Lain v. Unum Life Insurance Co. of America

279 F.3d 337, 27 Employee Benefits Cas. (BNA) 1570, 2002 U.S. App. LEXIS 1208, 2002 WL 46919
CourtCourt of Appeals for the Fifth Circuit
DecidedJanuary 29, 2002
Docket00-20889
StatusPublished
Cited by90 cases

This text of 279 F.3d 337 (Lain v. Unum Life Insurance Co. of America) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lain v. Unum Life Insurance Co. of America, 279 F.3d 337, 27 Employee Benefits Cas. (BNA) 1570, 2002 U.S. App. LEXIS 1208, 2002 WL 46919 (5th Cir. 2002).

Opinion

*340 CARL E. STEWART, Circuit Judge:

UNUM Life Insurance Company of America (“UNUM”) appeals the district court’s award of disability benefits and attorneys’ fees to Ellen Lain (“Lain”). For the reasons stated below, we affirm.

FACTUAL AND PROCEDURAL HISTORY

Lain is a former partner in the law firm of Schlanger, Mills, Macer & Grossberg (“Schlanger”) in Houston, Texas. She specialized in real estate, banking, and finance law. In late 1993, Lain began to suffer severe chest pains and on November 19, 1993, she sought treatment from Dr. John M. Bergland (“Bergland”), an internist. In January of 1994, Bergland, noting that Lain was having chest problems day and night, prescribed Inderol, which Lain contends did not alleviate her chest pains. The following month, Lain consulted Dr. Patrick Cook (“Cook”), a cardiologist. Cook reported that Lain’s chest pains had progressed and could last from seconds to hours. Shortly thereafter, on March 3, 1994, Lain consulted Dr. Philip Bentlif (“Bentlif’), a gastroenterologist, who administered an endoscopy of Lain’s esophagus. The test revealed that Lain’s esophagus had normal epithelium (i.e., the lining of her esophagus appeared normal and not damaged by stomach acid), but her esophagus had disordered motility. 2 Thus, Bentlif recommend a esophageal motility study.

On March 15, 1994, Dr. F.J. Garcia-Tores (“Garcia-Tores”) conducted a esophageal motility study on Lain at St. Luke’s Episcopal Hospital in Houston. Garcia-Tores reported that the motility study was normal, but that Lain’s peristaltic contractions were “top normal” with an amplitude of 175 mm Hg and several of the contractions were greater than 220 mm Hg. 3

In April of 1994, Lain visited Dr. Ira Klein (“Klein”), another specialist in gas-troenterology. Klein, finding that Lain suffered from severe chest pains, prescribed Procardia and Tofranil. Subsequently, Klein discontinued the use of Procardia, because Lain believed it was making her symptoms worse, and increased her dosage of Tofranil. On August 16, 1994, Lain returned to Bentlif, who, after reviewing the results of the esophageal motility test, diagnosed her condition as esophageal motor dysfunction, a form of esophageal motility disorder, and prescribed Valium and Nitrostat.

By November 10, 1994, Lain’s condition had progressed and she complained that the medication prescribed was not effective. As a result, Lain visited the Mayo Clinic in Rochester, Minnesota where she was examined by Dr. Michael D. O’Brien (“O’Brien”) and Dr. R.W. Hughes (“Hughes”). They discovered that Lain also suffered from hiatal hernia and prescribed Prilosec. On April 26, 1995, Bent-lif diagnosed Lain with Zenker’s diverticu-lum 4 and gastroesophageal reflux disease (“GERD”). He then started Lain on an anti-reflux program, including a prescription for Axid. The following month, Lain *341 contacted Bentlif and reported that the Axid was not effective.

In July of 1995, Lain visited Dr. A. David Axelrad (“Axelrad”), a psychiatrist, who diagnosed her with “[plain disorder associated with psychological factors and general medical condition,” and “Major Depressive Disorder secondary to Chronic Pain Syndrome.” Axelrad prescribed Zoloft and Desyrel.

Sometime in 1988 or 1989, Schlanger selected UNUM as the firm’s long-term disability insurance carrier. UNUM issued Legal Services Group Insurance Trust Policy 37700 (the “Policy”) for the employees of Schlanger, effective January 1, 1989. On April 3, 1995, Lain stopped working with Schlanger due to her deteriorating condition, and on July 12, 1995, she filed a disability claim under the Policy. Lain alleged that she was unable to work due to severe chest pains, esophagus motility disorder, and esophagal spasms.

Along with her claim, Lain submitted a physician statement written by Bentlif, which stated: (1) Lain’s symptoms were substernal pain; (2) his objective findings were esophageal motility disorder and GE Reflux; (3) the symptoms first appeared in late 1993; (4) Bentlif had first seen Lain on March 3, 1994; (5) he believed that Lain was first unable to work on April 3, 1995; (6) Lain saw him every two to three months; (7) Lain’s medical condition was such that she could not do normal legal professional work; and (8) his prognosis for recovery was “hopeful after a period of time.” Lain also submitted a statement from Schlanger stating that Lain stopped work on April 3,1995 due to illness. 5

Steven Feagon (“Feagon”), one of UNUM’s staff physicians, reviewed Lain’s file. Feagon reported that “[gjiven what [UNUM had], [he could] neither validate nor refute the claimant’s subjective pain complaints though the consistency across multiple providers and the presentation of pyseho[logical] evaluations] suggest a real ongoing problem.” Feagon also stated that he did not believe UNUM would be able to refute, with an independent examination, the findings of Bentlif and Axelrad regarding Lain’s impairment. Id.

Nonetheless, on November 30, 1995, UNUM denied Lain’s claim. It gave four reasons for the denial: (1) the doctors’ description of her restrictions and limitations was insufficient to support a finding of disability; (2) Lain was able to retain bodily nourishment, and she had not produced any evidence of persistent anemia; (3) she had not been receiving regular ongoing treatment for her condition; and (4) there was no evidence of a severe mental condition that would have prevented her from performing her job duties at the time she stopped working.

On December 7, 1996, Lain received notice of the denial of her claim. Because UNUM acted as both the insurer and the Employee Retirement Income Security Act (“ERISA”) administrator of the Policy, Lain sent a letter to UNUM appealing the decision. Thereafter, Carolyn Jackson (“Jackson”), another one of UNUM’s staff physicians, reviewed Lain’s file and determined that Lain’s “intermittent symptoms” were not frequent or severe enough to prevent her from working. On February 14, 1996, the day after Jackson made her recommendation, UNUM sent a letter to Lain rejecting her appeal. However, UNUM stated that it would submit Lain’s file to UNUM’s home office for further review. After Lain’s file was reviewed for *342 the third time, UNUM finally denied her appeal for the following reasons: (1) the medical restrictions assigned to her did not support disability; (2) the objective test results performed by Bentlif and the Mayo Clinic were normal; and (3) Lain was not under psychiatric care when she ceased active employment.

Lain filed suit against UNUM in state court and UNUM removed the action to federal district court asserting that ERISA preempted Lain’s state law claims. It also filed a counterclaim for attorneys’ fees.

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Bluebook (online)
279 F.3d 337, 27 Employee Benefits Cas. (BNA) 1570, 2002 U.S. App. LEXIS 1208, 2002 WL 46919, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lain-v-unum-life-insurance-co-of-america-ca5-2002.