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Benjamin v. Oxford Health Insurance, Inc.

United States District Court, D. Connecticut

January 8, 2019

AMY BENJAMIN, Plaintiff,



         This is an ERISA action. Plaintiff Amy Benjamin sued Defendant Oxford Health Insurance, Inc. ("Oxford") for denying coverage of Benjamin's residential treatment for a mental and/or behavioral health disorder. Benjamin asserted in her complaint that Oxford's denial of coverage was wrongful because she was entitled to coverage for the care received under the terms of her ERISA-governed policy issued by Oxford.

         On July 19, 2018, the Court decided cross-motions for summary judgment in a Ruling reported at Benjamin v. Oxford Health Ins., Inc., No. 3:16-cv-00408 (CSH), 2018 WL 3489588 (D. Conn. July 19, 2018) ("the July 19 Ruling"), familiarity with which is assumed. Plaintiff Benjamin partially prevailed in the July 19 Ruling, to the extent that the Court remanded the case to Oxford for that full and fair evaluation of Plaintiff's claim which the Court held Oxford had theretofore failed to give. The July 19 Ruling also gave preliminary consideration to Plaintiff's request for attorney's fees in her complaint, and the Court directed Plaintiff to file documents supporting her claim for attorney's fees and costs. Id. at *10-11.

         The case is again before the Court, on Plaintiff's renewed motion, based upon additional submissions. This Ruling resolves that motion, [Doc. 77]. For the reasons that follow, the Court declines to award Plaintiff the amount she requests and directs payment by Defendant of a lesser amount.

         I. BACKGROUND

         The theory of Benjamin's action against Oxford is that Oxford failed to make a full and fair evaluation of her claims, either at the time of her initial claim or at the time of her two administrative appeals. Benjamin, 2018 WL 3489588, at *1.

         The Court's July 19 Ruling granted Benjamin summary judgment on that assertion, notwithstanding Oxford's protestations of rectitude. The Ruling remanded Plaintiff's insurance claims to Defendant for a full and fair evaluation in the first instance. In that Ruling's relatively brief concluding discussion on attorney's fees, the Court held that Plaintiff "has achieved some success on the merits, sufficient to make her eligible for an award of fees under ERISA. This is so even where, as here, Defendant does not object to the remand order." Id. at *11. The Court reasoned that "where, by Defendant's own admission, the administrative appeals process failed Plaintiff, some award of fees is consistent with the aims of ERISA." Id.

         However, the July 19 Ruling, which is the law of the case, did not complete its analysis of whether Plaintiff was entitled to any attorney's fees, and, if so, the amount of the recoverable fees in practice remained for decision. This was due to Plaintiff not having filed the required supporting papers. Id. Plaintiff consequently moved for attorney's fees and costs, on the basis of additional submissions. Doc. 77. Defendant opposes the motion. The attorney's fee issue is now ripe for the Court's decision.


         "The district court retains discretion to determine . . . what constitutes a reasonable fee." Millea v. Metro-N. R.R. Co., 658 F.3d 154, 166 (2d Cir. 2011) (quoting LeBlanc-Sternberg v. Fletcher, 143 F.3d 748, 758 (2d Cir. 1998)); see also Morgan Guar. Trust Co. v. Republic of Palau, 971 F.2d 917, 924 (2d Cir. 1992) (noting that 28 U.S.C. § 1447(c) "affords a great deal of discretion and flexibility to the district courts in fashioning awards of costs and fees"). "However, this discretion is not unfettered," and "the district court must abide by the procedural requirements for calculating those fees articulated by [the Second Circuit] and the Supreme Court." Millea, 658 F.3d at 166.

         "The most useful starting point for determining the amount of a reasonable fee is the number of hours reasonably expended on the litigation multiplied by a reasonable hourly rate." Hensley v. Eckerhart, 461 U.S. 424, 433 (1983). The resulting amount "is only presumptively reasonable; it is still within the court's discretion to adjust the amount upward or downward based on the case-specific factors." Tyco Healthcare Grp. LP v. Ethicon Endo-Surgery, Inc., No. 3:10-CV-60, 2012 WL 4092515, at *1 (D. Conn. Sept. 17, 2012) (citation and internal quotation marks omitted).

         Judge Newman's opinion in New York State Ass'n for Retarded Children, Inc. v. Carey, 711 F.2d 1136 (2d Cir. 1983), declares this Circuit's governing evidentiary requirements for a party applying to recover attorney's fees from someone else:

All applications for attorney's fees, whether submitted by profit-making or non-profit lawyers, for any work done after the date of this opinion should normally be disallowed unless accompanied by contemporaneous time records indicating, for each attorney, the date, the hours expended, and the nature of the work done.

Id. at 1154. The Second Circuit subsequently clarified its use of the word "normally" in Carey, holding that while it "indicates that we intend to leave the district courts with some limited discretion to make exceptions to the hard-and-fast rule," Carey nonetheless "sets out unequivocally that absent unusual circumstances attorneys are required to submit contemporaneous records with their fee applications." Scott v. City of New York, 626 F.3d 130, 133 (2d Cir. 2010). "In other words, Carey establishes a strict rule from which attorneys may deviate only in the rarest of cases." Id. In the case at bar, Plaintiff's additional submissions satisfy the requirements of Newman and its progeny.

         "Attorney's fees must be reasonable in terms of the circumstances of the particular case[.]" Alderman v. Pan Am World Airways, 169 F.3d 99, 102 (2d Cir. 1999) (citing Lunday v. City of Albany, 42 F.3d 131, 134 (2d Cir. 1994)). In determining a fee award, the Court is mindful that "attorney's fees are to be awarded 'with an eye to moderation, seeking to avoid either the reality or the appearance of awarding windfall fees.'" Carey, 711 F.2d at 1139 (quoting Beazer v. New York City Transit Auth., 558 F.2d 97, 101 (2d Cir. 1997)).


         A. Attorney's Fees and Costs under ERISA

         It is within the discretion of the Court to award attorney's fees and costs under ERISA. 29 U.S.C. § 1132(g) (2016); see also Donachie v. Liberty Life Assur. Co. of Boston, 745 F.3d 41, 47 (2d Cir. 2014) ("[I]n light of the ERISA fee provision's statutory purpose of vindicating retirement rights, granting a prevailing plaintiff's request for fees is appropriate absent some particular justification for not doing so." (citation and internal quotation marks omitted)). Having begun examining this issue in the previous Ruling, I will first discuss what has already been decided and then continue the analysis here.

         The July 19 Ruling outlined factors the Court must or can consider when determining when a plaintiff is entitled to attorney's fees and costs pursuant to 29 U.S.C. § 1132(g):

[W]hether a plaintiff has obtained some degree of success on the merits is the sole factor that a court must consider in exercising its discretion. Although a court may, without further inquiry, award attorneys' fees to a plaintiff who has had "some degree of success on the merits," Hardt v. Reliance Standard Life Ins. Co., 560 U.S. 242, 255 n.8 (2010), also made clear that courts retain discretion to "consider [ ] five [additional] factors . . . in deciding whether to award ...

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