Desharnais v. UNUM Life Insurance Company of America

District Court, N.D. California·Decided September 30, 2021·No. 5:19-cv-06599·Unknown

Opinion

MATTHEW DESHARNAIS, Case No. 5:19-cv-06599-EJD Plaintiff, ORDER DENYING PLAINTIFF’S v. MOTION FOR ATTORNEYS’ FEES UNUM LIFE INSURANCE COMPANY OF AMERICA, Re: Dkt. No. 33 Defendant.

Plaintiff Matthew Desharnais (“Plaintiff”) brought suit against Unum Life Insurance Company of America (“Unum”) for denial of benefits Plaintiff claimed he was entitled to under a long-term disability insurance plan. Presently before the Court is Plaintiff’s motion for attorneys’ fees and costs which Plaintiff seeks following the reinstatement of his long-term disability benefits. Motion for Attorneys’ Fees and Costs (“Mot.”), Dkt. No. 33. Having considered the parties’ submissions, the relevant law, and the record in this case, the Court DENIES Plaintiff’s motion.1 Plaintiff has practiced law for the past twenty years, most recently as a corporate attorney for the law firm Pillsbury Winthrop Shaw Pittman, LLP (“Pillsbury”). Complaint (“Compl.”), Dkt. No. 1 ¶ 6. As part of his employment, Plaintiff participated in Employee Income Security Act (“ERISA”) plans insured and administered by Unum, including a long-term disability (“LTD”) plan sponsored by Pillsbury (the “Plan”). Id. ¶¶ 2, 4. On April 23, 2018, Plaintiff

1 The Court took this motion under submission without oral argument pursuant to Civil Local Rule 7-1(b). submitted an LTD benefits claim, claiming disability as of November 20, 2017, due to several ailments including abdominal pain, migraines, and chronic perianal fissures which were later compounded by the development of anal fistulas and pudendal neuralgia. See Decl. of Kasey Eriksen in Support of Defendant Unum Life Insurance Company of America Opposition (“Eriksen Decl.”), Dkt. No. 37-1 ¶ 4, Ex. B; see also Compl. ¶¶ 8-23. Unum initially approved Plaintiff’s claim for LTD benefits in late June 2018, but terminated them in January 2019 after determining that Plaintiff was no longer precluded from his occupational duties. Compl. ¶¶ 23-24. Unum’s decision was based on a review of Plaintiff’s medical records, which according to Unum “showed improvement and did not show exam findings or ongoing treatment interventions.” Eriksen Decl. ¶ 8, Ex. D. On June 24, 2019, Plaintiff appealed the decision to terminate his LTD benefits. Pursuant to the Plan and ERISA regulations, Unum had forty-five days to uphold the denial of benefits or reinstate Plaintiff’s LTD benefits based on the administrative appeal. Compl. ¶ 27; Eriksen Decl., Unum Group Insurance Summary of Benefits, Ex. A at 51. On July 25, 2019, Unum sent Plaintiff two separate in-house medical reviews it had commissioned. Id. ¶ 33. The first was conducted by Unum’s in-house registered nurse and clinical consultant who found that there had “been no significant improvement in [Plaintiff’s] condition” and that “his ongoing severe level of pain would interfere with his ability to perform his occupational demands.” Id. ¶ 34. The second review was done by Unum’s in-house operational staff physician (“OSP”), Scott B. Norris (“Dr. Norris”), who concluded that Plaintiff could “perform sustained full-time sedentary level activity.” Id. 35. Unum then requested that Plaintiff review and respond to the in-house reviews as part of the appeal. Id. ¶ 36; see also Eriksen Decl. ¶ 10, Ex. F. Unum also informed Plaintiff that it would need up to an additional forty-five days to review information and complete its review his appeal. Compl. ¶ 37. In August 2019, Plaintiff’s three physicians all responded to Dr. Norris’s remarks and expressed their disagreement with his conclusion that Plaintiff was capable of performing full-time sedentary work. Id. ¶¶ 38-41. Still, Unum informed Plaintiff that an independent medical exam (“IME”) was necessary. Id. ¶ 48. Plaintiff’s counsel objected to the need for an IME but ultimately, Plaintiff agreed to undergo an examination which Unum scheduled for October 1, 2019. Id. ¶ 52. Before Plaintiff could undergo the IME, however, Unum informed him that his IME was being cancelled and that the company was in the process of rescheduling a new date and location. Compl. ¶ 56. On October 8, 2019, the final day of Unum’s review period, Plaintiff’s counsel learned that Unum had arranged for Plaintiff to undergo an IME on October 21, 2019. Id. ¶ 57. Plaintiff’s counsel advised Unum that it had failed to make a final decision on Plaintiff’s appeal and emphasized that an IME was not warranted for his case. Id. ¶ 58. In response, Unum proposed arranging an earlier appointment for the IME. No new IME appointment was arranged at that time. Instead, Plaintiff’s counsel informed Unum that if it did not reach a resolution on Plaintiff’s appeal by October 11, 2019, he intended to exercise his right to file an action. Id. ¶ 59. When Unum did not give Plaintiff any indication that a decision had been reached, this action followed. Id. ¶¶ 60-61. On October 15, 2019, Plaintiff filed his complaint asserting one count for claim benefits pursuant to ERISA § 502(a)(1)(B). See Compl. ¶ 11. The following day Unum made the decision to reinstate Plaintiff’s benefits under a Reservation of Rights (“ROS”), including retroactive benefits, until it reached a decision on Plaintiff’s appeal. See Eriksen Decl. ¶ 28, Ex. V. Thereafter, Unum filed its initial answer to the complaint on January 10, 2020. See Dkt. No. 20. An amended answer followed on January 28, 2020. See Dkt. No. 24. During this time, Unum also continued to evaluate Plaintiff’s appeal. See Eriksen Decl. ¶ 46. Unum requested additional forms from Plaintiff regarding his condition, as well as updated medical records from his providers. Id. ¶ 30, Ex. X. On February 3, 2020, The parties agreed to continue their initial case management conference with the Court for ninety days to afford Plaintiff time to undergo an IME. See Feb. 3, 2021 Stipulation to Continue Case Management Conference, Dkt. No. 25. They expressed to the Court that Plaintiff had “agreed to undergo an [IME]” and therefore, it was necessary to continue the case management conference to allow for the scheduling, completion and review of the IME by Unum. Id. at 2. The stipulation also stated that Unum would be “able to make a determination on whether to approve or deny Plaintiff’s LTD claim” once it reviewed the IME report. Id. Although the parties attempted to arrange an IME following their stipulation, Unum states the two sides were unable to agree on a physician who would allow Plaintiff’s counsel to attend the examination. Decl. of Tatiana Semerjian Nunneri (“Nunneri Decl.”), Dkt. No. 37-41, ¶¶ 7-10; see also Nunneri Decl., Exs. AQ-AR. On March 13, 2020, Plaintiff’s counsel requested that the parties agree to “put over the IME until July,” and stipulate to a continuance of the case management conference until August 2020 in light of the COVID-19 pandemic. See Nunneri Decl. ¶ 11. Meanwhile, Plaintiff continued to submit additional and updated information about his condition. In addition to completed forms previously requested by Unum in January 2020, Plaintiff also submitted a Social Security Administration (“SSA”) Notice of Decision from February 2020 which reversed a previous denial of Plaintiff’s social security disability insurance (“SSDI”). Eriksen Decl. ¶ 34. Unum, in turn, requested Plaintiff’s claim file from the SSA to evaluate the basis for Plaintiff’s SSDI award. Eriksen Decl. ¶ 37, Ex. AE. On March 20, 2020, Unum informed Plaintiff that it was reviewing the updated information and SSDI decision, but that Plaintiff’s LTD benefits would continue under the ROR. Id., Ex. AB. As part of the review, an RN clinical consultant evaluated updated medical information provided by Plaintiff and concluded that his work capacity was unclear. Eriksen Decl., Ex. AC. The consultant also believed that an IME was necessary. Id. On April 2, 2020, an OSP reviewed the updated records and concluded that there was “no indication within the record of an inability to perform [Plaintiff’s] sedentary level

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Desharnais v. UNUM Life Insurance Company of America, (N.D. Cal. 2021).

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