Cranmore v. Unumprovident Corp.

430 F. Supp. 2d 1143, 2006 U.S. Dist. LEXIS 31210, 2006 WL 1302258
CourtDistrict Court, D. Nevada
DecidedApril 10, 2006
DocketCV-S-03-1079-PMP (RJJ)
StatusPublished
Cited by2 cases

This text of 430 F. Supp. 2d 1143 (Cranmore v. Unumprovident Corp.) is published on Counsel Stack Legal Research, covering District Court, D. Nevada primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cranmore v. Unumprovident Corp., 430 F. Supp. 2d 1143, 2006 U.S. Dist. LEXIS 31210, 2006 WL 1302258 (D. Nev. 2006).

Opinion

ORDER

PRO, Chief Judge.

Presently before the Court is Defendants UnumProvident Corporation (“Un-umProvident”) and Colonial Life and Accident Insurance Company’s (“Colonial”) Motion for Summary Judgment (Doc. # 31) filed on November 16, 2005. Defendants filed a Supplement to Motion for Summary Judgment (Doc. #32) on December 2, 2005. Plaintiff Mildred Cran-more (“Cranmore”) filed Plaintiff Mildred Cranmore’s Opposition to Defendant Un-umProvident Corporation and Colonial Life and Accident Insurance Company’s Motion for Summary Judgment (Doc. # 19) on December 22, 2005. Defendants filed a Reply in Support of Motion for Summary Judgment and Objection to Inadmissible Evidence (Doc. # 38) on January 26, 2006.

I. BACKGROUND

From 1988 to 2002, Plaintiff Cranmore was an employee of the Gordon Gaming Group, d/b/a the Sahara Hotel and Casino (“Sahara”). (Pl.’s Opp’n to Defs.’ Mot. for Determination That ERISA Applies (“PL’s Opp’n”) [Doc. # 19], Ex. A at 7-8, 30-31.) In 1992, Cranmore purchased accident, sickness, and cancer insurance policies from Colonial, and authorized direct payroll deductions from her Sahara paycheck to cover the premiums. (Pl.’s Opp’n, Ex. A at 9-10, Ex. 1, Ex. 2; Mot. for Determination that ERISA Applies [Doc. 317], Ex. 2 ¶ 3; Mot. for Summ. J. [Doc. # 31], Felicia Robinson Decl., Exs. A, B.) The *1146 accident policy provides that it will pay benefits if the insured is injured in an accident which causes the insured to “become totally disabled within ninety days after the accident.” (Mot. for Summ. J., Felicia Robinson Deck, Ex. A at COLSP00012.) The policy defines “totally disabled” as “you are unable to work at your job for pay or benefits and are under the care of a doctor.” (Id.) The policy further provides coverage for recurring total disability:

If we pay benefits for a period of total disability, and you become totally disabled again because of the same injury within six months after you return to work, we will treat this disability as the same disability. This means that the length of time shown for Total Disability (accident) in the Policy Schedule will not start over as it will for disabilities caused by different covered accidents.

(Id.) The policy provided coverage for total disability in the amount of $600 per month for twelve months. (Id. at COLSP00005.)

In December 1999, Cranmore was in an automobile accident. (Compl. ¶ 8; Answer ¶ 8.) Due to her injuries from the accident, Cranmore missed work at the Sahara from December 18 to December 24,1999. (Mot. for Summ. J., Felicia Robinson Deck, Ex. E at COLCR00164.) Cranmore thereafter returned to full time work at the Sahara as a security guard. (Mot. for Summ. J., Felicia Robinson Deck, Ex. F at 27.) On January 31, 2000, Sahara transferred Cranmore to a position as a PBX operator. (Reply in Supp. of Mot. for Summ. J. (“Reply”) [Doc. # 38], Exs. I, J.) Cranmore testified at her deposition that her transfer was due to her inability to walk for the security position. (Mot. for Summ. J., Felicia Robinson Deck, Ex. F at 27-28). The transfer request form Cranmore filled out with the Sahara did not indicate the reason for the requested job transfer. (Reply, Ex. J.) The Sahara’s personnel action form indicates the reason for the transfer was an “upgrade.” (Reply, Ex. I.) The personnel action form does not indicate the transfer was related to any disability, injury, or health reason. (Id.)

Cranmore continued to work full time from January 2000 to April 2001 as a PBX operator. (Mot. for Summ. J., Felicia Robinson Deck, Ex. F at 27.) Although she worked full time, Cranmore continued to be treated for her back pain from the time of the accident to at least May 2002. (PL Mildred Cranmore’s Opp’n to Def. Un-umProvident Corp. and Colonial Life & Accident Ins. Co.’s Mot. for Summ. J. (“PL’s Opp’n to Mot. for Summ. J.”), Ex. 1 at COLCR00033-41, COLCR00167, COLCR00174, COLCR00182-86, COLCR00220-32, COLCR00269-70, COLCR00317-40, COLCR00379-82, Exs. K, L.) COLCR00180, COLCR00196-200, COLCR00266, COLCR00303, COLCR00355-59, COLCR00387; Reply,

On May 10, 2001, Cranmore filed a claim for total disability benefits under her sickness policy with Colonial. (Mot. for

Summ. J., Felicia Robinson Deck, Ex. C at COLCR00002.) According to the claim form, Cranmore suffered from chronic obstructive pulmonary disease (“COPD”) and had been unable to work since April 14, 2001. (Id.) Cranmore did not return to work after April 14, 2001. (Mot. for Summ. J., Felicia Robinson Deck, Ex. F at 10, 43.) Colonial paid twelve months of total disability payments under Cran-more’s sickness policy in the amount of $7,200. (Mot. for Summ. J., Felicia Robinson Deck, Ex. C at COLCR00057.)

In June 2001, Cranmore applied for total disability benefits under her Colonial accident policy for the period from December 18 to December 24, 1999 when she missed work due to the accident. (Mot. for *1147 Summ. J., Felicia Robinson Decl., Ex. E at COLCR00164.) Colonial paid Cranmore total disability benefits for these days under the accident policy in the amount of $260.82. (Id. at COLCR00533.)

As her disability benefits expired under her sickness policy, Cranmore filed a new claim with Colonial under her sickness policy in May 2002 for total disability due to “CHF — Osteoperosis.” (Mot. for Summ. J., Felicia Robinson Decl., Ex. C at COLCR00022.) Colonial denied the claim, asserting Cranmore’s new claim of congestive heart failure was related to her COPD, and thus Colonial had paid the maximum benefits allowable under the sickness policy. (Id. at COLCR00057-58, COLCR00060.)

Thereafter, Cranmore made a claim for total disability under her accident policy from the period of April 2001 forward. (Compl. ¶ 9; Answer ¶ 9.) Colonial denied Cranmore’s claim under the accident policy. (PL’s Opp’n to Mot. for Summ. J., Ex. 1 at COLCR00058.) On September 27, 2002, Cranmore, through her attorney, sent Colonial a letter explaining that she was permanently disabled by her back injuries sustained in the accident. (Id. at COLCR00348.) Cranmore noted that although the policy states disability must commence within ninety days after the accident, the “Process of Nature Rule ... would bring her recurrent 2001 disability within coverage.” 1 (Id.) Colonial responded on October 11, 2002, and again denied the claim. (Id. at COLCR00346.) Colonial noted that it had paid for the five days of total disability in December 1999, but had not been aware that Cranmore was totally disabled from the accident any time thereafter. (Id.) Colonial requested a disability statement from Cranmore’s doctor and employer supporting the claim. (Id.)

Cranmore responded in a December 3, 2002 letter. (Id. at COLCR00343-45.) Cranmore asserted the December 1999 accident caused her recurrent total disability as of April 2001 when Cranmore ceased working. (Id. at COLCR00343.) Cran-more asserted that although her other illnesses were totally disabling, her back injury also was disabling even in the absence of her other illness. (Id.)

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430 F. Supp. 2d 1143, 2006 U.S. Dist. LEXIS 31210, 2006 WL 1302258, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cranmore-v-unumprovident-corp-nvd-2006.