Goodman v. First Unum Life Insurance Company

District Court, W.D. Washington·Decided May 3, 2023·No. 2:21-cv-00902·Unknown

Opinion

The Honorable Barbara J. Rothstein UNITED STATES DISTRICT COURT WESTERN DISTRICT OF WASHINGTON AT SEATTLE TANYA GOODMAN, CASE NO. 2:21-cv-00902-BJR Plaintiff, ORDER GRANTING IN PART v. PLAINTIFF TANYA GOODMAN’S MOTION FOR FIRST UNUM LIFE INSURANCE JUDGMENT ON THE RECORD COMPANY and UNUM GROUP, Defendants. This matter comes before the Court on the cross-motions for judgment on the record under Federal Rule of Civil Procedure 52 by Defendants First Unum Life Insurance Company and Unum Group (collectively, “Unum”), Dkt. No. 31, and Plaintiff Tanya Goodman, Dkt. No. 33, and on Goodman’s motion to supplement the record. Dkt. No. 34. The Court GRANTS IN PART Goodman’s motion for judgment on the record, GRANTS her motion to supplement the record, and DENIES IN PART Unum’s motion for judgment on the record. The Court hereby REMANDS the matter to Unum to determine whether Goodman can “perform the duties of any gainful occupation for which [she is] reasonably fitted by education, training or experience,” pursuant to the relevant benefit plan. Dkt No. 18-11 at 16. Goodman claims that Section 502(a)(1)(B) of the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1132(a)(1)(B), warrants judgment against Unum for failure to pay her

disability insurance benefits to which she was entitled under her employer’s benefit plan (“the Plan”). Dkt. No. 1 at 4. Goodman also claims that Unum violated the terms of the Plan and seeks an injunction under 29 U.S.C. § 1132(a)(3) “compelling Unum to correct its claims-handling policies, practices, training, and procedures, together with any other declaratory or equitable relief the Court deems appropriate.” Dkt. No. 1 at 5. “Under ERISA, the proper standard of review of a plan administrator’s benefits denial is de novo unless the plan grants discretionary authority to the administrator.” Mirick v. Prudential Ins. Co. of Am., 100 F. Supp. 3d 1094, 1096 (W.D. Wash. 2015) (citing Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)). The parties have stipulated to de novo review. Dkt. No.

13 at 2. The court accepts the parties’ stipulation, see Rorabaugh v. Cont’l Cas. Co., 321 F. App’x 708, 709 (9th Cir. 2009), conducts a trial of this matter under Rule 52 based on the administrative record considered by Unum, and issues the findings of fact and conclusions of law as set forth below. As an initial matter, the Court addresses Goodman’s motion to supplement the administrative record to add a June 24, 2022 decision by an administrative law judge (“ALJ”) at the Social Security Administration (“SSA”), granting her Social Security disability benefits. Dkt. No. 34 at 1; see Dkt. No. 34-4 (2022 SSA decision). The Court has discretion to expand the record where “additional evidence is necessary to conduct an adequate de novo review of the benefit decision.” Mongeluzo v. Baxter Travenol Long Term Disability Benefit Plan, 46 F.3d 938, 944 (9th Cir. 1995); see also Kearney v. Standard Ins. Co., 175 F.3d 1084, 1094 (9th Cir. 1999). The following circumstances should be considered when deciding whether supplementing the administrative record is necessary: [C]laims that require consideration of complex medical questions or issues regarding the credibility of medical experts; the availability of very limited administrative review procedures with little or no evidentiary record; the necessity of evidence regarding interpretation of the terms of the plan rather than specific historical facts; instances where the payor and the administrator are the same entity and the court is concerned about impartiality; claims which would have been insurance contract claims prior to ERISA; and circumstances in which there is additional evidence that the claimant could not have presented in the administrative process. Opeta v. Northwest Airlines Pension Plan for Cont. Emps., 484 F.3d 1211, 1217 (9th Cir. 2007) (citation omitted). The Opeta factors support expanding the record to include the 2022 SSA decision. The SSA’s prior decision in 2020 already forms part of the administrative record, Dkt. No. 17-6 at 38– 51, and the 2022 SSA decision results from this Court’s decision reversing and remanding the 2020 decision. See Tanya G. v. Comm’r of Social Security, C21-0530-SKV, 2022 WL 35494, at *1 (W.D. Wash. Jan. 3, 2022). The 2022 SSA decision was issued after the administrative record was filed, so it could not have been included in it. And this case certainly requires consideration of complex medical questions and issues regarding the credibility of medical experts, which are matters that the 2022 SSA decision speaks to. In light of the record and circumstances in this case, the Court grants Goodman’s motion to supplement the record with the 2022 SSA decision. Dkt. No. 34-4. The Court next turns to the parties’ cross-motions for judgment on the record. A. Goodman’s Employment and the Terms of Coverage Provided Under the Plan (1) Goodman worked as a Vice President Group Account Director for Aegis Media Americas, Inc.’s iProspect division. Dkt. No. 16-10 at 24, 27. She held an executive leadership role where she was responsible for the strategic management of clients’ digital marketing programs

and managed a $6,000,000 revenue stream. Dkt. No. 16-7 at 39; Dkt. No. 16-19 at 5. She handled accounts for companies such as T-Mobile and led a team of 20 employees. Dkt. No. 16-6 at 1; Dkt. No. 16-7 at 39. Before she requested disability benefits, her annual income was $202,878. Dkt. No. 18-12 at 28. (2) Goodman participated in her employer’s ERISA plan, the Aegis Media Americas, Inc. Plan. Dkt. No. 7 at 1–2; Dkt. No. 16 at 1. The Plan includes a disability insurance policy written by First Unum Life Insurance Company. Dkt. No. 18-11 at 1–42. Goodman was covered under the Plan’s short-term disability (“STD”) benefits, which are paid for up to 26 weeks. Dkt. No. 18-12 at 28; Dkt No. 18-17 at 15. Goodman was also covered under the Plan’s long-term disability

(“LTD”) benefits, which begin after a Plan participant’s STD benefits end. Dkt. No. 18-11 at 4–5. (3) The Plan defines disability as follows: You are disabled when Unum determines that:

- you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; and - you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury. After 24 months of payments, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience. You must be under the regular care of a physician in order to be considered disabled.

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Goodman v. First Unum Life Insurance Company, (W.D. Wash. 2023).

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