Barbour v. Unum Life Insurance Co. of America

803 F. Supp. 2d 1135, 2011 U.S. Dist. LEXIS 91060
CourtDistrict Court, S.D. California
DecidedAugust 15, 2011
DocketCase No. 09cv2724-WQH-WVG
StatusPublished

This text of 803 F. Supp. 2d 1135 (Barbour v. Unum Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, S.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Barbour v. Unum Life Insurance Co. of America, 803 F. Supp. 2d 1135, 2011 U.S. Dist. LEXIS 91060 (S.D. Cal. 2011).

Opinion

ORDER

HAYES, District Judge:

The matter before the Court is the Motion for Partial Summary Judgment, filed by Defendants Unum Life Insurance Company of America and Provident Life and Accident Insurance Company. ECF No. 23.

I. Background

On October 26, 2009, Plaintiff Patricia Barbour initiated this action by filing a Complaint against Defendants in San Diego County Superior Court. ECF No. 1, Ex. A. In connection with Defendants’ denial of benefits under a disability insurance policy, Plaintiff asserts claims for breach of contract, breach of the covenant of good [1137]*1137faith and fair dealing, and intentional infliction of emotional distress. Plaintiff seeks punitive damages as to the latter two claims.

On December 4, 2009, Defendants removed the action to this Court, alleging diversity jurisdiction.1 ECF No. 1.

On February 25, 2011, Defendants filed the Motion for Partial Summary Judgment, accompanied by evidence. ECF No. 23. Defendants seek partial summary judgment as to Plaintiffs claims for breach of the covenant of good faith and fair dealing and intentional infliction of emotional distress. In the alternative, Defendants seek partial summary judgment as to Plaintiffs request for punitive damages.

On May 2, 2011, Plaintiff filed an opposition to the motion, accompanied by evidence. ECF No. 26.

On May 9, 2011, Defendants filed a reply in support of the motion, accompanied by evidence and objections to the evidence submitted by Plaintiff. ECF No. 27.

On May 31, 2011, Plaintiff filed a surreply, accompanied by evidence and a response to Defendants’ evidentiary objections. ECF Nos. 29, 30.

On June 17, 2011, Defendants filed a response to Plaintiffs surreply, accompanied by objections to the evidence submitted by Plaintiff on surreply. ECF Nos. 35, 36.

On August 4, 2011, the Court conducted oral argument on the Motion for Partial Summary Judgment. ECF No. 38.

II. Facts

Defendants issued a Group Salary Protection Insurance Policy (“Policy”) to eligible employees of the Bonsall Union School District, effective September 1, 1991. Die-gel Decl. ¶ 3, ECF No. 23-2. Plaintiff was employed by the Bonsall Union School District in the position of Principal effective August 19, 2002, and Plaintiff became covered under the Policy effective September 1, 2002. Id.; Diegel Decl., Ex. 2 at 1, ECF No. 23-2. The Policy provides Accident and Sickness Disability Benefits for one year in the event of total disability; after one year, the Policy provides monthly Long Term Disability Income Benefits for as long as the claimant remains totally disabled and otherwise qualifies for benefits, up to the claimant’s 65th birthday. Diegel Deck, Ex. 1 at 4-5, 14, ECF No. 23-2. Under the Policy, during the first two benefit years, “Total Disability” is defined as the inability “to perform the material duties of your own occupation.” Id. at 25. After the first two benefit years, “Total Disability” is defined as the inability “to engage in any gainful occupation for which you are reasonably qualified by training, education or experience.” Id.

On February 5, 2003, Plaintiff submitted a claim for benefits under the Policy, claiming disability as a result of “severe right quadrant abdominal pain — inflammation small intestines.” Diegel Deck, Ex. 2 at 1, ECF No. 23-2. Plaintiff reported that she stopped working on January 6, 2003, when she was hospitalized for two weeks. Id. Plaintiffs claim contained a physician’s statement from Dr. Jeffrey Yusim, who stated that Plaintiff was diagnosed with “abdominal pain inflammation,” and stated that Plaintiff “has severe abdominal-pelvic pain.” Id. at 2. In January 2003 and February 2003, hernia surgeries were performed on Plaintiff. Diegel Deck, Ex. 7 at 1, ECF No. 23-2.

In February 2003, Defendants began paying Plaintiff disability benefits pursu[1138]*1138ant to the Policy. Diegel Decl., Ex. 8 at 1, ECF No. 23-2.

On July 3, 2003, Plaintiff submitted a statement to Defendants indicating that she is restricted from driving, walking/standing and sitting for extended periods. Diegel Decl., Ex. 3 at 1, ECF No. 23-2. On July 16, 2003, Dr. Melissa Hurd, Plaintiffs physician, submitted a statement indicating that Plaintiff underwent hernia surgery on April 16, 2003, and Plaintiff was presently able to tolerate standing for 30 minutes, sitting for one hour, walking one block, and no lifting or carrying. Die-gel Decl., Ex. 4 at 1, ECF No. 23-2. Dr. Hurd indicated that “workup remains in progress,” and Plaintiff was not totally disabled from performing her occupation. Id.

On November 17, 2003, Plaintiff submitted a statement to Defendants indicating that she “can no longer stand, sit, or walk,” due to “complication from ... hernia surgery.” Diegel Deck, Ex. 5 at 1, ECF No. 23-2. On November 19, 2003, Dr. Hurd submitted a statement indicating that Plaintiff is “currently unable to stand, sit, walk or drive,” and is totally disabled from performing her occupation or any other occupation. Diegel Deck, Ex. 6 at 1, ECF No. 23-2.

On February 10, 2004, Plaintiff submitted medical information to Defendants, including an August 13, 2003 MRI report which revealed an “irregular lesion,” and records related to Plaintiffs hospitalization from December 8, 2003 through December 31, 2003. PI. Ex. 2 at 2489, 2495, ECF No. 26-3. In a report dated February 2, 2004, Plaintiffs treating physician, Dr. David Smith, diagnosed Plaintiff with a “[n]euro-ma, right genitofemoral nerve.” Diegel Deck, Ex. 7 at 5, ECF No. 23-2. Dr. Smith stated that in August 2003, an ilioinguinal nerve block was performed on Plaintiff but it “was ineffective,” and in October 2003, another ilioinguinal nerve block was performed but it “caused increased pain.” Id. at 1. Dr. Smith stated that Plaintiff takes three to six 2mg tablets per day of Dilaudid, which “provides adequate pain relief with minimal side effects.” Id. at 5. Dr. Smith recommended that Plaintiff first undergo physical therapy, and “[i]f the physical therapy is not effective, then surgical explantation of the neuroma.” Id. Dr. Smith stated that, “as a last resort,” Plaintiff could undergo “a spinal cord stimulator trial in order to relieve [Plaintiff] of her persistent discomfort.” Id.

On March 3, 2004, Defendants informed Plaintiff that she had received her final benefit check for Disability Income Benefits, and she was now eligible for long-term disability benefits pursuant to the Policy. Diegel Deck, Ex. 8 at 1, ECF No. 23-2.

From 2004 through 2007, Plaintiff submitted medical records and statements, and Defendants continued paying benefits pursuant to the Policy. See generally, PI. Ex. 2, ECF No. 26-2 to 26-5. Among the records submitted by Plaintiff is a September 16, 2003 report from Dr. R. Lee Wagner, who stated that Plaintiff “will require significant intervention by treating physicians to get a handle on this problem and get her back to work. It is going to be a challenging problem.... ” PI. Ex. 2 at 2519, ECF No. 26-3. The records reflect that between 2003 and 2005, Plaintiff underwent four “nerve block” procedures, and multiple operative procedures. Id. at 2531, 2559, 2622, 2632, 2669, 2936, 2942, 3088, ECF No. 26-3 to 26-4.

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Bluebook (online)
803 F. Supp. 2d 1135, 2011 U.S. Dist. LEXIS 91060, Counsel Stack Legal Research, https://law.counselstack.com/opinion/barbour-v-unum-life-insurance-co-of-america-casd-2011.