Hackney v. Lincoln National Fire Insurance Co.

657 F. App'x 563
CourtCourt of Appeals for the Sixth Circuit
DecidedNovember 2, 2016
Docket15-5563/5606
StatusUnpublished
Cited by20 cases

This text of 657 F. App'x 563 (Hackney v. Lincoln National Fire Insurance Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hackney v. Lincoln National Fire Insurance Co., 657 F. App'x 563 (6th Cir. 2016).

Opinion

JULIA SMITH GIBBONS, Circuit Judge.

In the spring of 2011, James Hackney was terminated from his position with Vascular Solutions, Inc. (“VSI”) following his failure to return from a nearly seven-month medical leave. Hackney maintains that he did not return to VSI because his hypoparathyroidism rendered him totally disabled. VSI, on the other hand, considered Hackney’s failure to return “job abandonment” and refused to pay him severance, per the terms of Hackney’s Employment Agreement (the “Agreement”). During his leave, Hackney applied for and was denied benefits under VSI’s Salary Continuation Plan (the “Plan”), which was administered by Lincoln National Life Insurance Company (“Lincoln”).

Hackney brings a host of claims arising from these two denials. He claims that VSI breached the Agreement, the Plan, and its duty of good faith and fair dealing under both, and he claims that VSI owes him unpaid wages pursuant to Ky. Rev. Stat. § 337.385. Hackney also claims that Lincoln tortiously interfered with his contractual relationship with VSI under the Plan, and he alleges that VSI and Lincoln both engaged in the unlicensed practice of medicine, in violation of Ky. Rev. Stat. § 311.560. The district court granted summary judgment to the defendants on all claims. For the reasons that follow, we reverse the district court’s resolution of both breach of contract claims, as well as the breach of the duty of good faith and fair dealing claims. We affirm as to all other claims.

I.

VSI is a Minneapolis, Minnesota-based company that develops medical devices for coronary and peripheral vascular procedures. In June 2005, VSI hired Hackney, a Kentucky native and current Kentucky resident, as an Associate Account Manager. Over the next five years, Hackney received a series of promotions and pay raises, and in July 2010, he was named Director of Marketing-Catheters. In this position, his salary was $178,000 per year plus bonuses and stock.

Upon taking the Director of Marketing position, Hackney signed an Employment Agreement. The Agreement clarified that Hackney remained an “at-will” employee, *567 and Section 8 provided that Hackney was entitled to severance pay in the event he was terminated for any reason other than for “Violating Conduct,” which the Agreement defined to include “job abandonment.” (DE 116-2, Agreement, Page ID 1501-08.) The Agreement also stated that Hackney was “entitled to participate in benefit plans, which may be established by the Board of Directors” but clarified that “[o]ther than as specified in this Agreement, [Hackney] shall not have any entitlement to any benefits.” (Id. at 1502.)

, Under the Agreement, Hackney was entitled to participate inVSI’s Salary Continuation Plan, which provides six months of continued salary benefits to qualified employees who become “totally disabled.” The Plan defines “totally disabled” as the inability of the covered person, due to sickness or injury, “to perform each of the main duties of [the covered person’s] regular occupation.” (DE 116-4, Plan, Page ID 1520.) The Plan also notes that participants will continue to receive benefits payments until, among other dates, “the date you are no longer disabled” or “the date you fail to furnish proof that you continue to be disabled.” (Id. at 1516.) VSI paid all benefits under the Plan out of its general assets, and VSI retained all financial re-' sponsibility for payments under the plan; 1 employees did not pay premiums under the Plan, nor were any amounts deducted from their salaries. The Plan contained a disclaimer on the first page stating that “[n]either the benefit nor this policy is a contract of employment.” (DE 116-4, Plan, Page ID 1514.)

On August 1, 2009, VSI and Lincoln entered into an Advice to Pay Agreement, wherein Lincoln agreed to “[r]eview and investigate all claims and provide advice to [VSI] as to whether a claimant is eligible for disability benefits based on the nature of the disability and the terms of the Plan.” (DE 116-14, Advice to Pay Agreement, Page ID 1591-95.) The Advice to Pay Agreement specifies that Lincoln is “acting solely as a consultant and contractor of Plan Sponsor (VSI), not as an insurer or underwriter of the Plan.” (Id. at 1594.) In return for its role, Lincoln was paid $1.75 per month per covered employee.

Throughout his five-year employment with VSI, Hackney suffered from hypopar-athyroidism. On October 6, 2010, Hackney notified VSI, for the first time, of his disorder and notified his supervisor that he believed he was permanently and totally disabled. On October 11, 2010, he filed for Salary Continuation Benefits under the plan, citing his hypoparathyroidism and claiming an onset date of October 6, 2010. Hackney’s application included an attending physician’s statement from Dr. Paul Goodlett, who noted a disability onset date of October 6, 2010 and stated that Hackney’s disability was permanent.

Based on its review of Hackney’s claim, Lincoln recommended to VSI that it grant Hackney’s claim through November 2, 2010, which VSI ultimately did. Lincoln sent Hackney a letter on October 14, 2010, notifying him of this determination. The letter also informed Hackney that he was required to submit medical evidence of his continuing disability to be considered for extended benefits under the Plan. The letter emphasized that “a note from your physician without any supporting medical evidence may not be sufficient to consider further benefits.” (DE 108, Hackney Dep. Ex. 24, Page ID 1338.) At this time, VSI *568 also placed Hackney on FMLA leave through December 28, 2010.

On November 3, 2010, Hackney did not return to work. Instead, he sought continued benefits under the Plan, via a November 6, 2010 email, which stated that Hackney’s doctors “agree that [his] disability is permanent/life-long.” (DE 108, Hackney Dep. Ex. 25, Page ID 1339.) In addition to the email, Hackney submitted various medical records, including various treatment notes, two radiology reports, and statements from two of his treating physicians, Dr. Goodlett and Dr. Larry Fine-man. Both Dr. Goodlett and Dr. Fineman opined that Hackney was permanently disabled. After reviewing this claim, 2 Lincoln advised VSI to deny Hackney’s claims because he was not “totally disabled.” (DE 108, Hackney Dep. Ex. 26, Page ID 1340-41.) Lincoln sent Hackney a letter to this effect on November 10, 2010, explaining that VSI “ha[d] not received any other medical information that indicates a severity or complications that would prevent [Hackney] from performing [his] occupation.” (Id.) The letter further explained that Hackney’s current course of treatment, “Medication management,” was “considered conservative treatment” and that he would need to provide moré proof of his total disability in the form of “treatment notes, test results and any other medical data from [his] physician(s).” (Id.)

On December 21 and 28, 2010, and January 17, 2011, VSI sent letters asking Hackney when he planned to return to work.

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657 F. App'x 563, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hackney-v-lincoln-national-fire-insurance-co-ca6-2016.