Kagan v. Unum Provident

775 F. Supp. 2d 659, 2011 U.S. Dist. LEXIS 40098, 2011 WL 1325982
CourtDistrict Court, S.D. New York
DecidedMarch 31, 2011
DocketCase 03-CV-8130 (KMK)
StatusPublished
Cited by13 cases

This text of 775 F. Supp. 2d 659 (Kagan v. Unum Provident) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kagan v. Unum Provident, 775 F. Supp. 2d 659, 2011 U.S. Dist. LEXIS 40098, 2011 WL 1325982 (S.D.N.Y. 2011).

Opinion

OPINION AND ORDER

KENNETH M. KARAS, District Judge.

Plaintiff A. Michael Kagan (“Kagan”) brings this action against Defendant Unum Provident (“Unum”) for wrongful denial of disability benefits pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. 1 Plaintiff has now moved for summary judgment and Defendant has submitted papers in anticipation of a bench trial on the administrative record. For the reasons stated herein, Plaintiffs motion is denied, and judgment will be entered in favor of Defendant.

I. Background

A. Facts

Kagan was, until 1998, the President and Manager for Sales Insurance of KBC Systems Corporation (“KBC”) in Mamaroneck, New York. (FULCL 9, 14.) 2 According to an Education and Employment History form filled out by Kagan in June 2002, his primary duties while in his position at KBC included “[t]ravel[ing] to business meetings” and “[selling] insurance, while at client’s premises.” (FULCL 573.) Unum issued a Plan of coverage for KBC in 1995 (the “Plan”). (FULCL 790-92.) The Plan provided that Unum would pay disability benefits to KBC employees “when [Unum] receive[d] proof that the employee “(1) [was] disabled due to sickness or injury; and (2) requirefd] the regular attendance of a physician.” (FULCL 779.) A rider to the Plan defined “disability” as follows:

“Disability” and “disabled” mean that because of injury or sickness:
a. you cannot perform each of the material duties of your regular occupation; and
b. after benefits have been paid for 24 months, you cannot perform each of the material duties of any gainful occupation for which you are reasonably fitted by training, education or experience.

(FULCL 791.) 3

Kagan had a history of high cholesterol and smoked two packs of cigarettes per *662 day for over thirty years. (FULCL 23.) On July 22, 1998, Kagan was admitted to the hospital after experiencing two temporary losses of consciousness. (FULCL 23-24.) After a series of examinations suggesting Kagan suffered from, among other heart conditions, ischemic cardiomyopathy (congestive heart failure due to coronary artery disease) (FULCL 19-21), Kagan was referred to “urgent bypass surgery” five days later, (FULCL 18). Kagan underwent quadruple bypass surgery on July 27, 1998. (Id.) Kagan was discharged on August 10, 1998, after a defibrillator was implanted into his chest. (FULCL 16-17, 219.)

Kagan applied for benefits from Unum on September 17, 1998. (FULCL 2, 5-9.) Two relevant forms followed Kagan’s application: a Job Analysis form dated September 26, 1998, on which Kagan listed his job as “President” and “Manager/Sales Insurance” of KBC, but did not give further details (FULCL 14); 4 and a Physician’s Statement completed by Dr. Mark Warshofsky, Kagan’s treating physician during his initial hospitalization, who indicated that Kagan should avoid “physically demanding or mentally stressful activities” and that Kagan “w[ould] not have a complete recovery.” (FULCL 25.) Unum initially approved Kagan’s benefits claim on October 21, 1998, while continuing to gather financial information in order to determine the precise amount Kagan would be paid in benefits long-term. (FULCL 36-37.) Unum’s approval letter noted that Kagan would also be required to apply to the Social Security Administration (“SSA”) for Social Security Disability Insurance (“SSDI”) benefits if his disability was projected to last longer than five months. (FULCL 37.) This Kagan did and he began to receive SSDI benefits in January 2009. (FULCL 348-49.)

Kagan was clearly not well even following his surgery. An Unum report of a phone conversation with him on December 4, 1998, indicated “labored breathing” and that Kagan “had to stop talking every once in a while to catch his breath.” (FULCL 795.) An interviewer for the SSA indicated the same thing on December 30, 1998. (RSA/CRU 290-91.) One of his doctors predicted that his physical condition would likely “preclude him from further significant physical activities.” (RSA/CRU 965.) Between May 7 and 11, 1999, Kagan was hospitalized at White Plains Hospital (FULCL 335, 352), due to multiple “defibrillation events” and “shocks,” (FULCL 345, 353). According to a May 7-8, 1999 medical history form signed by Dr. Paul Pechman (“Dr. Peehman”) on Kagan’s admission to White Plains Hospital Center, Kagan had “shortness of breath with minimal exertion and frequently at rest,” “chronic obstructive pulmonary disease,” and suffered from “decreased attention span and concentration ability since his hospitalizations and procedures.” (FULCL 354.) Even after his hospitalization, Kagan’s condition apparently remained poor. According to notes of a phone call between an Unum employee and Kagan’s wife on July 29, 1999, Kagan still felt “very weak [and] very fatigued all *663 of the time.” His daily activities consisted of “not much of anything,” as it was “[t]oo hard for him to get around.” (FULCL 345.) Internal Unum memos from February and June 1999 indicate that Kagan’s “rtw [return to work] capacity is poor.” (FULCL 801, 807.) In a September 7, 1999 medical review completed by Unum, Kagan’s condition was listed as “precluding] work capacity.” (FULCL 363.)

In May 1999, Kagan was convicted, after a jury trial, of over thirty counts of mail fraud and conspiracy and sentenced to 70 months’ imprisonment. See United States v. Kagan, 97-CR-950-003 (DLC) (S.D.N.Y. judgment entered May 21, 1999) (“Kagan Judgment”); 5 see also United States v. Ferrarini, 219 F.3d 145, 147-51 (2d Cir.2000) (affirming Kagan’s conviction). 6 Kagan began serving his sentence in July 1999. See Kagan Judgment, supra. During his incarceration his Social Security benefits were stopped. (RSA/ CRU 1127.)

Kagan received a medical review upon his entry into a prison medical facility on July 9, 1999. (RSA/CRU 831.) The summary report of that episode, dated September 30, 1999, lists Kagan’s “condition on discharge” as “[sjtable” and recommended physical activity “[a]s tolerated by [the] patient.” (RSA/CRU 834.) The report also allowed Kagan to be placed on “[r]egular duty” in prison, with the restriction that he be given only “sedentary work.” (RSA/CRU 835.) 7

Kagan was incarcerated between July 1999 and June 2004 at a federal institution in Otisville, New York (“Otisville”), and received treatment at Horton Medical Center (“Horton”), in nearby Middletown.

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775 F. Supp. 2d 659, 2011 U.S. Dist. LEXIS 40098, 2011 WL 1325982, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kagan-v-unum-provident-nysd-2011.