Heffernan v. Unum Life Insurance Co. of America

101 F. App'x 99
CourtCourt of Appeals for the Sixth Circuit
DecidedJune 11, 2004
DocketNo. 02-3412
StatusPublished
Cited by21 cases

This text of 101 F. App'x 99 (Heffernan v. Unum Life Insurance Co. of America) 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
Heffernan v. Unum Life Insurance Co. of America, 101 F. App'x 99 (6th Cir. 2004).

Opinion

LAWSON, District Judge.

The plaintiff, Joan Heffernan, is a former litigation attorney who participated in an employee benefit plan provided by her former law firm. The parties agree that the plan constitutes an “employee welfare benefit plan” governed by the Employee Retirement Income Security Act (ERISA). See 29 U.S.C. § 1002(1)(A), et seq. Among the plan’s benefits afforded to Heffernan was a long-term disability insurance policy that provided monthly payments if a sickness or injury prevented her from performing the regular duties of her occupation. The policy was underwritten by the defendant, UNUM Life Insurance Company of America, which also administered the disability plan. Heffernan’s employment at her law firm ended in November 1994, approximately three years after she gave birth to her first child, and six months later she applied for long-term disability benefits under the policy. UNUM denied her claim after a lengthy review process, and the district court found that UNUM’s decision was arbitrary and capricious, ordered benefits paid, and awarded Heffernan attorney’s fees. In this appeal UNUM argues that the district court’s determination was wrong, that it erred in failing to view in UNUM’s favor certain evidence in the administrative record, and that it abused its discretion in awarding attorney’s fees. We find that the district court properly evaluated the administrative record in light of the policy language, arrived at the appropriate conclusion, and did not abuse its discretion in awarding attorney’s fees-. Therefore, we affirm.

I.

Heffernan began her legal career after law school graduation and a judicial clerkship in 1988 when she was hired as an attorney by the Cincinnati law firm of Taft, Stettinius & Hollister. She worked as an associate in the litigation department, concentrating on commercial litigation. She was a self-described “workaholic” who spent fifty to sixty hours per week on the job.

In late 1991, Heffernan gave birth to a child. She returned to work full time in March 1992 and continued working without incident for about one year. Sometime in mid-1993, Heffernan’s motivation to work along with her billable hour production declined precipitously. She began to experience episodes that she described as “spells.” J.A. at 420. Each spell lasted about a minute and occurred without warning. During these spells, Heffernan felt hot and lost the desire to speak and concentrate. After each spell, she returned to work but felt exhausted. Con[101]*101cerned that these spells might be seizures, Heffernan sought medical attention.

Heffernan first consulted with her primary care physician, Dr. Robert Weber, in July 1993; he treated her with Prozac but reached no definitive diagnosis regarding her condition. She switched physicians in 1994, and her new doctor, R. Clifton Smith, M.D., examined her and referred her to a neurologist, Dr. Arthur Hughes. After performing a battery of tests, Dr. Hughes concluded that the spells were not seizures. Heffernan’s CT scan revealed no obvious physical problems. In May 1994, Dr. Smith referred Heffernan to Dr. David Helm, a psychiatrist, who then became her treating physician, seeing her monthly.

Heffernan’s health problems persisted and she left her employment with the Taft law firm on November 28, 1994. She applied for and received short-term disability benefits, which were paid by the law firm without dispute. Six months later, on May 26, 1995, Heffernan submitted her application to UNUM for long-term disability benefits. The Taft law firm administrator responded to UNUM’s inquiry for claim verification by explaining that Heffernan had “performance issues” because of “health problems,” she was not given assignments because she could not complete them, her job was “too stressful,” and she could not even do administrative work because “she has trouble [with] concentration” and “would have difficulty [with] any responsibilities.” J.A. at 458.

UNUM then set about the task of assembling medical information concerning Heffernan’s ailments. It obtained signed authorization forms from Heffernan for her medical records. Apparently in response to UNUM’s request, Dr. Helm informed UNUM in writing in June 1995 that Heffernan “has Atypical Depression 296.90.” Although she was responding somewhat to treatment, “significant fatigue” and “social withdrawal” persisted. J.A. at 550-51. Dr. Helm wrote that Heffernan’s condition contrasted sharply with her previous levels of “very competitive” functioning and that the “high powered” law firm work that she had done before “would not suit her.” Ibid. Six months later, Dr. Helm updated his assessment, explaining that Heffernan’s inability “to focus,” “her impaired memory,” and “her basic fatigue” damaged Heffernan’s ability to function as an attorney. Id. at 474. In May 1996 he noted: “I do not feel that Mrs. Heffernan can function as a litigation attorney, or indeed I do not feel that she can function in her training as an attorney at all at this point.” Id. at 288.

UNUM retained a private investigator to conduct covert surveillance of Heffernan’s daily activities in August 1995. After reviewing the investigator’s reports, UNUM personnel concluded that the plaintiff was “not very active.” Id. at 516.

UNUM also sent Heffernan for an evaluation by a psychologist of its choosing, Robert Tureen, Ph.D. Dr. Tureen prepared a report on Heffernan’s condition after two days of testing and examination in September 1995. He reported that Heffernan “has difficulty remembering names and events (both recent and distant),” “struggles at times for words,” and also “suffers from severe fatigue.” Id. at 363. From his testing, Dr. Tureen found that “she is not able to use effective coping skills to handle any significant stress and she feels quite vulnerable and fears being overwhelmed.” Id. at 367. From a “diagnostic standpoint,” Dr. Tureen concluded “that the patient does at this point essentially suffer from a depressive disorder. What the evidence suggests is that she probably experienced a major depression.” Ibid. He stated that he was unable to recommend that she was capable of func[102]*102tioning as a litigation attorney, with these words:

This brings up the next point of whether or not [Heffernan] could function as a litigation attorney. At this time, it is not my opinion that she could function as a litigation attorney, at least as a lead attorney. I would think it would be more reasonable for her to consider either functioning in a non-litigation capacity, or possible in an advisory capacity in litigation situations or as she has suggested in a teaching situation. I do not think that this rules out her capacity to function as a litigation attorney again, but that may be eventually a matter of her desire in wishing to put herself back in that type of stressful work setting.

Id. at 374.

UNUM next contacted Karen Jaspers, one of its agents who operated a business in Massachusetts called “Options Associates, Inc.,” to perform a “labor market survey.” Jasper reviewed Heffernan’s medical records and work history, obtained data from a Pennsylvania-based telemarketer called WorkSource that had placed telephone calls to certain businesses in Cincinnati, and concluded in a February 1996 report that “Ms.

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Bluebook (online)
101 F. App'x 99, Counsel Stack Legal Research, https://law.counselstack.com/opinion/heffernan-v-unum-life-insurance-co-of-america-ca6-2004.