Barone v. Unum Life Insurance of America

186 F. Supp. 2d 777, 2002 U.S. Dist. LEXIS 2515, 2002 WL 230750
CourtDistrict Court, E.D. Michigan
DecidedJanuary 31, 2002
Docket2:00-cv-73626
StatusPublished
Cited by2 cases

This text of 186 F. Supp. 2d 777 (Barone v. Unum Life Insurance of America) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Barone v. Unum Life Insurance of America, 186 F. Supp. 2d 777, 2002 U.S. Dist. LEXIS 2515, 2002 WL 230750 (E.D. Mich. 2002).

Opinion

MEMORANDUM OPINION AND ORDER

HOOD, District Judge.

I. FACTS

Plaintiff Phyllis Barone (“Barone”) filed the instant cause of action against Defendant UNUM Life Insurance Company of America (“UNUM”) on July 10, 2000 in the 6th Judicial Circuit Court. Plaintiff is a resident of the Township of West Bloomfield in the County of Oakland. Defendant is a Delaware corporation which conducts business in the County of Oakland. On August 11, 2000, this cause of action was removed to the district court for the Eastern District of Michigan based upon a federal question (ERISA).

Plaintiff was hired by USA Networks on February 1, 1989 as an account executive. Plaintiff sold advertising time for the network in the states of Ohio and Michigan. On April 1, 1989 as a part of Plaintiffs benefits package, she became eligible for long term disability which covered through Defendant. On May 25, 1992 at the age of thirty-five (35) years old, Plaintiff suffered a stroke with bleeding on the brain. Plaintiff returned to work on January 4, 1992, but began to experience some difficulties as a result of the stroke. Plaintiff contended that her job caused her headaches and such stress increased the likelihood of rebleeding on the brain. In July of 1993, Plaintiff became totally disabled. Plaintiff filed a disability claim with Defendant. In compliance with the long term disability policy, Defendant reviewed Plaintiffs claim and began to pay her $5,063.38 per month in benefits. In November of 1999, Plaintiffs benefits were terminated. Defendant states that there is no objective evidence that stress would cause Plaintiff further problems with cerebral cavernous hemangioma (“CCH”) or that headaches were the predictor of such problems. Defendant also asserts that records from the Cleveland Clinic, the Mayo Clinic and the medical literature do not support Plaintiffs contention that she cannot perform the material duties of her occupation.

Plaintiff contends that Defendant has breached its duty to pay disability benefits under the policy. The parties have filed cross motions for the entry of judgment which are now before this Court.

II. STANDARD OF REVIEW

In Wilkins v. Baptist Healthcare System, Inc., 150 F.3d 609 (6th Cir.1998), a panel of the Sixth Circuit, in a majority decision, set forth “Suggested Guidelines” to adjudicate ERISA benefit denial actions. 1 Id. at 619. The panel began by *779 noting that a district court’s review of a plan administrator’s decision is confined to the evidence which was before the plan administrator. Id. at 618 (citing Rowan v. Unum Life Ins. Co., 119 F.3d 433, 437 (6th Cir.1997); Perry v. Simplicity Engineering, 900 F.2d 963, 966 (6th Cir.1990)). The Suggested Guidelines provide that the district court should conduct a review of the plan administrator’s decision based solely upon the administrative record and render findings of fact and conclusions of law. Id. Only if a procedural challenge is alleged, such as lack of due process afforded by the administrator or bias on its part, may the district court consider evidence outside of the administrative record. Id. Discovery must be limited to these procedural challenges. Id.

III. ANALYSIS

A. Plaintiff’s Motion for Entry of Judgment

Plaintiff asserts that when her disability benefits were terminated in August of 1999, the termination was done without regard to due process. It is Plaintiffs position that Defendant’s decision was directly contrary to the recommendations and studies in Plaintiffs medical file. Pursuant to the terms of the policy, disability or disabled is defined as:

1. The insured cannot perform each of the material duties of his regular occupation, or
2. The insured while unable to perform all of the material duties of his regular occupation on a full time basis, is:
a. performing at least one of the material duties of his regular occupation or another occupation on a part-time or full-time basis; and
b. earning currently at least 20% less per month than this indexed pre-disability earnings due to that some injury or sickness.

Plaintiff interprets the above definitions to mean that Plaintiff is entitled to same benefits as long as her monthly disability income does not exceed $6,752.10 which is 80% of her prior disability income (“PDI”) of $8,438.96 per month.

Plaintiff asserts that she has had no earnings after 1992. It is Plaintiffs position that in order for Defendant to terminate her benefits, Defendant is required to show that Plaintiff is able to perform all of the material duties of her job on a full time basis, or that in the alternative if she is not performing all of the material duties of her occupation, that she is earning more than 80% of her PDI or an amount in excess of $6,571.17 per month.

Plaintiff argues that Defendant did not even attempt to reduce her benefits but merely terminated them. Plaintiff asserts that she had no employment earnings as evidenced by her tax returns and 1099’s. Plaintiff argues that UNUM’s motive for terminating her benefits was to save money despite Defendant’s obligation to pay in excess of $60,000 per year until Plaintiff reaches the age of 65. Plaintiff states that Defendant offered Plaintiff a lump settlement sum of $175,000 in January of 1997 and when Plaintiff refused her benefits were eventually terminated. On July 14, 1999, Plaintiffs third claim representative sent Plaintiff correspondence stating that it had come to Defendant’s attention that Plaintiff had been or was working. Plaintiff, then, disclosed that she was volunteering for On Course Marketing, a company *780 owned by Plaintiffs significant other. Plaintiff asserts that Defendant was aware that Plaintiff was looking for something to do and encouraged her to do so. Plaintiffs intent to start a business was within Defendant’s knowledge. (See Claim File, p CL 0127). Plaintiff states that because Plaintiff has received no income for her participation with On Course Marketing her benefits should not be terminated.

Plaintiff also argues that the medical evidence does not support a finding that she is not disabled and incapable of performing all the material tasks of her occupation on a full time basis. Plaintiff cites the testimony of Dr. Lawrence Eilender, Plaintiffs treating physician, which states “[i]f she (Plaintiff) rebleeds from stress at work, I am not responsible for that. Emotional stress can precipitate a rebleed episode.” (Claim File, p CL 0656). Dr. Ei-lender also stated:

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Related

Vick v. Metropolitan Life Insurance
417 F. Supp. 2d 868 (E.D. Michigan, 2006)
Radford Trust v. First Unum Life Insurance Co. of America
321 F. Supp. 2d 226 (D. Massachusetts, 2004)

Cite This Page — Counsel Stack

Bluebook (online)
186 F. Supp. 2d 777, 2002 U.S. Dist. LEXIS 2515, 2002 WL 230750, Counsel Stack Legal Research, https://law.counselstack.com/opinion/barone-v-unum-life-insurance-of-america-mied-2002.