Disability began.

If hourly paid employees are insured, the number of hours worked during a regular work week, not to exceed

forty (40) hours per week, times 4.333, will be used to determine Covered Monthly Earnings. If an employee

is paid on an annual basis, then the Covered Monthly Earnings will be determined by dividing the basis

annual salary by 12.

Sharp Decl., Ex. 1 at 8. It is undisputed that Defendant was responsible for paying benefits under the insurance policy.

Sharp Decl., Ex. 7 at 14. It is further undisputed that the policy granted Defendant "the discretionary authority to interpret the

Plan and the insurance policy and to determine eligibility for benefits." Sharp Decl., Ex. 7 at 14.

On November 30, 2001, Plaintiff suffered a major stroke and became totally disabled. Joas Decl., ¶ 5 & Ex. B. Plaintiff filed

a claim under the disability insurance policy entered into between ASMG and Defendant, and on May 9, 2002, Defendant

approved the claim. Joas Decl., ¶¶ 8-9 & Ex. B. In its letter to Plaintiff approving Plaintiff's insurance claim, Defendant

outlined its benefits determination, and noted "[y]our net monthly benefit is $1,523.72 payable in accordance with the terms

of the group policy." Joas Decl., Ex. B. In calculating Plaintiff's net monthly benefit, Defendant concluded that Plaintiff was a

salaried employee, and thus Plaintiff's net monthly benefit was calculated as 60% of Plaintiff's salary the month before he

was disabled, less retirement pension and California state disability payments. Joas Decl., Ex. B. In calculating Plaintiff's

benefits, Defendant used Plaintiff's November, 2001, compensation of $8,578.41, as follows:

See Joas Decl., Ex. B.

Plaintiff immediately disagreed with Defendant's benefits calculation. On May 21, 2002, Plaintiff wrote Defendant to outline

Plaintiff's concerns and to indicate that Plaintiff did not accept Defendant's benefits determination. Joas Decl., ¶ 10 & Ex. C.

In the letter, Plaintiff noted that his compensation fluctuated month-to-month, and indicated that he should be classified as a

salesperson as opposed to a salaried employee. Joas Decl., Ex. C. As a "salesperson" under the policy, Plaintiff would have

received 60% of his average monthly compensation over the previous twenty-four months, less retirement and California

state disability deductions, which would have resulted in monthly benefit payments of approximately $5,058.17, or

$3,534.45 more per/month than Defendant outlined in its letter of May 9, 2002. Joas Decl., ¶ 14. Plaintiff's letter stated that,

"I do not expect to be penalized by the fact that my stroke happened to occur at the end of a period for which I had taken a

lot of time off to attend professional meetings." Joas Decl., Ex. C.

Defendant did not immediately respond to Plaintiff's letter of May 21, 2002, and on June 17, 2002, Plaintiff sent a follow-up

letter to Defendant. Joas Decl., Ex. D. Plaintiff wrote that:

I now find that it has been six and a half months since my stroke and I still do not have a final determination

as to the payments to which I am entitled under my disability insurance. I wrote to you on May 21, 2002 and

raised a fairly straightforward point about your interpretation of the meaning of the language *1005 in my

disability policy and now, over three weeks later, I have received no response to my questions. Since the

point that I raised is not complicated, it would seem to me that I should be able to obtain a prompt response

without having to enlist the services of an attorney.

1005

Joas Decl., Ex. D. In a letter dated June 25, 2002, Defendant responded to Plaintiff's letters, and, after citing the language

of the policy, concluded that,

EXHIBIT "C"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 63 of 70
We do understand your earnings fluctuate from month to month based upon the work you perform and the

fees collected; however, our position is an Anesthesiologist is not a "salesperson". We must administer your

benefits according to the provisions of your group policy. It is not our intent to penalize you; we would have

used the same pay period had your earnings been higher.

Joas Decl., Ex. E.

After receiving Defendant's letter of June 25, 2002, Plaintiff retained attorney David B. Sharp to assist with recovering

benefits from Defendant. Joas Decl., ¶ 13. On September 12, 2002, Sharp wrote to Defendant seeking "copies of all

documents and records which were relevant to determining [Dr. Joas's] benefit payment." Declaration of David B. Sharp

(Sharp Decl.) (Doc. # 63), Ex. 4. Sharp also sought, "copies of internal rules, guidelines, protocol and other criteria relied

upon in making Reliance's determination," as well as "examples of similarly situated persons where Reliance used the same

benefit analysis as for Dr. Joas, and examples of similarly situated persons for which Reliance used a different method of

determining benefits than you did for Dr. Joas." Sharp Decl., Ex. 4.

Reliance did not immediately answer Sharp's letter of June 25, 2002, resulting in follow-up letters dated October 4, 2002,

and October 22, 2002, in which Sharp once again requested copies of all relevant documentation. Sharp Decl., Exs. 5-6.

Thereafter, in a letter dated October 21, 2002, Defendant responded to Sharp's request, noting, "We apologize for our delay

in responding .... As per your request, enclosed are copies of all relevant documents and records pertaining to Dr. Joas'

benefit payment." Sharp Decl., Ex. 7. Defendant's letter of October 21, 2002, did not address Sharp's request for examples

of similarly situated persons, and did not include "work papers or documents generated or created by ... any [claim]

examiner," or Defendant's "file." Sharp Decl., Exs. 7-8. On October 25, 2002, and December 12, 2002, Sharp authored

letters to Defendant again seeking the previously requested information and documentation. Sharp Decl., Exs. 8, 11, 13. On

November 12, 2002, Sharp filed an official request for review of Defendant's benefits decision. Sharp Decl., Ex. 10.

Defendant did not address Sharp's requests for examples of similarly situated persons or "work papers" created by any

examiner until December 26, 2002, and then simply noted that, "[p]lease be advised that we have given you all of the

information you have requested.... Unfortunately, we cannot disclose to you data referencing other claimants." Sharp Decl.,

Ex 12. Sharp's later requests for specific examples and other information went unanswered. Sharp Decl., Exs. 13-15.

On July 25, 2007, and in connection with the cross-motions for summary judgment, Defendant filed the administrative

record in this case. (Doc. # 58). The administrative record filed on July 25, 2007, included substantially more documents

than were provided to Plaintiff and the Court in 2004 when the Court ruled on the parties' previous *1006 motions for

summary judgment. See (Doc. # 24); Sharp Decl., Ex. 7.

1006

STANDARDS OF REVIEW

I. Summary Judgment

Summary judgment is appropriate under Rule 56 of the Federal Rules of Civil Procedure where the moving party

demonstrates the absence of a genuine issues of material fact and entitlement to judgment as a matter of law. FED. R. CIV.

P. 56(c); see also Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). A fact is material

when, under the governing substantive law, it could affect the outcome of the case. Anderson v. Liberty Lobby, Inc., 477

U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). A dispute over a material fact is genuine if "the evidence is such that

a reasonable jury could return a verdict for the nonmoving party." Id.

In ruling on a motion for summary judgment, "[t]he district court may limit its review to the documents submitted for

purposes of summary judgment and those parts of the record specifically referenced therein." Carmen v. San Francisco

Unified Sch. Dist., 237 F.3d 1026, 1030 (9th Cir.2001). The court must view all inferences drawn from the underlying facts in

the light most favorable to the nonmoving party. Matsushita, 475 U.S. at 587, 106 S.Ct. 1348.

II. ERISA Benefits Decision

EXHIBIT "C"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 64 of 70
The parties seek review of Defendant's decision to deny certain benefits to Plaintiff under the insurance policy. Under the

facts of this case, it is undisputed that Defendant both funded the insurance policy and had discretion to interpret the

policy's terms and decide eligibility for benefits. The parties agree that Defendant operated under a structural conflict of

interest.

A. The Abatie Standard Generally

Where an ERISA-covered plan confers discretionary authority to interpret the plan upon a plan administrator operating

under a conflict of interest, a district court reviewing a benefits decision made pursuant to the plan applies the standard of

review articulated in Abatie v. Alta Health & Life Insurance, 458 F.3d 955 (9th Cir.2006) (en banc). In Abatie, the Court of

Appeal for the Ninth Circuit held that, where a plan confers discretion upon a conflicted plan administrator to interpret the

plan, a district court reviews the decision of the conflicted plan administrator for an abuse of discretion, "tempered by

skepticism commensurate with the plan administrator's conflict of interest." Abatie, 458 F.3d at 959. Specifically, the Court of

Appeal for the Ninth Circuit held that:

[a] district court, when faced with all the facts and circumstances, must decide in each case how much or

how little to credit the plan administrator's reason for denying insurance coverage. An egregious conflict may

weigh more heavily (that is, may cause the court to find an abuse of discretion more readily) than a minor,

technical conflict might. But in any given case, all the facts and circumstances must be considered .... A

straightforward abuse of discretion analysis allows a court to tailor its review to all the circumstances before

it.

Abatie, 458 F.3d at 968. Though the Court of Appeal noted that the standard articulated in Abatie was "indefinite," the Court

added that the district court's task was akin to assessing a witness's credibility in a bench trial—"[w]hat the district court is

doing in an ERISA benefits denial case is making something akin to a credibility determination about the insurance *1007

company's or plan administrator's reason for denying coverage under a particular set of medical and other records." Abatie,

458 F.3d at 969. The Court added that,

1007

The level of skepticism with which a court views a conflicted administrator's decision may be low if a

structural conflict of interest is unaccompanied, for example, by any evidence of malice, of self-dealing, or of

a parsimonious claims-granting history. A court may weigh a conflict more heavily if, for example, the

administrator provides inconsistent reasons for denial, Lang [v. Long-Term Disability Plan of Sponsor Applied

Remote Technology, Inc.], 125 F.3d [794] at 799 [ (9th Cir.1997) ]; fails adequately to investigate a claim or

ask the plaintiff for necessary evidence, Booton v. Lockheed Med. Benefit Plan, 110 F.3d 1461, 1463-64 (9th

Cir.1997); fails to credit a claimant's reliable evidence, Black & Decker Disability Plan v. Nord, 538 U.S. 822,

834, 123 S.Ct. 1965, 155 L.Ed.2d 1034 (2003); or has repeatedly denied benefits to deserving participants

by interpreting the plan terms incorrectly or by making decisions against the weight of evidence in the record.

Abatie, 458 F.3d at 968-69. In determining "the nature, extent, and effect on the decision-making process of any conflict of

interest," the district court may consider evidence outside the administrative record. Abatie, 458 F.3d at 970.

B. The Standard of Review Under the Facts of This Case

Defendant contends that the structural conflict of interest is a technical conflict which should not substantially alter the

abuse of discretion standard of review. Defendant contends that the Court should employ an abuse of discretion standard of

review tempered with only a low level of skepticism under the facts of this case. Plaintiff contends that the Court should

review Defendant's benefits decision either de novo or for an abuse of discretion tempered with a substantial and high

degree of skepticism. Plaintiff contends that the facts of this case warrant a high degree of skepticism toward Defendant's

interpretation because Defendant (1) failed to comply with ERISA's administrative review requirements, (2) has interpreted

similar policy language inconsistently in other cases, (3) failed to produce relevant information which Plaintiff requested in

order to challenge Defendant's benefits determination, and (4) produced an administrative record in July, 2007, which

included documents which had not been lodged with the Court or provided to Plaintiff prior to the originally filed crossmotions for summary judgment.

EXHIBIT "C"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 65 of 70
Where an ERISA plan denies an insured benefits, ERISA requires the plan to "establish and maintain a procedure by which

a claimant shall have a reasonable opportunity to appeal an adverse benefit determination ... under which there will be a full

and fair review of the claim and the adverse benefit determination." 29 C.F.R. § 2560.503-1(h)(1) (emphasis added). The

claims procedures will not be deemed to provide a claimant with a reasonable opportunity for a "full and fair review" of a

claim and adverse benefit decision unless, among other things, the claims procedures,

(iii) Provide that a claimant shall be provided, upon request and free of charge, reasonable access to, and

copies of, all documents, records, and other information relevant to the claimant's claim for benefits. Whether

a document, record, or other information is relevant to a claim for benefits shall be determined by reference

to paragraph (m)(8) of this section;

(iv) Provide for a review that takes into account all comments, documents, records, *1008 and other

information submitted by the claimant relating to the claim, without regard to whether such information was

submitted or considered in the initial benefit determination.

1008

29 C.F.R. § 2560.503-1(h)(2)(iii)-(iv). A document, record, or other information is "relevant" to a claimant's claim for benefits

if such document, record, or other information,

(i) Was relied upon in making the benefit determination, (ii) Was submitted, considered, or generated in the

course of making the benefit determination ..., (iii) Demonstrates compliance with the administrative

processes and safeguards required pursuant to paragraph (b)(5) of this section in making the benefits

determination, or (iv) ... constitutes a statement of policy or guidance with respect to the plan ....

29 C.F.R. § 2560.503-1(m)(8). In order for the claims procedures to be reasonable, 29 C.F.R. § 2560.503-1(b)(5) requires

that the claims procedures must, "contain administrative processes and safeguards designed to insure and to verify that

benefit claim determinations are made in accordance with governing plan documents and that, where appropriate, the plan

provisions have been applied consistently with respect to similarly situated claimants."

It is undisputed in this case that Defendant did not provide Plaintiff with examples of how Defendant interpreted the terms of

the policy with respect to similar situated persons seeking benefits, or examples of persons whom Defendant previously

deemed to be either salespersons or salaried employees under the policy, even though that information was requested by

Plaintiff on numerous occasions. Sharp Decl., ¶¶ 4-6, 8, 11, 13. Defendant failed to address Plaintiff's request for examples

several times, before informing Plaintiff that "[u]nfortunately, we cannot disclose to you data referencing other claimants."

Sharp Decl., Ex 12. Defendant did not offer or provide Plaintiff examples of similar situated persons which redacted

potentially personal or confidential information, and there is no evidence before the Court which would permit an inference

that Defendant sought to or considered its duty to interpret the policy consistently when it interpreted the policy with respect

to Plaintiff's claim. See 29 C.F.R. §§ 2560.503-1(b)(5), (m)(8). The Court concludes that Defendant's failure to provide

Plaintiff with requested information and to consider whether it was interpreting the insurance policy consistently during

Plaintiff's benefits determination requires this Court to temper the abuse of discretion standard of review with a fair amount

of skepticism. See Abatie, 458 F.3d at 972.

In addition to failing to follow ERISA review requirements in full, the Court notes that Defendant advocated a different

interpretation of similar "covered monthly earnings" language in a case before the Court of Appeal for the Fifth Circuit, and

the Court concludes that this fact also requires the Court to temper with skepticism the abuse of discretion standard under

the facts of this case. In Keszenheimer v. Reliance Standard Life Ins. Co., 402 F.3d 504 (5th Cir.2005), Defendant took the

position that salary was fixed compensation paid regularly, as opposed to Defendant's position in this case that salary is a

fixed method of calculating compensation. Defendant argued in Keszenheimer that an income which fluctuates month-tomonth does not plainly fit the definition of monthly salary, which is contrary to the position Defendant advocates in this case.

Id. at 507-09.

After reviewing Abatie and the facts before the Court on summary judgment, *1009 the Court concludes that it must review

Defendant's decision to deny Plaintiff benefits under the policy for an abuse of discretion tempered with an elevated degree

of skepticism and scrutiny for the reasons stated above. See, e.g., Archuleta v. Reliance Standard Life Ins. Co., 504

F.Supp.2d 876, 884-85 (C.D.Cal.2007). As established by other courts, "[a]n ERISA administrator abuses its discretion only

if it (1) renders a decision without explanation, (2) construes provisions of the plan in a way that conflicts with the plain

language of the plan, or (3) relies on clearly erroneous findings of fact." Wells v. Reliance Standard Life Ins. Co., CV 06-32-

1009

EXHIBIT "C"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 66 of 70
M-DWM-JCL, 2007 WL 433280, *4, 2007 U.S. Dist. LEXIS 16885, *11 (D.Mont. Jan. 11, 2007) (citing Boyd v. Bell/Rozell

NFL Players Retirement Plan, 410 F.3d 1173, 1178 (9th Cir.2005)).

DISCUSSION

In authorizing disability benefits for Plaintiff under the policy, Defendant deemed Plaintiff a salaried employee, and

calculated Plaintiff's monthly benefit using Plaintiff's November, 2001, compensation of $8,578.41. Defendant concluded

that Plaintiff was not a "salesperson" as that term is used in the policy's definition of "covered monthly earnings" because

Plaintiff's job description was unlike that of a salesperson, and in Defendant's opinion, "an Anesthesiologist [is] not a

salesperson." See Sharp Decl., Ex 14. Plaintiff immediately objected to Defendant's benefit calculation, and sought

administrative review of the decision with the help of attorney Sharp. Thereafter, Defendant denied Plaintiff's administrative

appeal on the grounds that Plaintiff could not be considered a salesperson under the policy. The question before the Court

is whether Defendant abused its discretion by classifying Plaintiff as a salaried employee under the policy and denying

additional benefits which Plaintiff requested.

I. Standard for Reviewing ERISA Policy Language

In order to determine whether Defendant abused its discretion in classifying Plaintiff as a salaried employee and denying

benefits, the Court must examine and interpret the "plain language" of the insurance policy using developed principles of

federal common law. See Canseco v. Construction Laborers Pension Trust for So. Calif., 93 F.3d 600, 606 (9th Cir.1996);

Padfield v. AIG Life Ins. Co., 290 F.3d 1121, 1125 (9th Cir.2002). Under the federal common law of ERISA, a district court

"interpret[s] terms in ERISA insurance policies in an ordinary and popular sense as would a person of average intelligence

and experience." Padfield, 290 F.3d at 1125. It is established that "trustees abuse their discretion if they ... construe

provisions of [a] plan in a way that clearly conflicts with the plain language of the plan." Canseco, 93 F.3d at 606; see also

Johnson v. The Trustees of the Western Conf. of Teamsters, 879 F.2d 651, 654 (9th Cir.1989); Neathery v. Chevron Texaco

Corp. Group Accident Policy, Case No. 05CV1883 JM (CAB), 2007 WL 2239195, *8, 2007 U.S. Dist. LEXIS 55351, *23

(S.D.Cal. July 31, 2007). Where an ERISA plan administrator is granted discretion to interpret insurance policy language

and a Plaintiff challenges the administrator's interpretation, the question the Court must ask is not "whose interpretation of

the plan documents is most persuasive, but whether the [plan administrator's] interpretation is unreasonable." Canseco, 93

F.3d at 606 (citation omitted).

II. Whether Defendant Abused Its Discretion in Interpreting Policy Language

On May 9, 2002, Defendant determined that Plaintiff was totally disabled. *1010 Sharp Decl., Ex. 2. Pursuant to the

insurance policy, Plaintiff was entitled to a monthly benefit equal to 60% of his "Covered Monthly Earnings," less other

income benefits. Sharp Decl., Ex. 1 at 6, 18. The policy defined "Covered Monthly Earnings" as:

1010

"Covered Monthly Earnings" means the insured's monthly salary received from you on the day just before

the date of Total Disability, prior to any deductions to a 401(k) plan. Covered Monthly Earnings do not include

commissions, overtime pay, bonuses or any other special compensation not received as Covered Monthly

Earnings. However, for a salesperson, "Covered Monthly Earnings" will include commissions received from

you averaged over the lesser of:

(1) the number of months worked; or

(2) the 24 months just prior to the date Total Disability began.

If hourly paid employees are insured, the number of hours worked during a regular work week, not to exceed

forty (40) hours per week, times 4.333, will be used to determine Covered Monthly Earnings. If an employee

is paid on an annual basis, then the Covered Monthly Earnings will be determined by dividing the basis

annual salary by 12.

Sharp Decl., Ex. 1 at 8.

EXHIBIT "C"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 67 of 70
Defendant contends that Plaintiff's "Covered Monthly Earnings" were his "monthly salary" received on the day just before

Plaintiff became totally disabled. Defendant contends that Plaintiff cannot be considered a salesperson because (1) Plaintiff

did not sell anything while employed by ASMG, (2) Plaintiff received a monthly salary based on a fixed method of

calculation, and (3) Plaintiff never received compensation which could be considered a commission. Plaintiff contends that

he did not receive a monthly salary while working for ASMG and that he should have been classified as a salesperson

under the plain language of the policy because his compensation severely fluctuated from month to month depending on

how much he worked. Plaintiff asserts that his compensation regime was more closely akin to that of a commissioned

salesperson than a salaried employee. Plaintiff contends that he is entitled to "Covered Monthly Earnings" equal to the

average of all his commissions received over the "24 months just prior to the date Total Disability began." Sharp Decl., Ex. 1

at 8.

The policy specifically provides four alternative definitions of "Covered Monthly Earnings." Sharp Decl., Ex. 1 at 8. If an

employee receives a "monthly salary," "Covered Monthly Earnings" means the monthly salary received on the day before

total disability. Sharp Decl., Ex. 1 at 8. If an employee is a salesperson, "Covered Monthly Earnings" means the employee's

salary plus commissions earned over either the previous 24 months before disability or the total number of months worked.

Sharp Decl., Ex. 1 at 8. Finally, if an employee is paid hourly, "Covered Monthly Earnings" means the number of hours

worked during an average week times 4.33, and if an employee is paid annually, "Covered Monthly Earnings" means the

base annual salary divided by twelve. Sharp Decl., Ex. 1 at 8. Here, the parties agree that Plaintiff was neither paid annually

nor hourly, and thus the question before the Court is whether Defendant's decision to classify Plaintiff as a salaried

employee as opposed to a salesperson was an unreasonable interpretation of the policy.

In including four alternative definitions for "Covered Monthly Earnings," the policy as a whole intended to ensure that

disability benefits for individual employees fairly stemmed from their average compensation for any given month or week.

*1011 Where an employee was paid a fixed monthly salary, that salary was used as "Covered Monthly Earnings." However,

where an employee did not receive a fixed monthly salary, and instead was paid according to sales made or hours worked,

the policy clearly provided that the employee should receive a monthly benefit which took into account and factored in

fluctuations in earnings from month-to-month and week-to-week. The policy ensured that a disabled hourly employee would

not be without benefits because he was on vacation the week preceding his disability, and a salesperson paid in part based

on sales would not be penalized simply because he made no sales the month before becoming totally disabled. Similarly,

the policy provided that an employee paid once a year would receive benefits equal to 1/12 of his yearly salary, thus

ensuring that the annually paid employee would receive a monthly benefit commensurate to his work and the benefits

received by other similarly disabled employees who had been paid at regular intervals. The Court finds that, when

interpreted in "an ordinary and popular sense as would a person of average intelligence and experience," the varied

definitions of "Covered Monthly Earnings" protected disabled employees benefits by ensuring that those with fluctuating

monthly or weekly compensation which have their benefits calculated by looking at greater periods of time than simply the

day, week, or month before total disability. See Padfield, 290 F.3d at 1125.

1011

"Salary" is commonly defined as a "fixed compensation for services, paid on a regular basis." Order of April 29, 2004 at 10

(citing Webster's II New College Dictionary 226 (3d ed. 2001)); see also Keszenheimer v. Reliance Standard Life Ins. Co.,

402 F.3d 504, 508 (5th Cir.2005) ("Salary is fixed compensation paid regularly (as by the year, quarter, month, or week) for

services."). In this case, Plaintiff's monthly compensation was not fixed, and, in fact, fluctuated significantly depending on a

number of factors, some of which were out of Plaintiff's control. Joas Decl., ¶¶ 4, 6. Accordingly, the Court concludes that it

is not reasonable to find that Plaintiff received a "monthly salary" as that term is used in the policy. This conclusion comports

with that of the Court of Appeal for the Fifth Circuit's conclusion in Keszenheimer v. Reliance Standard Life Ins. Co., where

the Court held that,

Compensation paid ad hoc for working discrete blocks of time—such as an hourly wage—is not typically

considered salary. Not unlike an hourly wage earner, Keszenheimer's per diem and auto allowance

compensation were not fixed, but were paid only for the days that he worked offshore. Given the fluctuation

in income day-to-day and month-to-month, this does not fit the plain meaning of `monthly salary' as

contemplated in the policy and as commonly understood.

Keszenheimer, 402 F.3d at 508. Indeed, Plaintiff's compensation, paid on a fluctuating basis and based on his work for

"discrete blocks of time," is not fixed, and does not fit within the plain meaning of "monthly salary" as used in the insurance

policy. See Sharp Decl., Ex. 1 at 8.

EXHIBIT "C"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 68 of 70
 Monthly Eligible Salary @

 60% [60% of $14,469.17] $8,681.50

 Less Retirement Pension $1,500.00

 Less CA State Disability $2,123.33

 _________

 Monthly Benefit $5,058.17

Defendant contends that Plaintiff received a monthly salary because the method of calculating Plaintiff's compensation was

fixed. However, as noted by this Court previously, salary is generally defined as "fixed compensation," which is not the same

as "a fixed method of compensation." Order of April 29, 2004 at 10. Furthermore, as noted in Keszenheimer, one of the key

characteristics of salary is that it does not fluctuate. Keszenheimer, 402 F.3d at 508. Under the facts of this case, it is clear

that Plaintiff's monthly compensation *1012 fluctuated significantly—Plaintiff earned $22,799.05 in September of 2000, and

only $4,915.79 in February of 2001.

1012

After interpreting the pertinent policy language in this case, the Court concludes that Plaintiff did not receive a "monthly

salary," as that term is used in the policy. Rather, after reviewing the method in which ASMG compensated Plaintiff, the

Court concludes that Plaintiff's monthly compensation regime is akin to commissions earned by salespersons. Plaintiff in

effect sold his services to ASMG, allowing ASMG to bill and collect from patients and pay Plaintiff a percentage. Joas Decl.,

¶¶ 4-6. Plaintiff only received compensation when he sold and performed medical services. If Plaintiff did not work, Plaintiff

was not paid.

Under the policy at issue in this case, a salesperson's covered monthly earnings include "commissions." Sharp Decl., Ex. 1

at 8. "Commission" is commonly defined as "a fee or percentage paid to a salesperson or agent for his or her services."

Order of April 29, 2004 (Doc. # 34) at 9-10; see also Keszenheimer, 402 F.3d at 510. Here, not only did Plaintiff in effect sell

his services to ASMG, ASMG paid Plaintiff according to a formula "dependent upon the amount billed and collected by

ASMG for services which Plaintiff rendered on ASMG's behalf." Joas Decl., ¶ 4. Furthermore, before paying Plaintiff, ASMG

deducted an administrative fee based upon a "percentage of the amount that ASMG billed and collected," which percentage

varied over the years and effected Plaintiff's compensation. Joas Decl., ¶ 4.

After reviewing and interpreting the policy language as a whole in "an ordinary and popular sense as would a person of

average intelligence and experience" see Padfield, 290 F.3d at 1125, the Court concludes that under the facts of this case,

Defendant's decision to classify Plaintiff as a salaried employee "construe[d] provisions of the plan in [a] way that conflict[ed]

with the plain language of the plan," and was unreasonable and an abuse of discretion. Wells, CV 06-32-M-DWM-JCL, 2007

WL 433280, *4, 2007 U.S. Dist. LEXIS 16885, *11 (D.Mont. Jan. 11, 2007) (citing Boyd v. Bell/Rozell NFL Players

Retirement Plan, 410 F.3d 1173, 1178 (9th Cir.2005)); see also Canseco, 93 F.3d at 606; Johnson v. The Trustees of the

Western Conf. of Teamsters, 879 F.2d 651, 654 (9th Cir.1989); Neathery v. Chevron Texaco Corp. Group Accident Policy,

Case No. 05CV1883 JM (CAB), 2007 WL 2239195, *8, 2007 U.S. Dist. LEXIS 55351, *23 (S.D.Cal. July 31, 2007).

CONCLUSION

Under the facts of this case Plaintiff's "Covered Monthly Earnings" were equal to Plaintiff's average compensation received

during the "24 months just prior to the date Total Disability began." Sharp Decl., Ex. 1 at 8. After reviewing the declarations

and evidence submitted, Plaintiff's average compensation for the 24 months just prior to the date of total disability was

$14,469.17. See Joas Decl., ¶ 6. Thus, Plaintiff's monthly benefit should have been calculated as follows:

See, e.g., Joas Decl., Ex. B. Defendant calculated Plaintiff's monthly benefit using Plaintiff's November, 2001, compensation

of $8,578.41, and thus concluded that Plaintiff was entitled to $1,523.72 per/month. The Court concludes that Defendant

abused its discretion in calculating Plaintiff's monthly benefit.

It is hereby ORDERED that:

1013 *1013 (1) Plaintiff's motion for summary judgment (Doc. # 59) is GRANTED.

(2) Defendant's motion for summary judgment (Doc. # 57) is DENIED.

EXHIBIT "C"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 69 of 70
Plaintiff shall submit a proposed judgment to the Court within 15 days of this Order. Defendant may file objections to the

proposed judgment within 15 days of receipt of Plaintiff's proposed judgment.

IT IS SO ORDERED.

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EXHIBIT "C"

Case 9:22-cv-81495-DMM Document 1-2 Entered on FLSD Docket 09/26/2022 Page 70 of 70